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Therapie der Psoriasisarthritis unter Berücksichtigung neuer Behandlungsoptionen

Published Online:October 16, 2018https://doi.org/10.1024/1661-8157/a003090

Abstract

Zusammenfassung. Die Psoriasisarthritis wird bei ca. 20–30 % der Patienten mit Psoriasis vulgaris diagnostiziert und weist ein heterogenes Erscheinungsbild auf. Die Therapie richtet sich nach den Manifestationsarten der Arthritis, wobei auch das Ausmass des Hautbefalls in die Therapieentscheidungen miteinfliessen soll. Es existieren verschiedene Klassen von Therapeutika, die gemäss einem Stufenschema eingesetzt werden, das in dieser Arbeit vereinfacht nach den Richtlinien der EULAR und der GRAPPA dargestellt wird. Eventuelle Kontraindikationen ausgehend von Komorbiditäten sollen mitberücksichtigt werden. Neuerdings sind Therapeutika zugelassen, die sich eng an der Pathogenese der Psoriasis und Psoriasisarthritis via IL-23/IL-17-Achse orientieren.


Therapy of Psoriasis Arthritis Taking into Account New Treatment Options

Abstract. Psoriatic arthritis occurs in about 20–30 % of patients with psoriasis. The disease is heterogeneous and can involve a variety of the distinct anatomical sites. The choice of medication depends on the type and the severity of clinical features. The recommendations of EULAR and GRAPPA serve as a guide for the choice of medication, which is used in sequential treatment steps. This is presented in our review in usable, simplified terms. Potential comorbidities leading to contraindication for certain treatments are considered. We present new and highly effective treatments, based on the pathogenesis of psoriasis and psoriatic arthritis, targeting the IL-23/IL-17 pathway.


Résumé. L’arthrite psoriasique est diagnostiquée chez environ 20 à 30 % des patients atteints de psoriasis vulgaire et a un aspect hétérogène. La thérapie est basée sur les types de manifestation de l’arthrite, étendue de l’atteinte cutanée devant également être prise en compte dans les décisions thérapeutiques. Il existe différentes classes thérapeutiques qui sont utilisées selon un schéma pas à pas, qui est simplifié dans le travail selon les directives de l’EULAR et du GRAPPA. Toute contre-indication fondée sur des comorbidités doit également être prise en compte. Des traitements étroitement liés à la pathogenèse du psoriasis et de l’arthrite psoriasique par IL-12/23 ont récemment été approuvés.

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