Besonderheiten Rheumatologischer Pharmakotherapie im Alter

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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