Darmerkrankungen und Arthropathie

Zusammenfassung

Es gibt keine wissenschaftlich exakte Definition des Krankheitsbildes, das durch eine Darmerkrankung und Gelenkaffektion, wie Arthralgie oder Arthritis, definiert ist. Krankheitsbilder mit vermuteter oder nachgewiesener Darminfektion, aber auch Autoimmunerkrankungen, wie die Psoriasis und andere Spondylarthropathien, gehören zu dieser heterogenen Gruppe. Während der letzten Jahre ergaben sensitivere Nachweismethoden immer häufiger einen Zusammenhang mit bakteriellen, viralen oder toxischen Darmschädigungen. Unerwartet war der Zusammenhang beim M. Bechterew und der Psoriasisarthritis. Andererseits wurden auch in den Synoviazellen Gesunder DNA-Spuren pathogener Keime gefunden. Man nimmt deshalb heute an, dass verschiedene, individuell unterschiedliche Antworten des Immun-systems, des Darmes und der nervalen Regelkreise, entsprechend der genetischen Veranlagung, zur Entstehung der Krankheit beitragen. Pathophysiologisch könnte die Darmerkrankungen primär zu einer Störung der Mukosabarriere führen und dadurch antigenes Material der Darmkeime von Immunzellen erkannt und als Antigen präsentiert werden. Weitere Schritte sind das Homing der programmierten Immunzellen im Gelenk, die Ände-rung der Immunantwort des Wirtes und die Persistenz der Erreger. Im Lichte dieser Erkenntnisse ergeben sich neue Ansätze zur Therapie durch medikamentöse oder immuntherapeutische Beeinflussung der Reaktionsfolge.

Summary

There is no strict scientific definition of an disease entity, characterized by gastrointestinal pathology and joint disease, as arthralgia or arthritis. Diseases with suspected or proven gastro-intestinal infection, and autoimmune diseases, e. g. psoriasis or other spondyloarthropathies belong to this heterogenous group. Improved analytical methods during the past decade revealed a relation to bacterial, viral or toxic intestinal damage. Unexpectedly, this was established in ankylosing spondylitis and psoriatic arthritis. Unexpected either, DNA derived from bacteria, was detected in synovial fluid cells of healthy individuals. This led to the concept that several individually different responses of the immune system, the intestine, and neural circuits, according to the genetic setting, contribute to disease manifestation. Pathogenetic mechanisms may include impairment of the gut barrier, leading to exposure of antigenic material to immune cells, and its presentation as antigen. Further hallmarks are homing of the programmed immune cells in the joint, conditioning of host’s immune response, and impaired antigen clearance. In the light of these findings new pharmacological and immune-modulating therapies emerge.

Schlüsselwörter

Reaktive Arthritis - enteropathische Arthropathie - Darminfektion - Immunologie

Keywords

Reactive Arthritis - enteropathic arthropathy - intestinal infection - immunology

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