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Zeitschrift für Rheumatologie

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11.03.2021 | Rheumatoide Arthritis | Leitthema

Sicherheitsaspekte der Therapie mit Glukokortikoiden bei rheumatoider Arthritis

verfasst von: apl. Prof. Dr. med. habil. Gernot Keyßer

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 4/2021

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Zusammenfassung

Glukokortikoide (GC) werden für die initiale Therapie der RA nach wie vor empfohlen – zeitlich befristet und in geringstmöglicher Dosierung. Ihre komplexe Wirkweise geht mit Nebenwirkungen einher, die v. a. in der Dauertherapie oberhalb von 5 mg Prednisolon pro Tag eine Rolle spielen. In diesem Dosisbereich begünstigen sie Osteoporose, Diabetes/Hyperglykämie, kardiovaskuläre Ereignisse und Infektionen und tragen damit zu einer vermehrten Frühsterblichkeit bei. Dabei sind die Risiken der GC-Therapie von patientenbezogenen Faktoren abhängig wie Alter, Komorbidität und Begleitmedikation. Ein negativer Einfluss sehr niedriger Steroiddosen auf das Gesamtüberleben ist möglicherweise bei hoher kumulativer Dosis nachweisbar, die Datenlage ist hier jedoch widersprüchlich. Das Monitoring einer GC-vermittelten Toxizität mithilfe eines validierten Index sollte in Zukunft dazu beitragen, die Vorteile einer steroidsparenden Behandlungsstrategie besser zu beschreiben. Selektiver wirkende Substanzen könnten in Zukunft eine Abkopplung der erwünschten Wirkungen von den Nebenwirkungen ermöglichen.

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Titel: Sicherheitsaspekte der Therapie mit Glukokortikoiden bei rheumatoider Arthritis
verfasst von: apl. Prof. Dr. med. habil. Gernot Keyßer
Publikationsdatum: 11.03.2021
Verlag: Springer Medizin
Schlagwörter: Rheumatoide Arthritis
Osteoporose
Osteoporose
Glucocorticoide
Prednisolon
Erschienen in: Zeitschrift für Rheumatologie / Ausgabe 4/2021
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI: https://doi.org/10.1007/s00393-021-00972-x

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