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Arthritis und Rheuma 2008; 28(01): 34-40
DOI: 10.1055/s-0037-1620092
Rheumatologie interdisziplinär
Schattauer GmbH

Leitsymptom Dyspnoe bei entzündlichrheumatischen Erkrankungen

Dyspnea in patients with rheumatic diseases
S. Kleinert
1   Med. Klinik und Poliklinik II (Direktor: Prof. H. Einsele), Abteilung Rheumatologie/ Klinische Immunologie, Würzburg
,
H.-P. Tony
1   Med. Klinik und Poliklinik II (Direktor: Prof. H. Einsele), Abteilung Rheumatologie/ Klinische Immunologie, Würzburg
› Author Affiliations
Further Information

Publication History

Publication Date:
24 December 2017 (online)

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Zusammenfassung

Dyspnoe bei „Rheumapatienten” sollte als Warnsignal ernst genommen werden und auch immer wieder gezielt anamnestiziertwerden.Neben den allgemeinen Differenzialdiagnosen des Symptoms müssen bei Patienten mit entzündlich-rheumatischen Erkrankungen spezifische Proble-me berücksichtigt werden. Dyspnoe kann Symptom einer koronaren Herzerkrankung sein. Aufgrund des erhöhten kardiovaskulären Risikos ist eine entsprechende Diagnostik erforderlich. Andere kardiovaskuläre Risikofaktoren sollten evaluiert und gegebenenfalls therapiert werden. Bei Pa-tienten mit Kollagenosen ist in besonderem Maße die Differenzialdiagnose der Lungenbeteiligung und der pulmonalarteriellen Hypertonie (PAH) zu berücksichtigen. Zum Screening eignen sich die Lungenfunktion mit Diffusions-kapazität und die Echokardiografie. Aufgrund der immunsuppressiven Medikation kommen bei einer Infektion auch atypische Krankheitserreger sowie ein atypischer Verlauf in Frage. Spezielle Krankheitsbilder im Rahmen der rheumatologischen Medikation sind z.B. Methotrexat-Pneumonitis oder Aggravierung einer Herzinsuffizienz durch nichtsteroi-dale Antirheumatika (NSAR).

Summary

Dyspnea in patients with inflammatory rheumatic diseases needs special attention. Specific characteristics of the diseases must be taken into consideration besides the usual differential diagnoses. Dyspnea may be a symptom of coronary artery disease. Due to the increased cardiovascular risk of chronic inflammatory diseases other cardivascular risk factors should be evaluated and treated. In vasculitis and connective tissue diseases pulmonary involvement and pulmonary arterial hypertension (PAH) must be excluded. Doppler echocardiography and pulmonary function tests including diffusing capacity are appropriate screening tools for PAH. Atypical infections under immunosuppressive therapy have to be considered. Metotrexate pneumonitis, and worsening of chronic heart failure due to non-steroidal antiinflammatory drugs are examples of adverse events of medication.

Schlüsselwörter

Dyspnoe - pulmonale Manifestationen von Kollagenosen und Vaskulitiden - pulmonal-arterielle Hypertonie - Methotrexat-Pneumonitis

Keywords

Dyspnea - pulmonary involvement in connective tissue disease - pulmonary arterial hypertension - Methotrexate pneumonitis
 

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