PharmaTicker+++ PharmaTicker+++ PharmaTicker+++ PharmaTicker+++ Die auf dem diesjährigen Kongress der European Alliance of Associations for Rheumatology (EULAR) vorgestellten Daten zu Baricitinib belegen eine anhaltende Wirksamkeit des JAK-Inhibitors und eine hohe Therapietreue seitens der Patient*innen mit rheumatoider Arthritis (RA). Überzeugende Ergebnisse liegen auch zur kontinuierlichen Effektivität des Interleukin (IL)-17A-Inhibitors Ixekizumab bei Patient*innen mit axialer Spondyloarthritis (axSpA) vor.
{"title":"PharmaNews","authors":"","doi":"10.1159/000527646","DOIUrl":"https://doi.org/10.1159/000527646","url":null,"abstract":"PharmaTicker+++ PharmaTicker+++ PharmaTicker+++ PharmaTicker+++ Die auf dem diesjährigen Kongress der European Alliance of Associations for Rheumatology (EULAR) vorgestellten Daten zu Baricitinib belegen eine anhaltende Wirksamkeit des JAK-Inhibitors und eine hohe Therapietreue seitens der Patient*innen mit rheumatoider Arthritis (RA). Überzeugende Ergebnisse liegen auch zur kontinuierlichen Effektivität des Interleukin (IL)-17A-Inhibitors Ixekizumab bei Patient*innen mit axialer Spondyloarthritis (axSpA) vor.","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"253 1","pages":"200 - 204"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75202564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren's syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren's demonstrate pulmonary involvement with higher mortality and lower quality of life. Research question: Clinical practice guidelines for pulmonary manifestations of Sjögren's were developed by the Sjögren's Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care. Study design and methods: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. Results: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%–100%). The recommendations span topics of evaluating Sjögren's patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease. Interpretation: Clinical practice guidelines for pulmonary manifestations in Sjögren's will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.
{"title":"Leitlinie zu Evaluation und Management von pulmonalen Manifestationen bei Sjögren-Syndrom","authors":"N. Kahn","doi":"10.1159/000527303","DOIUrl":"https://doi.org/10.1159/000527303","url":null,"abstract":"Background: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren's syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren's demonstrate pulmonary involvement with higher mortality and lower quality of life. Research question: Clinical practice guidelines for pulmonary manifestations of Sjögren's were developed by the Sjögren's Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care. Study design and methods: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. Results: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%–100%). The recommendations span topics of evaluating Sjögren's patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease. Interpretation: Clinical practice guidelines for pulmonary manifestations in Sjögren's will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"73 1","pages":"187 - 189"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73952847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Die Haut ist nur nicht nur eines der größten Organe des Menschen, sondern auch das extrovertierteste, am besten einsehbare. Daher sind eigenständige Erkrankungen, die nur dieses Organ betreffen, aber auch Hauterscheinungen im Rahmen von Erkrankungen innerer Organe sehr gut sichtbar. Die Haut wird in diesem Zusammenhang gerne, wenn auch banalisierend, als «Spiegel des Körperinneren» bezeichnet. Hier können unter anderem chronisch-entzündliche, autoimmune und endokrinologische Erkrankungen zugrunde liegen. Auch wenn in der Tat viele Hauterscheinungen innerer Erkrankungen eher harmlos sind, bedeuten sie für die Betroffenen deutliche tägliche Einschränkungen sowie eine Verminderung der Lebensqualität und sind häufig aus kosmetischen Gründen sehr störend. Vielfach können sie auch bei suffizienter Therapie der inneren Erkrankungen persistieren bzw. benötigen zu ihrer erfolgreichen Behandlung therapeutische Ansätze und Medikamentendosierungen, die kritisch abgewogen werden müssen. Beispielsweise kann die Behandlung einer Beteiligung innerer Organe beim systemischen Lupus erythematodes (SLE) oder der Dermatomyositis erfolgreich sein, die charakteristischen Hautveränderungen kön-
