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S1-Leitlinie der DGRh zur sequenziellen medikamentösen Therapie der rheumatoiden Arthritis 2012

Adaptierte EULAR-Empfehlungen und aktualisierter Therapiealgorithmus

German 2012 guidelines for the sequential medical treatment of rheumatoid arthritis

Adapted EULAR recommendations and updated treatment algorithm

Zusammenfassung

Auf Basis der 2010 publizierten EULAR-Empfehlungen ist von der DGRh eine S1-Leitlinie für die sequenzielle medikamentöse Therapie der rheumatoiden Arthritis erstellt und der Therapiealgorithmus überarbeitet worden. Die Neufassung erfolgte auf der Grundlage einer aktualisierten systematischen Literaturrecherche und eines Expertenkonsensus. Bei Diagnosestellung ist Methotrexat die Standardbasistherapie und wird in der Regel mit niedrig dosiertem Prednisolon kombiniert. Bei nicht ausreichendem Ansprechen sollte nach 12 Wochen eine klassische DMARD-Kombinationstherapie eingesetzt werden. Bei anhaltend hoher Krankheitsaktivität wird spätestens nach 6 Monaten der Einsatz eines Biologikums empfohlen, in Sondersituationen (z. B. frühe Destruktionen, ungünstige Prognose) ggf. früher. Falls sich das zuerst angewendete Biologikum in einem Zeitraum von 3 bis 6 Monaten als nicht ausreichend effektiv erweist, sollte der Wechsel auf ein anderes Biologikum erfolgen. Bei lang anhaltender Remission kann eine kontrollierte Reduktion der Basistherapie versucht werden.

Abstract

Following the EULAR recommendations published in 2010 German guidelines for the medical treatment of rheumatoid arthritis were developed based on an update of the systematic literature search and expert consensus. Methotrexate is the standard treatment option at the time of diagnosis, preferably in combination with low dose glucocorticoids. Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks. Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment and in exceptional situations (e.g. early destruction or unfavorable prognosis) even earlier. If treatment with biologicals remains ineffective, changing to another biological is recommended after 3–6 months. In cases of long-standing remission a controlled reduction of medical treatment can be considered.

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Abb. 1

Abbreviations

ABC:

Abatacept

ADM:

Adalimumab

CEZ:

Certolizumab

ETC:

Etanercept

GOM:

Golimumab

INX:

Infliximab

RIX:

Rituximab

TOZ:

Tocilizumab

CiA:

Ciclosporin A

HCQ:

Hydroxychloroquin

LEF:

Leflunomid

MTX:

Methotrexat

SSZ:

Sulfasalazin

TNF:

TNF-Inhibitoren

Literatur

  1. 1.

    Albrecht K, Krüger K, Müller-Ladner U, Wollenhaupt J (2012) Systematische Literaturrecherche für die S1-Leitlinie zur sequentiellen medikamentösen Therapie der rheumatoiden Arthritis. Z Rheum

  2. 2.

    Aletaha D, Neogi T, Silman A et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581

    PubMed  Article  Google Scholar 

  3. 3.

    Aletaha D, Smolen JS (2002) Effectiveness profiles and dose dependent retention of traditional disease modifying antirheumatic drugs for rheumatoid arthritis. An observational study. J Rheumatol 29:1631–1638

    PubMed  CAS  Google Scholar 

  4. 4.

    Bakker MF, Jacobs JW, Welsing PM et al (2011) Early clinical response to treatment predicts 5-year outcome in RA patients: follow-up results from the CAMERA study. Ann Rheum Dis 70:1099–1103

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Bathon J, Robles M, Ximenes AC (2011) Sustained disease remission and inhibition of radiographic progression in methotrexate-naïve patients with rheumatoid arthritis and poor prognostic factors treated with abatacept: 2-year outcomes. Ann Rheum Dis 70:1949–1956

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Bosello S, Fedele AL, Peluso G et al (2011) Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression. Ann Rheum Dis 70:1292–1295

    PubMed  Article  Google Scholar 

  7. 7.

