Zusammenfassung
Die weit verbreitet eingesetzten Antirheumatika können eine Vielzahl gastrointestinaler
Komplikationen hervorrufen. Symptomatische Therapeutika wie Glukokortikoide und nicht-steroidale
Antirheumatika sind bekannt für das Auftreten von Magen- und Duodenalulzera, besonders
unter ihrer Kombinationsbehandlung. Das Nebenwirkungsspektrum der Basistherapeutika
(Methotrexat, Leflunomid, Hydroxy-/Chloroquin, Sulfasalazin) umfasst neben unspezifischen
gastrointestinalen Reizsymptomen wie Übelkeit, Erbrechen und Diarrhöen auch die Induktion
von ulzerösen Schleimhautläsionen (Methotrexat) und vor allem das Auftreten einer
Hepatopathie. Diese kann sich durch eine asymptomatische Erhöhung der Transaminasen
oder Cholestaseparameter manifestieren, jedoch in Einzelfällen unter einer Monotherapie
(Hydroxy-/Chloroquin, Sulfasalazin), besonders aber unter einer Kombinationsbehandlung
(Methotrexat + Leflunomid) zur fulminanten Hepatitis führen. Die TNF-α-blockierenden
Substanzen (Etanercept, Infliximab) als neue Generation antiinflammatorischer Therapeutika
weisen nach derzeitiger klinischer Erfahrung und Datenlage in der Literatur keine
relevanten gastrointestinalen Nebenwirkungen auf.
Abstract
Antirheumatic drugs may lead to a number of relevant gastrointestinal complications.
Symptomatical treatments with glucocorticoids and non steroidal antirheumatic drugs
(NSAD) are known to induce gastric or duodenal ulcers, above all under combination
therapies. Side effects of DMARD's (methotrexate, leflunomide, hydroxy/chloroquine,
sulfasalazine) include unspecifical gastrointestinal symptoms like nausea, vomiting
and diarrhea as well as induction of ulcerative mucosal lesions (methotrexate) and
occurrence of a hepatopathy. The latter may appear as an asymptomatical elevation
of liver transaminases or cholestase parameters, but can also lead, in some cases
of a monotherapy (hydroxy-/chloroqine, sulfasalazine) or combination therapy (methotrexate
+ leflunomide) to a fulminant hepatitis. TNF-α-inhibiting drugs (etanercept, infliximab)
as a new generation of anti-inflammatory therapeutics don't have relevant gastrointestinal
side effects according recently published data.
Schlüsselwörter
Rheumatoide Arthitis - Ulcusventriculi - NSAR-Gastropathie
Key words
Rheumatoid arthritis - gastric ulcer - NSAID gastropathy
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Dr. med. Uwe Schiemann
Medizinische Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München
Pettenkoferstraße 8a
80336 München
eMail: uwe.schiemann@pk-i.med.uni-muenchen.de
