Medikamentöse Therapie rheumatischer System­erkrankungen

Zusammenfassung

Rheumatische Systemerkrankungen manifestieren sich meist an kleinen und großen Gelenken bzw. der Wirbelsäule, wo sie durch entzündliche Prozesse Destruktionen hervorrufen können. Ihre Erstmanifestation stellt sich häufig bereits im jungen Lebensalter, teils sogar in der Kindheit ein. Durch den chronischen Verlauf entstehen Schäden, die zu einer erheblichen Minderung der Lebensqualität und Einfluss auf die Erwerbsfähigkeit führen. Volkswirtschaftlich gesehen gehören sie zu den teuersten Erkrankungen. Die Erkenntnis, dass bei aggressiven Krankheitsverläufen bereits nach 6 Monaten irreversible Gelenkzerstörungen eintreten können und die Entwicklung neuer, hochwirksamer Medikamente, die spezifisch an den Entzündungsabläufen in den Gelenken angreifen (Biologika), haben zu einer grundlegenden Änderung der Behandlungskonzepte rheumatischer Gelenkerkrankungen geführt. Ziel ist es, durch einen möglichst frühen Behandlungsbeginn mit immunsuppressiven Medikamenten, kurzfristigen Verlaufskontrollen unter Validierung der Krankheitsaktivität, der bedarfsorientierten Nutzung kombinierter Therapiekonzepte oder auch den Einsatz der Biologika eine Remission der Erkrankung zu erreichen.

Abstract

Systemic rheumatic diseases usually manifest on small and large joints as well as on the vertebral joints where they cause destruction by inflammatory processes. Initial manifestation is often at an early age, sometimes starting during childhood. The chronic course of these diseases cause severe damage leading to a decreased quality of life and specifically impedes the ability to work. From an economic point of view, systemic rheumatic diseases have one of the most costly impacts. Changes in how rheumatic diseases are treated have come about with the knowledge that irreparable joint destruction can occur as early as 6 months in aggressive courses of the disease. The result is the development of new, highly effective drugs (biologics) that target the inflammatory processes directly in the joint. Current treatment concepts aim to start immunosuppressive treatment as early as possible while closely and frequently monitoring disease progression, thus moving toward disease specific treatment instead of general symptom repression.

Schlüsselwörter

medikamentöse Behandlung - rheumatische Systemerkrankungen - Rheumatoide Arthritis - DMARD - Biologika

Key words

medical treatment - systemic rheumatic diseases - rheumatoid arthritis - DMARD - biologics

• Literatur

• 1 Bergholz R, Schroeter J, Rüther K. Evaluation of risk factors for retinal damage due to chloroquine and hydroxychloroquine. Br J Ophthalmol 2010; 94: 1637-1642
• 2 Choi Y, Arron JR, Townsend MJ. Promising bone-related therapeutic targets for rheumatoid arthritis. Nature Reviews Rheumatology 2009; 5: 543-548
• 3 Dolhain RJ, Tak PP, Dijkmans RA et al. Methotrexate reduces inflammatory cell numbers, expression of monokines and of adhesion molecules in synovial tissue of patients with rheumatoid arthritis. Br J Rheumatol 1998; 37: 502-508
• 4 Engvall IL, Svensson B, Tengstrand B et al Impact of low-dose prednisolone on bone synthesis and resorption in early rheumatoid arthritis: Experiences from a two-year randomized study. Arthritis Research and Therapy 2008; 10
• 5 Furst DE. Anakinra: Review of recombinant human interleukin-I receptor antagonist in the treatment of rheumatoid arthritis. Clin Ther 2004; 26: 1960-1975
• 6 Gartlehner G, Hansen RA, Jonas BL et al. The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: A systematic review and metaanalysis. J Rheumatol 2006; 33: 2398-2408
• 7 Hallert E, Husberg M, Bernfort L. The incidence of permanent work disability in patients with rheumatoid arthritis in Sweden 1990-2010: Before and after introduction of biologic agents. Rheumatology 2012; 51: 338-346
• 8 Housby JN, Cahill CM, Chu B et al. Non-steroidal anti-inflammatory drugs inhibit the expression of cytokines and induce HSP70 in human monocytes. Cytokine 1999; 11: 347-358
• 9 Inaoka M, Kimishima M, Takahashi R et al. Non-steroidal anti-inflammatory drugs selectively inhibit cytokine production by NK cells and γδ T cells. Exp Dermatol 2006; 15: 981-990
• 10 Justice E, Carruthers DM. Cardiovascular risk and COX-2 inhibition in rheumatological practice. J Hum Hypertens 2005; 19: 1-5
• 11 Kawaguchi A, Nakaya H, Okabe T et al. Blocking of tumor necrosis factor activity promotes natural repair of osteochondral defects in rabbit knee. Acta Orthopaedica 2009; 80: 606-611
• 12 Marmor MF, Kellner V, Lai TY et al. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 2011; 118: 415-422
• 13 Mau W, Beyer W, Ehlebracht-König I et al. Burden of illness: First routine report on socio-medical consequences of inflammatory rheumatic disease in Germany. Z Rheumatol 2008; 67: 157-164
• 14 McNulty AL, Moutos FT, Weinberg JB et al. Enhanced integrative repair of the porcine meniscus in vitro by inhibition of interleukin-1 or tumor necrosis factor α. Arthritis Rheum 2007; 56: 3033-3043
• 15 Miehle W. Rheumatologie in Praxis und Klinik, Medikamentöse Therapie. Thieme 2000; 2: 256-268
• 16 Nikiphorou E, Guh D, Bansback N et al. Work disability rates in RA. Results from an inception cohort with 24 years follow-up. Rheumatology 2012; 51: 385-392
• 17 O’Dell JR, Leff R, Paulsen G et al. Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: Results of a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2002; 46: 1164-1170
• 18 Rau R, Wassenberg S, Zeidler H. Low dose prednisolone therapy (LDPT) retards radiographically detectable destruction in early rheumatoid arthritis – Preliminary results of a multicenter, randomized, parallel, double blind study. Z Rheumatol 2000; 59: II90-II96
• 19 Singh A. 2012 Update of the 2008 ACR recommendations for the treatment of RA [abstract]. Arthritis Rheum 2011; 63 2011
• 20 Smolen JS, Landewé R, Breedveld FC et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Revmatologiia 2011; 19: 5-21
• 21 Svensson B, Boonen A, Albertsson K et al. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: A two-year randomized trial. Arthritis Rheum 2005; 52: 3360-3370
• 22 Thomas R, Carroll GJ Reduction of leukocyte and interleukin-1β concentrations in the synovial fluid of rheumatoid arthritis patients treated with methotrexate. Arthritis Rheum 1993; 36: 1244-1252