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DOI: 10.1055/a-1004-3274
Aktuelle Therapie der Psoriasisarthritis
Current treatment options for psoriatic arthritisPublication History
Publication Date:
15 October 2019 (online)
![](https://www.thieme-connect.de/media/rheuma/201905/lookinside/thumbnails/2019-07-0584_10-1055-a-1004-3274-1.jpg)
Zusammenfassung
Die Psoriasis Arthritis tritt klinisch als heterogene Erkrankung mit phänotypisch sehr variabler Ausprägung auf. Neben der Beteiligung von Haut und Gelenken, manifestiert sich die Erkrankung mit enthesialem, axialem und extra-muskuloskelettalen Erscheinungsbild. Verschiedene Empfehlungen zur Auswahl und Steuerung der geeigneten Therapie stehen zur Behandlung zur Verfügung. Hierbei finden die Empfehlungen der European League Against Rheumatism (EULAR) und die der Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) national und international in der Routine Anwendung. Beide Empfehlungen stehen seit 2016 in der aktuellen Version zur Verfügung, beide werden derzeit aktualisiert, um den umfangreichen Entwicklungen in diesem Indikationsfeld Rechnung zu tragen. Spezielle deutsche Therapieempfehlungen fehlen derzeit noch. Neue Therapieoptionen, die gezielt unterschiedliche Targets adressieren, bieten Möglichkeiten einer differenzierten medikamentösen Behandlung zur Verbesserung der Versorgung der PsA-Patienten, v. a. mit Fokus auf personalisierte Strategien zur optimalen Behandlung verschiedener Manifestationsformen und -muster.
Abstract
Psoriatic arthritis is a heterogeneous immune-mediated disease, which usually involves skin and joints, but can also affect entheses, the spine and extraarticular structures. An effective, patient-oriented therapy must be guided by the diagnosis of dominant manifestations of the disease and should be performed on an individual basis. Different recommendations for the treatment of psoriatic arthritis are available for clinical use. The recommendations from the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) are most frequently used and internationally acknowledged. Both recommendations are available as an update from 2016. German treatment recommendations are not available to date. New treatment options targeting different, specific molecules offer possibilities for a differentiated personalised therapy to improve patient care.
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Literatur
- 1 Reich K, Kruger K, Mossner R. et al. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol 2009; 160: 1040-1047
- 2 Helliwell PS, Taylor WJ. Classification and diagnostic criteria for psoriatic arthritis. Annals of the rheumatic diseases 2005; 64 Suppl 2 ii3-ii8
- 3 AWMF. AWMF Therapieleitlinie der Psoriasis vulgaris [Leitlinie] 2011. cited. 2011; Available from: AWMF.org
- 4 Nast A, Amelunxen L, Augustin M. et al. et al. S3 Guideline for the treatment of psoriasis vulgaris, update - Short version part 1 – Systemic treatment. Journal der Deutschen Dermatologischen Gesellschaft=Journal of the German Society of Dermatology: JDDG 2018; 16: 645-669
- 5 Gossec L, Smolen JS, Ramiro S. et al. et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Annals of the rheumatic diseases 2016; 75: 499-510
- 6 Coates LC, Murphy R, Helliwell PS. New GRAPPA recommendations for the management of psoriasis and psoriatic arthritis: process, challenges and implementation. Br J Dermatol 2016; 174: 1174-1178
- 7 Behrens F, Thaci D, Wollenhaupt J. et al. Psoriatic arthritis: Overview of drug therapy options and administration characteristics. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 2017; 68: 153-169
- 8 Eder L, Chandran V, Ueng J. et al. Predictors of response to intra-articular steroid injection in psoriatic arthritis. Rheumatology (Oxford, England) 2010; 49: 1367-1373
- 9 Kingsley GH, Kowalczyk A, Taylor H. et al. A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatology (Oxford, England) 2012; 51: 1368-1377
- 10 Coates LC, Moverley AR, McParland L. et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet (London, England) 2015; 386: 2489-2498
- 11 Baranauskaite A, Raffayova H, Kungurov NV. et al. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Annals of the rheumatic diseases 2012; 71: 541-548
- 12 Behrens F, Koehm M, Arndt U. et al. Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study. J Rheumatol 2016; 43: 632-639
