nach oben

Die Innere Medizin

Erschienen in:

31.10.2016 | Stammzell-Transplantation | Schwerpunkt: Was ist gesichert in der Therapie?

Systemische Sklerose

Was ist gesichert in der Therapie?

verfasst von: Dr. M. O. Becker, M.Sc.

Erschienen in: Die Innere Medizin | Ausgabe 12/2016

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die systemische Sklerose (Sklerodermie) ist eine rheumatologische Erkrankung, die neben Entzündung und Autoimmunität auch durch Fibrose und vaskuläre Komplikationen gekennzeichnet ist. Die Therapie der Patienten richtet sich im Wesentlichen nach den vorliegenden Organbeteiligungen und beinhaltet nicht nur eine Immunsuppression, sondern auch die Behandlung der vaskulären und fibrotischen Krankheitsmanifestationen. Insbesondere letztere können oft nur ungenügend behandelt werden, während für vaskuläre Komplikationen in den letzten Jahren viele Medikamente getestet worden sind. Die aktuellen Therapieoptionen bei systemischer Sklerose werden hier noch einmal zusammengefasst. In der Therapie dieser seltenen Erkrankung hat sich in den letzten 10 Jahren vieles geändert. Auch in Zukunft wird sich dieser Trend fortsetzen.

Gabrielli A, Avvedimento EV, Krieg T (2009) Scleroderma. N Engl J Med 360(19):1989–2003CrossRefPubMed

Allanore Y et al (2015) Systemic sclerosis. Nat Rev Dis Primers 1:15002CrossRefPubMed

Katsumoto TR, Whitfield ML, Connolly MK (2011) The pathogenesis of systemic sclerosis. Annu Rev Pathol 6:509–537CrossRefPubMed

Andreasson K et al (2014) Prevalence and incidence of systemic sclerosis in southern Sweden: population-based data with case ascertainment using the 1980 ARA criteria and the proposed ACR-EULAR classification criteria. Ann Rheum Dis 73(10):1788–1792CrossRefPubMed

Humbert M et al (2011) Screening for pulmonary arterial hypertension in patients with systemic sclerosis: clinical characteristics at diagnosis and long-term survival. Arthritis Rheum 63(11):3522–3530CrossRefPubMed

Kowal-Bielecka O et al (2009) EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann Rheum Dis 68(5):620–628CrossRefPubMed

McHugh NJ et al (1988) Infusion of iloprost, a prostacyclin analogue, for treatment of Raynaud’s phenomenon in systemic sclerosis. Ann Rheum Dis 47(1):43–47CrossRefPubMedPubMedCentral

Kyle MV, Belcher G, Hazleman BL (1992) Placebo controlled study showing therapeutic benefit of iloprost in the treatment of Raynaud’s phenomenon. J Rheumatol 19(9):1403–1406PubMed

Pope J (2011) Measures of systemic sclerosis (scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), physician- and patient-rated global assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler’s Index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud’s Condition Score (RCS). Arthritis Care Res (Hoboken) 63(Suppl 11):98–111CrossRef

10.

Rademaker M et al (1989) Comparison of intravenous infusions of iloprost and oral nifedipine in treatment of Raynaud’s phenomenon in patients with systemic sclerosis: a double blind randomised study. BMJ 298(6673):561–564CrossRefPubMedPubMedCentral

11.

Rodeheffer RJ et al (1983) Controlled double-blind trial of nifedipine in the treatment of Raynaud’s phenomenon. N Engl J Med 308(15):880–883CrossRefPubMed

12.

Thompson AE et al (2001) Calcium-channel blockers for Raynaud’s phenomenon in systemic sclerosis. Arthritis Rheum 44(8):1841–1847CrossRefPubMed

13.

Wigley FM et al (1994) Intravenous iloprost infusion in patients with Raynaud phenomenon secondary to systemic sclerosis. A multicenter, placebo-controlled, double-blind study. Ann Intern Med 120(3):199–206CrossRefPubMed

14.

Caglayan E et al (2012) Vardenafil for the treatment of raynaud phenomenon: a randomized, double-blind, placebo-controlled crossover study. Arch Intern Med 172(15):1182–1184CrossRefPubMed

15.

Herrick AL (2011) Contemporary management of Raynaud’s phenomenon and digital ischaemic complications. Curr Opin Rheumatol 23(6):555–561CrossRefPubMed

16.

Roustit M et al (2013) Phosphodiesterase-5 inhibitors for the treatment of secondary Raynaud’s phenomenon: systematic review and meta-analysis of randomised trials. Ann Rheum Dis 72(10):1696–1699CrossRefPubMed

17.

