Skip to main content
SpringerLink
Log in

Was ist gesichert in der Therapie der rheumatoiden Arthritis?

What is certain in the treatment of rheumatoid arthritis?

  • Schwerpunkt: Was ist gesichert in der Therapie?
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die rheumatoide Arthritis (RA) ist mit einer Prävalenz von ca. 1 % die wichtigste chronisch-entzündliche Gelenkerkrankung. Unbehandelt führt sie zu Gelenkzerstörungen und damit zu Behinderungen der Patienten, aber auch zu erhöhter Rate an Krebs- und Herz-Kreislauf-Erkrankungen. Nachdem die Pathophysiologie der Erkrankung besser verstanden wurde, konnten in den letzten 20 Jahren mit den Biologika Medikamente entwickelt werden, die sehr gezielt in den Entzündungsprozess bei der RA eingreifen. Sie haben bereits zu einem deutlichen Anstieg der Remissionsraten geführt. Seit 2017 sind in Deutschland zusätzlich Januskinase(JAK)-Inhibitoren zugelassen, die die therapeutischen Optionen noch deutlich erweitern und oral appliziert werden. Die Ansprechraten auf die Therapie sind umso besser, je eher die Erkrankung diagnostiziert und behandelt wird. Patienten, bei denen wegen einer neu aufgetretenen Polyarthritis der Verdacht auf eine RA besteht, sollten daher kurzfristig einem Rheumatologen vorgestellt werden.

Abstract

Rheumatoid arthritis (RA) is the most important chronic inflammatory joint disease with a prevalence of 1%. When untreated the disease leads to joint destruction and therefore to functional restrictions of the patients and also to increased rates of cardiovascular and malignant diseases. After the pathophysiology of rheumatoid arthritis was better understood, in the last 20 years biologics could be developed, which are directed against targets involved in the inflammatory process in RA. Since then the remission rates of RA have substantially increased. In 2017 Janus kinase (JAK) inhibitors were additionally approved for the treatment of RA in Germany. They further broaden the therapeutic options and, in contrast to biologics, are administered orally. The response rates to therapy are better the earlier the disease is diagnosed and treated. Patients in whom RA is suspected due to a new onset of polyarthritis, should therefore be promptly referred to a rheumatologist.

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

Abb. 1

Literatur

  1. Crowson CS, Matteson EL, Myasoedova E et al (2011) The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 63:633–639

    Article  Google Scholar 

  2. Wolfe F, Mitchell DM, Sibley JT et al (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37:481–494

    Article  CAS  Google Scholar 

  3. Noack M, Miossec P (2017) Selected cytokine pathways in rheumatoid arthritis. Semin Immunopathol 39:365–383

    Article  CAS  Google Scholar 

  4. 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 

  5. Ward MM, Leigh JP, Fries JF (1993) Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care. Arch Intern Med 153:2229–2237

    Article  CAS  Google Scholar 

  6. Schellekens GA, Visser H, de Jong BA et al (2000) The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum 43:155–163

    Article  CAS  Google Scholar 

  7. Prevoo ML, van’t Hof MA, Kuper HH et al (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    Article  CAS  Google Scholar 

  8. Smolen JS, Breedveld FC, Schiff MH et al (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 42:244–257

    Article  CAS  Google Scholar 

  9. van der Heide A, Jacobs JW, Bijlsma JW et al (1996) The effectiveness of early treatment with „second-line“ antirheumatic drugs. A randomized controlled trial. Ann Intern Med 124:699–707

    Article  Google Scholar 

  10. Fiehn C, Holle J, Iking-Konert C et al (2018) S2e guideline: treatment of rheumatoid arthritis with disease-modifying drugs. Z Rheumatol. https://doi.org/10.1007/s00393-018-0481-y

    Article  PubMed  Google Scholar 

  11. Grigor C, Capell H, Stirling A et al (2004) Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized controlled trial. Lancet 364:263–269

    Article  Google Scholar 

  12. Haugeberg G, Hansen IJ, Soldal SM, Sokka T (2015) Arthritis Res Ther 17:219

    Article  Google Scholar 

  13. Zink A, Manger B, Kaufmann J et al (2014) Evaluation of the RABBIT risk score for serious infections. Ann Rheum Dis 73:1673–1676

    Article  CAS  Google Scholar 

  14. Murray PJ (2007) The JAK-STAT signaling pathway: input and output integration. J Immunol 178:2623–2629

    Article  CAS  Google Scholar 

  15. Taylor PC, Keystone EC, van der Heijde D et al (2017) Baricitinib versus placebo or adalimumab in rheumatoid arthritis. N Eng J Med 376:652–662

    Article  CAS  Google Scholar 

  16. Häkkinen A, Sokka T, Kotaniemi A, Hannonen P (2001) A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum 44:515–522

    Article  Google Scholar 

  17. Baillet A, Zeboulon N, Gossec L et al (2010) Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials. Arthritis Care Res 62:984–992

    Article  Google Scholar 

  18. Macedo AM, Oakley SP, Panayi GS, Kirkham BW (2009) Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Arthritis Rheum 61:1522–1530

    Article  Google Scholar 

  19. Proudman SM, James MJ, Spargo LD et al (2015) Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis 74:89–95

    Article  CAS  Google Scholar 

  20. 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  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Torsten Witte

Authors
  1. Torsten Witte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Torsten Witte.

Ethics declarations

Interessenkonflikt

T. Witte gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

H. Haller, Hannover

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Witte, T. Was ist gesichert in der Therapie der rheumatoiden Arthritis?. Internist 59, 1249–1254 (2018). https://doi.org/10.1007/s00108-018-0510-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-018-0510-6

Schlüsselwörter

Keywords

Search

Navigation