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Remission in der Kinderrheumatologie

Remission in pediatric rheumatology

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Zusammenfassung

Durch Definition von Krankheitsaktivität, Besserung und Verschlechterung und die Etablierung großer internationaler Forschungsverbünde gelang es, bei Patienten mit juveniler idiopathischer Arthritis (JIA) neue Medikamente wie die Biologika in kontrollierten Studien zu testen und ihre Wirksamkeit zu zeigen. Häufiger als früher erreichten auch Kinder mit polyartikulärer JIA einen Status ohne verbliebene Krankheitsaktivität, weshalb die Notwendigkeit der Definition von Remission entstand. Am weitesten verbreitet sind die Wallace-Kriterien mit Definition von inaktiver Erkrankung und Remission unter und ohne antirheumatische Medikamente. Allerdings gibt es bisher keine Assoziation mit der Prognose. Bisher sind keine Biomarker oder bildgebenden Verfahren etabliert, die die klinischen Kriterien der Remission verbessern könnten. Zwar erreichen viele Patienten den Status der inaktiven Erkrankung, aber die wenigsten bleiben ohne einen erneuten Krankheitsschub, wenn die Medikation abgesetzt wird. Die Genexpression von Kindern in Remission ist zudem weiterhin pathologisch verändert. Das bestätigt, dass die JIA immer besser behandelbar, aber nicht heilbar ist.

Abstract

After definition of disease activity, improvement and deterioration and establishing large international research alliances, the new biologicals could be tested in patients with juvenile idiopathic arthritis (JIA) in controlled studies and the effectiveness could be shown. More frequently than ever before even children with polyarticular JIA achieved a state without residual disease activity indicating the need for a definition of remission. The Wallace criteria have attained a large circulation and define inactive disease and remission under and without antirheumatic medication. However, they are not associated with the prognosis. So far biomarkers or imaging cannot improve these clinical criteria. Although many patients achieve inactive disease few of them remain free of disease when all drugs have been stopped. Moreover, gene expression of children in remission still remains pathological. This confirms that children with JIA can be treated better and better but still cannot be cured.

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  1. Klinikum Bremen-Mitte, Prof.-Hess-Kinderklinik, Sankt-Jürgen-Str. 1, 28177, Bremen, Deutschland

    H.-l. Huppertz

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Huppertz, Hl. Remission in der Kinderrheumatologie. Z. Rheumatol. 72, 354–360 (2013). https://doi.org/10.1007/s00393-012-1062-0

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