nach oben

Erschienen in:

28.05.2018 | Recommendations

Expert recommendations on the psychological needs of patients with rheumatoid arthritis

verfasst von: Leticia Leon, Marta Redondo, Antonio Fernández-Nebro, Susana Gómez, Estíbaliz Loza, María Montoro, Rosario Garcia-Vicuña, María Galindo

Erschienen in: Rheumatology International | Ausgabe 12/2018

Einloggen, um Zugang zu erhalten

Abstract

Objective

To establish feasible and practical recommendations for the management of the psychological needs of patients with rheumatoid arthritis (RA) from the moment of diagnosis through the course of the disease.

Methods

A nominal group meeting was held with an RA expert team including rheumatologists and psychologists, at which a guided discussion addressed the most important psychological and emotional needs in RA. Based on the comments collected, and a literature review, a matrix document of recommendations for telematics discussion was prepared, as well as a Delphi survey to test agreement with these recommendations. Agreement was defined if at least 80% of participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grading of recommendations was established following the Oxford criteria, and the degree of agreement through the Delphi.

Results

Thirteen recommendations were established, addressing several key processes: (1) identification of psychological problems and needs in patients with RA, and a guideline for their management in daily practice; (2) communication with patients; (3) referral criteria to mental health professionals.

Conclusions

These recommendations are intended to help health care professionals openly address the psychological aspects of patients in daily practice to follow and treat them properly.

Redondo MM, León Mateos L, Pérez Nieto MA, JJ JA, Abasolo Alcazar L (2008) El dolor en los pacientes con artritis reumatoide: variables psicológicas relacionadas e intervención. Clínica y Salud 19:359–378

Balsa A, Lojo-Oliveira L, Alperi-Lopez M, Garcia-Manrique M, Ordonez-Canizares C, Perez L, Ruiz-Esquide V, Corrales A, Narvaez J, Rey-Rey J, Rodriguez-Lozano C, Ojeda S, Munoz-Fernandez S, Nolla JM, Garcia-Torron J, Gamero F, Garcia-Vicuna R, Hernandez-Cruz B, Campos J, Rosas J, Garcia-Llorente JF, Gomez-Centeno A, Caliz R, Sanmarti R, Bermudez A, Abasolo-Alcazar L, Fernandez-Nebro A, Rodriguez-Rodriguez L, Marras C, Gonzalez-Gay MA, Hmamouchi I, Martin-Mola E (2017) Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring in clinical practice: the spanish cohort of the COMORA study. Reumatol Clin. https://doi.org/10.1016/j.reuma.2017.06.002 CrossRefPubMed

Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG, Tennant A (2012) Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 12:6. https://doi.org/10.1186/1471-244X-12-6 CrossRefPubMedPubMedCentral

Matcham F, Rayner L, Steer S, Hotopf M (2013) The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology 52(12):2136–2148. https://doi.org/10.1093/rheumatology/ket169 CrossRefPubMed

Creed F (1990) Psychological disorders in rheumatoid arthritis: a growing consensus? Ann Rheum Dis 49(10):808–812CrossRef

Walsh JD, Blanchard EB, Kremer JM, Blanchard CG (1999) The psychosocial effects of rheumatoid arthritis on the patient and the well partner. Behav Res Ther 37(3):259–271CrossRef

Young LD (1992) Psychological factors in rheumatoid arthritis. J Consult Clin Psychol 60(4):619–627CrossRef

Goes ACJ, Reis LAB, Silva MBG, Kahlow BS, Skare TL (2017) Rheumatoid arthritis and sleep quality. Revista Brasileira de Reumatologia 57(4):294–298. https://doi.org/10.1016/j.rbre.2016.07.011 CrossRefPubMed

Guo G, Fu T, Yin R, Zhang L, Zhang Q, Xia Y, Li L, Gu Z (2016) Sleep quality in Chinese patients with rheumatoid arthritis: contributing factors and effects on health-related quality of life. Health Qual Life Outcomes 14(1):151. https://doi.org/10.1186/s12955-016-0550-3 CrossRefPubMedPubMedCentral

10.

