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Frühdiagnose einer rheumatoiden Arthritis

Early diagnosis of rheumatoid arthritis

  • BEITRAG ZUM SCHWERPUNKTTHEMA
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Zusammenfassung

Das therapeutische Konzept der rheumatoiden Arthritis (RA) hat sich in den letzten Jahren wesentlich geändert: Es gibt eine starke Evidenz für den frühen Einsatz einer krankheitsmodifizierenden Therapie mit dem neuen Therapieziel „Remission“. Dieser Artikel will für Probleme im Umfeld einer frühen Diagnose sensibilisieren: Es gibt keine Diagnosekriterien für die RA; lassen sich die Klassifikationskriterien nutzen? Viele Früharthritis-Fälle heilen spontan aus; welche Patienten müssen wirklich behandelt werden? Die Daten zur Frühbehandlung basieren auf Patienten mit einer nach den Klassifikationskriterien gesicherten RA; muss/darf man schon vor der Diagnosesicherung behandeln? Das Krankheitsbild ist zu Beginn noch heterogener als im Verlauf; was sind sensitive und spezifische Prognose-Marker? Es gibt neue sensitivere bildgebende Verfahren; kann sich die Diagnose schon auf diese stützen? Nicht alle diese Fragen lassen sich heute bereits beantworten. Aber nur eine intensive Auseinandersetzung mit diesen und ähnlichen Fragestellungen wird helfen, sie auf der Dauer im Sinne der Betroffenen zu lösen.

Summary

The therapeutic concept of rheumatoid arthritis changed dramatically during the last years. There is significant evidence for the need of an early treatment with disease modifying drugs, the new therapeutic aim is remission. And then the question is: what is a rheumatoid arthritis and when does it start? There is move into the direction of an early undifferentiated arthritis, which may or may not become a persistent arthritis with or without development of erosions. Diagnostic criteria for rheumatoid arthritis are not exsisting, and this article comes after reviewing the existing instruments to the conclusion there is no need for such criteria. In fact, there is a need for instruments that evaluate the risk of an individual patient for persistence, erosive arthritis, and even better, the severity of the disease, which means a judgement of progression. And then the rheumatologists can set the crossbar for starting a DMARD-therapy.

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Authors and Affiliations

  1. Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf

    M. Schneider & B. Ostendorf

  2. Rheumatologische Abteilungen der Heinrich-Heine-Universität Düsseldorf und der Kliniken Essen-Süd, Essen-Süd

    Ch. Specker

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  1. M. Schneider
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  2. B. Ostendorf
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  3. Ch. Specker
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Correspondence to M. Schneider.

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Schneider, M., Ostendorf, B. & Specker, C. Frühdiagnose einer rheumatoiden Arthritis. Z. Rheumatol. 64, 516–523 (2005). https://doi.org/10.1007/s00393-005-0790-9

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