Lungenbeteiligung bei rheumatischen Erkrankungen

Zusammenfassung

Lungenmanifestationen, insbesondere interstitielle Lungenerkrankungen, gehören zu den häufigsten Organbeteiligungen entzündlich-rheumatischer Erkrankungen und sind mit einer erheblichen Morbidität und Mortalität verbunden. Besonders betroffen sind Patienten mit rheumatoider Arthritis, systemischer Sklerose und idiopathischen inflammatorischen Myopathien. Bei diesen Patienten sollte auf pulmonale Symptome geachtet und, abhängig von Grunderkrankung und klinischer Symptomatik, eine weitere Diagnostik insbesondere mittels Lungenfunktionsprüfung und HR-CT der Lunge durchgeführt werden. Die optimale Therapie der pulmonalen Manifestationen ist bisher nicht bekannt. Außer bei der systemischen Sklerose existieren bisher keine kontrollierten Studien. Neben Glukokortikoiden, Cyclophosphamid, Azathioprin und Mycophenolat kommen andere Immunsuppressiva und auch Biologika in kleinen Fallserien erfolgreich zum Einsatz. Die Behandlung sollte in Zusammenarbeit von Rheumatologen und Pneumologen erfolgen.

Summary

Lung manifestations, including interstitial lung diseases, belong to the most frequent organ manifestations of inflammatory rheumatic diseases and are associated with significant morbidity and mortality. Especially patients with rheumatoid arthritis, systemic sclerosis, and idiopathic inflammatory myopathies are affected. These patients should be screened for pulmonary symptoms, and, if positive, pulmonary function tests and HR-CT of the lungs should be performed. Optimal treatment of rheumatic pulmonary manifestations is unknown so far. Except for systemic sclerosis no controlled trials have been performed yet. Besides glucocorticoids, cyclophosphamide, azathioprine and mycophenolate other immunosuppressives and biologics have successfully been tried in small case series. An interdisciplinary approach is recommended in the management of rheumatic patients with pulmonary involvement.

Schlüsselwörter

Interstitielle Lungenerkrankungen - rheumatoide Arthritis - systemische Sklerose - idiopathische inflammatorische Myopathien - IPAF

Keywords

Interstitial lung diseases - rheumatoid arthritis - systemic sclerosis - idiopathic inflammatory myopathies - IPAF

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