{"title":"Interdisziplinäre Betrachtung von Hauterkrankungen erleichtert die richtige Diagnose und Therapie","authors":"M. Sticherling","doi":"10.1159/000527517","DOIUrl":"https://doi.org/10.1159/000527517","url":null,"abstract":"Die Haut ist nur nicht nur eines der größten Organe des Menschen, sondern auch das extrovertierteste, am besten einsehbare. Daher sind eigenständige Erkrankungen, die nur dieses Organ betreffen, aber auch Hauterscheinungen im Rahmen von Erkrankungen innerer Organe sehr gut sichtbar. Die Haut wird in diesem Zusammenhang gerne, wenn auch banalisierend, als «Spiegel des Körperinneren» bezeichnet. Hier können unter anderem chronisch-entzündliche, autoimmune und endokrinologische Erkrankungen zugrunde liegen. Auch wenn in der Tat viele Hauterscheinungen innerer Erkrankungen eher harmlos sind, bedeuten sie für die Betroffenen deutliche tägliche Einschränkungen sowie eine Verminderung der Lebensqualität und sind häufig aus kosmetischen Gründen sehr störend. Vielfach können sie auch bei suffizienter Therapie der inneren Erkrankungen persistieren bzw. benötigen zu ihrer erfolgreichen Behandlung therapeutische Ansätze und Medikamentendosierungen, die kritisch abgewogen werden müssen. Beispielsweise kann die Behandlung einer Beteiligung innerer Organe beim systemischen Lupus erythematodes (SLE) oder der Dermatomyositis erfolgreich sein, die charakteristischen Hautveränderungen kön-","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"20 1","pages":"161 - 161"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80701251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: An understanding of skin conditions associated with rheumatic diseases ensures accurate diagnosis and management. Cutaneous manifestations of rheumatological disease are legion. Objective: The aim of this article is to increase clinician familiarity with the dermatological manifestations of rheumatic conditions to enable accurate diagnosis and effective management. Discussion: This article will address the skin manifestations of lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, dermatomyositis and scleroderma, including their implications in diagnosis, prognosis and treatment.
{"title":"Hautveränderungen bei rheumatologischen Erkrankungen – Zusammenarbeit zwischen Dermatologen und Rheumatologen unerlässlich","authors":"M. Sticherling","doi":"10.1159/000527518","DOIUrl":"https://doi.org/10.1159/000527518","url":null,"abstract":"Background: An understanding of skin conditions associated with rheumatic diseases ensures accurate diagnosis and management. Cutaneous manifestations of rheumatological disease are legion. Objective: The aim of this article is to increase clinician familiarity with the dermatological manifestations of rheumatic conditions to enable accurate diagnosis and effective management. Discussion: This article will address the skin manifestations of lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, dermatomyositis and scleroderma, including their implications in diagnosis, prognosis and treatment.","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"1 1","pages":"175 - 176"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79873245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Calugareanu, C. Grolleau, H. Le Buanec, F. Chasset, M. Jachiet, M. Battistella, M. Bagot, D. jullien, S. Poutrel, J.-D. Bouaziz, B. Ben Said
