Diagnose und Therapie der rheumatoiden Arthritis

 

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Zusammenfassung

Die RA ist zwar nach wie vor nicht heilbar, aber heute zu einer gut behandelbaren Erkrankung geworden, bei der das Therapieziel eine komplette Remission unter Einschluss eines intakten radiologischen und funktionellen Status und erhaltener Arbeitsfähigkeit und Lebensqualität ist. Eine optimale Voraussetzung für einen solchen günstigen Langzeitverlauf ist eine frühe Diagnosestellung und ein umgehender Beginn gezielter Therapie. Die Therapie wird nach dem Treat-to-Target-Prinzip mit Überprüfung und ggf.Modifikation in regelmäßigen Abständen, bis das Therapieziel erreicht ist, durchgeführt. In der Regel besteht die Starttherapie aus Mtx + GC, bei ausbleibendem Erfolg dann aus einer Kombination mehrerer kDMARD bzw. bei einem erneuten Misserfolg Mtx + Biologika. In Fällen sehr hoher Aktivität und ungünstiger Prognose können Biologika auch bereits als Zweittherapie zum Einsatz kommen. Neben Medikamenten sind eine Reihe nicht-medikamentöser Behandlungsverfahren wie Krankengymnastik elementare Bestandteile der multimodalen Therapie. Insgesamt ist die Krankheitslast der RA durch das optimierte Vorgehen in den letzten zwanzig Jahren dramatisch zurückgegangen.

Abstract

Rheumatoid arthritis today is still not curable but satisfactory treatable. Treatment targets include clinical remission (or at least low disease activity), lack of radiological destructions and functional disability as well as acceptable life quality and unimpaired working ability. Diagnosing and adequately treating the disease as early as possible is essential for a favourable long-term outcome. Treatment to target with validation and if necessary modification at least every three months until target is achieved ensures good results. Predominantly treatment starts with a combination of methotrexate and glucocorticoids followed by a conventional DMARD combination and then addition of a biologic DMARD in case of failing target. Presence of adverse risk factors and/or high disease activity a cDMARD/bDMARD combination might be used already after starting treatment failure. Additional treatment options such as physiotherapy should be added. Altogether with current treatment possibilities burden of disease declined dramatically in recent years.

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