Immunsystem und rheumatische Erkrankungen im Alter

Zusammenfassung

Störungen des Immunsystems spielen bei allen immunmediierten rheumatologischen Erkrankungen eine bedeutsame Rolle. Kürzlich wurden über folgende Neuigkeiten berichtet:

1. Frühe Alterung des Immunsystems mit Thymusinsuffizienz wurde nun sowohl für Patienten mit rheumatoider Arthritis als auch für solche mit axialer Spondyloarthritis nachgewiesen, ohne dass zumindest bei der rheumatoiden Arthritis ein Mangel an Vorläuferzellen vorhanden ist.

2. Bei Riesenzellarteritis, der häufigsten Vasculitis im Alter, spricht eine vermehrte Expression von Anti-IL-17-Antikörper in den Temporalbiopsien für eine günstige Prognose und Ansprechen auf Glukokortikoide.

3. Zur Immunseneszenz bei systemischem Lupus erythematosus: BAFF scheint eine wichtige Rolle bei Erkrankungschüben nach B-Zelldepletion zu haben.

In Zukunft werden einheitliche Klassifikationen von rheumatologischen Erkrankungen (wie bei der Polymyalgia rheumatica durch die 2012 EULAR / ACR-Klassifikationskriterien) zur besseren Vergleichbarkeit von immunologischen Studien auch im Alter beitragen.

Abstract

Impairments of the immune system play an important role in all immun-mediated rheumatic diseases. Recently, the following news were reported:

1. Early aging of the immune system with thymus insufficiency has now been reported for both patients with rheumatoid arthritis and axial spondyloarthritis, without prethymic lack of progenitors at least in rheumatoid arthritis.

2. For giant cell arteritis, the most frequent vasculitis in the elderly, an increased expression of IL-17A in temporal artery biopsies coincides with good prognosis and reponse to glucocorticoids.

3. Concerning immunosenescence in systemic lupus erythematosus, BAFF appears to have an important role for relapses after B-cell depletion.

For the future it can be anticipated that the use of unified classification criteria for rheumatic diseases (as with the new 2012 EULAR / ACR classification criteria for polymyalgia rheumatica) will ensure better comparability of immunological studies also in the elderly.

Schlüsselwörter

Geriatrie - Thymus - Arthritis - Vaskulitis - Anti-IL-17-Antikörper

Keywords

aging - thymus - arthritis - vasculitis - anti-IL-17 antibody

• Literatur

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