Sklerodermie-assoziierte Autoantikörper – klinische und diagnostische Relevanz

[The situation of rare skin diseases in Germany]

In Germany a disease is considered to be "rare" when its prevalence is less than 5:10,000. However, as far as genetic skin diseases are concerned, they are often much more uncommon with a prevalence in the range of 1:100,000. Currently considerable deficits prevail in both diagnosis and treatment of rare skin diseases. Driven by scientific research on rare skin diseases and benefiting from start-up grants of the Federal Ministry for Education and Research (BMBF), the following networks for rare skin diseases were formed: a) epidermolysis bullosa, b) ichthyosis and related keratinisation disorders, c) systemic scleroderma. From a scientific point of view these networks are very successful, they publish in high impact journals and at the same time developed into national centres of reference for the respective disease groups, although formally this status does not exist in Germany. Thus, the 5 year start-up grants considerably improved the clinical care for these three skin disease groups. However, now we are confronted with the threat that the newly formed structures will be difficult to maintain, due to lack of adequate financing. In contrast to France, Germany does not have a "national plan for rare diseases"--probably because the federal structure in Germany is difficult to reconcile with "national plans". In France the situation of clinical care for rare diseases is permanently restructured by the establishment of official national reference centres and by allocation of additional financial means to fulfill these national tasks. In our view, a similar approach is also necessary in Germany.

Labordiagnostik bei systemischer Sklerose

For systemic sclerosis, laboratory tests can play a supplementary role to clinical investigations, imaging techniques and functional tests. Typical autoantibodies support early diagnosis and help in assigning patients to subgroups of the disease; negative results for antinuclear antibodies suggest exclusion of the diagnosis. To detect organ involvement and comorbidity, the laboratory contributes by clinical chemistry, in certain cases by histopathological findings and by the cytological assessment of broncho-alveolar lavage fluid. Inflammatory parameters are of minor importance. Multiple autoantibody determinations in the course of the disease are not yet helpful. Numerous additional laboratory parameters are of value for investigating pathogenesis, but have not yet been generally introduced into the routine diagnostics of systemic sclerosis.