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Zeitschrift für Rheumatologie
Erschienen in: Zeitschrift für Rheumatologie 2/2018

03.07.2018 | Methotrexat | Leitlinien

S2e-Leitlinie: Therapie der rheumatoiden Arthritis mit krankheitsmodifizierenden Medikamenten

verfasst von: Prof. Dr. med. C. Fiehn, J. Holle, C. Iking-Konert, J. Leipe, C. Weseloh, M. Frerix, R. Alten, F. Behrens, C. Baerwald, J. Braun, H. Burkhardt, G. Burmester, J. Detert, M. Gaubitz, A. Gause, E. Gromnica-Ihle, H. Kellner, A. Krause, J. Kuipers, H.-M. Lorenz, U. Müller-Ladner, M. Nothacker, H. Nüsslein, A. Rubbert-Roth, M. Schneider, H. Schulze-Koops, S. Seitz, H. Sitter, C. Specker, H.-P. Tony, S. Wassenberg, J. Wollenhaupt, K. Krüger

Erschienen in: Zeitschrift für Rheumatologie | Sonderheft 2/2018

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Zusammenfassung

Hintergrund

Medikamentöse Therapiestrategien zur Behandlung der rheumatoiden Arthritis sind entscheidend für den Langzeitverlauf. Sie dienen dem Ziel, durch frühe und konsequente Unterdrückung der Entzündung Gelenkzerstörung zu verhindern und damit die Funktion zu erhalten.

Ziel der Arbeit

Erarbeitung eines Konsenses für evidenzbasierte Empfehlungen zur Behandlung der rheumatoiden Arthritis mit krankheitsmodifizierenden Medikamenten in Deutschland.

Methoden

Nach einer systematischen Literatursuche wurde ein strukturierter Konsensprozess durchgeführt.

Ergebnisse

Sechs übergeordnete Prinzipien und 10 Empfehlungen fassen die Ergebnisse des Konsensprozesses zusammen. Verschiedene Punkte sind gegenüber der Fassung von 2012 neu, so die differenzierte Anpassung des Therapieregimes nach Zeitpunkt und Ausmaß des Ansprechens, das Therapieziel Remission gemessen mithilfe des simplified disease activity index (SDAI) wie auch der potentielle Einsatz zielgerichteter synthetischer DMARDs (tsDMARDs), der JAK-Inhibitoren sowie Empfehlungen zur Deeskalation nach dem Erreichen einer anhaltenden Remission. Wie bisher steht Methotrexat (MTX) im Mittelpunkt der Therapie zu Beginn und als Kombinationspartner im weiteren Verlauf. Die Kombination mehrerer konventioneller synthetischer DMARDs, oder, bei ungünstigen prognostischen Faktoren, der Einsatz von biologischen oder tsDMARDs kommen nach dem Algorithmus bei nicht ausreichendem Ansprechen auf Methotrexat zur Anwendung. Empfehlungen für die Deeskalation der Therapie mit Glukokortikoiden und konsekutiv gegebenenfalls auch DMARDs geben Hilfe für den Umgang mit Patienten, die eine anhaltende Remission erreicht haben.

Zusammenfassung

Die neue S2-Leitlinie gibt Empfehlungen für die Therapie der RA nach dem Prinzip des „Treat-to-Target“ (T2T) mit etablierten und neuen krankheitsmodifizierenden Medikamenten (DMARDs), einschließlich der Biologika und JAK-Inhibitoren und macht Vorschläge zur Deeskalation nach Erreichen einer anhaltenden Remission.
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Metadaten
Titel
S2e-Leitlinie: Therapie der rheumatoiden Arthritis mit krankheitsmodifizierenden Medikamenten
verfasst von
Prof. Dr. med. C. Fiehn
J. Holle
C. Iking-Konert
J. Leipe
C. Weseloh
M. Frerix
R. Alten
F. Behrens
C. Baerwald
J. Braun
H. Burkhardt
G. Burmester
J. Detert
M. Gaubitz
A. Gause
E. Gromnica-Ihle
H. Kellner
A. Krause
J. Kuipers
H.-M. Lorenz
U. Müller-Ladner
M. Nothacker
H. Nüsslein
A. Rubbert-Roth
M. Schneider
H. Schulze-Koops
S. Seitz
H. Sitter
C. Specker
H.-P. Tony
S. Wassenberg
J. Wollenhaupt
K. Krüger
Publikationsdatum
03.07.2018
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Rheumatologie / Ausgabe Sonderheft 2/2018
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI
https://doi.org/10.1007/s00393-018-0481-y

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