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Aktuelle Rheumatologie 2010; 35(3): 178-183
DOI: 10.1055/s-0030-1255039
Übersichtsarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Schmerztherapie mit selektiven und nichtselektiven Cyclooxygenaseinhibitoren in der Rheumatologie

Pain Therapy with Selective and Non-Selective Cyclooxygenase Inhibitors in RheumatologyS. I. Unger1 , C. Baerwald1
  • 1Universitätsklinikum Leipzig, Medizinische linik II, Sektion Rheumatologie, Leipzig
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Publication History

Publication Date:
30 June 2010 (online)

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Zusammenfassung

Nichtselektive und selektive Cyclooxygenaseinhibitoren (Coxibe) sind potente Analgetika und Antiphlogistika und werden erfolgreich bei der Therapie degenerativer und entzündlich-rheumatischer Gelenkerkrankungen eingesetzt. Traditionelle NSAR und Coxibe unterscheiden sich dabei nicht wesentlich in der analgetischen Potenz. Bei der Wahl dieser Prostaglandinsynthesehemmer sollte jedoch eine individuelle patientenorientierte Nutzen-Risiko-Abwägung erfolgen. Kardiovaskuläre und gastrointestinale Risikofaktoren sind dabei für eine differenzialtherapeutische Entscheidung von großer Bedeutung. Bei Patienten mit beiden Risikokonstellationen, Herzinsuffizienz, Leberzirrhose oder renalen Erkrankungen sollte auf eine Behandlung mit COX-Inhibitoren verzichtet und Analgetika anderer Substanzklassen eingesetzt werden. Mithilfe von Studien muss in Zukunft eine individuelle, auf den Patienten zugeschnittene, Evidenz-basierte Therapie und damit ein Konzept zum differenzialtherapeutischen Einsatz der nichtselektiven und selektiven COX-Hemmer in der Rheumatologie entwickelt werden.

Abstract

Non-selective and selective Cyclooxygenase inhibitors (coxibs) are potent analgesics and antiphlogistics and are successfully used in treatment of degenerative and inflammatory joint diseases. Traditional non-steroid anti-inflammatory drugs (NSAID) do not differ from coxibs in their analgesic effects. Physicians should analyse the risks and benefits of prescribing inhibitors of prostaglandin synthesis for each individual patient, especially focusing on both the gastrointestinal and cardiovascular risks. Patients with both risks, heart failure and liver cirrhosis or renal diseases should not be treated with COX-inhibitors. Other analgesic agents should be chosen. Studies must clarify which therapy is appropriate for individual patients to develop an evidence-based concept for the differential use of traditional NSAID and coxibs in rheumatology.

Schlüsselwörter

Cyclooxygenaseinhibitoren - Coxibe - NSAR - Schmerz

Key words

cyclooxygenase inhibitors - coxibs - NSAID - pain

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Korrespondenzadresse

Dr. Susette Ilona Unger

Universitätsklinikum Leipzig

Medizinische Klinik II

Liebigstraße 20

04103 Leipzig

Phone: +49/0341/972 4353

Fax: +49/0341/972 4849

Email: Susette.Unger@medizin.uni-leipzig.de

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