Zeitschrift für Rheumatologie

, Volume 69, Issue 10, pp 879–888 | Cite as

Infektionskomplikationen unter Biologika-Therapie bei Patienten mit rheumatoider Arthritis

Leitthema

Zusammenfassung

Die Einführung der biologischen krankheitsmodifizierenden Therapeutika (DMARDs) hat die Therapieoptionen für die rheumatoide Arthritis deutlich verbessert. Zu den häufigsten Nebenwirkungen der biologischen DMARDs gehören Infektionskomplikationen, inklusive schwere Infektionen sowie auch selten opportunistische Infektionen. Die Betreuung von Patienten unter einer biologischen DMARD-Therapie gehört somit mit zu den größten Herausforderungen in der rheumatologischen Praxis. Wir beschreiben hier den gegenwärtigen Wissensstand zu Häufigkeit und Art von Infektionskomplikationen unter biologischen DMARDs. Es wird ein besonderer Schwerpunkt auf das Risikomanagement von Problempatienten, insbesondere auf die Diagnostik und Rezidivprophylaxe der latenten Tuberkulose und Prävention der Reaktivierung der Hepatitis-B-Virus-Infektion gelegt. Weiterhin diskutieren wir den Stellenwert von Indikationsimpfungen in der Primärprophylaxe bei Patienten mit rheumatoider Arthritis.

Schlüsselwörter

Rheumatoide Arthritis Immunsuppression Infektionsrisiko Tuberkulose Hepatitis-B-Virus-Infektion Impfung 

Infectious complications of biologic therapy in patients with rheumatoid arthritis

Abstract

The introduction of biological disease-modifying drugs (DMARDs) has substantially improved the treatment options for patients with rheumatoid arthritis. However, infectious complications represent the most common side effects of these drugs, including severe infections as well as rare opportunistic infections. Treating patients on biological DMARDs is therefore one of the biggest challenges in rheumatology care. The present review describes the current state of knowledge regarding frequency and type of infectious complications associated with biological DMARDs. The article focuses mainly on risk management, in particular on diagnosis and recurrence prevention of tuberculosis and reactivation of hepatitis B virus infection. Furthermore, we discuss the importance of vaccinations in primary disease prevention in patients with rheumatoid arthritis.

Keywords

Rheumatoid arthritis Immunosuppression Risk of infection Tuberculosis Hepatitis B virus infection Vaccination 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: D. Meyer-Olson: Abbott, Bristol Myers Squibb, Roche, UCB und Wyeth/Pfizer. R.E. Schmidt: Abbott, Chugai, Essex und Roche.

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© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für Immunologie und RheumatologieMedizinische Hochschule HannoverHannoverDeutschland

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