    Britsemmer K, Ursum J, Gerritsen M et al (2011) Validation of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: slight improvement over the 1987 ACR criteria. Ann Rheum Dis 70:1468–1470

    PubMed  Article  Google Scholar 

  8. 8.

    Brocq O, Millasseau E, Albert C et al (2009) Effect of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine 76:350–355

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Cader MZ, Filer A, Hazlehurst J et al (2011) Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 ACR criteria in a very early synovitis cohort. Ann Rheum Dis 70:949–955

    PubMed  Article  Google Scholar 

  10. 10.

    Chatzidionysiou K, Lie E, Nasonov E et al (2012) Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients: results of a 1-year follow-up study from the CERERRA collaboration. Ann Rheum Dis 71:374–377

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Criswell LA, Such CL, Yelin EH (1997) Differences in the use of second-line agents and prednisone for treatment of rheumatoid arthritis by rheumatologists and non-rheumatologists. J Rheumatol 24:2283–2290

    PubMed  CAS  Google Scholar 

  12. 12.

    Curtis JR, Yang S, Chen L et al (2012) Predicting low disease activity and remission using early treatment response to antitumour necrosis factor therapy in patients with rheumatoid arthritis: exploratory analyses from the TEMPO trial. Ann Rheum Dis 71:206–212

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    De Boer KV, Visser K, Ronday HK et al (2010) Induction therapy with methotrexate and prednisone in rheumatoid or very early arthritic disease: IMPROVED study. Arthritis Rheum 62(Suppl 10):1396

    Google Scholar 

  14. 14.

    Dougados M, Huizinga T, Sheeran T et al (2011) Tocilizumab plus methotrexate does not have superior clinical efficacy to TCZ alone in RA patients with inadequate response to MTX: 24-week results of the ACT-RAY study. Ann Rheum Dis 70(Suppl 3):73

    Google Scholar 

  15. 15.

    Emery P, Durez P, Dougados M et al (2010) Impact of T-cell costimulation modulation in patients with undifferentiated inflammatory arthritis or very early rheumatoid arthritis: a clinical and imaging study of abatacept (the ADJUST trial). Ann Rheum Dis 69:510–516

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Engström A, Saevarsdottir S, Rezaei H et al (2011) Development of a matrix risk model for prediction of rapid radiographic progression based on the Swefot trial population. Ann Rheum Dis 70(Suppl 3):77

    Google Scholar 

  17. 17.

    Finckh A, Dehler S, Gabay C et al (2009) The effectiveness of leflunomide as a co-therapy of tumour necrosis factor inhibitors in rheumatoid arthritis: a population-based study. Ann Rheum Dis 68:33–39

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Gaujoux-Viala C, Smolen JS, Landewe R et al (2010) Current evidence for the management of rheumatoid arthritis with synthetic disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 69:1004–1009

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Hafstrem I, Albertsson K, Boonen A et al (2009) Remission achieved after 2 years treatment with low-dose prednisolone in addition to disease-modifying anti-rheumatic drugs in early rheumatoid arthritis is associated with reduced joint destruction still present after 4 years: an open 2-year continuation study. Ann Rheum Dis 68:508–513

    Article  Google Scholar 

  20. 20.

    Haraoui B, Emery P, Mozaffarian N et al (2010) Change in CRP at 12 weeks predicts the risk of rapid radiographic progression at 2 years in methotrexate-treated patients with early rheumatoid arthritis. Arthritis Rheum 62(Suppl 10):1101

    Google Scholar 

  21. 21.

    Hetland ML, Stengaard-Pedersen K, Junker P et al (2010) Radiographic progression and remission rates in early rheumatoid arthritis – MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomized CIMESTRA trial. Ann Rheum Dis 69:1789–1795

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Hoes JN, Jacobs JWG, Boers M et al (2007) EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 66:1560–1567

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Ichikawa Y, Saito T, Yamanaka H et al (2010) Clinical activity after 12 weeks of treatment with nonbiologics in early rheumatoid arthritis may predict articular destruction 2 years later. J Rheumatol 37:723–729

    PubMed  Article  Google Scholar 

  24. 24.

