Die Rolle der Komorbiditäten bei Arthritis psoriatica

Zusammenfassung

Wie bei anderen entzündlich-rheumatischen Erkrankungen spielen auch bei der Arthritis psoriatica (PsA) Komorbiditäten eine wichtige Rolle für den Outcome und die Krankheitslast der Patienten. Das Spektrum typischer Komorbiditäten zeigt Gemeinsamkeiten, aber auch Unterschiede zur rheumatoiden.Arthritis (RA): Gemeinsam ist die dominante Rolle kardiovaskulärer Komorbiditäten, die auch die Mortalität beider Erkrankungen mitbestimmen. In engem Zusammenhang damit findet sich das metabolische Syndrom bei PsA (deutlich mehr als bei RA) gehäuft. Depression und Angststörung sind bei beiden Erkrankungen häufig und werden oft vom Rheumatologen bzw. Dermatologen übersehen.

Infektionen finden sich bei PsA häufiger als in der Normalbevölkerung aber seltener als bei der RA (möglicherweise mitbegründet durch das höhere Durchschnittsalter der RA-Patienten). Unterschiedliche Daten findet man zur Assoziation mit Malignomen, es zeigt sich allenfalls eine geringe Risikoerhöhung. Dies gilt – im Unterschied zur RA – auch für die Osteoporose. Als okuläre Komorbiditäten sind vor allem die Uveitis anterior (vor allem bei HLA-B 27-positiven Patienten) und die Blepharitis von Bedeutung. Eine Verbindung zwischen PsA/Psoriasis und anderen Autoimmunerkrankungen betrifft in erster Linie die Zöliakie und die chronisch-entzündlichen Darmerkrankungen. Wie bei der RA sollte auch bei der PsA der Rheumatologe Komorbiditäten im Blick haben und danach suchen – in praktischen Alltag bestehen hier große Defizite.

Abstract

Comorbidities play an important role for outcome and burden of disease in psoriatic arthritis as well as in other inflammatory rheumatic diseases. Addressing the typical comorbidities in PsA reveals both similarities as well as differences in comparison to RA. Most importantly, a high rate of cardiovascular complications contributing to the mortality of the disease is seen. In tight connection to that, PsA is linked to metabolic syndrome and its components. Prevalence of depression and anxiety is raised in psoriasis/PsA and in RA with equal frequency and is overlooked by rheumatologists and dermatologists very often.

The risk of infectious complications is increased in PsA but in RA a higher rate is found (possibly due to the higher mean age in the RA population). According to oncological comorbidities. we found different study results with at most a small risk elevation. This applies to osteoporosis, too, in contrast to RA. Ocular complications in psoriasis/PsA include uveitis anterior (mainly associated with HLA-B27 positivity) and blepharitis. Finally psoriasis/PsA are linked to autoimmune comorbidities with coeliac disease and inflammatory bowel diease being the most important. When treating the PsA patient, the rheumatologist should keep in mind the possibility of comorbidities and moreover should actively look for them.

Schlüsselwörter

Arthritis psoriatica - Komorbiditäten - kardiovaskuläres Risiko - metabolisches Syndrom - Depression

Key words

psoriatic arthritis - comorbidities - cardiovascular risk - metabolic syndrome - depression

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