Hari A, Rostom S, Lahlou R, Bahiri R, Hajjaj-Hassouni N (2015) Sexual function in Moroccan women with rheumatoid arthritis and its relationship with disease activity. Clin Rheumatol 34(6):1047–1051. https://doi.org/10.1007/s10067-015-2888-z CrossRefPubMed

11.

Hashimoto A, Sato H, Nishibayahi Y, Shiino Y, Kutsuna T, Ishihara Y, Hoshi K, Fujimori J, Tsuboi S, Kondo H, Akizuki M, Moroi Y, Yoshida S (2002) [A multicenter cross-sectional study on the health related quality of life of patients with rheumatoid arthritis using a revised Japanese version of the arthritis impact measurement scales version 2 (AIMS 2), focusing on the medical care costs and their associative factors]. Ryumachi 42(1):23–39PubMed

12.

Leon L, Jover JA, Loza E, Zunzunegui MV, Lajas C, Vadillo C, Fontsere O, Rodriguez-Rodriguez L, Martinez C, Fernandez-Gutierrez B, Abasolo L (2013) Health-related quality of life as a main determinant of access to rheumatologic care. Rheumatol Int 33(7):1797–1804. https://doi.org/10.1007/s00296-012-2599-6 CrossRefPubMed

13.

Vangeli E, Bakhshi S, Baker A, Fisher A, Bucknor D, Mrowietz U, Ostor AJ, Peyrin-Biroulet L, Lacerda AP, Weinman J (2015) A systematic review of factors associated with non-adherence to treatment for immune-mediated inflammatory diseases. Adv Ther 32(11):983–1028. https://doi.org/10.1007/s12325-015-0256-7 CrossRefPubMedPubMedCentral

14.

Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Norton S, Scott DL, Steer S (2014) The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Seminars Arthritis Rheumat 44(2):123–130. https://doi.org/10.1016/j.semarthrit.2014.05.001 CrossRef

15.

Matcham F, Norton S, Scott DL, Steer S, Hotopf M (2016) Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology 55(2):268–278. https://doi.org/10.1093/rheumatology/kev306 CrossRefPubMed

16.

Matcham F, Davies R, Hotopf M, Hyrich KL, Norton S, Steer S, Galloway J (2018) The relationship between depression and biologic treatment response in rheumatoid arthritis: an analysis of the British Society for Rheumatology Biologics Register. Rheumatology. https://doi.org/10.1093/rheumatology/kex528 CrossRefPubMed

17.

Leon L, Jover JA, Candelas G, Lajas C, Vadillo C, Blanco M, Loza E, Perez MA, Redondo M, Abasolo L (2009) Effectiveness of an early cognitive-behavioral treatment in patients with work disability due to musculoskeletal disorders. Arthritis Rheum 61(7):996–1003. https://doi.org/10.1002/art.24609 CrossRefPubMed

18.

Arends RY, Bode C, Taal E, van de Laar MA (2016) The longitudinal relation between patterns of goal management and psychological health in people with arthritis: the need for adaptive flexibility. Br J Health Psychol 21(2):469–489. https://doi.org/10.1111/bjhp.12182 CrossRefPubMed

19.

Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R (2015) Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev (3):CD010523. https://doi.org/10.1002/14651858.CD010523.pub2

20.

Howick J, Chalmers I, Paul Glasziou P, Greenhalgh T, Carl Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H (2018) Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence (background document). https://www.cebm.net/index.aspx?o=5653. Accessed 1 Nov 2017

21.

Suarez-Almazor ME (2004) Patient-physician communication. Curr Opin Rheumatol 16(2):91–95CrossRef

22.

Gafvels C, Hagerstrom M, Nordmark B, Wandell PE (2012) Psychosocial problems among newly diagnosed rheumatoid arthritis patients. Clin Rheumatol 31(3):521–529. https://doi.org/10.1007/s10067-011-1894-z CrossRefPubMed

23.

