Dtsch Med Wochenschr 2016; 141(11): 794-796
DOI: 10.1055/s-0042-103513
Klinischer Fortschritt
Rheumatologie
© Georg Thieme Verlag KG Stuttgart · New York

Immunsystem und rheumatische Erkrankungen im Alter

Immune system and rheumatic diseases in the elderly
Michael Schirmer
1   Universitätsklinik für Innere Medizin VI, Medizinische Universität Innsbruck
› Author Affiliations
Further Information

Publication History

Publication Date:
02 June 2016 (online)

Zusammenfassung

Störungen des Immunsystems spielen bei allen immunmediierten rheumatologischen Erkrankungen eine bedeutsame Rolle. Kürzlich wurden über folgende Neuigkeiten berichtet:

  1. Frühe Alterung des Immunsystems mit Thymusinsuffizienz wurde nun sowohl für Patienten mit rheumatoider Arthritis als auch für solche mit axialer Spondyloarthritis nachgewiesen, ohne dass zumindest bei der rheumatoiden Arthritis ein Mangel an Vorläuferzellen vorhanden ist.

  2. Bei Riesenzellarteritis, der häufigsten Vasculitis im Alter, spricht eine vermehrte Expression von Anti-IL-17-Antikörper in den Temporalbiopsien für eine günstige Prognose und Ansprechen auf Glukokortikoide.

  3. Zur Immunseneszenz bei systemischem Lupus erythematosus: BAFF scheint eine wichtige Rolle bei Erkrankungschüben nach B-Zelldepletion zu haben.

In Zukunft werden einheitliche Klassifikationen von rheumatologischen Erkrankungen (wie bei der Polymyalgia rheumatica durch die 2012 EULAR / ACR-Klassifikationskriterien) zur besseren Vergleichbarkeit von immunologischen Studien auch im Alter beitragen.

Abstract

Impairments of the immune system play an important role in all immun-mediated rheumatic diseases. Recently, the following news were reported:

  1. Early aging of the immune system with thymus insufficiency has now been reported for both patients with rheumatoid arthritis and axial spondyloarthritis, without prethymic lack of progenitors at least in rheumatoid arthritis.

  2. For giant cell arteritis, the most frequent vasculitis in the elderly, an increased expression of IL-17A in temporal artery biopsies coincides with good prognosis and reponse to glucocorticoids.

  3. Concerning immunosenescence in systemic lupus erythematosus, BAFF appears to have an important role for relapses after B-cell depletion.

For the future it can be anticipated that the use of unified classification criteria for rheumatic diseases (as with the new 2012 EULAR / ACR classification criteria for polymyalgia rheumatica) will ensure better comparability of immunological studies also in the elderly.

 
  • Literatur

  • 1 Cosway E, Anderson G, Garside P et al. The thymus and rheumatology: should we care?. Curr Opin Rheumatol 2016; 28: 189-195
  • 2 Koetz K, Bryl E, Spickschen K et al. T cell homeostasis in patients with rheumatoid arthritis. Proc Natl Acad Sci U S A 2000; 97: 9203-9208
  • 3 Wagner U, Schatz A, Baerwald C et al. Brief report: deficient thymic output in rheumatoid arthritis despite abundance of prethymic progenitors. Arthritis Rheum 2013; 65: 2567-2572
  • 4 Fessler J, Raicht A, Husic R et al. Premature senescence of T-cell subsets in axial spondyloarthritis. Ann Rheum Dis 2015; DOI: 10. 1136/annrheumdis-2014–206119.. [Epub ahead of print]
  • 5 Schmidt D, Goronzy JJ, Weyand CM. CD4+ CD7- CD28- T cells are expanded in rheumatoid arthritis and are characterized by autoreactivity. J Clin Invest 1996; 97: 2027-2037
  • 6 Duftner C, Goldberger C, Falkenbach A et al. Prevalence, clinical relevance and characterization of circulating cytotoxic CD4+CD28- T cells in ankylosing spondylitis. Arthritis Res Ther 2003; 5 (5) R292-300
  • 7 Dejaco C, Duftner C, Klauser A et al. Altered T-cell subtypes in spondyloarthritis, rheumatoid arthritis and polymyalgia rheumatica. Rheumatol Int 2010; 30: 297-303
  • 8 Weyand CM Goronzy JJ. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med 2014; 371: 50-57
  • 9 Espígol-Frigolé G, Corbera-Bellalta M, Planas-Rigol E et al. Increased IL-17A expression in temporal artery lesions is a predictor of sustained response to glucocorticoid treatment in patients with giant-cell arteritis. Ann Rheum Dis 2013; 72: 1481-1487
  • 10 Koster MJ, Matteson EL, Warrington KJ. Recent advances in the clinical management of giant cell arteritis and Takayasu arteritis. Curr Opin Rheumatol 2016; 28: 211-217
  • 11 Keren Z, Naor S, Nussbaum S et al. B-cell depletion reactivates B lymphopoiesis in the BM and rejuvenates the B lineage in aging. Blood 2011; 117: 3104-3112
  • 12 Witt M, Grunke M, Proft F et al. German Registry of Autoimmune Diseases (GRAID) Investigators. Clinical outcomes and safety of rituximab treatment for patients with systemic lupus erythematosus (SLE) – results from a nationwide cohort in Germany (GRAID). Lupus 2013; 22: 1142-1149
  • 13 Carter LM, Isenberg DA, Ehrenstein MR. Elevated serum BAFF levels are associated with rising anti-double-stranded DNA antibody levels and disease flare following B cell depletion therapy in systemic lupus erythematosus. Arthritis Rheum 2013; 65: 2672-2679
  • 14 Ehrenstein MR, Wing C. The BAFFling effects of rituximab in lupus: danger ahead?. Nat Rev Rheumatol 2016; DOI: 10.1038/nrrheum.2016.
  • 15 Schirmer M, Dejaco C, Dasgupta B et al. Polymyalgia rheumatica: strategies for efficient practice and quality assurance. Rheumatol Int 2015; 35: 1781-1789
  • 16 Dasgupta B, Cimmino MA, Maradit-Kremers H et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism / Ameri- can College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71: 484-492
  • 17 Macchioni P, Boiardi L, Catanoso M et al. Performance of the new 2012 EULAR / ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study. Ann Rheum Dis 2014; 73: 1190-1193
  • 18 Codreanu C, Enache L. Is ultrasound changing the way we understand rheumatology? Including ultrasound examination in the classification criteria of polymyalgia rheumatica and gout. Med Ultrasonogr 2015; 17: 97-103