Therapie der juvenilen idiopathischen Arthritis mit TNF-α-Antagonisten

Zusammenfassung

Die Diagnose „juvenile idiopathische Arthritis” steht für eine heterogene Gruppe von Erkrankungen im Kindes- und Jugendalter mit den gemeinsamen Merkmalen einer chronischen Arthritis unklarer Ätiologie mit Unterschieden in der Verteilung und Anzahl betroffener Gelenke, im Auftreten extraartikulärer Manifestationen, wie z. B. einer chronischen Uveitis, und in der Prognose. Sowohl die Akuität auch das Risiko für einen persistierenden oder destruierenden Verlauf bestimmen Art und Notwendigkeit der medikamentösen Kombinationstherapie. Über eine profunde Entzündungshemmung ermöglichen neue Therapiestrategien unter Einsatz von Tumornekrosefaktor-α-Antagonisten der weit überwiegenden Mehrheit der Patienten bei überraschend guter Verträglichkeit eine Krankheitsverbesserung mit Verminderung subjektiver Beschwerden, Morgensteifigkeit, Gelenkschmerzen, Müdigkeit/Fatigue, Verhinderung von Knorpel- und Knochendestruktionen und Aufholwachstum. Nicht alle Manifestationen der juvenilen idiopathischen Arthritis lassen sich in gleicher Zuverlässigkeit behandeln, zudem bestehen Risiken und Limitierungen der Therapie. Die vorliegende Übersicht soll die aktuelle Situation des Einsatzes von Tumornekrosefaktor-α-Antagonisten bei der juvenilen idiopathischen Arthritis darstellen.

Summary

The term „juvenile idiopathic arthritis” (JIA) stands for a group of heterogeneous chronic inflammatory diseases which have in common chronic persistent arthritis of unknown aetiology but are differentiable with regard to the distribution and the number of affected joints, the occurrence of extraarticular manifestations, especially of uveitis, and the prognosis. The intensity of drug therapy will be determined by the acuity as well as the estimated risk for a persistent and destructive course. The availability of Tumor Necrosis Factor-α antagonists enables a profound inhibition of inflammation leading to improvement of signs and symptoms of the disease, preventing the risk for cartilage and bone destruction and inducing catch up growth in the majority of patients with a surprisingly low toxicity. However, not all manifestations of JIA can be treated equally effective. Furthermore, there may be limitations and unknown risks on the long run. The aim of this report is to introduce the current therapeutic options of blocking Tumor Necrosis Factor-α in juvenile idiopathic arthritis.

Schlüsselwörter

Juvenile idiopathische Arthritis - Adalimumab - Etanercept - Infliximab - Uveitis

Keywords

Juvenile idiopathic arthritis - Adalimumab - Etanercept - Infliximab - Uveitis

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