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Behandlung der Komorbiditäten entzündlich-rheumatischer Erkrankungen

Managing comorbidities of inflammatory rheumatic diseases

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Zusammenfassung

Patienten mit entzündlich-rheumatischen Erkrankungen leiden häufig an relevanten Komorbiditäten, die durch die chronisch-entzündliche Systemaktivität der rheumatischen Krankheit selbst, durch Störungen der immunologischen Abwehr oder durch Folgen der antirheumatischen Therapie bedingt sein können, aber auch unabhängig davon auftreten können. So weisen zum Beispiel Patienten mit rheumatoider Arthritis bereits zum Zeitpunkt der Erstmanifestation in knapp 50% der Fälle 2 weitere chronische Krankheiten auf. Hinsichtlich der bei Rheumapatienten erhöhten Mortalität sind v. a. die kardiovaskuläre Morbidität und die erhöhte Disposition für Infektionen zu nennen. In diesem Artikel sollen zudem weitere wichtige mögliche Begleiterkrankungen, nämlich die Osteoporose und Tumorerkrankungen, behandelt werden. Es gilt, Komorbiditäten zu erkennen und ebenso konsequent zu behandeln wie die rheumatische Grunderkrankung, somit den an Rheuma erkrankten Patienten in jeder Krankheitsphase interdisziplinär internistisch zu begleiten. Eine effektive Beherrschung der systemischen Entzündungsaktivität vermag das Risiko bestimmter kardiovaskulärer und neoplastischer Komorbiditäten zu reduzieren.

Abstract

Patients with inflammatory rheumatic diseases often suffer from considerable comorbidities that can arise due to the chronic systemic inflammatory activity of the rheumatic disease itself, disorders of immune defense, or as a result of antirheumatic treatment; they can also occur independently. For example, almost 50% of patients with rheumatoid arthritis already exhibit two further chronic diseases at the time of initial manifestation. With regard to the elevated mortality observed in patients with rheumatism, particularly cardiovascular morbidity and increased predisposition to infections are of note. In addition, this article addresses further important possible concomitant diseases, i.e., osteoporosis and tumor diseases. A ground rule is to identify comorbidities and treat them just as diligently as the underlying rheumatic disease so that the patient with rheumatism should be accompanied by an interdisciplinary team of internists during each phase of the disease. Effective control of the systemic inflammatory activity may serve to reduce the risk of certain cardiovascular and neoplastic comorbidities.

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  1. Medizinische Klinik III, Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach, Deutschland

    K. de Groot

  2. Klinik Innere Medizin IV, HSK Dr. Horst Schmidt Kliniken GmbH, Wiesbaden, Deutschland

    E. Märker-Hermann

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  1. K. de Groot
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de Groot, K., Märker-Hermann, E. Behandlung der Komorbiditäten entzündlich-rheumatischer Erkrankungen. Internist 52, 688–696 (2011). https://doi.org/10.1007/s00108-010-2769-0

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