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Arthritis und Rheuma 2014; 34(05): 269-273
DOI: 10.1055/s-0037-1618001
Multimorbidität
Schattauer GmbH

Glukokortikoide bei multimorbiden Rheumapatienten

Teil der Lösung oder Teil des Problems?Use of glucocorticoids in the treatment of rheumatoid arthritis in multimorbid patientsPart of the solution or part of the problem?
G. Keyßer
1   Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
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Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Glukokortikoide haben ihren festen Platz in der Therapie der rheumatoiden Arthritis. Ihre komplexe Wirkweise bedingt eine Reihe von Nebenwirkungen, die vor allem in der Dauertherapie oberhalb von 5 mg Prednisolon pro Tag eine Rolle spielen. In diesem höheren Dosisbereich verschlechtern sie die Prognose durch eine vermehrte Frühsterblichkeit und ein erhöhtes kardiovaskuläres Risiko. Auch ihre ungünstigen metabolischen Eigenschaften, wie die Beeinträchtigung der Glukose toleranz, sind deutlich dosisabhängig. Ihr Einsatz sollte – gemäß den Empfehlungen der S1-Leitlinie der Deutschen Gesellschaft für Rheumatologie (DGRh) – vorwiegend in der Initialphase der Erkrankung, möglichst zeitlich befristet und in geringstmöglicher Dosierung vorgenommen werden. Ihre Anwendung kann auch bei multimorbiden Patienten eine Option darstellen, wenn eine Kontrolle der entzündlichen Aktivität anders nicht erreicht werden kann.

Summary

Glucocorticoids are a cornerstone of the treatment of rheumatoid arthritis. The complex mechanism of action of these substances gives rise to a variety of side effects that occur preferentially at a dose range above 5 mg prednisolone per day. In higher dosages, they deteriorate the prognosis of the patients by causing increased mortality and an increased cardiovascular risk. In addition, higher doses of steroids worsen the glucose tolerance. According to the recommendations of the treatment guideline of the German Society of Rheumatology, glucocorticoids should be given preferentially in the early phase of arthritis, for a limited time period only, and in the smallest possible dose. However, in patients with a high level of comorbidity the application of corticosteroids is justified if the control of the inflammatory activity cannot be achieved by other means.

Schlüsselwörter

Glukokortikoide - rheumatoide Arthritis - kardiovaskuläres Risiko

Keywords

Glucocorticoids - rheumatoid arthritis - cardiovascular risk
 

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