Rheumatologische Schmerztherapie mit nichtsteroidalen Antirheumatika

Zusammenfassung

Die antialgetische Pharmakotherapie wird bei muskuloskelettalen Erkrankungen vornehmlich mit nichtsteroidalen Antirheumatika (NSAR) durchgeführt. NSAR inhibieren in geschädigtem Gewebe die von der stimulierbaren Cyclooxygenase (COX)-2 abhängige parakrine Synthese von Prostaglandinen (PGs), die am peripheren Neuron die Transmission des Schmerzsignals modulieren. Nicht selektive/traditionelle NSAR inhibieren darüber hinaus die COX-1-abhängige Synthese von PGs, die gewebeerhaltende („housekeeping”) Funktion haben. GI-, CV-und renale Funktionsstörungen bis hin zu lebensbedrohlichen Komplikationen sind die wichtigsten Nebenwirkungen. Bei Risikopatienten sind Komplikationen vermeidende Präventivmaßnahmen angezeigt. Dazu gehören der Einsatz COX-2-selektiver NSAR, die Komedikation von Protonenpumpeninhibitoren (PPI), die Wahl möglichst niedriger NSARDosen u. a. Kontraindikationen müssen beachtet werden. Die Empfehlungen der Deutschen Gesellschaft für Rheumatologie (DGRh) zum risikoarmen Einsatz von NSAR können der Therapieplanung zugrunde gelegt werden.

Summary

Antialgesic pharmacotherapy in musculo-skeletal diseases is carried out primarily with non-steroidal antiinflammatory drugs (NSAIDs). NSAIDs inhibit the paracrine synthesis of prostaglandins (PGs) in damaged tissue, which is dependent on the stimulatable Cyclooxygenase (COX)-2. PGs modulate the transmission of the pain signal to the peripheral neuron. Traditional/non-selective NSAIDs also inhibit the COX-1-dependent synthesis of PGs, which have a tissue-preserving („housekeeping”) function. The main side effects are GI-, CV-and renal dysfunction and right up to life-threatening complications. In patients at risk, preventive measures are indicated to avoid complications. These include the use of COX-2 selective NSAIDs, concomitant medication with PPI, choosing the lowest possible dose of NSAID. Contraindications must be considered. The recommendations of the German society for rheumatology (DGRh) for low-risk use of NSAIDs can be taken as a basis for therapy planning.

Schlüsselwörter

Schmerztherapie - nichtsteroidale Antirheumatika - NSAR - Cyclooxygenase - COX-2- selektive NSAR - Prostaglandine

Keywords

Pain management - non-steroidal anti-inflamatory drugs - NSAIDs - Cyclooxygenase - COX-2 selective NSAIDs - prostaglandins

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