Glukokortikoid-Therapie bei rheumatoider Arthritis – Contra

 

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Zusammenfassung

Glukokortikoide wirken pleiotrop und beeinflussen eine Vielzahl von zellulären Funktionen. Dies resultiert nicht nur in einem breiten therapeutischen Effekt, sondern auch in einer Vielzahl von unerwünschten Wirkungen. Eine Untersuchung hat gezeigt, dass in Deutschland ca. 60 % der Patienten mit rheumatoider Arthritis (RA) Glukokortikoide erhalten, davon ca. jeder Fünfte mehr als 7,5 mg / d Prednisonäquivalent. Bereits in niedrigen Dosen erhöhen Glukokortikoide aber schon erheblich das Risiko z. B. für Osteoporose oder Katarakt, wie auch das für schwere Infektionen. Der Nutzen einer niedrig-dosierten Glukokortikoidtherapie durch Hemmung der radiologischen Erosivität der RA ist dagegen gering und wirkt die Risiken nicht auf.

Abstract

Corticosteroids have a pleiotropic mechanism of action and influence a great number of cellular functions. This does not only result in a broad therapeutic effect, but in a large number of adverse events as well. It has been shown that about 60 % of all patients with rheumatoid arthritis in Germany are receiving corticosteroids and about every fifth of them more than the equivalence of 7.5 mg prednisone per day. Already small doses increase the risk f. e. for osteoporosis or cataract, as well as for severe infections. The benefit of a treatment with low dose corticosteroids in inhibiting the radiological erosivity of the disease is low and does not outweigh the risks.

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