Der chronische diskoide Lupus erythematodes (CDLE) ist die häufigste Unterform des chronisch kutanen Lupus erythematodes (CCLE) und kann mit systemischen Lupusmanifestationen einhergehen [1]. Es wurde festgestellt, dass Interferone (IFNs) vom Typ I eine Schlüsselrolle bei der Entstehung der Krankheit spielen [2, 3]. Nach dem Kontakt mit Kernbestandteilen (wie en-dogener Nukleinsäure), die durch Zellschäden freigesetzt werden, produzieren plasmazytoide dendritische Zellen (pDC) und Keratinozyten
{"title":"Klinische Wirksamkeit der selektiven JAK1-Hemmung und Transkriptomanalyse bei chronischem diskoidem Lupus erythematodes","authors":"A. Calugareanu, C. Grolleau, H. Le Buanec, F. Chasset, M. Jachiet, M. Battistella, M. Bagot, D. jullien, S. Poutrel, J.-D. Bouaziz, B. Ben Said","doi":"10.1159/000527270","DOIUrl":"https://doi.org/10.1159/000527270","url":null,"abstract":"Der chronische diskoide Lupus erythematodes (CDLE) ist die häufigste Unterform des chronisch kutanen Lupus erythematodes (CCLE) und kann mit systemischen Lupusmanifestationen einhergehen [1]. Es wurde festgestellt, dass Interferone (IFNs) vom Typ I eine Schlüsselrolle bei der Entstehung der Krankheit spielen [2, 3]. Nach dem Kontakt mit Kernbestandteilen (wie en-dogener Nukleinsäure), die durch Zellschäden freigesetzt werden, produzieren plasmazytoide dendritische Zellen (pDC) und Keratinozyten","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"51 4 1","pages":"205 - 207"},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79865375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Rheumatoid arthritis is the most common autoimmune disease worldwide and requires long-term treatment to suppress inflammation. Currently, treatment is started when arthritis is clinically apparent. We aimed to evaluate whether earlier intervention, in the preceding phase of arthralgia and subclinical joint inflammation, could prevent the development of clinical arthritis or reduce the disease burden. Methods: We conducted a randomised, double-blind, placebo-controlled, proof-of-concept-trial at the Leiden University Medical Centre, Leiden, Netherlands. Adults aged 18 years or older with arthralgia clinically suspected of progressing to rheumatoid arthritis and MRI-detected subclinical joint inflammation were eligible for enrolment across 13 rheumatology outpatient clinics in the southwest region of the Netherlands and randomly assigned (1:1) to a single intramuscular glucocorticoid injection (120 mg) and a 1-year course of oral methotrexate (up to 25 mg/week), or placebo (single injection and tablets for 1 year). Participants and investigators were masked to group assignment. Follow-up continued for 1 year after the end of the 1-year treatment period. The primary endpoint was development of clinical arthritis (fulfilling the 2010 rheumatoid arthritis classification criteria or involving two or more joints) that persisted for at least 2 weeks. Patient-reported physical functioning, symptoms, and work productivity were secondary endpoints, which were measured every 4 months. Additionally, the course of MRI-detected inflammation was studied. All participants entered the intention-to-treat analysis. This trial is registered with EudraCT, 2014-004472-35, and the Netherlands Trial Register, NTR4853-trial-NL4599. Findings: Between April 16, 2015, and Sept 11, 2019, 901 patients were assessed for eligibility and 236 were enrolled and randomly assigned to active treatment (n = 119) or placebo (n = 117). At 2 years, the frequency of the primary endpoint was similar between the groups (23 [19%] of 119 participants in the treatment group vs 21 [18%] of 117 in the placebo group; hazard ratio 0.81, 95% CI 0.45 to 1.48). Physical functioning improved more in the treatment group during the first 4 months and remained better than in the placebo group (mean between-group difference in Health Assessment Questionnaire disability index over 2 years: –0.09, 95% CI –0.16 to –0.03; p = 0.0042). Similarly, pain (on scale 0–100, mean between-group difference: –8, 95% CI –12 to –4; p < 0.0001), morning stiffness of joints (–12, –16 to –8; p < 0.0001), presenteeism (–8%, –13 to –3; p = 0.0007), and MRI-detected joint inflammation (–1.4 points, –2.0 to –0.9; p < 0.0001) showed sustained improvement in the treatment group compared with the placebo group. The number of serious adverse events was equal in both groups; adverse events were consistent with the known safety profile for methotrexate. Interpretation: Methotrexate, the cornerstone treatment of rheumatoid
