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Psoriasisarthritis

Übersicht medikamentöser Therapieoptionen und Anwendungsbesonderheiten

Psoriatic arthritis

Overview of drug therapy options and administration characteristics

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Zusammenfassung

Die Psoriasisarthritis, eine chronisch entzündliche Erkrankung des Bewegungsapparates mit Assoziation zur Psoriasis der Haut, zeichnet sich durch ein variables klinisches Bild mit sehr heterogener Krankheitsbelastung der Patienten aus. Klinische Manifestationen umfassen im Wesentlichen Haut- und Nagelveränderungen, periphere Arthritis, Enthesitis, Daktylitis und/oder Wirbelsäulenbefall. Diese Variabilität bedingt eine individuelle Therapie des Patienten mit unterschiedlichen Therapiezielen. Außer internationalen Leitlinien liegen für die Behandlung der Psoriasisarthritis in Deutschland keine Therapieempfehlungen vor. Aus diesem Grund werden in der vorliegenden Arbeit die gesicherten Punkte, Besonderheiten und zu beachtende Aspekte in der Therapie der Psoriasisarthritis in Deutschland unter Berücksichtigung der verschiedenen Hauptformen der Erkrankung zusammengefasst.

Abstract

Psoriatic arthritis is a chronic inflammatory disease of the musculoskeletal system with association to skin psoriasis and is characterized by variable clinical symptoms with very heterogeneous degrees of disease suffering for patients. Clinical manifestations essentially include alterations to the skin and nails, peripheral arthritis, enthesitis, dactylitis and/or spinal involvement. This variability necessitates an individualized therapy of patients with different therapy targets. Apart from international guidelines no therapy recommendations are available in Germany for treatment of psoriatic arthritis. For this reason this article summarizes the established points, characteristics and aspects to be considered in the therapy of psoriatic arthritis in Germany, taking the various main forms of the disease into consideration.

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Danksagung

Die Autoren danken Frau M. Lampl und Frau H. von Krempelhuber für die Hilfe beim Erstellen des Manuskriptes und Frau A. Bernhard für die grafische Gestaltung der Abbildung.

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Authors and Affiliations

  1. CIRI/Rheumatologie und Fraunhofer IME, Translationale Medizin und Pharmakologie, Universitätsklinikum Goethe Universität Frankfurt, Frankfurt am Main, Deutschland

    F. Behrens

  2. Exzellenzzentrum Entzündungsmedizin, UKSH – Campus Lübeck, Lübeck, Deutschland

    D. Thaçi

  3. Klinik für Rheumatologie und klinische Immunologie, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland

    J. Wollenhaupt

  4. Internistisch-rheumatologische Praxis, München, Deutschland

    K. Krüger

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  1. F. Behrens
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  2. D. Thaçi
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  3. J. Wollenhaupt
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  4. K. Krüger
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Correspondence to J. Wollenhaupt.

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Interessenkonflikt

F. Behrens erhielt Forschungsförderung von Roche, Pfizer, AbbVie, Janssen und Vortrags- bzw. Beratungshonorar von AbbVie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly, Morphosys. D. Thaçi erhielt Forschungsförderung, Vortrags- oder Beraterhonorare von AbbVie, Amgen, Almiral, Boehringer-Ingelheim, Biogen-Idec, Dignity, Galapagos, GSK, Maruho, Mitsubishi-Pharma, MSD, Jansen, Leo-Pharma, Lilly, Pfizer, UCB, Novartis, Xenoport. J. Wollenhaupt erhielt Forschungsförderung, Vortrags- oder Beraterhonorare von AbbVie, BMS, Chugai Celgene, Janssen, Lilly, MSD (Essex), Novartis, Pfizer (Wyeth), Roche sowie UCB. K. Krüger erhielt Forschungsförderung und/oder Vortrags- und Beratungshonorare von AbbVie, BMS, Celgene, Janssen, Medac, MSD, Novartis, Pfizer, Roche sowie UCB.

Diese Publikation wurde durch eine unbeschränkte Zuwendung der Firma Celgene unterstützt und beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

J. Wollenhaupt, Hamburg (Leitung)

O. Distler, Zürich

M. Fleck, Bad Abbach

J. Grifka, Bad Abbach

CME-Fragebogen

CME-Fragebogen

Welches der folgenden Medikamente besitzt die Zulassung sowohl für die Psoriasis als auch für die Psoriasis arthritis?

Sulfasalazin

Leflunomid

Golimumab

Secukinumab

Certolizumab

Welches Biologikum ist für die Therapie der Psoriasis vulgaris (ohne PsA) nicht zugelassen?

Adalimumab

Etanercept

Infliximab

Golimumab

Ustekinumab

Welches der konventionellen DMARDs besitzt die größte Wirkung bei Nagelpsoriasis?

Leflunomid

Methotrexat

Apremilast

Ciclosporin

Fumarsäureester

Sie betreuen einen Patienten mit Psoriasis und neu aufgetretener peripherer Arthritis. Wie sollte nach EULAR-Empfehlungen Ihre initiale Therapie aussehen?

Sulfasalazin

Apremilast

Ciclosporin A

Methotrexat

Certolizumab

Sie betreuen einen Patienten mit Psoriasis arthritis, bei dem als Nebendiagnose eine dilatative Kardiomyopathie mit Herzinsuffizienz NYHA III vorliegt. Welche Therapie sollten Sie bei ihm nicht einsetzen?

Certolizumab

Ciclosporin

Leflunomid

Apremilast

Methotrexat

Welche der folgenden Aussagen zu den in der PsA-Therapie verwendeten Substanzen ist falsch?

Nach derzeitigem Wissenstand sollte Ustekinumab nicht mit anderen Biologika kombiniert eingesetzt werden.

Unter Secukinumab kommt es gehäuft zu Darmperforationen.

Apremilast sollte in der Schwangerschaft nicht eingesetzt werden.

Unter TNF-Inhibitor-Therapie sind Blutbildveränderungen eher ungewöhnlich.

Unter Leflunomid sind Blutdruckkontrollen wegen nicht seltenem RR-Anstieg sinnvoll.

Sie betreuen einen Patienten mit Psoriasis und neu aufgetretener Enthesitis. Wie sollte der aktuellen Datenlage nach Ihre initiale Therapie am ehesten aussehen?

Infliximab

Methotrexat

Leflunomid

Certolizumab

Golimumab

Welches Biologikum zeigt aktuell die besten PASI-Ansprechraten bei Psoriasis?

Apremilast

Secukinumab

Golimumab

Ustekinumab

Certolizumab

Sie betreuen eine Patientin mit Psoriasis arthritis bei der sich eine Daktylitis manifestiert. Wie sollte Ihre Therapie am ehesten aussehen?

Apremilast

Golimumab

Adalimumab

Leflunomid

Sulfasalazin

Welches der folgenden Medikamente zur Therapie der Psoriasis arthritis können Sie auch in der Schwangerschaft einsetzen?

Methotrexat

Apremilast

Ustekinumab

Ciclosporin A

Leflunomid

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Behrens, F., Thaçi, D., Wollenhaupt, J. et al. Psoriasisarthritis. Z Rheumatol 75, 471–488 (2016). https://doi.org/10.1007/s00393-016-0110-6

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