Neues zur Therapie mit Glukokortikoiden in der Rheumatologie

Zusammenfassung

Glukokortikoide werden auch heute noch, mehr als 65 Jahre nach ihrer Einführung in die klinische Medizin, sehr erfolgreich zur Behandlung von entzündlich rheumatischen Erkrankungen wie rheumatoide Arthritis, Vaskulitiden und Kollagenosen eingesetzt. Sie haben sehr ausgeprägte therapeutische Wirkungen, können aber vor allem bei längerfristiger Anwendung von höheren Dosen auch unerwünschte Wirkungen auslösen. Dazu gehören zum Beispiel Osteoporose, kardiovaskuläre Erkrankungen, unerwünschte metabolische Wirkungen oder das verstärkte Auftreten von Infektionen. Daher gab und gibt es ständig Bemühungen, das Nutzen-Risiko-Verhältnis dieser wichtigen Medikamente zu optimieren. In diesem Artikel werden neue Erkenntnisse zu diesem Thema zusammenfassend vorgestellt. Es geht primär um die Definition von Bedingungen, unter denen auch eine notwendige Langzeittherapie mit Glukokortikoiden ein akzeptabel niedriges Nebenwirkungsniveau haben kann. Des Weiteren werden aktuelle Informationen zur Anwendung von Glukokortikoiden bei der Polymyalgia rheumatica und zu interessanten Entwicklungen von verbesserten Glukokortikoiden vorgestellt.

Summary

More than 65 years after their introduction into clinical medicine, glucocorticoids are very successfully used to treat inflammatory rheumatic diseases such as rheumatoid arthritis, vasculitides and connective tissue diseases. They induce impressive therapeutic effects, but especially long-term use of glucocorticoids at higher dosages may cause unwanted adverse effects. These include for example osteoporosis, cardiovascular diseases, unwanted metabolic effects, and the increased risk for infections. Therefore, a salient question was and still is how to optimize the benefit-risk balance of these important drugs. This article focuses on this question by providing timely information in this regard. First, very recently published data are presented which aim to identify conditions where a necessary long-term glucocorticoid treatment has an acceptably low level of harm. Furthermore, up-to-date information about the treatment of polymyalgia rheumatica with glucocorticoids and news regarding the development of improved glucocorticoids are provided.

Schlüsselwörter

Glukokortikoide - Dauertherapie - Nebenwirkungen - Polymyalgia rheumatica - DAGR

Keywords

Glucocorticoids - long-term therapy - adverse events - polymyalgia rheumatica - DAGR

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