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Zeitschrift für Rheumatologie

, Volume 76, Issue 2, pp 125–132 | Cite as

Neue Optionen für die Praxis

„Update S1/S2-Leitlinie Rheumatoide Arthritis“?
  • M. Schneider
Leitthema

Zusammenfassung

Leitlinien zur medikamentösen Behandlung der rheumatoiden Arthritis leisten einen wesentlichen Beitrag zu einer evidenzbasierten Versorgung der Betroffenen. Die Empfehlungen unterstützen den Behandler bei seiner Entscheidungsfindung, die letztliche Entscheidung sollte aber immer in einer partizipativen Entscheidung gemeinsam von Patient und Arzt getroffen werden. Dieser Prozess wird eher durch grundlegende Konzepte der Leitlinien, wie z. B. „treat-to-target“, gesteuert als durch konkrete Empfehlungen für oder gegen eine bestimmte Substanz(klasse). Dort, wo die Empfehlungen schon sehr konkret sind, wie z. B. für Methotrexat als Ersttherapie, sind diese eher ökonomisch getrieben als evidenzbasiert. Das ist nicht grundsätzlich falsch, sollte allerdings bei der Entscheidungsfindung deutlich werden. Eine differenziertere Empfehlung über Leitlinien benötigt eine bessere Risikostratifizierung für den Einzelnen und eine deutlichere Profilbildung der verschiedenen Substanzen.

Schlüsselwörter

Disease modifying antirheumatic drug Evidenz Medikamente Methotrexat Risikostratifizierung 

New options for the practice

Update S1/S2 guidelines on rheumatoid arthritis?

Abstract

Guidelines are important tools for evidence-based pharmacological treatment of patients suffering from rheumatoid arthritis. Recommendations assist physicians in identifying the best form of treatment but ultimately, the final decision is based on joint participation by the patient and physician. Nowadays, general concepts, such as treat to target seem to be more important in rheumatoid arthritis than differencies between various drugs or drug classes. The universal recommendation to use methotrexate as the initial disease-modifying antirheumatic drug (DMARD) is driven more by economic reasons than by scientific data, which is not completely wrong but should be disclosed. For the future, more differentiated recommendations need better individual risk stratification and more distinct profiling of the different substances.

Keywords

Disease modifying antirheumatic drugs Evidence Pharmaceuticals Methotrexate Risk stratification 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Schneider weist auf folgende Beziehung hin: Beratung und Vorträge für Abbvie, Astra-Zeneca, BMS, Boehringer-Ingelheim, Chugai, Lilly, MSD, Pfizer, Roche, Sanofi-Aventis, UCB. Zudem erhält M. Schneider Forschungsförderung von Abbvie, Chugai und UCB.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Poliklinik und Funktionsbereich für Rheumatologie, Hiller ForschungszentrumHeinrich-Heine-Universität Universitätsklinikum DüsseldorfDüsseldorfDeutschland

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