Das Sjögren-Syndrom im Fokus

Was ist neu?

Diagnostik – Der Teufel steckt im Detail! Die Speicheldrüsensonografie (SGUS) hat sich in der Diagnostik des Sjögren-Syndroms (SjS) etabliert und kann zu einer höheren Sensitivität der geltenden Klassifikationskriterien führen, gleichwohl sie bislang nicht in die Kriterien aufgenommen wurde. In der Labordiagnostik erhalten die Subspezifizierung von anti-SSA/Ro-Antikörpern – ggf. auch neue Biomarker – eine zunehmende Bedeutung. Präventiv müssen psychische Belastungen im Auge behalten werden, und das kardiovaskuläre Risiko und das Lymphomrisiko spielen eine große Rolle. Mittels Cluster-Analysen konnten verschiedene Phänotyp-Gruppen erschlossen werden, denen sich klinische Parameter zuordnen lassen.

Therapie 2020 wurden Therapieempfehlungen publiziert, die sich an den klinischen Manifestationen des SjS orientieren und Medikamente empfehlen, die auch in der Therapie des systemischen Lupus erythematodes (SLE) oder bei der rheumatoiden Arthritis eingesetzt werden. In den EULAR-Empfehlungen hat die Anti-B-Zell-Therapie mit Rituximab und Belimumab für schwerwiegende Manifestationen Einzug gefunden, und Ianalumab ist ein weiterer aussichtsreicher Wirkstoff. Ein weiterer Schwerpunkt der aktuellen Forschung liegt in der Inhibition der Costimulation zwischen Immunzellen. Nach zuletzt enttäuschenden Ergebnissen von Abatacept sind mit Iscalimab und Dazodalibep aber auch auf dieser Therapieachse aussichtsreiche Wirkstoffe in der Pipeline.

Abstract

In the diagnosis of Sjögren’s syndrome the Salivary gland sonography (SGUS) has become established and can lead to a higher specificity of the applicable classification criteria. The OMERACT score is used to objectify the SGUS findings. In laboratory diagnostics, the subspecification of anti-SSA/Ro antibodies, but possibly also new biomarkers, are becoming increasingly important regarding diagnostic safety and the expected manifestations. When it comes to prevention, it has been shown that not only psychological stress, but also cardiovascular risk and the risk of lymphoma allow high-risk patients to be identified more precisely in the future. Using cluster analyses, various phenotype groups could be identified to which clinical parameters could be assigned. In 2020, therapy recommendations were published that are based on the clinical manifestations of SjS and recommend medications that are also used in the treatment of systemic lupus erythematosus (SLE) or rheumatoid arthritis. A particularly large number of therapeutic approaches are dedicated to the B cell: Rituximab and Belimumab have been included in the EULAR recommendations for serious manifestations and Ianalumab has a promising effect. Another focus of current research is the inhibition of co-stimulation between immune cells. After recent disappointing results for Abatacept, clinical trials show promising effects on Iscalimab and Dazodalibep.

Schlüsselwörter

Sjögren-Syndrom - Diagnostik - SGUS - anti-SSA/Ro-Antikörper - Lymphomrisiko - B-Zell-Therapie - Costimulation

Keywords

sjogren's syndrome - diagnosis - SGUS - anti-SSA/Ro antibodies - lymphoma risk - B cell therapy - co-stimulation

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