Download PDF
Arthritis und Rheuma 2016; 36(04): 222-228
DOI: 10.1055/s-0037-1617737
Neues zur rheumatologischen Pharmakotherapie
Schattauer GmbH

Neues zur Therapie mit Glukokortikoiden in der Rheumatologie

Ein Update 2016News about glucocorticoid therapy in rheumatologyAn update 2016
F. Buttgereit
1   Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
2   Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin
,
C. Strehl
1   Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
2   Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
27 December 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Glukokortikoide werden auch heute noch, mehr als 65 Jahre nach ihrer Einführung in die klinische Medizin, sehr erfolgreich zur Behandlung von entzündlich rheumatischen Erkrankungen wie rheumatoide Arthritis, Vaskulitiden und Kollagenosen eingesetzt. Sie haben sehr ausgeprägte therapeutische Wirkungen, können aber vor allem bei längerfristiger Anwendung von höheren Dosen auch unerwünschte Wirkungen auslösen. Dazu gehören zum Beispiel Osteoporose, kardiovaskuläre Erkrankungen, unerwünschte metabolische Wirkungen oder das verstärkte Auftreten von Infektionen. Daher gab und gibt es ständig Bemühungen, das Nutzen-Risiko-Verhältnis dieser wichtigen Medikamente zu optimieren. In diesem Artikel werden neue Erkenntnisse zu diesem Thema zusammenfassend vorgestellt. Es geht primär um die Definition von Bedingungen, unter denen auch eine notwendige Langzeittherapie mit Glukokortikoiden ein akzeptabel niedriges Nebenwirkungsniveau haben kann. Des Weiteren werden aktuelle Informationen zur Anwendung von Glukokortikoiden bei der Polymyalgia rheumatica und zu interessanten Entwicklungen von verbesserten Glukokortikoiden vorgestellt.

Summary

More than 65 years after their introduction into clinical medicine, glucocorticoids are very successfully used to treat inflammatory rheumatic diseases such as rheumatoid arthritis, vasculitides and connective tissue diseases. They induce impressive therapeutic effects, but especially long-term use of glucocorticoids at higher dosages may cause unwanted adverse effects. These include for example osteoporosis, cardiovascular diseases, unwanted metabolic effects, and the increased risk for infections. Therefore, a salient question was and still is how to optimize the benefit-risk balance of these important drugs. This article focuses on this question by providing timely information in this regard. First, very recently published data are presented which aim to identify conditions where a necessary long-term glucocorticoid treatment has an acceptably low level of harm. Furthermore, up-to-date information about the treatment of polymyalgia rheumatica with glucocorticoids and news regarding the development of improved glucocorticoids are provided.

Schlüsselwörter

Glukokortikoide - Dauertherapie - Nebenwirkungen - Polymyalgia rheumatica - DAGR

Keywords

Glucocorticoids - long-term therapy - adverse events - polymyalgia rheumatica - DAGR
 

  • Literatur

  • 1 Pincus T, Cutolo M. Clinical trials documenting the efficacy of low-dose glucocorticoids in rheumatoid arthritis. Neuroimmunomodulation 2015; 22 (1–2): 46-50.
    CrossrefPubMedSearch in Google Scholar
  • 2 van der Goes MC, Jacobs JW, Bijlsma JW. Rediscovering the therapeutic use of glucocorticoids in rheumatoid arthritis. Current opinion in rheumatology 2016; 28 (03) 289-296.
    CrossrefPubMedSearch in Google Scholar
  • 3 Matteson EL, Buttgereit F, Dejaco C, Dasgupta B. Glucocorticoids for Management of Polymyalgia Rheumatica and Giant Cell Arteritis. Rheum Dis Clin North Am 2016; 42 (01) 75-90 viii.
    CrossrefPubMedSearch in Google Scholar
  • 4 van der Goes MC, Jacobs JW, Boers M. et al. Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Ann Rheum Dis 2010; 69 (11) 1913-1919.
    CrossrefPubMedSearch in Google Scholar
  • 5 Rau R. Glucocorticoid treatment in rheumatoid arthritis. Expert opinion on pharmacotherapy 2014; 15 (11) 1575-1583.
    CrossrefPubMedSearch in Google Scholar
  • 6 Mazzantini M, Torre C, Miccoli M. et al. Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study. J Rheumatol 2012; 39 (03) 552-557.
    CrossrefPubMedSearch in Google Scholar
  • 7 Kavanaugh A, Wells AF. Benefits and risks of lowdose glucocorticoid treatment in the patient with rheumatoid arthritis. Rheumatology (Oxford) 2014; 53 (10) 1742-5171.
    CrossrefPubMedSearch in Google Scholar
  • 8 Buttgereit F, Burmester GR, Lipworth BJ. Inflammation, glucocorticoids and risk of cardiovascular disease. Nat Clin Pract Rheumatol 2009; 05 (01) 18-19.
    Search in Google Scholar
  • 9 Strehl C, Bijlsma JW, de Wit M. et al. Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis. 2016 March 1. [Epub ahead of print].
    PubMedSearch in Google Scholar
  • 10 Dejaco C, Singh YP, Perel P. et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/ American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015; 74 (10) 1799-1807.
    CrossrefPubMedSearch in Google Scholar
  • 11 van der Goes MC, Jacobs JW, Boers M. et al. Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2010; 69 (06) 1015-1021.
    CrossrefPubMedSearch in Google Scholar
  • 12 Pereira RM, Carvalho JF, Paula AP. et al. Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis. Revista brasileira de reumatologia 2012; 52 (04) 580-593.
    CrossrefPubMedSearch in Google Scholar
  • 13 Compston J. Clinical question: What is the best approach to managing glucocorticoid-induced osteoporosis?. Clinical endocrinology 2011; 74 (05) 547-550.
    CrossrefPubMedSearch in Google Scholar
  • 14 Friedman MA, Winthrop K. Vaccinations for rheumatoid arthritis. Current opinion in rheumatology 2016; 28 (03) 330-336.
    CrossrefPubMedSearch in Google Scholar
  • 15 Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA 2002; 288 (20) 2569-2578.
    CrossrefPubMedSearch in Google Scholar
  • 16 Ito S, Ogishima H, Kondo Y. et al. Early diagnosis and treatment of steroid-induced diabetes mellitus in patients with rheumatoid arthritis and other connective tissue diseases. Modern rheumatology/ the Japan Rheumatism Association 2014; 24 (01) 52-59.
    Search in Google Scholar
  • 17 Metsios GS, Stavropoulos-Kalinoglou A, Veldhuijzen van Zanten JJ. et al. Individualised exercise improves endothelial function in patients with rheumatoid arthritis. Ann Rheum Dis 2014; 73 (04) 748-751.
    CrossrefPubMedSearch in Google Scholar
  • 18 Dejaco C, Singh YP, Perel P. et al. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/ American College of Rheumatology collaborative initiative. Arthritis Rheumatol 2015; 67 (10) 2569-2580.
    CrossrefPubMedSearch in Google Scholar
  • 19 van der Geest T, Metselaar JM, Gerrits D. et al. [(18)]F FDG PET/CT imaging to monitor the therapeutic effect of liposome-encapsulated prednisolone in experimental rheumatoid arthritis. J Control Release 2015; 209: 20-26.
    CrossrefPubMedSearch in Google Scholar
  • 20 Conrado DJ, Krishnaswami S, Shoji S. et al. Predicting the probability of successful efficacy of a dissociated agonist of the glucocorticoid receptor from dose-response analysis. J Pharmacokinet Pharmacodyn. 2016 May 13.
    PubMedSearch in Google Scholar