Zeitschrift für Rheumatologie

, Volume 66, Issue 8, pp 693–702 | Cite as

Frühe rheumatoide Arthritis – wer schnell hilft, hilft doppelt

CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Frühe Erkennung und Behandlung der persistierenden (oder chronischen) Polyarthritis tragen erheblich dazu bei, Dauerschäden zu vermeiden. Die DGRh-Leitlinie empfiehlt die Vorstellung beim Rheumatologen nach (spätestens) 6 Wochen. Spätestens 12 Wochen nach Beschwerdebeginn sollte eine Basistherapie begonnen werden. Schon früher ergeben hochtitrig positiver Rheumafaktor, nachweisbare Anti-CCP-Antikörper oder frühe Usuren die Indikation zur Basistherapieeinstellung. Zu diesem Zeitpunkt ist mit einer schnell wirksamen Therapiekombination häufig rasch eine Remission oder zumindest niedrige Krankheitsaktivität zu erzielen. Da TNF-Blocker kaum als Primärtherapie infrage kommen, sollte jede Basistherapieeinstellung mit mittelhoch dosierten Kortikosteroiden unterstützt werden. Ausreichende Kapazitäten in Frühsprechstunden, gute Kommunikation mit den Hausärzten und Sensibilisierung der Bevölkerung sind entscheidend, um möglichst alle Patienten vor Dauerschäden zu bewahren.

Schlüsselwörter

Rheumatoide Arthritis Polyarthritis Rheumafaktor Methotrexat Prednisolon 

Early rheumatoid arthritis – rapid help is double help

Abstract

Early diagnosis and therapy of persisting (or chronic) polyarthritis is essential for preventing permanent damage. The guidelines of the German Society for Rheumatology recommend referral to a rheumatologist 6 weeks (at the latest) after symptom onset. DMARD therapy should be initiated within 12 weeks. Even earlier, high titer rheumatoid factor, detectable antibodies to CCP, or early erosion, constitute firm arguments for initiating DMARD therapy in patients with arthritis. At this time point, fast acting combination therapy frequently achieves remission or at least low disease activity. Since TNF blockers are not commonly available for first line therapy, corticosteroids should accompany DMARD initiation. Sufficient capacity in early consultation at arthritis clinics, optimized communication with primary care physicians and sensibilisation of the entire population are essential to prevent permanent damage in as many patients as possible.

Keywords

Rheumatoid arthritis Polyarthritis Rheumatoid factor Methotrexate Prednisone 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Bereich RheumatologieMedizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Technische Universität DresdenDresdenDeutschland
  2. 2.Klinische Abteilung für RheumatologieUniversitätsklinik für Innere Medizin III, Medizinische UniversitätWienÖsterreich

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