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Der Einfluss von Adipositas auf die Krankheitsaktivität bei entzündlich rheumatischen Erkrankungen

The effect of obesity on disease activity of inflammatory rheumatic diseases

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Zusammenfassung

Eines der aktuellsten wissenschaftlichen Gebiete ist die Interaktion zwischen dem Immunsystem und metabolischen Vorgängen. In diese Interaktionen werden zunehmend intra- wie extrazelluläre Signalmoleküle und deren Rezeptoren sowie molekulare Mechanismen eingebracht, die von beiden Systemen, genutzt werden. Das Resultat hieraus wird durch den Begriff „Metaflammation“ charakterisiert und bezieht insbesondere auch das ubiquitär im Körper vorhandene Fettgewebe mit ein. Die bisher identifizierten Verbindungen zwischen Immunsystem und Metabolismus spielen eine größere Rolle bei entzündlich rheumatischen Gelenkerkrankungen als bisher angenommen. Allgemein gilt, dass v. a. ein ausgeprägt hoher Body-Mass-Index (BMI) mit einer erhöhten Entzündungsaktivität assoziiert ist, und dies unabhängig von der Grunderkrankung. Ein höherer BMI zu Beginn einer Therapie bedingt auch ein schwierigeres Ansprechen auf die immunmodulatorische Medikation. Als aktuelle wissenschaftliche Zielsetzung ergibt sich hieraus, dass v. a. die individuellen „immunometabolischen“ Stoffwechselwege herausgearbeitet werden müssen, um die eingesetzten Medikamente zielgerichtet am Ort des Geschehens wirken zu lassen. Des Weiteren sollten alle neueren Therapeutika, insbesondere die spezifisch gegen einzelne immunologische Moleküle wirkende, hinsichtlich ihrer metabolischen Begleiteffekte und ihres Einflusses auf metabolische Komorbiditäten systematisch analysiert werden.

Abstract

One of the most recent scientific fields is the interaction between the immune system and metabolic processes. These interactions increasingly involve intracellular and extracellular signaling molecules and their receptors as well as molecular mechanisms that are used by both systems. The result of these intensive interactions is characterized by the term “metaflammation” and involves in particular, the ubiquitous adipose tissue present throughout the body. The links identified to date between the immune system and metabolism play a greater role in inflammatory rheumatic joint diseases than previously thought. In general, a markedly high body mass index (BMI) in particular, is associated with increased inflammatory activity and this is independent of the underlying disease entity. A higher BMI at the beginning of an immunomodulatory therapy also causes a more difficult response to the medication. Thus, the current scientific objective is to identify the individual “immuno-metabolic” pathways in order to apply the medications specifically to the site of action. Furthermore, all newer therapeutic agents, especially those specifically acting against individual immunological molecules, should be systematically analyzed with respect to their metabolic concomitant effects and their influence on metabolic comorbidities.

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  1. Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2–8, 61231, Bad Nauheim, Deutschland

    Ulf Müller-Ladner, Klaus Frommer & Elena Neumann

  2. Klinik und Poliklinik für Innere Medizin III – Endokrinologie und Diabetologie, Justus-Liebig Universität Gießen, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    Thomas Karrasch & Andreas Schäffler

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Correspondence to Ulf Müller-Ladner.

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Müller-Ladner, U., Frommer, K., Karrasch, T. et al. Der Einfluss von Adipositas auf die Krankheitsaktivität bei entzündlich rheumatischen Erkrankungen. Z Rheumatol 80, 353–361 (2021). https://doi.org/10.1007/s00393-021-00987-4

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