Hepatologische Aspekte der immunsuppressiven Therapie rheumatologischer Erkrankungen

Zusammenfassung

Immunsuppressive Konzepte stellen die Basis der modernen Therapie entzündlich rheumatischer Erkrankungen dar. Trotz stetig verbesserter Verträglichkeit der Medikamente ist eine planmäßige Kontrolle der Patienten erforderlich, da mit Nebenwirkungen zu rechnen ist. Besonders zu beachten ist dabei die komplexe Beziehung zwischen der Leber und rheumatischen Erkrankungen. So können z. B. im Verlauf eines SLE durch die Beteiligung des hepatischen Gefäßsystems schwere Leberschäden entstehen. Die autoimmune Hepatitis, die primäre biliäre Zirrhose und die primär sklerosierende Cholangitis sind ebenfalls mit rheumatologischen Erkrankungen assoziiert. NSAR verursachen sehr häufig hepatotoxische Effekte. Leiden die Patienten an einer Virushepatitis, kann der Einsatz von klassischen DMARD incl. Biologicals kontraindiziert sein. Dies gilt besonders für Rituximab. Ohne vorherige effektive antivirale Therapie ist die Gefahr einer Reaktivierung unter Immunsuppression sehr hoch.

Abstract

Immunosuppressive concepts are the basis of the modern therapy for inflammatory rheumatic diseases. Despite steadily improved tolerability of the drugs a scheduled supervision of patients is necessary, as side-effects are to be expected. Particular attention must be paid to the complex relationship between the liver and rheumatic diseases. For instance, in the course of systemic lupus erythematosus (SLE) severe liver damage can occur through the involvement of the hepatic vascular system. Autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis are also associated with rheumatic diseases. NSAIDs very frequently cause hepatotoxic effects. For patients suffering from a viral hepatitis, the use of classic DMARDs including biologics can be contraindicated. This particularly applies for Rituximab. Without a preceding effective antiviral therapy the danger of reactivation during immunosuppression is very high.

Schlüsselwörter

Rheumatische Erkrankungen - Lebererkrankungen - Antirheumatische Therapie - Hepatitis - Immunsuppression

Key words

rheumatic diseases - liver diseases - antirheumatic therapy - hepatitis - immunosuppression

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