Schiopu E et al (2009) Randomized placebo-controlled crossover trial of tadalafil in Raynaud’s phenomenon secondary to systemic sclerosis. J Rheumatol 36(10):2264–2268CrossRefPubMed

18.

Shenoy PD et al (2010) Efficacy of tadalafil in secondary Raynaud’s phenomenon resistant to vasodilator therapy: a double-blind randomized cross-over trial. Rheumatology (Oxford) 49(12):2420–2428CrossRef

19.

Korn JH et al (2004) Digital ulcers in systemic sclerosis: prevention by treatment with bosentan, an oral endothelin receptor antagonist. Arthritis Rheum 50(12):3985–3993CrossRefPubMed

20.

Matucci-Cerinic M et al (2011) Bosentan treatment of digital ulcers related to systemic sclerosis: results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann Rheum Dis 70(1):32–38CrossRefPubMed

21.

Scorza R et al (2001) Effects of long-term cyclic iloprost therapy in systemic sclerosis with Raynaud’s phenomenon. A randomized, controlled study. Clin Exp Rheumatol 19(5):503–508PubMed

22.

Tingey T et al (2013) Meta-analysis of healing and prevention of digital ulcers in systemic sclerosis. Arthritis Care Res (Hoboken) 65(9):1460–1471CrossRef

23.

Vayssairat M (1999) Preventive effect of an oral prostacyclin analog, beraprost sodium, on digital necrosis in systemic sclerosis. French Microcirculation Society Multicenter Group for the Study of Vascular Acrosyndromes. J Rheumatol 26(10):2173–2178PubMed

24.

Coleiro B et al (2001) Treatment of Raynaud’s phenomenon with the selective serotonin reuptake inhibitor fluoxetine. Rheumatology (Oxford) 40(9):1038–1043CrossRef

25.

Abou-Raya A, Abou-Raya S, Helmii M (2008) Statins: potentially useful in therapy of systemic sclerosis-related Raynaud’s phenomenon and digital ulcers. J Rheumatol 35(9):1801–1808PubMed

26.

Avouac J et al (2010) Prevalence of pulmonary hypertension in systemic sclerosis in European Caucasians and metaanalysis of 5 studies. J Rheumatol 37(11):2290–2298CrossRefPubMed

27.

Clements PJ et al (2012) The pulmonary arterial hypertension quality enhancement research initiative: comparison of patients with idiopathic PAH to patients with systemic sclerosis-associated PAH. Ann Rheum Dis 71(2):249–252CrossRefPubMed

28.

Galie N et al (2015) ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J 46(4):903–975CrossRefPubMed

29.

Ghofrani HA et al (2013) Riociguat for pulmonary hypertension. N Engl J Med 369(23):2268CrossRefPubMed

30.

Pulido T et al (2013) Macitentan and morbidity and mortality in pulmonary arterial hypertension. N Engl J Med 369(9):809–818CrossRefPubMed

31.

Galie N et al (2008) Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (EARLY study): a double-blind, randomised controlled trial. Lancet 371(9630):2093–2100CrossRefPubMed

32.

Sitbon O et al (2015) Selexipag for the treatment of pulmonary arterial hypertension. N Engl J Med 373(26):2522–2533CrossRefPubMed

33.

Johnson SR et al (2012) Dual therapy in IPAH and SSc-PAH. A qualitative systematic review. Respir Med 106(5):730–739CrossRefPubMed

34.

Preston IR et al (2015) Effect of warfarin treatment on survival of patients with pulmonary arterial hypertension (PAH) in the registry to evaluate early and long-term PAH disease management (REVEAL). Circulation 132(25):2403–2411CrossRefPubMedPubMedCentral

35.

Tashkin DP et al (2006) Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med 354(25):2655–2666CrossRefPubMed

36.

Tashkin DP et al (2007) Effects of 1‑year treatment with cyclophosphamide on outcomes at 2 years in scleroderma lung disease. Am J Respir Crit Care Med 176(10):1026–1034CrossRefPubMedPubMedCentral

37.

Tashkin DP et al (2016) Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): a randomised controlled, double-blind, parallel group trial. Lancet Respir Med 4(9):708–719CrossRefPubMed

38.

Owen C et al (2016) Mycophenolate mofetil is an effective and safe option for the management of systemic sclerosis-associated interstitial lung disease: results from the Australian Scleroderma Cohort Study. Clin Exp Rheumatol 34(5, Suppl.100):PI0170,PF0176

39.