- 13 Mease PJ, Gladman DD, Collier DH et al. Etanercept and Methotrexate as Monotherapy or in Combination for Psoriatic Arthritis: Primary Results From a Randomized, Controlled Phase 3 Trial. Arthritis & rheumatology (Hoboken, NJ) 2019
- 14 Nash P, Thaci D, Behrens F. et al. Leflunomide improves psoriasis in patients with psoriatic arthritis: an in-depth analysis of data from the TOPAS study. Dermatology 2006; 212: 238-249
- 15 Ho VC, Griffiths CE, Albrecht G. et al. Intermittent short courses of cyclosporin (Neoral(R)) for psoriasis unresponsive to topical therapy: a 1-year multicentre, randomized study. The PISCES Study Group. Br J Dermatol 1999; 141: 283-291
- 16 Acosta Felquer ML, Coates LC, Soriano ER. et al. Drug therapies for peripheral joint disease in psoriatic arthritis: a systematic review. J Rheumatol. 2014; 41: 2277-2285
- 17 Clegg DO, Reda DJ, Mejias E. et al. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study. Arthritis and rheumatism 1996; 39: 2013-2020
- 18 Cutolo M, Myerson GE, Fleischmann RM. et al. A Phase III, Randomized, Controlled Trial of Apremilast in Patients with Psoriatic Arthritis: Results of the PALACE 2 Trial. J Rheumatol 2016; 43: 1724-1734
- 19 Gladman D, Rigby W, Azevedo VF. et al. Tofacitinib for Psoriatic Arthritis in Patients with an Inadequate Response to TNF Inhibitors. The New England journal of medicine 2017; 377: 1525-1536
- 20 Yoo DH, Hrycaj P, Miranda P. et al. A randomised, double-blind, parallel-group study to demonstrate equivalence in efficacy and safety of CT-P13 compared with innovator infliximab when coadministered with methotrexate in patients with active rheumatoid arthritis: the PLANETRA study. Annals of the rheumatic diseases 2013; 72: 1613-1620
- 21 Zweegers J, Groenewoud JM, van den Reek JM et al. Comparison of the one and 5-years effectiveness of adalimumab, etanercept and ustekinumab in psoriasis patients in daily clinical practice: Results from the prospective BioCAPTURE registry. Br J Dermatol 2016
- 22 Leonardi CL, Kimball AB, Papp KA. et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet (London, England) 2008; 371: 1665-1674
- 23 Papp KA, Langley RG, Lebwohl M. et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet (London, England) 2008; 371: 1675-1684
- 24 McInnes IB, Kavanaugh A, Gottlieb AB. et al. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet (London, England) 2013; 382: 780-789
- 25 Ritchlin C, Rahman P, Kavanaugh A. et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Annals of the rheumatic diseases 2014; 73: 990-999
- 26 Araujo EG, Englbrecht M, Hoepken S. et al. Effects of ustekinumab versus tumor necrosis factor inhibition on enthesitis: Results from the enthesial clearance in psoriatic arthritis (ECLIPSA) study. Seminars in arthritis and rheumatism 2019; 48: 632-637
- 27 Mease PJ, McInnes IB, Kirkham B. et al. Secukinumab Inhibition of Interleukin-17A in Patients with Psoriatic Arthritis. The New England journal of medicine 2015; 373: 1329-1339
- 28 Langley RG, Elewski BE, Lebwohl M. et al. Secukinumab in plaque psoriasis--results of two phase 3 trials. The New England journal of medicine 2014; 371: 326-338
- 29 Krueger JG, Fretzin S, Suarez-Farinas M. et al. IL-17A is essential for cell activation and inflammatory gene circuits in subjects with psoriasis. The Journal of allergy and clinical immunology 2012; 130: 145-154 e9
- 30 Griffiths CE, Reich K, Lebwohl M. et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet (London, England) 2015; 386: 541-551
- 31 Mease PJ. Inhibition of interleukin-17, interleukin-23 and the TH17 cell pathway in the treatment of psoriatic arthritis and psoriasis. Curr Opin Rheumatol 2015; 27: 127-133
- 32 Mease PJ, Genovese MC, Greenwald MW. et al. Brodalumab, an anti-IL17RA monoclonal antibody, in psoriatic arthritis. The New England journal of medicine 2014; 370: 2295-2306
- 33 Papp K, Leonardi C, Menter A. et al. Safety and efficacy of brodalumab for psoriasis after 120 weeks of treatment. Journal of the American Academy of Dermatology 2014; 71: 1183-1190 e3
- 34 Papp K, Menter A, Strober B. et al. Efficacy and safety of brodalumab in subpopulations of patients with difficult-to-treat moderate-to-severe plaque psoriasis. Journal of the American Academy of Dermatology 2015; 72: 436-439 e1
- 35 Blauvelt A, Papp KA, Griffiths CE. et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. Journal of the American Academy of Dermatology 2017; 76: 405-417