    Katchamart W, Trudeau J, Phumethum V, Bombardier C (2010) Methotrexate monotherapy versus methotrexate combination therapy with non-biologic disease modifying antirheumatic drugs for rheumatoid arthritis. Cochrane Database Syst Rev 4:S CD008495

    Google Scholar 

  25. 25.

    Keystone E, Ogale S, Devenport J, Lepley D (2011) Benefit of continuing tocilizumab therapy (8 mg/kg every 4 weeks) in rheumatoid arthritis patients who have not responded adequately within the first 8 weeks. Ann Rheum Dis 70(Suppl 3):461

    Google Scholar 

  26. 26.

    Kievit W, Fransen J, Adang EM et al (2011) Long-term effectiveness and safety of TNF-blocking agents in daily clinical practice: results from the Dutch Rheumatoid Arthritis Monitoring register. Rheumatology 50:196–203

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Kirwan JR, Bijlsma JW, Boers M, Shea BJ (2007) Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database Syst Rev 24:CD006356

    Google Scholar 

  28. 28.

    Klarenbeek NB, Kooij SM van der, Güler-Yüksel M et al (2011) Discontinuing treatment in patients with rheumatoid arthritis in sustained clinical remission: exploratory analyses from the BeSt study. Ann Rheum Dis 70:315–319

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Klarenbeek NB, Güler-Yüksel M, Kooij SM van der et al (2011) The impact of four dynamic, goal-steered treatment strategies on the 5-year outcomes of rheumatoid arthritis patients in the BeSt study. Ann Rheum Dis 70:1039–1046

    PubMed  Article  Google Scholar 

  30. 30.

    Kremer JM, Genovese MC, Cannon GW (2002) Concomitant leflunomide therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 137:726–733

    PubMed  CAS  Google Scholar 

  31. 31.

    Lacaille D, Anis AH, Guh DP, Esdaile JM (2005) Gaps in care for rheumatoid arthritis: a population study. Arthritis Rheum 53:241–248

    PubMed  Article  Google Scholar 

  32. 32.

    Lard LR, Visser H, Speyer I et al (2001) Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 111:446–451

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Liao KP, Weinblatt ME, Cui J et al (2011) Clinical predictors of erosion-free status in rheumatoid arthritis: a prospective cohort study. Rheumatology 50:1473–1479

    PubMed  Article  Google Scholar 

  34. 34.

    Mease PJ (2010) Improving the routine management of rheumatoid arthritis: the value of tight control. J Rheumatol 37:1570–1578

    PubMed  Article  Google Scholar 

  35. 35.

    Müller-Ladner U (2009) Unifying abbreviations for biologics in rheumatology-does the idea hold promise? Rheumatology 48:704

    PubMed  Article  Google Scholar 

  36. 36.

    Nam JL, Winthrop KL, Vollenhoven RF van (2010) Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of RA. Ann Rheum Dis 69:976–986

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Navarro-Sarrabia F, Ruiz-Montesinos D, Hernandez B et al (2009) DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists. BMJ Muskuloskeletal Disorders 10:91

    Article  Google Scholar 

  38. 38.

    Nell VP, Machold KP, Eberl G et al (2004) Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 43:906–914

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    O’Dell JR, Leff R, Paulsen G (2002) Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: results of a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 46:1164–1170

    Article  Google Scholar 

  40. 40.

    O’Mahony R, Richards A, Deighton C, Scott D (2010) Withdrawal of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis 69:1823–1826

    Article  Google Scholar 

  41. 41.

    Pincus T, Yazici Y, Sokka T et al (2003) Methotrexate as the „anchor drug“ for the treatment of early rheumatoid arthritis. Clin Exp Rheumatol 21(Suppl 31):179–185

    Google Scholar 

  42. 42.

    Rantalaiho V, Korpela M, Hannonen P et al (2009) The good initial response to therapy with a combination of traditional disease-modifying antirheumatic drugs is sustained over time: the eleven year results of the Finnish rheumatoid arthritis combination therapy trial. Arthritis Rheum 60:1222–1231

    PubMed  Article  Google Scholar 

  43. 43.

