Zusammenfassung
Die Anämie ist die häufigste extraartikuläre Manifestation der rheumatoiden Arthritis (RA) und trägt zur Reduktion der gesundheitsbezogenen Lebensqualität der betroffenen Patienten bei. Unter den vielfältigen möglichen Ursachen für die Entstehung einer Anämie im Rahmen der RA stehen die chronische Entzündungsanämie und die Eisenmangelanämie - meist als Folge chronisch-okkulter Blutungen - ganz im Vordergrund. Während die Blutungsanämie möglicherweise durch den Einsatz der neuen COX-2-Hemmer als Ersatz der klassischen nichtsteroidalen Antirheumatika (NSAR) in ihrer Häufigkeit reduziert werden kann, wird die chronische Entzündungsanämie, deren Pathogenese eng mit der RA als zugrundeliegender Krankheit verknüpft ist, auch in Zukunft ihre klinische Bedeutung beibehalten. Mit humanem rekombinanten Erythropoietin (rHu-Epo) steht heute ein Medikament zur Verfügung, das auch die Therapie dieser Anämieform ermöglicht, die lange als reines Epiphänomen der RA betrachtet wurde und nicht gezielt therapiert werden konnte. Die vorliegende Übersichtsarbeit fasst die klinische Bedeutung und Diagnose der chronischen Entzündungsanämie bei RA zusammen und diskutiert die Möglichkeiten eines optimierten therapeutischen Einsatzes von rHu-Epo als sinnvoller Erweiterung der bereits etablierten medikamentösen Therapiekonzepte bei Patienten mit RA.
Therapy of Anaemia in Rheumatoid Arthritis with Recombinant Human Erythropoietin
Anaemia is the most frequent extraarticular manifestation of rheumatoid arthritis (RA). Anaemia significantly reduces health-related quality of life of RA patients. The most commonly occurring among the various forms of anaemia associated with RA are anaemia of chronic disease (ACD) and iron deficiency anaemia, the latter being mostly caused by occult gastrointestinal blood losses due to NSAR treatment. In the near future NSAR-induced iron deficiency anaemia may be reduced by an increasing use of the new COX-2 selective NSAR. In contrast ACD, which is closely related to the pathogenesis of RA itself, will remain clinically important. ACD was formerly regarded as an epiphenomenon of RA without direct therapeutic option. Since recombinant human erythropoietin (rHu-Epo) has now been introduced in the treatment of anaemia, this may be successfully treated by direct stimulation of erythropoiesis by rHu-Epo. This paper reviews the clinical and diagnostic aspects of ACD in RA patients and summarises the therapeutic options for an optimised use of rHu-Epo in combination with current treatment modalities in RA patients.
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Dr. med. Uta Kessler
Abteilung RheumatologieMedizinische Klinik IIIJ. W. Goethe-Universität
Theodor-Stern-Kai 760596 Frankfurt a. Main
