Zusammenfassung
Faktoren wie Multimorbidität und Multimedikation, häufige Nierenfunktionseinschränkung
und weitere pharmakokinetische Besonderheiten sorgen dafür, dass die medikamentöse
Behandlung des geriatrischen Rheumapatienten oft nicht ganz unkompliziert ist. Durch
die Vielfalt der heutigen Behandlungsmöglichkeiten gelingt es jedoch dennoch, jeden
älteren Rheumatiker therapeutisch gut zu versorgen. Leider werden in dieser Altersstufe
kaum kontrollierte Studien durchgeführt, sodass das Vorgehen eher empirisch als evidenzbasiert
begründet ist. Grundsätzlich empfiehlt sich ein vorsichtigeres Vorgehen bei Anfangsdosierung
und Dosissteigerung. Problemlos sind in der Regel Glucocorticoide einsetzbar, ebenso
sind milde Basistherapeutika wie Hydroxychloroquin und Sulfasalazin, aber auch Leflunomid
einsetzbar. Das ansonsten in der Rheumatologie vielverwendete Methotrexat steht hingegen
nur bei guter Nierenfunktion zur Verfügung. Bei hochaktiver RA kann durchaus auf Biologika
zurückgegriffen werden, die auch in dieser Altersstufe gut wirken, allerdings mit
höherem Infektionsrisiko verbunden sind.
Abstract
Factors like multimorbidity, multimedication, frequent impairment of renal function
and pharmacokinetic differences make drug treatment in elderly patients a challenge.
Nevertheless satisfactory treatment of the elderly RA patient is possible in most
cases because of the many different treatment possibilities existing today. Unfortunately
nearly all controlled studies exclude geriatric patients, and studiies targeting this
population are rare which means drug treatment in the elderly is rather empirical
than evidence-based. Basically the “go low go slow” principle is recommended for drug
use in geriatric patients. Among the frequently applied antirheumatic drugs, the use
of glucorticoids, hydroxychloroquine and sulphasalazine and leflunomide is rather
uncomplicated whereas the DMARD “gold standard” methotrexate can be used only in patients
without signs of renal insufficiency. In highly active disease, biologicals are effective
also in geriatric RA patients but a higher rate of infectious complications in this
age group has to be kept in mind.
Schlüsselwörter
Pharmakotherapie - Antirheumatika - geriatrische Patienten
Key words
drug treatment - antirheumatic drugs - elderly patients
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Korrespondenzadresse
Prof. Dr. Klaus Krüger
Praxiszentrum/Rheumatologie
Rheumatologie
Sankt Bonifatius Straße 5/II
81541 München
Telefon: +49-(0)89-691-4222
Fax: +49-(0)89-6914230
eMail: klaus.krueger@med.uni-muenchen.de