    Rezaei H, Saevarsdottir S, Forslind K et al (2012) In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial. Ann Rheum Dis 71:186–191

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Roddy E, Zhang W, Doherty M et al (2006) Evidence-based clinical guidelines: a new system to better determine true strength of recommendation. J Eval Clin Pract 12:347–352

    PubMed  Article  Google Scholar 

  45. 45.

    Salliot C, Heijde D van der (2009) Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 68:1100–1104

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Schiff M, Beaulieu A, Scott DL, Rashford M (2010) Mycophenolate mofetil in the treatment of adults with advanced rheumatoid arthritis: three 24-week, randomized, double-blind, placebo- or ciclosporin-controlled trials. Clin Drug Investig 30:613–624

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Schipper LG, Fransen J, Broeder AA den, Van Riel PL (2010) Time to achieve remission determines time to be in remission. Arthritis Res Ther 12:R97

    PubMed  Article  Google Scholar 

  48. 48.

    Schipper LG, Fransen J, Barrera P et al (2009) Methotrexate therapy in rheumatoid arthritis after failure to sulphasalazine: to switch or to add? Rheumatology 48:1247–1253

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Schneider M, Lelgemann M, Abholz HH et al (2011) Management der frühen rheumatoiden Arthritis. Interdisziplinäre Leitlinie, 3. überarbeitete Aufl. Steinkopf, Darmstadt

  50. 50.

    Schoels M, Wong J, Scott DL et al (2010) Economic aspects of treatment options in rheumatoid arthritis: a systematic review informing the EULAR recommenations for the management of rheumatoid arthritis. Ann Rheum Dis 69:955–1003

    Article  Google Scholar 

  51. 51.

    Sibilia J, Graninger W, Östör A et al (2011) Comparison of tocilizumab as monotherapy or with add-on DMARDs in patients with rheumatoid arthritis and an inadequate response to previous treatments: ACT-SURE results. Ann Rheum Dis 70(Suppl 3):466

    Google Scholar 

  52. 52.

    Smolen JS, Landewe R, Breedveld FC et al (2010) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 69:964–975

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Smolen JS, Fleischmann R, Emery P et al (2011) The OPTIMA study of methotrexate and adalimumab: 78-week outcomes in early rheumatoid arthritis patients based on achieving a low DAS28 target after 26 weeks. Ann Rheum Dis 70(Suppl 3):259

    Article  Google Scholar 

  54. 54.

    Soubrier M, Puéchal X, Sibilia J et al (2009) Evaluation of two strategies (initial methotrexate monotherapy vs its combination with adalimumab) in management of early active rheumatoid arthritis: data from the GUEPARD trial. Rheumatology 48:1429–1434

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Soubrier M, Lukas C, Sibilia J et al (2011) Disease activity score-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis: data from the GUEPARD trial and ESPOIR cohort. Ann Rheum Dis 70:611–615

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    Strangfeld A, Hierse F, Kekow J et al (2009) Comparative effectiveness of tumour necrosis factor alpha inhibitors in combination with either methotrexate or leflunomide. Ann Rheum Dis 68:1856–1862

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Svensson B, Boonen A, Albertsson K et al (2005) Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: a two-year randomized trial. Arthritis Rheum 52:3360–3370

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Tanaka Y, Takeuchi T, Mimori T et al (2010) Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) study. Ann Rheum Dis 69:1286–1291

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Tarner IH, Manger B, Fleck E et al (2009) Evidenzbasierte Empfehlungen einer nationalen Expertenrunde zum Einsatz von Methotrexat bei entzündlich-rheumatischen Erkrankungen. Akt Rheum 34:59–66

    Article  Google Scholar 

  60. 60.

    Tiippana-Kinnunen T, Paimela L, Kautiainen H et al (2010) Can disease-modifying anti-rheumatic drugs be discontinued in long-standing rheumatoid arthritis? A 15-year follow-up. Scand J Rheum 39:12–18

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Todoerti M, Scire CA, Boffini N et al (2010) Early disease control by low-dose prednisone comedication may affect the quality of remission in patients with early rheumatoid arthritis. Ann N Y Acad Sci 1193:139–145

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Tugwell P, Pincus T, Yocum D et al (1995) Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis. The methotrexate-cyclosporine combination study group. N Engl J Med 333:137–141

    PubMed  Article  CAS  Google Scholar 

  63. 63.

