Behandlung therapierefraktärer Verläufe der polyartikulären JIA

ZUSAMMENFASSUNG

Als juvenile idiopathische Arthritis (JIA) wird eine Arthritis mit einer Dauer von mehr als 6 Wochen bezeichnet, wenn: (i) sie vor dem 16. Lebensjahr erstmalig auftritt und (ii) keine anderen Ursachen gefunden werden können. Aus heutiger Sicht lassen sich mindestens 4 Gruppen kindlicher rheumatischer Polyarthritis differenzieren: (a) die zumeist ANA-positiven, Rheumafaktor-negativen kindlichen Formen (eo-JIA und RF– pJIA), (b) die Rheumafaktor-positive Form mit Beginn im Kindes- und Jugendalter (RF+ pJIA), (c) eine polyartikuläre Verlaufsform der sJIA ohne Symptome systemischer Inflammation, (d) die monogenetisch bedingte Polyarthritis aufgrund einer LACC1/FAMIN-Mutation. Letztere ist damit eigentlich keine rheumatische, sondern eine hereditäre Polyarthritis. Ausgehend von den ProKind-Protokollen zur Therapie der polyartikulären JIA wird das Vorgehen bei Nichterreichen der angestrebten Therapieziele erarbeitet. Dies sind neben ausführlicher Diagnostik und Dokumentation der Aktivität die Einschätzung von Komorbiditäten (z. B. Infektionen), Medikamenteninteraktionen und Problemen der „Non-Compliance“ bzw. „Non-Adherence“. Neben Maßnahmen zur Therapie einer fortbestehenden lokalen therapierefraktären Aktivität werden systemische Therapieoptionen, insbesondere die neu verfügbaren Januskinase-Inhibitoren (JAKi), diskutiert.

Schlüsselwörter

Polyartikuläre juvenile idiopathische Arthritis - Treat-to-Target - therapierefraktäre JIA - Pro-KIND

