Zusammenfassung
Auf Basis der 2010 publizierten EULAR-Empfehlungen ist von der DGRh eine S1-Leitlinie für die sequenzielle medikamentöse Therapie der rheumatoiden Arthritis erstellt und der Therapiealgorithmus überarbeitet worden. Die Neufassung erfolgte auf der Grundlage einer aktualisierten systematischen Literaturrecherche und eines Expertenkonsensus. Bei Diagnosestellung ist Methotrexat die Standardbasistherapie und wird in der Regel mit niedrig dosiertem Prednisolon kombiniert. Bei nicht ausreichendem Ansprechen sollte nach 12 Wochen eine klassische DMARD-Kombinationstherapie eingesetzt werden. Bei anhaltend hoher Krankheitsaktivität wird spätestens nach 6 Monaten der Einsatz eines Biologikums empfohlen, in Sondersituationen (z. B. frühe Destruktionen, ungünstige Prognose) ggf. früher. Falls sich das zuerst angewendete Biologikum in einem Zeitraum von 3 bis 6 Monaten als nicht ausreichend effektiv erweist, sollte der Wechsel auf ein anderes Biologikum erfolgen. Bei lang anhaltender Remission kann eine kontrollierte Reduktion der Basistherapie versucht werden.
Abstract
Following the EULAR recommendations published in 2010 German guidelines for the medical treatment of rheumatoid arthritis were developed based on an update of the systematic literature search and expert consensus. Methotrexate is the standard treatment option at the time of diagnosis, preferably in combination with low dose glucocorticoids. Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks. Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment and in exceptional situations (e.g. early destruction or unfavorable prognosis) even earlier. If treatment with biologicals remains ineffective, changing to another biological is recommended after 3–6 months. In cases of long-standing remission a controlled reduction of medical treatment can be considered.
Abbreviations
- ABC:
-
Abatacept
- ADM:
-
Adalimumab
- CEZ:
-
Certolizumab
- ETC:
-
Etanercept
- GOM:
-
Golimumab
- INX:
-
Infliximab
- RIX:
-
Rituximab
- TOZ:
-
Tocilizumab
- CiA:
-
Ciclosporin A
- HCQ:
-
Hydroxychloroquin
- LEF:
-
Leflunomid
- MTX:
-
Methotrexat
- SSZ:
-
Sulfasalazin
- TNF:
-
TNF-Inhibitoren
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Danksagung
Die wissenschaftliche Mitarbeit von Dr. Katinka Albrecht und der Konsensprozess wurden von der DGRh finanziert mit Unterstützung durch ein „unrestricted grant“ folgender korporativer Mitglieder der DGRh: Abbott GmbH & Co. KG, Chugai Pharma Marketing Ltd., Pfizer Pharma GmbH, Roche Pharma AG, Sanofi-Aventis Deutschland GmbH, UCB Pharma GmbH.
Hinweis
Die Autoren wurden von der DGRh zur Erarbeitung der Leitlinie autorisiert.
Interessenkonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Vortragshonorare von Abbott (K.A.); Beratungstätigkeit, Vortragshonorare, Reisekostenunterstützung und/oder Forschungsunterstützung von Abbott, BMS, GSK, Lilly, Mundipharma, Novartis, Pfizer, Roche, UCB (R.A.);Forschungsunterstützung für Abbott, BMS, Pfizer, Roche, Honorar von Abbott, BMS, MSD, Pfizer, Roche, UCB (M.B.); Forschungsunterstützung, Vortragstätigkeit, Beratertätigkeit: Abbott, Amgen, GSK, Genzyme, MSD, Pfizer, Roche, Shire, Sanofi-Aventis (C.B.); Forschungsunterstützung, Vortragshonorare, Reisekostenunterstützung oder Beratungshonorare von Abbott, BMS, MSD, Pfizer, Roche, UCB (G.B.); Vortragshonorare/Reisekostenübernahmen von Abbott, Amgen, BMS, Chugai, Hexal, Merck, MSD, Mundipharma, Pfizer, Roche, SOBI und UCB (M.G.); E.G-I. gibt an, dass kein Interessenskonflikt besteht; Vortragshonorare, Forschungsgelder Beratertätigkeiten: Abbott, Actelion, Berlin Chemie, BMS, Chugai, GSK/HGS, Medac, Merck, MSD, Pfizer, Roche, Sanofi-Aventis, UCB (J.K.); Honorare für Beratertätigkeit, Vortragshonorare, Reisekostenübernahmen und/oder Forschungsförderung durch: Abbott, BMS, Chugai, MSD, Pfizer, Roche, UCB (A.K.); Vortrags- und/oder Beratungshonorare von: Abbott, BMS, MSD, Mundipharma, Pfizer, UCB, Roche (K.K.); Vortragshonorare, Reisekostenunterstützung oder Beratungshonorare von Abbott, Bristol-Myers Squibb, Chugai, Glaxo Smithkline, Medac, Merck, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB (H.L.); Honorare für Vortrags- und/oder Beratungstätigkeit: Abbott, Berlin-Chemie, BMS, Biomarin, Chugai, Genzyme, GSK, MSD, Novartis, Nycomed, Pfizer, SOBI, UCB (B.M.); Honorar von Abbott, BMS, Chugai, MSD, Pfizer, Roche, UCB (U.M.-L.); Abbott, BMS, Chugai, Essex, Merck, MSD, Mundipharma, Pfizer, Roche, UCB, Wyeth (H.N.); Beratungstätigkeiten und/oder Vortragshonorare von Abbott, BMS, MSD, Pfizer und UCB (H.-G. P.); Forschungsunterstützung von Roche, Chugai und Pfizer, Vorträge und Beratertätigkeit bei Abbott, BMS, Chugai, MSD, Novartis, Pfizer, Roche, UCB (A.R.); Forschungsunterstützung, Vortrags- oder Beratungshonorare von Abbott, Chugai, GSK, MSD, Novartis, Pfizer, Roche, UCB, Wyeth (C.S.); Forschungsunterstützung von Abbott, Pfizer, UCB, Beratertätigkeit bei Abbott, Pfizer, Roche, UCB und Vortragshonorar von Abbott, Chugai, MSD, Pfizer, Roche, UCB (M.S.); Honorare für Vorträge und Beratungen der Firmen Abbott, Actelion, Astra-Zeneca, Biotest, BMS, Chugai, Essex, Gilead, GSK, HGS, MSD, Medac, Merck, Mundai Pharma, Novartis, Nycomed, Savient, Pfizer, Roche, UCB, Wyeth (H.S.-K.); Vorträge, Reisekostenübernahme und Studienunterstützung von Abbott, BMS, Chugai, MSD, Roche (H.P.T.); Honorar von Abbott, BMS, Chugai, MSD, Pfizer, Roche, UCB (J.W.). Vortragshonorar, Beratungstätigkeit von AstraZeneca, MSD (W.B.); Vortragshonorare oder Beratungstätigkeit von Abbott, BMS, Chugai, Roche, UCB (A.G.); Vortragshonorare, Forschungsunterstützung oder Reisekostenübernahme von Abbott, BMS, Chugai, Medac, MSD, Novartis, Pfizer, Roche, UCB (H.K.)
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Diese Leitlinie wird bei der AWMF unter folgender Nr. geführt: 060-004.
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Krüger, K., Wollenhaupt, J., Albrecht, K. et al. S1-Leitlinie der DGRh zur sequenziellen medikamentösen Therapie der rheumatoiden Arthritis 2012. Z. Rheumatol. 71, 592–603 (2012). https://doi.org/10.1007/s00393-012-1038-0
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DOI: https://doi.org/10.1007/s00393-012-1038-0