Berezne A et al (2008) Therapeutic strategy combining intravenous cyclophosphamide followed by oral azathioprine to treat worsening interstitial lung disease associated with systemic sclerosis: a retrospective multicenter open-label study. J Rheumatol 35(6):1064–1072PubMed

40.

Hoyles RK et al (2006) A multicenter, prospective, randomized, double-blind, placebo-controlled trial of corticosteroids and intravenous cyclophosphamide followed by oral azathioprine for the treatment of pulmonary fibrosis in scleroderma. Arthritis Rheum 54(12):3962–3970CrossRefPubMed

41.

Poormoghim H et al (2014) Systemic sclerosis: comparison of efficacy of oral cyclophosphamide and azathioprine on skin score and pulmonary involvement– a retrospective study. Rheumatol Int 34(12):1691–1699CrossRefPubMed

42.

Schram ME et al (2011) Off-label use of azathioprine in dermatology: a systematic review. Arch Dermatol 147(4):474–488CrossRefPubMed

43.

Bosello S et al (2010) B cell depletion in diffuse progressive systemic sclerosis: safety, skin score modification and IL-6 modulation in an up to thirty-six months follow-up open-label trial. Arthritis Res Ther 12(2):R54CrossRefPubMedPubMedCentral

44.

Daoussis D et al (2010) Experience with rituximab in scleroderma: results from a 1‑year, proof-of-principle study. Rheumatology (Oxford) 49(2):271–280CrossRef

45.

Jordan S et al (2015) Effects and safety of rituximab in systemic sclerosis: an analysis from the European Scleroderma Trial and Research (EUSTAR) group. Ann Rheum Dis 74(6):1188–1194CrossRefPubMed

46.

Moazedi-Fuerst FC et al (2014) Rituximab for systemic sclerosis: arrest of pulmonary disease progression in five cases. Results of a lower dosage and shorter interval regimen. Scand J Rheumatol 43(3):257–258CrossRefPubMedPubMedCentral

47.

Smith V et al (2010) Rituximab in diffuse cutaneous systemic sclerosis: an open-label clinical and histopathological study. Ann Rheum Dis 69(1):193–197CrossRefPubMed

48.

Lafyatis R et al (2009) B cell depletion with rituximab in patients with diffuse cutaneous systemic sclerosis. Arthritis Rheum 60(2):578–583CrossRefPubMedPubMedCentral

49.

Keir GJ et al (2014) Rituximab in severe, treatment-refractory interstitial lung disease. Respirology 19(3):353–359CrossRefPubMed

50.

Khanna D et al (2016) Safety and efficacy of subcutaneous tocilizumab in adults with systemic sclerosis (faSScinate): a phase 2, randomised, controlled trial. Lancet 387(10038):2630–2640CrossRefPubMed

51.

Johnson SR et al (2009) Shifting our thinking about uncommon disease trials: the case of methotrexate in scleroderma. J Rheumatol 36(2):323–329PubMed

52.

Pope JE et al (2001) A randomized, controlled trial of methotrexate versus placebo in early diffuse scleroderma. Arthritis Rheum 44(6):1351–1358CrossRefPubMed

53.

van den Hoogen FH et al (1996) Comparison of methotrexate with placebo in the treatment of systemic sclerosis: a 24 week randomized double-blind trial, followed by a 24 week observational trial. Br J Rheumatol 35(4):364–372CrossRefPubMed

54.

Su TI et al (2009) Rapamycin versus methotrexate in early diffuse systemic sclerosis: results from a randomized, single-blind pilot study. Arthritis Rheum 60(12):3821–3830CrossRefPubMedPubMedCentral

55.

Chiba N et al (1997) Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology 112(6):1798–1810CrossRefPubMed

56.

Donnellan C et al (2005) Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database Syst Rev 2:CD003245

57.

van Pinxteren B et al (2010) Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev 11:CD002095. doi:10.1002/14651858.CD002095.pub4

58.

Pakozdi A et al (2009) Does long term therapy with lansoprazole slow progression of oesophageal involvement in systemic sclerosis? Clin Exp Rheumatol 27(3 Suppl 54):5–8PubMed

59.

Ali T, Roberts DN, Tierney WM (2009) Long-term safety concerns with proton pump inhibitors. Am J Med 122(10):896–903CrossRefPubMed

60.

Vakil N (2012) Prescribing proton pump inhibitors: is it time to pause and rethink? Drugs 72(4):437–445CrossRefPubMed

61.

Horowitz M et al (1987) Effects of cisapride on gastric and esophageal emptying in progressive systemic sclerosis. Gastroenterology 93(2):311–315CrossRefPubMed

62.