Publication History

Article published online:
21 December 2023

• Literatur

• 1 Heiligenhaus A, Klotsche J, Niewerth M. et al Similarities in clinical course and outcome between juvenile idiopathic arthritis (JIA)-associated and ANA-positive idiopathic anterior uveitis: data from a population-based nationwide study in Germany. Arthritis Res Ther 2020; 22: 81
• 2 Ramsey SE, Bolaria RK, Cabral DA. et al Comparison of criteria for the classification of childhood arthritis. J Rheumatol 2000; 27: 1283-1286
• 3 Krumrey-Langkammerer M, Hafner R. Evaluation of the ILAR criteria for juvenile idiopathic arthritis. J Rheumatol 2001; 28: 2544-2547
• 4 Bertilsson L, Andersson-Gare B, Fasth A. et al Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years. J Rheumatol 2013; 40: 715-724
• 5 Hugle B, Hinze C, Lainka E. et al Development of positive antinuclear antibodies and rheumatoid factor in systemic juvenile idiopathic arthritis points toward an autoimmune phenotype later in the disease course. Pediatr Rheumatol Online J 2014; 12: 28
• 6 Thomschke S, Schulz M, Bätzing J.. Epidemiologie der juvenilen idiopathischen Arthritis (JIA) in der ambulanten Versorgung – eine Analyse anhand bundesweiter vertragsärztlicher Abrechnungsdaten der Jahre 2009 bis 2015 (2018). In: Versorgungsatlas.de. Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi), Berlin. 1-16
• 7 Martini A, Ravelli A, Avcin T. et al Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. J Rheumatol 2019; 46: 190-197
• 8 Lainka E, Haas JP, Horneff G. et al Systemic Juvenile Idiopathic Arthritis – New Aspects of Clinical Features, Diagnostic Tools and Treatment Strategies. Ann Paediatr Rheumatol 2013; 02: 3-13
• 9 Weiss PF, Xiao R, Brandon TG. et al Comparative Effectiveness of Tumor Necrosis Factor Agents and Disease-modifying Antirheumatic Therapy in Children with Enthesitis-related Arthritis: The First Year after Diagnosis. J Rheumatol 2018; 45: 107-114
• 10 Zisman D, Stoll ML, Butbul Aviel Y. et al Juvenile Psoriatic Arthritis: A Report from the GRAPPA 2017 Annual Meeting. J Rheumatol Suppl 2018; 94: 11-16
• 11 Brunner HI, Ivaskova E, Haas JP. et al Class I associations and frequencies of class II HLA-DRB alleles by RFLP analysis in children with rheumatoid-factor-negative juvenile chronic arthritis. Rheumatol Int 1993; 13: 83-88
• 12 Hall PJ, Burman SJ, Barash J. et al HLA and complement C4 antigens in polyarticular onset seronegative juvenile chronic arthritis: association of early onset with HLA-DRw8. J Rheumatol 1989; 16: 55-59
• 13 Oen K, Malleson PN, Cabral DA. et al Early predictors of longterm outcome in patients with juvenile rheumatoid arthritis: subset-specific correlations. J Rheumatol 2003; 30: 585-593
• 14 Hameed K, Bowman S, Kondeatis E. et al The association of HLA-DRB genes and the shared epitope with rheumatoid arthritis in Pakistan. Br J Rheumatol 1997; 36: 1184-1188
• 15 Haas JP, Andreas A, Rutkowski B. et al A model for the role of HLA-DQ molecules in the pathogenesis of juvenile chronic arthritis. Rheumatol Int 1991; 11: 191-197
• 16 Haas JP, Kimura A, Truckenbrodt H. et al Early-onset pauciarticular juvenile chronic arthritis is associated with a mutation in the Y-box of the HLA-DQA1 promoter. Tissue Antigens 1995; 45: 317-321
• 17 Haas JP, Metzler M, Frank C. et al HLA-DQA1 gene expression profiling in oligoarticular JIA. Autoimmunity 2009; 42: 389-391
• 18 Hinks A, Cobb J, Marion MC. et al Dense genotyping of immune-related disease regions identifies 14 new susceptibility loci for juvenile idiopathic arthritis. Nat Genet 2013; 45: 664-669
• 19 Eyre S, Bowes J, Diogo D. et al High-density genetic mapping identifies new susceptibility loci for rheumatoid arthritis. Nat Genet 2012; 44: 1336-1340
• 20 Hinks A, Marion MC, Cobb J. et al Brief Report: The Genetic Profile of Rheumatoid Factor-Positive Polyarticular Juvenile Idiopathic Arthritis Resembles That of Adult Rheumatoid Arthritis. Arthritis Rheumatol 2018; 70: 957-962
• 21 Haas JP, Weimann V, Feist E. [Polyarticular juvenile idiopathic arthritis and rheumatoid arthritis : Common features and differences]. Z Rheumatol 2022; 81: 4-13
• 22 Rabionet R, Remesal A, Mensa-Vilaro A. et al Biallelic loss-of-function LACC1/FAMIN Mutations Presenting as Rheumatoid Factor-Negative Polyarticular Juvenile Idiopathic Arthritis. Sci Rep 2019; 09: 4579
• 23 Dueckers G, Guellac N, Arbogast M. et al Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis. Clin Immunol 2012; 142: 176-193
• 24 Lucas P, Bodemer C, Barbarot S. et al Methotrexate in Severe Childhood Alopecia Areata: Long-term Follow-up. Acta Derm Venereol 2016; 96: 102-103
