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Vorsorgeuntersuchungen während intensivierter Immunsuppression bei Kindern und Jugendlichen

Teil 1

Screening investigations during intensified immunosuppression in children and adolescents

Part 1

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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

In der Rheumatologie zeigt der zunehmende Einsatz von Kombinationstherapien aus „disease modifying drugs“ (DMARDs) und Biologika auch bei schwer verlaufenden rheumatischen Grunderkrankungen im Kindes- und Jugendalter Erfolge. Diese Strategie steigert jedoch die medikamentenspezifischen infektiologischen Risiken. Zusätzlich bedingen viele Erkrankungen per se bereits ein erhöhtes Infektionsrisiko. Einige Patienten weisen weitere immunologische oder organische Komorbiditäten auf, wie beispielsweise einen Komplementmangel oder eine pulmonale Gerüsterkrankung, wodurch die Infektanfälligkeit zusätzlich steigt. Die hier vorgeschlagene Checkliste mit gezielten apparativen und immunologischen Vorsorgeuntersuchungen basiert auf einer „State-of-the-art-Auswertung“ der verfügbaren Literatur und eigenen Erfahrungen. Sie soll helfen, Risikofaktoren aufzudecken. Eine zusammenfassende Beurteilung von Grunderkrankung, Komorbiditäten und Wirkungsweise der Medikation ermöglicht somit 1) eine individuelle Risikostratifizierung der geplanten Immunsuppression und 2) eine Beurteilung der infektiologischen Gefährdung des Patienten.

Abstract

The increasing use of combination therapies, including disease-modifying antirheumatic drugs (DMARD) and biologicals has improved the outcome for children and adolescents in several rheumatic diseases. However, this strategy has increased the risk of drug-specific side-effects, such as an increased risk of infections. Furthermore, the underlying rheumatic disease itself often includes an increased risk of infections and some patients additionally present with immunological or organic comorbidities (e.g. complement deficiency and interstitial pulmonary disease) further increasing the susceptibility to infections. The presented review is based on an analysis of the currently available literature proposing a checklist of diagnostic procedures and immunological laboratory tests specific for the detection of patients prone to infections. The combined stratification of the underlying disease, comorbidities and the immunological mechanisms of the medication enables (1) an individual risk stratification of planned immunosuppressive therapy and (2) a prediction of the risks of infection for the patient.

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Authors and Affiliations

  1. Deutschen Zentrum für Kinder- und Jugendrheumatologie (DZKJR), Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland

    F. Speth &  J.-P. Haas

  2. MVZ Labor Dr. Gärtner & Kollegen, Ravensburg, Deutschland

    N. Wellinghausen

  3. Gesellschaft für Kinder- und Jugendrheumatologie (GKJR), Berlin, Deutschland

    J.-P. Haas

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  1. F. Speth
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  2. N. Wellinghausen
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  3. J.-P. Haas
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Correspondence to F. Speth or J.-P. Haas.

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Speth, F., Wellinghausen, N. & Haas, JP. Vorsorgeuntersuchungen während intensivierter Immunsuppression bei Kindern und Jugendlichen. Z. Rheumatol. 72, 814–821 (2013). https://doi.org/10.1007/s00393-013-1200-3

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  • DOI: https://doi.org/10.1007/s00393-013-1200-3

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