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Behandlungsstrategien bei Psoriasis vulgaris und Psoriasisarthritis

Therapeutic strategies for psoriasis and psoriatic arthritis

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Zusammenfassung

Die Psoriasis ist eine chronisch-entzündliche, immunvermittelte Erkrankung mit genetischem Hintergrund, die gegenwärtig einem Paradigmenwechsel unterliegt. Für viele Patienten steht zwar der Haut- und/oder Gelenkbefall im Vordergrund, jedoch muss durch Erkenntnisse der letzten Jahre die hohe Komorbidität zunehmend in einem Kausalzusammenhang gesehen werden. Da aus Patientenperspektive die Lebensqualität gleichermaßen relevant ist, müssen diese 3 Sachverhalte in die Formulierung von Therapiezielen einfließen. Moderne Therapiekonzepte sind zunehmend pathogenetisch orientiert; entsprechende Substanzklassen greifen teils an definierten molekularen Targets an („targeted therapies“). Die Entwicklung der Psoriasistherapeutika reflektiert den erheblichen pathogenetischen Wissenszuwachs der letzten Jahre. Bei indikationsgerechtem Einsatz aller zur Verfügung stehenden Medikamente ist die Psoriasis heute eine Erkrankung, die effektiv, frühzeitig und langfristig behandelt werden kann.

Abstract

Psoriasis is a chronic, immune-mediated inflammatory disorder with a genetic background, whose treatment is currently undergoing a paradigm shift. For many patients clinical signs and symptoms of psoriatic skin and joint disease are most important. From the public health perspective, however, recent findings that suggest a high degree of co-morbidity is becoming increasingly relevant. Because it is also highly significant from the patients’ perspective, the improvement of health-related quality of life should be considered as the third treatment goal. Modern therapeutic concepts interact with specific pathogenetically relevant molecular targets. The development of such“targeted therapies” reflects our increasing understanding of the pathogenetic principles of psoriasis. Provided that the whole spectrum of approved remedies is employed as indicated, psoriasis has become a condition that is amenable to early intervention and can be treated effectively in the long run.

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Abbreviations

CD:

Cluster of Differentiation (Nomenklatur der Oberflächenmarker)

DLQI:

Dermatology Life Quality Index

GCP:

Good Clinical Practice

ICAM:

Intercellular Adhesion Molecule

IL:

Interleukin

IL-12R:

Interleukin-12-Rezeptor

INF-γ:

Interferon γ

LFA:

Lymphocyte Function-associated Antigen

PASI:

Psoriasis Area and Severity Index

PGA:

Physician Global Assessment

SAPASI:

Self-Administered PASI

STAT:

Signal Transducer and Activator of Transcription

TACE:

TNF-α-Converting Enzyme

TH:

T-Helfer-Lymphozyt

TNF-α:

Tumor-Nekrose-Faktor α

VEGF:

Vascular Endothelial Growth Factor

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor ist Mitglied der Advisory Boards von Abbott GmbH & Co. KG, Astellas Pharma GmbH, Biogen Idec GmbH, Essex Pharma GmbH sowie Wyeth Pharma GmbH und hat Honorar für wissenschaftliche Präsentationen erhalten. Darüber hinaus ist er LKP und Sponsor für eine binationale Studie mit Efalizumab und in mehrere klinische nationale und internationale Studien als Principle Investigator eingebunden. Es liegt eine wissenschaftliche Kooperation mit Wyeth Pharma GmbH vor.

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  1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstraße 74, 01309, Dresden, Deutschland

    G. Wozel

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Wozel, G. Behandlungsstrategien bei Psoriasis vulgaris und Psoriasisarthritis. Hautarzt 60, 91–99 (2009). https://doi.org/10.1007/s00105-008-1662-4

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