Skip to main content
SpringerLink
Log in

Strategien zur verbesserten Versorgung von Menschen mit der Volkskrankheit „Rheuma“ am Beispiel der rheumatoiden Arthritis

Strategies for improved healthcare of people with the endemic disease rheumatism exemplified by rheumatoid arthritis

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Neue Therapieprinzipien und Fortschritte in der Diagnostik haben es ermöglicht, bei Erkrankungen des rheumatischen Formenkreises und hier besonders bei der rheumatoiden Arthritis (RA) ein Krankheitsbild früh zu definieren und durch eine frühzeitig begonnene Medikation bei einem beträchtlichem Anteil der Patienten eine niedrige Krankheitsaktivität oder Remission zu erzielen. Mit der zusätzlichen Entwicklung neuer Parameter zur Analyse der Krankheitsaktivität stellte sich eine internationale Arbeitsgruppe von Rheumatologen und Rheumapatienten – in Anlehnung an die Optimierung der Therapie von Patienten mit einem Hypertonus oder Diabetes – die Aufgabe, einen Behandlungsplan für die RA zu entwickeln mit dem Ziel, so häufig wie möglich eine Remission zu erzielen. Diese Treat-To-Target-Empfehlungen wurden von nationalen Arbeitsgruppen, so auch in Deutschland, hinsichtlich ihrer Umsetzbarkeit in die Infrastruktur des deutschen Gesundheitswesens diskutiert und Möglichkeiten zur Implementierung erörtert. Am Modell der RA wurden wichtige Aktionselemente und Postulate für eine verbesserte Versorgung von Menschen mit der Volkskrankheit Rheuma aufgestellt, die in dem vorliegenden Manuskript im Einzelnen diskutiert werden.

Abstract

New therapeutic principles and considerable diagnostic advances have made it possible to define different rheumatic diseases and especially rheumatoid arthritis (RA) at an early stage and by starting an early and aggressive medication a considerable proportion of patients with RA will reach the status of low disease activity or even remission. With the additional development of composite measures to estimate the disease activity of RA, it was the goal of an international working group consisting of rheumatologists and patients to develop recommendations for treating rheumatoid arthritis in a similar way as for patients with hypertension or diabetes, with the aim to achieve remission as often as possible. This treat-to-target initiative has taken off in quite a number of different countries including Germany leading to discussions on how this initiative can be integrated into the specific national healthcare systems and what possibilities would exist for its implementation. To develop strategies for an improved healthcare of people suffering from rheumatic diseases and using RA as an example, action elements and postulates were developed which will be discussed in more detail in the present manuscript.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Bejarano V, Conaghan PG, Quinn MA et al (2010) Benefits 8 yrs after a remission induction regime with an infliximab and methotrexate combination in early rheumatoid arthritis. Rheumatology 49:1971–1974

    Article  PubMed  CAS  Google Scholar 

  2. Bejarano V, Quinn M, Conaghan PG et al; Yorkshire Early Arthritis Register Consortium (2008) Effect of the early use of the anti-tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis. Arthritis Rheum 59:1467–1474

    Article  PubMed  Google Scholar 

  3. Goekoop-Ruiterman YP, Vries-Bouwstra JK de, Allaart CF et al (2005) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 52:3381–3390

    Article  PubMed  CAS  Google Scholar 

  4. Hill J, Bird H, Johnson S (2001) Effect of patient education on adherence to drug treatment for rheumatoid arthritis: a randomised controlled trial. Ann Rheum Dis 60:869–875

    PubMed  CAS  Google Scholar 

  5. Jacobsson LT, Turesson C, Gulfe A et al (2005) Treatment with tumor necrosis factor blockers is associated with a lower incidence of first cardiovascular events in patients with rheumatoid arthritis. J Rheumatol 32:1213–1218

    PubMed  CAS  Google Scholar 

  6. Kjeken I, Dagfinrud H, Mowinckel P et al (2006) Rheumatology care: involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum 55:394–401

    Article  PubMed  Google Scholar 

  7. Kleinert S, Krüger K (2011) Kardiovaskuläre Komorbidität und ihre Risikofaktoren bei rheumatoider Arthritis. Z Rheumatol 70(6):464–472