背景:类风湿关节炎是世界范围内最常见的自身免疫性疾病，需要长期治疗以抑制炎症。目前，当关节炎临床表现明显时才开始治疗。我们的目的是评估早期干预，在关节痛和亚临床关节炎症的前期，是否可以预防临床关节炎的发展或减轻疾病负担。方法:我们在荷兰莱顿的莱顿大学医学中心进行了一项随机、双盲、安慰剂对照、概念验证试验。在荷兰西南地区的13家风湿病门诊诊所，18岁或以上的成人关节痛临床怀疑进展为类风湿关节炎和mri检测到的亚临床关节炎症符合入组条件，随机分配(1:1)到单次肌内糖皮质激素注射(120 mg)和1年的口服甲氨蝶呤(高达25 mg/周)，或安慰剂(单次注射和片剂1年)。参与者和调查人员被分组分配。1年治疗期结束后，随访1年。主要终点是临床关节炎的发展(满足2010年类风湿性关节炎分类标准或涉及两个或更多关节)持续至少2周。患者报告的身体功能、症状和工作效率是次要终点，每4个月测量一次。此外，研究mri检测炎症的过程。所有参与者都进入了意向治疗分析。该试验已在euddraft注册，编号为2014-004472-35，荷兰试验注册号为NTR4853-trial-NL4599。研究结果:2015年4月16日至2019年9月11日期间，901名患者接受了资格评估，236名患者入组，随机分配到积极治疗组(n = 119)或安慰剂组(n = 117)。2年后，两组之间主要终点的频率相似(治疗组119名参与者中有23名[19%]vs安慰剂组117名参与者中有21名[18%];风险比0.81,95% CI 0.45 ~ 1.48)。治疗组在前4个月的身体功能改善更多，且优于安慰剂组(健康评估问卷残疾指数2年内组间平均差异:-0.09,95% CI -0.16 ~ -0.03;P = 0.0042)。同样，疼痛(评分0-100，组间平均差异:-8,95% CI -12至-4;P < 0.0001)，关节早晨刚度(-12，-16至-8;P < 0.0001)，出勤率(-8%，-13至-3;p = 0.0007)， mri检测关节炎症(-1.4分，-2.0 ~ -0.9;P < 0.0001)显示治疗组与安慰剂组相比持续改善。两组严重不良事件数量相等;不良事件与已知的甲氨蝶呤安全性相符。解释:甲氨蝶呤是类风湿关节炎的基础治疗，在关节炎前期症状和亚临床炎症阶段开始，并不能阻止临床关节炎的发展，但与安慰剂相比，mri检测到的炎症、相关症状和损伤的持续改善显示，它改变了疾病的进程。
{"title":"Methotrexat bei Risikopatienten für die Entwicklung einer RA – die TREAT EARLIER-Studie","authors":"S. Adler","doi":"10.1159/000527302","DOIUrl":"https://doi.org/10.1159/000527302","url":null,"abstract":"Background: Rheumatoid arthritis is the most common autoimmune disease worldwide and requires long-term treatment to suppress inflammation. Currently, treatment is started when arthritis is clinically apparent. We aimed to evaluate whether earlier intervention, in the preceding phase of arthralgia and subclinical joint inflammation, could prevent the development of clinical arthritis or reduce the disease burden. Methods: We conducted a randomised, double-blind, placebo-controlled, proof-of-concept-trial at the Leiden University Medical Centre, Leiden, Netherlands. Adults aged 18 years or older with arthralgia clinically suspected of progressing to rheumatoid arthritis and MRI-detected subclinical joint inflammation were eligible for enrolment across 13 rheumatology outpatient clinics in the southwest region of the Netherlands and randomly assigned (1:1) to a single intramuscular glucocorticoid injection (120 mg) and a 1-year course of oral methotrexate (up to 25 mg/week), or placebo (single injection and tablets for 1 year). Participants and investigators were masked to group assignment. Follow-up continued for 1 year after the end of the 1-year treatment period. The primary endpoint was development of clinical arthritis (fulfilling the 2010 rheumatoid arthritis classification criteria or involving two or more joints) that persisted for at least 2 weeks. Patient-reported physical functioning, symptoms, and work productivity were secondary endpoints, which were measured every 4 months. Additionally, the course of MRI-detected inflammation was studied. All participants entered the intention-to-treat analysis. This trial is registered with EudraCT, 2014-004472-35, and the Netherlands Trial Register, NTR4853-trial-NL4599. Findings: Between April 16, 2015, and Sept 11, 2019, 901 patients were assessed for eligibility and 236 were enrolled and randomly assigned to active treatment (n = 119) or placebo (n = 117). At 2 years, the frequency of the primary endpoint was similar between the groups (23 [19%] of 119 participants in the treatment group vs 21 [18%] of 117 in the placebo group; hazard ratio 0.81, 95% CI 0.45 to 1.48). Physical functioning improved more in the treatment group during the first 4 months and remained better than in the placebo group (mean between-group difference in Health Assessment Questionnaire disability index over 2 years: –0.09, 95% CI –0.16 to –0.03; p = 0.0042). Similarly, pain (on scale 0–100, mean between-group difference: –8, 95% CI –12 to –4; p < 