    Van den Broek M, Klarenbeek NB, Dirven L et al (2011) Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study. Ann Rheum Dis 70:1389–1394

    Article  Google Scholar 

  64. 64.

    Van der Linden MPM, Le Cessie S, Raza K et al (2010) Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum 62:3537–3546

    Article  Google Scholar 

  65. 65.

    Van Tuyl LHD, Boers M, Lems WF et al (2010) Survival, comorbidities and joint damage 11 years after the COBRA combination therapy trial in early rheumatoid arthritis. Ann Rheum Dis 69:807–812

    Article  Google Scholar 

  66. 66.

    Van der Woude D, Young A, Jayakumar K et al (2009) Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis. Arthritis Rheum 60:2262–2271

    Article  Google Scholar 

  67. 67.

    Van Dongen H, Aken J van, Lard LR et al (2007) Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 56:1424–1432

    Article  Google Scholar 

  68. 68.

    Vermeer M, Kuper IH, Hoekstra M et al (2011) Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the dutch rheumatoid arthritis monitoring remission induction cohort study. Arthritis Rheum 63:2865–2872

    PubMed  Article  Google Scholar 

  69. 69.

    Verschueren P, Esselens G, Westhovens R (2009) Predictors of remission, normalized physical function, and changes in the working situation during follow-up of patients with early rheumatoid arthritis an observational study. Scand J Rheum 38:166–172

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Visser K, Heijde D van der (2009) Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature. Ann Rheum Dis 68:1094–1099

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Visser K, Goekoop-Ruiterman YP, Vries-Bouwstra JK de et al (2010) A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Ann Rheum Dis 69:1333–1337

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Ward MM, Leigh JP, Fries JF (1993) Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care. Arch Intern Med 153:2229–2237

    PubMed  Article  CAS  Google Scholar 

  73. 73.

    Wassenberg S, Rau R, Steinfeld P, Zeidler H (2005) Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum 52:3371–3380

    PubMed  Article  CAS  Google Scholar 

  74. 74.

    Wollenhaupt J, Alten R, Burckhardt H et al (2007) Aktuelle Therapiestrategien bei rheumatoider Arthritis. Entzündung rasch beherrschen ist entscheidend für die Prognose. MMW Fortschritte Medizin 148:38–42

    Google Scholar 

  75. 75.

    Wollenhaupt J, Alten R, Backhaus M et al (2009) Aktualisiertes Therapieschema der Rheumatoiden Arthritis. Ergebnisse eines Konsensusprozesses deutscher Rheumatologen. Akt Rheumatol 34:234–239

    Article  Google Scholar 

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Danksagung

Die wissenschaftliche Mitarbeit von Dr. Katinka Albrecht und der Konsensprozess wurden von der DGRh finanziert mit Unterstützung durch ein „unrestricted grant“ folgender korporativer Mitglieder der DGRh: Abbott GmbH & Co. KG, Chugai Pharma Marketing Ltd., Pfizer Pharma GmbH, Roche Pharma AG, Sanofi-Aventis Deutschland GmbH, UCB Pharma GmbH.

Hinweis

Die Autoren wurden von der DGRh zur Erarbeitung der Leitlinie autorisiert.