• 25 Truckenbrodt H, Hafner R. Methotrexate therapy in juvenile rheumatoid arthritis: a retrospective study. Arthritis Rheum 1986; 29: 801-807
• 26 Huang B, Qiu T, Chen C. et al Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis. RMD Open 2020: 6
• 27 Minden K, Horneff G, Niewerth M. et al Time of Disease-Modifying Antirheumatic Drug Start in Juvenile Idiopathic Arthritis and the Likelihood of a Drug-Free Remission in Young Adulthood. Arthritis Care Res (Hoboken) 2019; 71: 471-481
• 28 Wallace CA, Giannini EH, Spalding SJ. et al Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: time to achievement, total duration, and predictors. J Rheumatol 2014; 41: 1163-1170
• 29 Ravelli A, Consolaro A, Horneff G. et al Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis 2018; 77: 819-828
• 30 Oommen PT, Schütz K, Baltruschat K. et al S2k-Leitlinie „Therapie der Juvenilen Idiopathischen Arthritis“ (2019). Im Internet. www.awmf.org/leitlinien/aktuelle-leitlinien.html Stand: 02.10.2020
• 31 Horneff G, Klein A, Ganser G. et al Protocols on classification, monitoring and therapy in children’s rheumatology (PRO-KIND): results of the working group Polyarticular juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2017; 15: 78
• 32 Lim LSH, Lokku A, Pullenayegum E. et al Probability of Response in the First Sixteen Weeks After Starting Biologics: An Analysis of Juvenile Idiopathic Arthritis Biologics Trials. Arthritis Care Res (Hoboken) 2023; 75: 1238-1249
• 33 Wallace CA, Giannini EH, Huang B. et al American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011; 63: 929-936
• 34 Consolaro A, Ruperto N, Bazso A. et al Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum 2009; 61: 658-666
• 35 Consolaro A, Ruperto N, Bracciolini G. et al Defining criteria for high disease activity in juvenile idiopathic arthritis based on the juvenile arthritis disease activity score. Ann Rheum Dis 2014; 73: 1380-1383
• 36 Singh G, Athreya BH, Fries JF. et al Measurement of health status in children with juvenile rheumatoid arthritis. Arthritis Rheum 1994; 37: 1761-1769
• 37 Merker J, Hartmann M, Haas JP. et al Combined three-dimensional gait and plantar pressure analyses detecting significant functional deficits in children with juvenile idiopathic arthritis. Gait & posture 2018; 66: 247-254
• 38 Consolaro A, Bracciolini G, Ruperto N. et al Remission, minimal disease activity, and acceptable symptom state in juvenile idiopathic arthritis: defining criteria based on the juvenile arthritis disease activity score. Arthritis Rheum 2012; 64: 2366-2374
• 39 Brinster A, Guillot X, Prati C. et al Evolution over thirty years of the profile of inpatients with reactive arthritis in a tertiary rheumatology unit. Reumatol Clin (Engl Ed) 2018; 14: 36-39
• 40 Furness L, Riley P, Wright N. et al Monogenic disorders as mimics of juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20: 44
• 41 Genovese G, Moltrasio C, Garcovich S. et al PAPA spectrum disorders. G Ital Dermatol Venereol 2020; 155: 542-550
• 42 Gunes A, Akin A, Ture M. et al Evaluation of Children with Acute Rheumatic Fever: A Single-Center Experience. Turk Arch Pediatr 2022; 57: 26-31
• 43 Haas JP. Vaskulitiden des Kindes- und Jugendalters. Pädiatrische Praxis 2022; 98: 1-19
• 44 Häfner R, Haas JP. Arthropathien bei Kindern und Jugendlichen als Folge genetischer Erkrankungen. Akt Rheumatologie 2016; 41: 396-404
• 45 Horneff G. Juveniler systemischer Lupus erythematodes. päd Praxis 2023; 100: 110-130
• 46 Huang XF, Brown MA. Progress in the genetics of uveitis. Genes Immun 2022; 23: 57-65
• 47 Lampe C, Scarpa M, Bellettato CM. et al Milde Mukopolysaccharidose-Formen [Mild Forms of Mucopolysaccharidosis]. Akt Rheumatol 2016; 41: 383-389
• 48 Nikolic RPA, Moran Toro C. Childhood-Onset COPA Syndrome Recognized Retrospectively in the Context of Polyarticular Juvenile Idiopathic Arthritis and Rheumatoid Arthritis. Case Rep Rheumatol 2023; 2023: 3240245
• 49 Solyom A, Hügle B, Beck M. et al Morbus Farber: eine Ursache der Arthritis im Kindesalter [Farber Disease: A Cause of Arthritis in Childhood]. Akt Rheumatol 2016; 41: 372-376
• 50 Oen K, Malleson PN, Cabral DA. et al Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort. J Rheumatol 2002; 29: 1989-1999
• 51 Kallinich T, Hinze C, Wittkowski H. [Classification of autoinflammatory diseases based on pathophysiological mechanisms]. Z Rheumatol 2020; 79: 624-638
• 52 Rubbert-Roth A. [Differential diagnosis of polyarthritis]. Deutsche medizinische Wochenschrift 2015; 140: 1125-1130
• 53 Murias S, Magallares L, Albizuri F. et al Current Practices for Therapeutic Drug Monitoring of Biopharmaceuticals in Pediatrics. Ther Drug Monit 2017; 39: 370-378