    Article  PubMed  CAS  Google Scholar 

  8. Lard LR, Visser H, Speyer I et al (2001) Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 111:446–451

    Article  PubMed  CAS  Google Scholar 

  9. Kommission Versorgung der Deutschen Gesellschaft für Rheumatologie (Hrsg) (2008) Memorandum Rheumatologische Versorgung von akut und chronisch Rheumakranken in Deutschland. Juni 2008, http://dgrh.de/rheumamemorandum.html

  10. Meune C, Touzé E, Trinquart L, Allanore Y (2009) Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 48:1309–1313

    Article  PubMed  Google Scholar 

  11. Mitchell DM, Spitz PW, Yound DY et al (1986) Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum 29:706–714

    Article  PubMed  CAS  Google Scholar 

  12. Mottonen T, Hannonen P, Korpela M et al; FIN-RACo Trial Group (2002) Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 46:894–898

    Article  PubMed  CAS  Google Scholar 

  13. Nell VP, Mechold KP, Eberl G et al (2004) Benefit of very early referral and very early therapy with disease-modifying, anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 43:906–914

    Google Scholar 

  14. Peters MJ, Symmons DP, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    Article  PubMed  CAS  Google Scholar 

  15. Pincus T, Callahan LF, Sale WG et al (1984) Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum 27:864–872

    Article  PubMed  CAS  Google Scholar 

  16. Quinn MA, Conaghan PG, O’Connor PJ et al (2005) Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum 52:27–35

    Article  PubMed  CAS  Google Scholar 

  17. Schipper LG, Hulst LT van, Grol R et al (2010) Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcome. Rheumatology 49:2154–2164

    Article  PubMed  Google Scholar 

  18. Schoels M, Knevel R, Aletaha D et al (2010) Evidence for treating rheumatoid arthritis to target: results of a systematic literature search. Ann Rheum Dis 69:638–643

    Article  PubMed  Google Scholar 

  19. Smolen JS, Aletaha D (2011) Monitoring rheumatoid arthritis. Curr Opin Rheumatol 23:252–258

    Article  PubMed  CAS  Google Scholar 

  20. Smolen JS, Aletaha D, Bijlsma JW et al; T2T Expert Committee (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637

    Article  PubMed  Google Scholar 

  21. Smolen JS, Landewe R, Breedveld FC et al (2010) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 69:964–975

    Article  PubMed  CAS  Google Scholar 

  22. Sokka T, Abelson B, Pincus T (2008) Mortality in rheumatoid arthritis: 2008 update. Clin Exp Rheumatol 26:35–61

    Google Scholar 

  23. Van der Linden MP, le Cessie S, Raza K et al (2010) Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum 62:3537–3546

    Article  Google Scholar 

  24. Van Nies JA, De Jong Z, Van der Helm-van Mil AH et al (2010) Improved treatment strategies reduce the increased mortality risk in early RA patients. Rheumatology 49:2210–2216

    Article  Google Scholar 

  25. Westhoff G, Edelmann E, Kekow J, Zink A (2010) Diagnosespektrum, Behandlungsindikation und Symptomdauer von Erstzuweisungen zum Rheumatologen. Z Rheumatol 69:910–918

    Article  PubMed  CAS  Google Scholar 

  26. Westlake SL, Colebatch AN, Baird J et al (2010) The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology 49:295–307

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Molekulare Immunologie, Universitätsklinikum Erlangen, Glückstr. 6, 91054, Erlangen, Deutschland

    J.R. Kalden

Authors
  1. J.R. Kalden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Burkhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Buß
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Donhauser-Gruber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Erstling
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Gromnica-Ihle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Karberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Karger
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C.H. Kneitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. K. Krüger
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. H.-M. Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. U. Müller-Ladner
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A. Rubbert-Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. P. Steffens-Korbanka
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. H.-P. Tony
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. J. Wendler
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. J. Wollenhaupt
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. G. Burmester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.R. Kalden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kalden, J., Burkhardt, H., Buß, B. et al. Strategien zur verbesserten Versorgung von Menschen mit der Volkskrankheit „Rheuma“ am Beispiel der rheumatoiden Arthritis. Z. Rheumatol. 70, 641–650 (2011). https://doi.org/10.1007/s00393-011-0763-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-011-0763-0

Schlüsselwörter

Keywords

Search

Navigation