0.0001), morning stiffness of joints (–12, –16 to –8; p < 0.0001), presenteeism (–8%, –13 to –3; p = 0.0007), and MRI-detected joint inflammation (–1.4 points, –2.0 to –0.9; p < 0.0001) showed sustained improvement in the treatment group compared with the placebo group. The number of serious adverse events was equal in both groups; adverse events were consistent with the known safety profile for methotrexate. Interpretation: Methotrexate, the cornerstone treatment of rheumatoid ","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"18 1","pages":"184 - 186"},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87987248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dermatitis herpetiformis (DH), Morbus Duhring, wird durch Glutensensitivität verursacht und betrifft 11,2 bis 75,3 pro 100 000 Menschen in den Vereinigten Staaten und Europa mit einer Inzidenz von 0,4 bis 3,5 pro 100 000 Menschen pro Jahr. DH zeichnet sich durch einen symmetrischen Blasenausschlag auf den Streckflächen mit starkem Juckreiz aus. Die Diagnose wird weiterhin primär durch pathognomonische Befunde der Histopathologie, insbesondere der direkten Immunfluoreszenz (DIF), gestellt. In jüngster Zeit haben sich Antikörper gegen epidermale Transglutaminase (TG3) als primäre diagnostische Serologie erwiesen, während Anti-Gewebstransglutaminase (TG2) und andere Autoantikörper zur Unterstützung der Diagnose und zur Krankheitsüberwachung verwendet werden können. Neu diagnostizierte Patienten mit DH sollten auf Begleiterkrankungen und Komplikationen untersucht und beurteilt werden. Eine glutenfreie Diät (GFD) und Dapson sind nach wie vor die Hauptpfeiler der Behandlung, aber bei hartnäckigen Fällen können andere Medikamente erforderlich sein. Gut kontrollierte DH-Patienten, die von einem Dermatologen, einem Gastroenterologen und einem Ernährungsberater betreut werden, haben eine hervorragende Prognose. Unsere Übersichtsarbeit beschreibt umfassend die aktuellen diagnostischen Methoden sowie Methoden zur Überwachung des Krankheitsverlaufs. Wir beschreiben zudem sowohl die traditionellen als auch die neuartigen Optionen für die Krankheitsbehandlung, die in der Literatur beschrieben werden.
{"title":"Dermatitis Herpetiformis: Ein aktualisierter Überblick zu Diagnose, Krankheitsüberwachung und Management","authors":"Christopher N. Nguyen, Soo-Jung Kim","doi":"10.1159/000527117","DOIUrl":"https://doi.org/10.1159/000527117","url":null,"abstract":"Dermatitis herpetiformis (DH), Morbus Duhring, wird durch Glutensensitivität verursacht und betrifft 11,2 bis 75,3 pro 100 000 Menschen in den Vereinigten Staaten und Europa mit einer Inzidenz von 0,4 bis 3,5 pro 100 000 Menschen pro Jahr. DH zeichnet sich durch einen symmetrischen Blasenausschlag auf den Streckflächen mit starkem Juckreiz aus. Die Diagnose wird weiterhin primär durch pathognomonische Befunde der Histopathologie, insbesondere der direkten Immunfluoreszenz (DIF), gestellt. In jüngster Zeit haben sich Antikörper gegen epidermale Transglutaminase (TG3) als primäre diagnostische Serologie erwiesen, während Anti-Gewebstransglutaminase (TG2) und andere Autoantikörper zur Unterstützung der Diagnose und zur Krankheitsüberwachung verwendet werden können. Neu diagnostizierte Patienten mit DH sollten auf Begleiterkrankungen und Komplikationen untersucht und beurteilt werden. Eine glutenfreie Diät (GFD) und Dapson sind nach wie vor die Hauptpfeiler der Behandlung, aber bei hartnäckigen Fällen können andere Medikamente erforderlich sein. Gut kontrollierte DH-Patienten, die von einem Dermatologen, einem Gastroenterologen und einem Ernährungsberater betreut werden, haben eine hervorragende Prognose. Unsere Übersichtsarbeit beschreibt umfassend die aktuellen diagnostischen Methoden sowie Methoden zur Überwachung des Krankheitsverlaufs. Wir beschreiben zudem sowohl die traditionellen als auch die neuartigen Optionen für die Krankheitsbehandlung, die in der Literatur beschrieben werden.","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"8 1","pages":"162 - 174"},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84088335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gut microbiota dysbiosis is involved in the development of systemic lupus erythematosus (SLE). The safety and efficacy of fecal microbiota transplantation (FMT) for the treatment of SLE patients has not been explored. In this 12-week, single-arm pilot clinical trial of oral encapsulated fecal microbiome from healthy donors to patients with active SLE, we aimed to evaluate the safety and efficacy of FMT in patients with SLE (ChiCTR2000036352). 