• 54 Rodriguez-Baez AS, Huerta-Garcia AP, Medellin-Garibay SE. et al Disease activity and therapeutic drug monitoring of polyglutamates of methotrexate after daily or weekly administration of low-dose methotrexate in patients recently diagnosed with rheumatoid arthritis. Basic Clin Pharmacol Toxicol 2022; 130: 644-654
• 55 De Klerk E, Van Der Heijde D, Landewé R. et al The compliance-questionnaire-rheumatology compared with electronic medication event monitoring: a validation study. J Rheumatol 2003; 30: 2469-2475
• 56 Hebing RC, Aksu I, Twisk JW. et al Effectiveness of electronic drug monitoring feedback to increase adherence in patients with RA initiating a biological DMARD: a randomised clinical trial. RMD. 2022 Open 8
• 57 Santer M, Ring N, Yardley L. et al Treatment non-adherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers’ views. BMC Pediatr 2014; 14: 63
• 58 Brüning T, Oberle A, Mohr C. et al Kinderschutz bei Kindern und Jugendlichen mit chronischen Erkrankungen. Monatsschr Kinderheilkd 2022; 170: 716-721
• 59 Wolfs JF, Arts MP, Peul WC. Juvenile chronic arthritis and the craniovertebral junction in the paediatric patient: review of the literature and management considerations. Adv Tech Stand Neurosurg 2014; 41: 143-156
• 60 Stoustrup P, Resnick CM, Abramowicz S. et al Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Arthritis Rheumatol 2023; 75: 4-14
• 61 Bovid KM, Moore MD. Juvenile Idiopathic Arthritis for the Pediatric Orthopedic Surgeon. Orthop Clin North Am 2019; 50: 471-488
• 62 Rongo R, Michelotti A, Pedersen TK. et al Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists. Orthod Craniofac Res. 2023 May 2024
• 63 Rubin S, Ohana O, Goldberg O. et al The efficacy and safety of intra-articular injection of triamcinolone acetonide versus triamcinolone hexacetonide for treatment of juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20: 5
• 64 Arbogast M, Haas JP. [Treatment options in juvenile idiopathic arthritis – Part 2: Orthopedics und surgery]. Orthopade 2018; 47: 917-925
• 65 Haas JP, Arbogast M. [Therapeutic options in juvenile idiopathic arthritis : Surgical and conservative orthopedic rheumatological treatment]. Z Rheumatol 2021; 80: 467-480
• 66 Buttgereit F, Doering G, Schaeffler A. et al Efficacy of modified-release versus standard prednisone to reduce duration of morning stiffness of the joints in rheumatoid arthritis (CAPRA-1): a double-blind, randomised controlled trial. Lancet 2008; 371: 205-214
• 67 Ruperto N, Brunner HI, Synoverska O. et al Tofacitinib in juvenile idiopathic arthritis: a double-blind, placebo-controlled, withdrawal phase 3 randomised trial. Lancet 2021; 398: 1984-1996
• 68 Ruperto N, Brunner HI, Zuber Z. et al Pharmacokinetic and safety profile of tofacitinib in children with polyarticular course juvenile idiopathic arthritis: results of a phase 1, open-label, multicenter study. Pediatr Rheumatol Online J 2017; 15: 86
• 69 Carmichael SJ, Beal J, Day RO. et al Combination therapy with methotrexate and hydroxychloroquine for rheumatoid arthritis increases exposure to methotrexate. J Rheumatol 2002; 29: 2077-2083
• 70 Ramanan AV, Quartier P, Okamoto N. et al Baricitinib in juvenile idiopathic arthritis: an international, phase 3, randomised, double-blind, placebo-controlled, withdrawal, efficacy, and safety trial. Lancet 2023; 402: 555-570
• 71 Kuek A, Hazleman BL, Gaston JH. et al Successful treatment of refractory polyarticular juvenile idiopathic arthritis with rituximab. Rheumatology (Oxford) 2006; 45: 1448-1449
• 72 Sakamoto AP, Pinheiro MM, Barbosa CM. et al Rituximab use in young adults diagnosed with juvenile idiopathic arthritis unresponsive to conventional treatment: report of 6 cases. Rev Bras Reumatol 2015; 55: 536-541
• 73 Wallace CA, Ruperto N, Giannini E. et al Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol 2004; 31: 2290-2294
• 74 Hartmann M, Kreuzpointner F, Haefner R. et al Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations. Int J Pediatr 2010; 2010: 835984
• 75 Barth S, Haas JP, Schlichtiger J. et al Long-Term Health-Related Quality of Life in German Patients with Juvenile Idiopathic Arthritis in Comparison to German General Population. PLoS One 2016; 11: e0153267
• 76 Hartmann M, Kreuzpointner F, Schrödl S. et al Sport bei rheumatischen Erkrankungen im Kindes- und Jugendalter. Akt Rheumatol 2012; 37: 154-160
• 77 Hartmann M, Merker J, Schrodl S. et al [Back to school physical education despite rheumatism : Development and testing of a sport scientific-based physical education certification]. Z Rheumatol 2018; 77: 651-666
• 78 Spamer M, Georgi M, Hafner R. et al [Physiotherapy for juvenile idiopathic arthritis]. Z Rheumatol 2012; 71: 387-395