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Aktuelle Rheumatologie 2012; 37(01): 22-26
DOI: 10.1055/s-0031-1283174
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Perioperatives Management der medikamentösen Therapie mit Antirheumatika

Perioperative Management of Immunosuppression in Rheumatic Diseases
R. Alten
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Publication History

Publication Date:
28 July 2011 (online)

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Zusammenfassung

In der Therapie der Rheumatoiden Arthritis spielen vor allem immunsuppressive Medikamente eine bedeutende Rolle. Stehen operative Eingriffe bevor, stellt sich immer wieder die Frage, wie mit der aktuellen Medikation umgegangen werden soll. Das perioperative Beibehalten immunsuppressiver Medikamente kann sich negativ auf den geplanten Eingriff auswirken und postoperativ Wundheilungsstörungen und -infektionen nach sich ziehen. Hingegen führt ein präoperatives Absetzen der Therapeutika nicht selten zu einer Exazerbation des autoimmunen entzündlichen Geschehens. In diesem Artikel wird die aktuelle Evidenz für und wider das perioperative Absetzen von Steroiden, nicht-biologischen und biologischen Basistherapeutika zusammengestellt. Da derzeit zu den meisten in der Therapie der RA eingesetzten Medikamenten leider keine ausreichenden Daten aus klinischen kontrollierten Studien vorliegen, scheint ein individualisiertes Vorgehen d. h. die Berücksichtigung der jeweiligen Risikofaktoren der zu operierenden Patienten, adäquat zu sein.

Abstract

Immunosuppressive agents play a major role in the therapy for patients with rheumatoid arthritis. When an elective surgical intervention is pending, the question of how to deal with the current medical treatment arises. If immunosupressive treatment is maintained the surgical intervention might be complicated by wound healing disorders and infections. However, stopping the current antirheumatic treatment may lead to an exacerbation of autoimmune inflammatory activity. This article presents the pros and cons of stopping antirheumatic treatment (i. e., steroids, non-biologic and biologic DMARD therapy), prior to an elective surgery following the latest evidence. Since at present data from controlled clinical studies are insufficent and scarce, an individualised approach taking all the risk factors of the patient undergoing surgery into consideration seems to be the appropriate approach.

Schlüsselwörter

Rheumatoide Arthritis - Perioperatives Management - Biologika - DMARDs - Steroide

Key words

rheumatoid arthritis - perioperative management - biologic agents - DMARDs - steroids
 

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