Kahan A et al (1991) The effect of cisapride on gastro-oesophageal dysfunction in systemic sclerosis: a controlled manometric study. Br J Clin Pharmacol 31(6):683–687CrossRefPubMedPubMedCentral

63.

Limburg AJ, Smit AJ, Kleibeuker JH (1991) Effects of cisapride on the esophageal motor function of patients with progressive systemic sclerosis or mixed connective tissue disease. Digestion 49(3):156–160CrossRefPubMed

64.

Wang SJ et al (2002) Effects of cisapride on oesophageal transit of solids in patients with progressive systemic sclerosis. Clin Rheumatol 21(1):43–45CrossRefPubMed

65.

Fiorucci S et al (1994) Effect of erythromycin administration on upper gastrointestinal motility in scleroderma patients. Scand J Gastroenterol 29(9):807–813CrossRefPubMed

66.

Nikou GC et al (2007) Treatment of small intestinal disease in systemic sclerosis with octreotide: a prospective study in seven patients. J Clin Rheumatol 13(3):119–123CrossRefPubMed

67.

Perlemuter G et al (1999) Octreotide treatment of chronic intestinal pseudoobstruction secondary to connective tissue diseases. Arthritis Rheum 42(7):1545–1549CrossRefPubMed

68.

Soudah HC, Hasler WL, Owyang C (1991) Effect of octreotide on intestinal motility and bacterial overgrowth in scleroderma. N Engl J Med 325(21):1461–1467CrossRefPubMed

69.

Verne GN et al (1995) Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction. Dig Dis Sci 40(9):1892–1901CrossRefPubMed

70.

Marie I et al (2009) Small intestinal bacterial overgrowth in systemic sclerosis. Rheumatology (Oxford) 48(10):1314–1319CrossRef

71.

Parodi A et al (2008) Small intestinal bacterial overgrowth in patients suffering from scleroderma: clinical effectiveness of its eradication. Am J Gastroenterol 103(5):1257–1262CrossRefPubMed

72.

Bose N, Chiesa-Vottero A, Chatterjee S (2015) Scleroderma renal crisis. Semin Arthritis Rheum 44(6):687–694CrossRefPubMed

73.

Shanmugam VK, Steen VD (2012) Renal disease in scleroderma: an update on evaluation, risk stratification, pathogenesis and management. Curr Opin Rheumatol 24(6):669–676CrossRefPubMedPubMedCentral

74.

Steen VD, Medsger TA (2007) Changes in causes of death in systemic sclerosis, 1972–2002. Ann Rheum Dis 66(7):940–944CrossRefPubMedPubMedCentral

75.

Steen VD et al (1990) Outcome of renal crisis in systemic sclerosis: relation to availability of angiotensin converting enzyme (ACE) inhibitors. Ann Intern Med 113(5):352–357CrossRefPubMed

76.

Steen VD, Medsger TA Jr. (2000) Long-term outcomes of scleroderma renal crisis. Ann Intern Med 133(8):600–603CrossRefPubMed

77.

Guillevin L et al (2012) Scleroderma renal crisis: a retrospective multicentre study on 91 patients and 427 controls. Rheumatology (Oxford) 51(3):460–467CrossRef

78.

Penn H et al (2007) Scleroderma renal crisis: patient characteristics and long-term outcomes. QJM 100(8):485–494CrossRefPubMed

79.

Hudson M et al (2014) Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the International Scleroderma Renal Crisis Survey. Semin Arthritis Rheum 43(5):666–672CrossRefPubMed

80.

DeMarco PJ et al (2002) Predictors and outcomes of scleroderma renal crisis: the high-dose versus low-dose D‑penicillamine in early diffuse systemic sclerosis trial. Arthritis Rheum 46(11):2983–2989CrossRefPubMed

81.

Helfrich DJ et al (1989) Normotensive renal failure in systemic sclerosis. Arthritis Rheum 32(9):1128–1134CrossRefPubMed

82.

Montanelli G et al (2013) Effect of dihydropyridine calcium channel blockers and glucocorticoids on the prevention and development of scleroderma renal crisis in an Italian case series. Clin Exp Rheumatol 31(2 Suppl 76):135–139PubMed

83.

Steen VD, Medsger TA Jr. (1998) Case-control study of corticosteroids and other drugs that either precipitate or protect from the development of scleroderma renal crisis. Arthritis Rheum 41(9):1613–1619CrossRefPubMed

84.

Burt RK et al (2011) Autologous non-myeloablative haemopoietic stem-cell transplantation compared with pulse cyclophosphamide once per month for systemic sclerosis (ASSIST): an open-label, randomised phase 2 trial. Lancet 378(9790):498–506CrossRefPubMed

85.

