Aktuelles zu Enthesitis-assoziierter Arthritis und juvenilen Spondyloarthritiden

Zusammenfassung

Spondyloarthritiden im Kindesalter zu erkennen, insbesondere früh im Krankheitsverlauf, ist eine besondere Herausforderung für den klinischen Rheumatologen. Die Symptome und Anzeichen bei Erkrankungsbeginn sind im Vergleich zu denen bei Erwachsenen deutlich unterschiedlich, mit häufigerer Arthritis von peripheren Gelenken, Enthesitis und Tarsitis. Juvenile Spondyloarthritiden können neben der archetypischen Enthesitis-assoziierten Arthritis auch in anderen Formen, einschließlich Psoriasis-Arthritis und undifferenzierte Arthritis, auftreten, was eine Abgrenzung schwierig macht. Die Langzeitprognose für Patienten mit juveniler SpA ist variabel und abhängig von den herangezogenen Studien. Diese Inkonsistenz ist wahrscheinlich eine Folge verschiedener Faktoren einschließ-lich der Verwendung unterschiedlicher Klassifikationssysteme, aber auch der untersuchten Bevölkerung. Die Studienlage zu Behandlung und Verlauf der Spondyloarthritiden im Kindesalter ist noch immer sehr dürftig, in den vergangenen Jahren ist vor allem die Datenlage zur Wirksamkeit von TNF-Antagonisten untermauert worden. Langzeitremissionen bei juvenilen Spondyloarthritiden ohne Medikamente sind jedoch weiterhin selten.

Summary

To recognize spondyloarthritides in childhood, especially early in the disease course, is challenging for the clinical rheumatologist. Signs and symptoms at the start of the disease course are markedly different compared to adults, with more frequent arthritis in peripheral joints, enthesitis and tarsitis. Besides the archetypical enthesitis-related arthritis, juvenile spondyloarthritides can also occur in other forms, such as psoriatic arthritis and undifferentiated arthritis, which makes discrimination difficult. Long term prognosis for patients with juvenile spondyloarthritis is variable and depends on the studies consulted. This inconsistency probably is the result of different factors including usage of various classification systems as well as the population investigated. The evidence base for treatment and course of spondyloarthri-tides in childhood is rather thin; research in recent years has mostly demonstrated efficacy of TNF antagonists. However, long term remissions in juvenile spondyloarthritides off medication are still a rare occurence.

Schlüsselwörter

Juvenile idiopathische Arthritis - juvenile Spondyloarthritis - Enthesitis-assoziierte Arthritistherapie

Keywords

Juvenile idiopathic arthritis - juvenile spondyloarthritis - enthesitis-related arthritis - treatment

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