Bekannte und neue therapeutische Konzepte der Behandlung der Psoriasis und der Arthritis psoriatica

Zusammenfassung

Die Arthritis psoriatica (A. ps.) fristete lange Zeit ein „Mauerblümchendasein”. Die Bestrebungen, sie als eigene nosologische Entität anzuerkennen, verliefen schleppend und sind letztlich bis heute nicht abgeschlossen. Angesiedelt zwischen chronischer Polyarthritis (Synonym: rheumatoide Arthritis) und den Spondarthritiden sucht die überwiegend mit charakteristischen Hautveränderungen einhergehende chronische Arthritis noch ihren Platz. Die mögliche polyarthritische Verlaufsform sowie Wirbelsäulenmanifestationen und Enthesitiden bilden Gemeinsamkeiten mit den beiden häufigsten rheumatologischen Krankheitsbildern. Alle Bemühungen um ein stichhaltiges therapeutisches Konzept erfolgten bisher „im Windschatten” der chronischen Polyarthritis (c. P.) und der Psoriasis. Zusätzlich erschwerend erscheint, dass die ärztliche Zuständigkeit für die Erkrankung oft nicht eindeutig geklärt ist, was z. B. auch an den unterschiedlichen Bezeichnungen abzulesen ist: Der Dermatologe spricht von der Osteoarthropathia psoriatica oder Psoriasis arthropathica, der Rheumatologe von der Psoriasisarthritis oder Arthritis psoriatica. Internistische Rheumatologen verwenden bevorzugt die Bezeichnung Arthritis psoriatica, da Zeichen der Gelenkentzündung das Krankheitsbild charakterisieren.

Abstract

For a long time, psoriatic arthritis had a “wallflower existence.” Efforts to recognize the disease as a distinct nosologic entity were slow in progress and are still not completed. Allocated somewhere between rheumatoid arthritis and spondyloarthropathies, this disease, which is predominantly associated with characteristic skin lesions, is still searching for its true place. It shares the potential polyarthritic course, axial skeletal involvement and enthesopathic manifestation with both of the most frequent inflammatory rheumatic diseases. All therapeutic concepts were derived from those established in treating rheumatoid arthritis and psoriasis. The search for its place is hampered further by the fact that the right medical specialist is often not consulted. This also reflects the inconsistent terminology: the dermatologist calls it osteoarthritis psoriatica or arthropathic psoriasis and the rheumatologist psoriatic arthritis. As internal medicine-oriented rheumatologists, we prefer the term arthritis psoriatica (psoriasis arthritis) since the arthritic inflammation characterize the clinical manifestation of this disease.

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