Leblanc-Trudeau C, Dobkin PL, Carrier N, Cossette P, de Brum-Fernandes AJ, Liang P, Masetto A, Boire G (2015) Depressive symptoms predict future simple disease activity index scores and simple disease activity index remission in a prospective cohort of patients with early inflammatory polyarthritis. Rheumatology 54(12):2205–2214. https://doi.org/10.1093/rheumatology/kev272 CrossRefPubMed

24.

Evers AW, Kraaimaat FW, Geenen R, Jacobs JW, Bijlsma JW (2003) Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behav Res Ther 41(11):1295–1310CrossRef

25.

Leon L, Redondo M, Garcia-Vadillo A, Perez-Nieto MA, Rodriguez-Rodriguez L, Jover JA, Gonzalez-Alvaro I, Abasolo L (2016) Influence of patient personality in the treatment of rheumatoid arthritis. Rheumatol Int 36(11):1549–1555. https://doi.org/10.1007/s00296-016-3561-9 CrossRefPubMed

26.

Evers AW, Kraaimaat FW, Geenen R, Bijlsma JW (1997) Determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients. J Behav Med 20(5):489–504CrossRef

27.

Guillem-Mesado A, de Andres C, Lopez-Longo J, Gimenez-Roldan S (1998) [Information about the diagnosis: a subjective experience of patients with multiple sclerosis and rheumatoid arthritis]. Rev Neurol 26(149):25–28PubMed

28.

Lindgren S, Storli SL, Wiklund-Gustin L (2014) Living in negotiation: patients’ experiences of being in the diagnostic process of COPD. Int J Chron Obstruct Pulmon Dis 9:441–451. https://doi.org/10.2147/COPD.S60182 CrossRefPubMedPubMedCentral

29.

Salt E, Rowles GD, Reed DB (2012) Patient’s perception of quality patient–provider communication. Orthop Nurs 31(3):169–176. https://doi.org/10.1097/NOR.0b013e3182558cdb CrossRefPubMed

30.

Sheppard J, Kumar K, Buckley CD, Shaw KL, Raza K (2008) ‘I just thought it was normal aches and pains’: a qualitative study of decision-making processes in patients with early rheumatoid arthritis. Rheumatology 47(10):1577–1582. https://doi.org/10.1093/rheumatology/ken304 CrossRefPubMed

31.

Powley L, McIlroy G, Simons G, Raza K (2016) Are online symptoms checkers useful for patients with inflammatory arthritis? BMC Musculoskelet Disord 17(1):362. https://doi.org/10.1186/s12891-016-1189-2 CrossRefPubMedPubMedCentral

32.

Strand V, Khanna D (2010) The impact of rheumatoid arthritis and treatment on patients’ lives. Clin Exp Rheumatol 28(3 Suppl 59):S32-40PubMed

33.

Cadena J, Vinaccia S, Perez A, Rico MI, Hinojosa R, Anaya JM (2003) The impact of disease activity on the quality of life, mental health status, and family dysfunction in colombian patients with rheumatoid arthritis. J Clin Rheumatol 9(3):142–150. https://doi.org/10.1097/01.RHU.0000073434.59752.f3 CrossRefPubMed

34.

Verstappen SM (2015) Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol 29(3):495–511. https://doi.org/10.1016/j.berh.2015.06.001 CrossRefPubMed

35.

Sandberg EH, Sharma R, Sandberg WS (2012) Deficits in retention for verbally presented medical information. Anesthesiology 117(4):772–779. https://doi.org/10.1097/ALN.0b013e31826a4b02 CrossRefPubMed

36.

Warmington K, Flewelling C, Kennedy CA, Shupak R, Papachristos A, Jones C, Linton D, Beaton DE, Lineker S (2017) Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program. Open Access Rheumatol 9:11–19. https://doi.org/10.2147/OARRR.S122015 CrossRefPubMedPubMedCentral

37.

