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Empfehlungen der Deutschen Gesellschaft für Rheumatologie zur perioperativen Vorgehensweise unter Therapie mit DMARD und Biologicals bei entzündlich-rheumatischen Erkrankungen

Recommendations of the German Society for Rheumatology on the perioperative approach under therapy with DMARDs and biologicals in inflammatory rheumatic diseases

  • Empfehlungen und Stellungnahmen von Fachgesellschaften
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Zusammenfassung

Hintergrund

Der perioperative Einsatz antirheumatischer Arzneimittel kann zu einem erhöhten Infektionsrisiko und zu einer Wundheilungsstörung bis zum manifesten Infekt führen, andererseits kann eine Unterbrechung der antirheumatischen Therapie einen Krankheitsschub zur Folge haben. Beides kann, insbesondere in der Endoprothetik, den Operationserfolg gefährden.

Methodik

Die Empfehlungen sind vom Vorstand und der Kommission Pharmakotherapie der Deutschen Gesellschaft für Rheumatologie nach einer systematischer Literaturrecherche (Stand 30.04.2013) und einem Konsensprozess entwickelt und verabschiedet worden.

Ergebnis

Da nur wenige Daten mit ausreichend hoher Evidenz vorhanden sind, sind die vorliegenden Empfehlungen als hinweisgebend einzuordnen. Es ist stets eine individuelle Risikoeinschätzung vorzunehmen. Klassische DMARD wie Methotrexat können im Normalfall fortgeführt werden – ob dies auch für Leflunomid gilt, ist noch umstritten. Für Biologicals wird eine Unterbrechung von zwei Halbwertszeiten vor der geplanten Operation empfohlen. Die Therapie kann nach abgeschlossener Wundheilung und bei fehlenden Zeichen einer Infektion fortgeführt werden.

Abstract

Background

The perioperative administration of antirheumatic medication can lead to an increased risk of infection and to a malfunction in wound healing up to a manifest infection; however, the termination of antirheumatic therapy can result in a flare up of the disease. Both situations can endanger the success of the operation, particularly in arthroplasty.

Method

The recommendations have been developed and approved by the Pharmacotherapy Commission of the German Society for Rheumatology following a systematic literature search (as of 30 April 2013) and a consensus process.

Results

As very little data with sufficiently high evidence are available, the present recommendations should be considered as having an advisory quality and an individual risk assessment should always be carried out. Classical disease-modifying antirheumatic drugs (DMARD), such as methotrexate can be continued in normal cases but whether this is also true for leflunomide is still undecided. For biologicals a break of two half-life periods before the operation is recommended. The therapy can be continued after wound healing has been completed and when there are no signs of infection.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Krüger, K. Albrecht, S. Rehart und R. Scholz geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Niedergelassener Rheumatologe, Praxiszentrum, Sankt-Bonifatius, 81541, München, Deutschland

    K. Krüger, K. Albrecht, S. Rehart & R. Scholz

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Krüger, K., Albrecht, K., Rehart, S. et al. Empfehlungen der Deutschen Gesellschaft für Rheumatologie zur perioperativen Vorgehensweise unter Therapie mit DMARD und Biologicals bei entzündlich-rheumatischen Erkrankungen. Z. Rheumatol. 73, 77–84 (2014). https://doi.org/10.1007/s00393-013-1301-z

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