Del Papa N et al (2016) Autologous hematopoietic stem cell transplantation has better outcomes than conventional therapies in patients with rapidly progressive systemic sclerosis. Bone Marrow Transplant. doi:10.1038/bmt.2016.211

86.

van Laar JM et al (2014) Autologous hematopoietic stem cell transplantation vs intravenous pulse cyclophosphamide in diffuse cutaneous systemic sclerosis: a randomized clinical trial. JAMA 311(24):2490–2498CrossRefPubMed

87.

Henes JC et al (2012) Optimization of autologous stem cell transplantation for systemic sclerosis – a single-center longterm experience in 26 patients with severe organ manifestations. J Rheumatol 39(2):269–275CrossRefPubMed

88.

Henes JC et al (2014) Autologous stem cell transplantation with thiotepa-based conditioning in patients with systemic sclerosis and cardiac manifestations. Rheumatology (Oxford) 53(5):919–922CrossRef

89.

Burt RK et al (2013) Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis. Lancet 381(9872):1116–1124CrossRefPubMed

90.

Gordon J et al (2014) Imatinib mesylate (Gleevec) in the treatment of diffuse cutaneous systemic sclerosis: results of a 24-month open label, extension phase, single-centre trial. Clin Exp Rheumatol 32(6 Suppl 86):189–193

91.

Spiera RF et al (2011) Imatinib mesylate (Gleevec) in the treatment of diffuse cutaneous systemic sclerosis: results of a 1‑year, phase IIa, single-arm, open-label clinical trial. Ann Rheum Dis 70(6):1003–1009CrossRefPubMedPubMedCentral

92.

Pope J et al (2011) Imatinib in active diffuse cutaneous systemic sclerosis: results of a six-month, randomized, double-blind, placebo-controlled, proof-of-concept pilot study at a single center. Arthritis Rheum 63(11):3547–3551CrossRefPubMed

93.

Prey S et al (2012) Imatinib mesylate in scleroderma-associated diffuse skin fibrosis: a phase II multicentre randomized double-blinded controlled trial. Br J Dermatol 167(5):1138–1144CrossRefPubMed

94.

Fraticelli P et al (2014) Low-dose oral imatinib in the treatment of systemic sclerosis interstitial lung disease unresponsive to cyclophosphamide: a phase II pilot study. Arthritis Res Ther 16(4):R144CrossRefPubMedPubMedCentral

95.

Richeldi L et al (2014) Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med 370(22):2071–2082CrossRefPubMed

96.

King TE Jr. et al (2014) A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 370(22):2083–2092CrossRefPubMed

97.

Noble PW et al (2011) Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet 377(9779):1760–1769CrossRefPubMed

98.

Miura Y et al (2014) Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 31(3):235–238PubMed

99.

Khanna D et al (2016) An Open-label, Phase II Study of the Safety and Tolerability of Pirfenidone in Patients with Scleroderma-associated Interstitial Lung Disease: the LOTUSS Trial. J Rheumatol 43(9):1672–1679CrossRefPubMed

Titel: Systemische Sklerose
Was ist gesichert in der Therapie?
verfasst von: Dr. M. O. Becker, M.Sc.
Publikationsdatum: 31.10.2016
Verlag: Springer Medizin
Schlagwörter: Stammzell-Transplantation
Stammzell-Transplantation
Arterielle Hypertonie
Systemische Sklerodermie
Pulmonale Hypertonie
Sklerodermie
Stammzell-Transplantation
Pulmonale Hypertonie
Pulmonale Hypertonie
Pulmonale Hypertonie
Arterielle Hypertonie
Erschienen in: Die Innere Medizin / Ausgabe 12/2016
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI: https://doi.org/10.1007/s00108-016-0148-1

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

19.04.2024 | Vorhofflimmern | Nachrichten

Update Innere Medizin

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

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Systemische Sklerose

Was ist gesichert in der Therapie?

Zusammenfassung

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Denken Sie bei starker Blutung auch an die Hemmkörper-Hämophilie

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

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

Weitere Artikel der Ausgabe 12/2016

Erratum zu: Transkutaner Aortenklappenersatz kombiniert mit Stenting der A. carotis interna bei einer 74-jährigen Patientin

Transkutaner Aortenklappenersatz kombiniert mit Stenting der A. carotis interna bei einer 74-jährigen Patientin

Was ist gesichert in der Therapie?

Influenza

Hypophosphatasie

Mitteilungen der DGIM

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Denken Sie bei starker Blutung auch an die Hemmkörper-Hämophilie

Update Innere Medizin