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Z Gastroenterol 2002; 40(11): 937-943
DOI: 10.1055/s-2002-35412
Übersicht
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Gastrointestinale Nebenwirkungen der Therapie rheumatischer Erkrankungen

Gastrointestinal Side Effects in the Therapy of Rheumatologic DiseasesU. Schiemann1 , H. Kellner1
  • 1Medizinische Poliklinik, Klinikum der Universität München - Innenstadt, Ludwig-Maximilians-Universität München
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Publication Date:
18 November 2002 (online)

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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