20 SLE patients with SLEDAI ≥6 were recruited. FMT was administered once a week for three consecutive weeks along with standard treatment and the patients were followed for 12 weeks. Safety was evaluated throughout the trial. The primary endpoint was the SLE Responder Index-4 (SRI-4) at week 12. Microbiome composition, levels of short chain fatty acids (SCFAs) in the gut and of cytokines in the sera were measured along with lymphocyte phenotyping. No serious adverse events were observed after FMT. At week 12, the SRI-4 response rate was 42.12%, and significant reductions in the SLEDAI-2K scores and the level of serum anti-dsDNA antibody were observed compared to baseline. Significant enrichment of SCFAs-producing bacterial taxa and reduction of inflammation-related bacterial taxa were observed, along with increased production of SCFAs in the gut and reduced levels of IL-6 and CD4+ memory/naïve ratio in the peripheral blood. Furthermore, SRI-4 responding patients displayed specific microbiota signatures both before and after FMT. The first clinical trial of FMT in active SLE patients provides supportive evidence that FMT might be a feasible, safe, and potentially effective therapy in SLE patients by modifying the gut microbiome and its metabolic profile.
{"title":"Wirksamkeit des fäkalen Mikrobiota-Transfers bei systemischem Lupus erythematodes","authors":"I. Blumenstein","doi":"10.1159/000527288","DOIUrl":"https://doi.org/10.1159/000527288","url":null,"abstract":"Gut microbiota dysbiosis is involved in the development of systemic lupus erythematosus (SLE). The safety and efficacy of fecal microbiota transplantation (FMT) for the treatment of SLE patients has not been explored. In this 12-week, single-arm pilot clinical trial of oral encapsulated fecal microbiome from healthy donors to patients with active SLE, we aimed to evaluate the safety and efficacy of FMT in patients with SLE (ChiCTR2000036352). 20 SLE patients with SLEDAI ≥6 were recruited. FMT was administered once a week for three consecutive weeks along with standard treatment and the patients were followed for 12 weeks. Safety was evaluated throughout the trial. The primary endpoint was the SLE Responder Index-4 (SRI-4) at week 12. Microbiome composition, levels of short chain fatty acids (SCFAs) in the gut and of cytokines in the sera were measured along with lymphocyte phenotyping. No serious adverse events were observed after FMT. At week 12, the SRI-4 response rate was 42.12%, and significant reductions in the SLEDAI-2K scores and the level of serum anti-dsDNA antibody were observed compared to baseline. Significant enrichment of SCFAs-producing bacterial taxa and reduction of inflammation-related bacterial taxa were observed, along with increased production of SCFAs in the gut and reduced levels of IL-6 and CD4+ memory/naïve ratio in the peripheral blood. Furthermore, SRI-4 responding patients displayed specific microbiota signatures both before and after FMT. The first clinical trial of FMT in active SLE patients provides supportive evidence that FMT might be a feasible, safe, and potentially effective therapy in SLE patients by modifying the gut microbiome and its metabolic profile.","PeriodicalId":17887,"journal":{"name":"Kompass Autoimmun","volume":"90 1","pages":"177 - 179"},"PeriodicalIF":0.0,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82272653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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