Cottrell JE, Jonas M, Bergsten U, Blaas E, de la Torre Aboki J, Howse C, Korandova J, Lofman P, Logtenberg C, Lupton T, Mallon C, Oliver S, Pickles D, Bulinckx L (2013) The nurse’s role in addressing unmet treatment and management needs of patients with rheumatoid arthritis: Delphi-based recommendations. Int J Nurs Knowl 24(2):66–76. https://doi.org/10.1111/j.2047-3095.2013.01231.x CrossRefPubMed

38.

Haraoui B, Bensen W, Thorne C, Wade J, Deamude M, Prince J, Legare J (2014) Treating rheumatoid arthritis to target: a Canadian patient survey. J Clin Rheumatol 20(2):61–67. https://doi.org/10.1097/RHU.0000000000000081 CrossRefPubMed

39.

Strand V, Wright GC, Bergman MJ, Tambiah J, Taylor PC (2015) Patient expectations and perceptions of goal-setting strategies for disease management in rheumatoid arthritis. J Rheumatol 42(11):2046–2054. https://doi.org/10.3899/jrheum.140976 CrossRefPubMed

40.

Funahashi K, Matsubara T (2012) What RA patients expect of their treatment–discussion over the result of our survey. Clin Rheumatol 31(11):1559–1566. https://doi.org/10.1007/s10067-012-2048-7 CrossRefPubMed

41.

Flurey CA, Morris M, Pollock J, Richards P, Hughes R, Hewlett S (2014) A Q-methodology study of flare help-seeking behaviours and different experiences of daily life in rheumatoid arthritis. BMC Musculoskelet Disord 15:364. https://doi.org/10.1186/1471-2474-15-364 CrossRefPubMedPubMedCentral

42.

Bazzichi L, Maser J, Piccinni A, Rucci P, Del Debbio A, Vivarelli L, Catena M, Bouanani S, Merlini G, Bombardieri S, Dell’Osso L (2005) Quality of life in rheumatoid arthritis: impact of disability and lifetime depressive spectrum symptomatology. Clin Exp Rheumatol 23(6):783–788PubMed

43.

Sociedad Española de Reumatología (2011) Guía de práctica clínica para el manejo de la artritis reumatoide. https://www.ser.es/wp-content/uploads/2015/09/GUIPCAR_2011_V7_definitiva.pdf. Accessed 1 Nov 2017

44.

Herrero MJ, Blanch J, Peri JM, De Pablo J, Pintor L, Bulbena A (2003) A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gener Hosp Psychiatry 25(4):277–283CrossRef

45.

Costa TF, Silva CR, Muniz LF, Mota LM (2015) Prevalence of sexual dysfunction among female patients followed in a Brasilia Cohort of early rheumatoid arthritis. Rev Bras Reumatol 55(2):123–132. https://doi.org/10.1016/j.rbr.2014.10.006 CrossRefPubMed

46.

Lin MC, Lu MC, Livneh H, Lai NS, Guo HR, Tsai TY (2017) Factors associated with sexual dysfunction in Taiwanese females with rheumatoid arthritis. BMC Womens Health 17(1):12. https://doi.org/10.1186/s12905-017-0363-5 CrossRefPubMedPubMedCentral

47.

Leon L, Abasolo Alcazar L (2016) Relaciones de pareja y enfermedad reumática. EP Health Marketing, SL. http://socareu.com/wp-content/uploads/2017/03/Folleto-Relaciones-de-Pareja.pdf. Accessed 1 Nov 2017

48.

Royuela Rico A, Macías Fernández JA (1997) Propiedades clinimetricas de la versión castellana del cuestionario de Pittsburgh. 9 (2):81–94

49.

Kool MB, van Middendorp H, Lumley MA, Schenk Y, Jacobs JW, Bijlsma JW, Geenen R (2010) Lack of understanding in fibromyalgia and rheumatoid arthritis: the Illness Invalidation Inventory (3*I). Ann Rheum Dis 69(11):1990–1995. https://doi.org/10.1136/ard.2009.123224 CrossRefPubMed

50.

Bouhouche L, Rostom S, Idrissi ZM, Bahiri R, Hajjaj-Hassouni N (2017) Perceptions in rheumatoid arthritis: comparative study between patients and their close families. J Clin Rheumatol 23(5):262–266. https://doi.org/10.1097/RHU.0000000000000478 CrossRefPubMed

51.

