Glukokortikoidtherapie in der Rheumatologie – welche Dosis ist optimal?

Zusammenfassung

Glukokortikoide sind von hohem Wert in der Behandlung von Patienten mit rheumatischen Erkrankungen. Die Ziele der Glukokortikoid-Therapie variieren für die unterschiedlichen Indikationen von Symptomkontrolle bis zur Modifizierung des Krankheitsverlaufes und zur Immunmodulation. Selbst nach 60-jähriger Erfahrung mit Glukokortikoid-Therapien gibt es noch viele offene Fragen hinsichtlich optimaler Therapiestrategien. Mit Blick auf die begrenzte Evidenzlage werden optimale Dosierungen für entzündlich rheumatische Krankheiten diskutiert.

Abstract

Glucocorticoids (GCs) have been an invaluable tool in the treatment of patients with rheumatic diseases. The aims of GC therapy vary for different indications from symptom management to disease-modification and immunmodulation. Even after 60 years of GC use, there is still a lack of knowledge concerning optimal therapeutic strategies with GCs. Taking this into account, optimal dosage schedules for inflammatory rheumatic diseases are discussed.

Schlüsselwörter

Glukokortikoide - optimale Dosis - Polymyalgia rheumatica - Riesenzellarteriitis - rheumatoide Arthritis

Keywords

glucocorticoids - optimal dose - polymyalgia rheumatica - giant cell arteritis - rheumatoid arthritis

• Literatur

• 1 Aringer M, Hiepe F. Systemischer Lupus erythematodes. Z Rheumatol 2011; 70: 313-323
• 2 Bakker MF, Jacobs JWG, Welsing PMJ et al. Low-dose prednisone inclusion in a methotrexate-based, tight-control strategy for early rheumatoid arthritis. Ann Int Med 2012; 156: 329-339
• 3 Boers M. The COBRA trial 20 years later. Clin Exp Rheumatol 2011; 29 (Suppl. 68) S46-S51
• 4 Braun J, van den Berg R, Baraliakos X et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896-904
• 5 Buttgereit F, Da Silva JA, Boers N et al. Standardized nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002; 61: 718-722
• 6 Caporali R, Cimmino MA, Montecucco C et al. Glucocorticoid treatment of polymyalgia rheumatic. Clin Exp Rheumatol 2011; 29 (Suppl. 68) S143-S147
• 7 Dasgupta B, Borg F, Hassan N et al. BSR and BHPR guidelines for the management of polymyalgia rheumatic. Rheumatology (Oxford) 2010; 49: 186-190
• 8 Dasgupta B, Borg F, Hassan N et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford) 2010; 49: 1594-1597
• 9 Dasgupta B, Cimmino MA, Kremers HM et al. 2012 provisional classification criteria for polymyalgia rheumatica. Arthritis Rheum 2012; 64: 943-954
• 10 Delecoeuillerie G, Joly P, Cohen de Lara A et al. Polymyalgia rheumatica and temporal arteritis: a retrospective analysis for prognostic features und different corticosteroid regimens. Ann Rheum Dis 1988; 47: 733-739
• 11 de Groot K, Reinhold-Keller E. Wegener-Granulomatose und mikroskopische Polyangiitis. Z. Rheumatol 2009; 68: 49-64
• 12 Gossec L, Smolen JS, Gaujoux-Viala C et al. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmocological therapies. Ann Rheum Dis 2012; 712: 4-12
• 13 Grossman JM, Gordon R, Ranganath VK et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res 2010; 62: 1515-1526
• 14 Hahn BA, McMahon MA, Wilkinson A et al. American College of Rheumatology guidelines for screening, treatment and management of lupus nephritis. Arthritis Care Res 2012; 64: 797-808
• 15 Hench PS, Kendall EC, Slocumb CH et al. The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocorticosterone: Compound E) and of pituitary adrenocorticotropic hormone on rheumatoid arthritis. Preliminary report. Proc Staff Mayo Clin 1949; 24: 181-197
• 16 Hoes JN, Jacobs JW, Boers M et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007; 68: 1560-1567
• 17 Huscher D, Thiele K, Gromnica-Ihle E et al. Dose-related pattern of glucocorticoid-induced side effects. Ann Rheum Dis 2009; 68: 1119-1124
• 18 Kirwan JR. and the Arthritis and Rheumatism Council. Low-Dose Glucocorticoid Study Group: The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995; 333: 142-146
• 19 Kowal-Bielecka O, Landewé R, Avouac J et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group. Ann Rheum Dis 2009; 68: 620-628
• 20 Krause D, Rau R, Braun J. Glucocorticoid treatment in early rheumatoid arthritis. Clin Exp Rheumatol 2011; 29 (Suppl. 68) 121-S125
• 21 Kyle V, Hazleman B. Treatment of polymyalgia rheumatic and giant cell arteritis. I. Steroid regimens in the first two months. Ann Rheum Dis 1989; 48: 658-661
• 22 Moosig F, Dalhoff K. Pulmonale infektiöse Komplikationen rheumatischer Erkrankungen. Z Rheumatol 2009; 68: 658-664
• 23 Mukhtyar C, Guillevin L, Cid MD et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009; 68: 310-317
• 24 Pfeilschifter J. Risikostratifizierte Therapie der Osteoporose. Dtsch Med Wochenschr 2011; 136: 525-532
• 25 Schoser B. Inflammatorische Myopathien. Z. Rheumatol 2009; 68: 665-677
• 26 Smolen JS, Landewé R, Breedveld FC et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69: 964-975
• 27 Van der Goes MC, Jacobs JWG, Boers M et al. Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2010; 69: 1015-1021
• 28 Walsh M, Merkel PA, Mahr A et al. Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis. Arthritis Care Res 2010; 62: 1166-1173