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Vortragshonorare von Abbott (K.A.); Beratungstätigkeit, Vortragshonorare, Reisekostenunterstützung und/oder Forschungsunterstützung von Abbott, BMS, GSK, Lilly, Mundipharma, Novartis, Pfizer, Roche, UCB (R.A.);Forschungsunterstützung für Abbott, BMS, Pfizer, Roche, Honorar von Abbott, BMS, MSD, Pfizer, Roche, UCB (M.B.); Forschungsunterstützung, Vortragstätigkeit, Beratertätigkeit: Abbott, Amgen, GSK, Genzyme, MSD, Pfizer, Roche, Shire, Sanofi-Aventis (C.B.); Forschungsunterstützung, Vortragshonorare, Reisekostenunterstützung oder Beratungshonorare von Abbott, BMS, MSD, Pfizer, Roche, UCB (G.B.); Vortragshonorare/Reisekostenübernahmen von Abbott, Amgen, BMS, Chugai, Hexal, Merck, MSD, Mundipharma, Pfizer, Roche, SOBI und UCB (M.G.); E.G-I. gibt an, dass kein Interessenskonflikt besteht; Vortragshonorare, Forschungsgelder Beratertätigkeiten: Abbott, Actelion, Berlin Chemie, BMS, Chugai, GSK/HGS, Medac, Merck, MSD, Pfizer, Roche, Sanofi-Aventis, UCB (J.K.); Honorare für Beratertätigkeit, Vortragshonorare, Reisekostenübernahmen und/oder Forschungsförderung durch: Abbott, BMS, Chugai, MSD, Pfizer, Roche, UCB (A.K.); Vortrags- und/oder Beratungshonorare von: Abbott, BMS, MSD, Mundipharma, Pfizer, UCB, Roche (K.K.); Vortragshonorare, Reisekostenunterstützung oder Beratungshonorare von Abbott, Bristol-Myers Squibb, Chugai, Glaxo Smithkline, Medac, Merck, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB (H.L.); Honorare für Vortrags- und/oder Beratungstätigkeit: Abbott, Berlin-Chemie, BMS, Biomarin, Chugai, Genzyme, GSK, MSD, Novartis, Nycomed, Pfizer, SOBI, UCB (B.M.); Honorar von Abbott, BMS, Chugai, MSD, Pfizer, Roche, UCB (U.M.-L.); Abbott, BMS, Chugai, Essex, Merck, MSD, Mundipharma, Pfizer, Roche, UCB, Wyeth (H.N.); Beratungstätigkeiten und/oder Vortragshonorare von Abbott, BMS, MSD, Pfizer und UCB (H.-G. P.); Forschungsunterstützung von Roche, Chugai und Pfizer, Vorträge und Beratertätigkeit bei Abbott, BMS, Chugai, MSD, Novartis, Pfizer, Roche, UCB (A.R.); Forschungsunterstützung, Vortrags- oder Beratungshonorare von Abbott, Chugai, GSK, MSD, Novartis, Pfizer, Roche, UCB, Wyeth (C.S.); Forschungsunterstützung von Abbott, Pfizer, UCB, Beratertätigkeit bei Abbott, Pfizer, Roche, UCB und Vortragshonorar von Abbott, Chugai, MSD, Pfizer, Roche, UCB (M.S.); Honorare für Vorträge und Beratungen der Firmen Abbott, Actelion, Astra-Zeneca, Biotest, BMS, Chugai, Essex, Gilead, GSK, HGS, MSD, Medac, Merck, Mundai Pharma, Novartis, Nycomed, Savient, Pfizer, Roche, UCB, Wyeth (H.S.-K.); Vorträge, Reisekostenübernahme und Studienunterstützung von Abbott, BMS, Chugai, MSD, Roche (H.P.T.); Honorar von Abbott, BMS, Chugai, MSD, Pfizer, Roche, UCB (J.W.). Vortragshonorar, Beratungstätigkeit von AstraZeneca, MSD (W.B.); Vortragshonorare oder Beratungstätigkeit von Abbott, BMS, Chugai, Roche, UCB (A.G.); Vortragshonorare, Forschungsunterstützung oder Reisekostenübernahme von Abbott, BMS, Chugai, Medac, MSD, Novartis, Pfizer, Roche, UCB (H.K.)

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Diese Leitlinie wird bei der AWMF unter folgender Nr. geführt: 060-004.

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Krüger, K., Wollenhaupt, J., Albrecht, K. et al. S1-Leitlinie der DGRh zur sequenziellen medikamentösen Therapie der rheumatoiden Arthritis 2012. Z. Rheumatol. 71, 592–603 (2012). https://doi.org/10.1007/s00393-012-1038-0

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Schlüsselwörter

  • Rheumatoide Arthritis
  • Medikamentöse Therapie
  • DMARDs
  • Glukokortikoide
  • Biologika

Keywords

  • Rheumatoid arthritis
  • Medical treatment
  • Disease-modifying antirheumatic drugs
  • Glucocorticoids
  • Biological agents