Zusammenfassung
Es wird eine kurze Übersicht über die niedrig dosierte orale Corticosteroid-Therapie der RA mit 5–7,5 mg Prednisolon täglich unter besondererBerücksichtigung des Einflusses auf die röntgenologische Progression gegeben. In Kurzzeitstudienüber 1–2 Wochen mit Dosen bis zu 15 mg täglich ist Prednison dem Placebo bezüglich Symptombesserung überlegen, nichtsteroidalen Antirheumatika gegenüber aber kaum. Bei einer Therapiedauer von 6–12 Monaten sind Corticosteroide nur wenig wirksamer als Placebo oder NSAR. Eine eindeutige Beeinflussung der röntgenologisch feststellbaren Progression war in früheren Studien mit einer Ausnahme nicht nachweisbar. Die Kirwan-Studie ergab eine signifikante Hemmung der Progression mit 7,5 mg Prednisolon täglich im Vergleich zu Placebo. Die LDPT-Studie ergab für 5 mg Prednisolon in Kombination mit einer Basistherapie mit Gold oder Methotrexat im ersten Jahr der Behandlung eine signifikant stärkere Hemmung der röntgenologisch feststellbaren Progression gegenüber der Basistherapie in Kombination mit Placebo; im zweiten Jahr aber war die Progression in beiden Gruppen vergleichbar. Die Risiken der Steroid-Therapie, u. a. auch als unabhängiger Risikofaktor für eine erhöhte Mortalität, werden diskutiert. Zwei randomisierte Studien und eine Meta-Analyse sprechen für die Induktion einer Steroidosteoporose schon mit kleinen Dosen. Wie bei allen Therapien müssen Nutzen und Risiko gegeneinander abgewogen werden.
Summary
This is a short overview of low dose oral treatment with 5–7.5 mg prednisolone/day in RA with emphasis on radiographic progression. Shortterm studies over 1–2 weeks with 7.5–15 mg prednisolone/day demonstrate advantage over placebo and — less so — over NSAID in improving RA symptoms; over 6–12 months prednisolone seems to be less superior. Older studies were unable to demonstrate an inhibition of progression seen on radiographs. In the Kirwan study, there was a significant inhibition of x-ray progression with 7.5 mg prednisolone/day versus placebo. The German low-dose prednisolone treatment (LDPT) study demonstrated a significant retardation of radiographic progression with only 5 mg prednisolone/day in addition to DMARD treatment with parenteral gold or methotrexate versus DMARD + placebo in early RA during the first year of treatment while there was no difference between both groups during the second year. These data are in favor of a “bridging” treatment with low dose prednisolone. The risks of corticosteroid treatment are discussed, including an increased mortality rate as an independent risk factor. Two randomized studies and a metaanalysis indicate the development of steroid osteoporosis in RA already with low doses. As with every treatment, benefit and risk have to be considered carefully.
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Rau, R. (2002). Einsatz von Glukokortikoiden bei der RA. In: Hein, G., Zeidler, H., Meznerits, I. (eds) Umsetzung neuer Therapien in der rheumatologischen Praxis und Versorgung. Steinkopff. https://doi.org/10.1007/978-3-642-85445-3_12
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DOI: https://doi.org/10.1007/978-3-642-85445-3_12
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