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Therapie der Psoriasisarthritis

Therapy of psoriatic arthritis

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Zusammenfassung

In der Therapie der Psoriasisarthritis sind das heterogene Spektrum der Krankheitsmanifestationen (Arthritis/Synovitis, axialer Befall, Enthesitis, Daktylitis, kutane Psoriasis, Nagelpsoriasis) ebenso wie der Aktivitäts- und Schweregrad der Erkrankung und Komorbiditäten zu berücksichtigen. Die in Studien zur rheumatoiden Arthritis (RA) oder Spondylitis ankylosans eingesetzten Messinstrumente werden der Komplexität der PsA häufig nicht gerecht.

In dieser Übersichtsarbeit werden die etablierten Therapien der PsA mit nichtsteroidalen Antirheumatika, „disease modifying antirheumatic drugs“ (DMARDs) und TNF-α-Inhibitoren dargestellt, die auch in den Therapieempfehlungen der European League Against Rheumatism (EULAR) 2012 resultierten. Darüber hinaus besteht aber ein Bedarf an neuen Therapien für solche Patienten, die auf die zugelassenen Substanzen nicht ansprechen oder diese nicht vertragen.

Andere bei der RA eingesetzte Biologicals wurden auch bei PsA-Patienten untersucht. Ihre Wirksamkeit war allerdings weniger überzeugend bzw. auf wenige Patienten beschränkt. Neue Therapieoptionen bei PsA zeichnen sich für den gegen Interleukin-12 und IL-23-Rezeptor gerichteten, monoklonalen Antikörper Ustekinumab und für „small molecules“ wie den oralen PDE-4-Inhibitor Apremilast ab.

Abstract

In psoriatic arthritis (PsA) the heterogeneous spectrum of the disease with arthritis/synovitis, axial manifestation, enthesitis, dactylitis, psoriatic skin disease and nail psoriasis has to be considered. Moreover, PsA activity and severity as well as comorbidities are of importance for making therapeutic decisions. Measurement instruments developed for therapeutic studies of rheumatoid arthritis or ankylosing spondylitis are often not appropriate for application in PsA investigations. In this paper established therapies with nonsteroidal antirheumatic drugs, disease modifying antirheumatic drugs (DMARDs) and TNF-alpha inhibitors and the current EULAR guidelines from 2012 are reviewed. However, there is a need for new therapeutic agents for those patients who do not respond to or do not tolerate the current therapies. Other biologic agents have also been tested for PsA with moderate effects only. New therapeutic options could result from the anti-IL12 and anti-IL23 receptor monoclonal antibody ustekinumab and from small molecules such as the oral PDE-4 inhibitor apremilast.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Märker-Hermann gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik Innere Medizin IV (Rheumatologie, klinische Immunologie, Nephrologie), HSK Dr. Horst Schmidt Kliniken GmbH, Ludwig Erhard Str. 100, 65199, Wiesbaden, Deutschland

    E. Märker-Hermann

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Märker-Hermann, E. Therapie der Psoriasisarthritis. Z. Rheumatol. 72, 784–790 (2013). https://doi.org/10.1007/s00393-013-1190-1

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