Riemsma RP, Taal E, Rasker JJ (2000) Perceptions about perceived functional disabilities and pain of people with rheumatoid arthritis: differences between patients and their spouses and correlates with well-being. Arthritis Care Res 13(5):255–261CrossRef

52.

Kool MB, van de Schoot R, Lopez-Chicheri Garcia I, Mewes R, Da Silva JA, Vangronsveld K, Wismeijer AA, Lumley MA, van Middendorp H, Bijlsma JW, Crombez G, Rief W, Geenen R (2014) Measurement invariance of the Illness Invalidation Inventory (3*I) across language, rheumatic disease and gender. Ann Rheum Dis 73(3):551–556. https://doi.org/10.1136/annrheumdis-2012-201807 CrossRefPubMed

53.

Martinez Lopez JA, Garcia Vivar ML, Caliz R, Freire M, Galindo M, Hernandez MV, Lopez Longo FJ, Martinez Taboada V, Pego Reigosa JM, Rubio E, Trujillo E, Vela-Casasempere P (2017) Recommendations for the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding. Reumatol Clin 13(5):264–281. https://doi.org/10.1016/j.reuma.2016.05.003 CrossRefPubMed

54.

Castaneda S, Martin-Martinez MA, Gonzalez-Juanatey C, Llorca J, Garcia-Yebenes MJ, Perez-Vicente S, Sanchez-Costa JT, Diaz-Gonzalez F, Gonzalez-Gay MA, Group CPC (2015) Cardiovascular morbidity and associated risk factors in Spanish patients with chronic inflammatory rheumatic diseases attending rheumatology clinics: Baseline data of the CARMA Project. Seminars Arthritis Rheumat 44(6):618–626. https://doi.org/10.1016/j.semarthrit.2014.12.002 CrossRef

55.

Nyhall-Wahlin BM, Petersson IF, Nilsson JA, Jacobsson LT, Turesson C, group Bs (2009) High disease activity disability burden and smoking predict severe extra-articular manifestations in early rheumatoid arthritis. Rheumatology 48(4):416–420. https://doi.org/10.1093/rheumatology/kep004 CrossRefPubMed

56.

Wolfe F (2000) The effect of smoking on clinical, laboratory, and radiographic status in rheumatoid arthritis. J Rheumatol 27(3):630–637PubMed

57.

Manfredsdottir VF, Vikingsdottir T, Jonsson T, Geirsson AJ, Kjartansson O, Heimisdottir M, Sigurdardottir SL, Valdimarsson H, Vikingsson A (2006) The effects of tobacco smoking and rheumatoid factor seropositivity on disease activity and joint damage in early rheumatoid arthritis. Rheumatology 45(6):734–740. https://doi.org/10.1093/rheumatology/kei240 CrossRefPubMed

58.

Saevarsdottir S, Wedren S, Seddighzadeh M, Bengtsson C, Wesley A, Lindblad S, Askling J, Alfredsson L, Klareskog L (2011) Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts. Arthritis Rheum 63(1):26–36. https://doi.org/10.1002/art.27758 CrossRefPubMed

59.

Daien CI, Hua C, Combe B, Landewe R (2017) Non-pharmacological and pharmacological interventions in patients with early arthritis: a systematic literature review informing the 2016 update of EULAR recommendations for the management of early arthritis. RMD Open 3(1):e000404. https://doi.org/10.1136/rmdopen-2016-000404 CrossRefPubMedPubMedCentral

60.

Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Alvaro-Gracia JM, Bakkers M, Brodin N, Burmester GR, Codreanu C, Conway R, Dougados M, Emery P, Ferraccioli G, Fonseca J, Raza K, Silva-Fernandez L, Smolen JS, Skingle D, Szekanecz Z, Kvien TK, van der Helm-van Mil A, van Vollenhoven R (2017) 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 76(6):948–959. https://doi.org/10.1136/annrheumdis-2016-210602 CrossRefPubMed

61.

Matheson L, Harcourt D, Hewlett S (2010) Your whole life, your whole world, it changes: partners’ experiences of living with rheumatoid arthritis. Musculoskelet Care 8(1):46–54. https://doi.org/10.1002/msc.165 CrossRef

62.

Hope HF, Bluett J, Barton A, Hyrich KL, Cordingley L, Verstappen SM (2016) Psychological factors predict adherence to methotrexate in rheumatoid arthritis; findings from a systematic review of rates, predictors and associations with patient-reported and clinical outcomes. RMD Open 2(1):e000171. https://doi.org/10.1136/rmdopen-2015-000171 CrossRefPubMedPubMedCentral

63.

Fisher A, Bassett K, Goel G, Stanely D, Brookhart MA, Freeman HR, Wright JM, Dormuth CR (2016) Heterogeneity in comparisons of discontinuation of tumor necrosis factor antagonists in rheumatoid arthritis—a meta-analysis. PloS one 11(12):e0168005. https://doi.org/10.1371/journal.pone.0168005 CrossRefPubMedPubMedCentral

64.

Kobue B, Moch S, Watermeyer J (2017) “It’s so hard taking pills when you don’t know what they’re for”: a qualitative study of patients’ medicine taking behaviours and conceptualisation of medicines in the context of rheumatoid arthritis. BMC Health Serv Res 17(1):303. https://doi.org/10.1186/s12913-017-2246-8 CrossRefPubMedPubMedCentral

65.

Voshaar M, Vriezekolk J, van Dulmen S, van den Bemt B, van de Laar M (2016) Barriers and facilitators to disease-modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskelet Disord 17(1):442. https://doi.org/10.1186/s12891-016-1289-z CrossRefPubMedPubMedCentral

66.

Gobbo M, Redondo M, León L, Torres X, Solorzano A, Brat M, Romero S, Medrano M, Díaz F, Núñez Cornejo C, Alegre C (2013) Criterios de derivación desde reumatología a psicología. Reumatol Clin 9 (Espec Cong):54

67.

Silva Luna K, Ortiz AM, Patino E, Aguilera C, Velasco T, Garcia de Vicuna R, Gonzalez-Alvaro I (2012) Influence of the structure of mood in the assessment of rheumatoid arthritis through the visual analog scale for pain, HAQ and DAS28. Reumatol Clin 8(6):328–333. https://doi.org/10.1016/j.reuma.2012.04.002 CrossRefPubMed

68.

Marin-Jimenez I, Gobbo Montoya M, Panadero A, Canas M, Modino Y, Romero de Santos C, Guardiola J, Carmona L, Barreiro-de Acosta M (2017) Management of the psychological impact of inflammatory bowel disease: perspective of doctors and patients-The ENMENTE Project. Inflamm Bowel Dis 23(9):1492–1498. https://doi.org/10.1097/MIB.0000000000001205 CrossRefPubMed

Titel: Expert recommendations on the psychological needs of patients with rheumatoid arthritis
verfasst von: Leticia Leon
Marta Redondo
Antonio Fernández-Nebro
Susana Gómez
Estíbaliz Loza
María Montoro
Rosario Garcia-Vicuña
María Galindo
Publikationsdatum: 28.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Rheumatology International / Ausgabe 12/2018
Print ISSN: 0172-8172
Elektronische ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-018-4057-6

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Objective

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2018

Use of prognostic factors of rheumatoid arthritis in clinical practice and perception of their predictive capacity before and after exposure to evidence

Severe strongyloidiasis and systemic vasculitis: comorbidity, association or both? Case-based review

Brain abscess caused by Micrococcus luteus in a patient with systemic lupus erythematosus: case-based review

Fibromyalgia as a challenge for patients and physicians

Clinical presentation, treatment and outcome of Takayasu’s arteritis in southern Chinese: a multicenter retrospective study

Infliximab biosimilar CT-P13 therapy in patients with Takayasu arteritis with low dose of glucocorticoids: a prospective single-arm study