Rheumatoide Arthritis – T2T (treat to target)

Das erreichbare Ziel der Behandlung der Rheumatoiden Arthritis ist die Remission, bei langjährigen Verläufen eine niedrige Krankheitsaktivität. Engmaschige, 3-monatliche Kontrollen durch den internistischen Rheumatologen mit Erfassung der Krankheitsaktivität und Folgen und Adaptation der antirheumatischen Langzeittherapie im Konsens mit dem Patienten sind dafür notwendig. Methotrexat und niedrig dosierte Steroide sind die zentralen hierfür genutzten Medikamente. Auch schwere Verläufe sind durch Hinzunahme sog. Biologika beherrschbar. Bei stabil remittierter Erkrankung ist eine kontrollierte Therapiedeeskalation möglich.

Remission is a realistic target in Rheumatoid Arthritis therapy, in long standing disease low disease activity is appropriate. Disease activity and consequence should be measured 3-monthly and therapy has to be adapted consequently by the rheumatologist consensual with the patient. Methotrexate and low dose steroids are the therapeutic anchor. In severe disease biologics play a major role. Treatment de-escalation is possible, when remission is reached, but should be monitored adequately.

Key words

Rheumatoid Arthritis - treat to target - remission - therapy

• Literatur

• 1 Smolen JS, Aletaha D, Bijlsma JWJ et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-637
• 2 Symmons DPM. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol 2002; 16: 707-722
• 3 Abdel-Nasser AM, Rasker JJ, Valkenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum 1997; 27: 123-140
• 4 Young A, Dixey J, Cox N et al. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS). Rheumatology (Oxford) 2000; 39: 603-611
• 5 Crowson CS, Liang KP, Therneau TM et al. Could Accelerated Aging Explain the Excess Mortality in Patients With Seropositive Rheumatoid Arthritis?. Arthritis Rheum 2010; 62: 378-382
• 6 Radovits BJ, Fransen J, Al Shamma S. Excess Mortality Emerges After 10 Years in an Inception Cohort of Early Rheumatoid Arthritis. Arthritis Care Res 2010; 62: 362-370
• 7 Wolfe F, Michaud K, Gefeller O, Choi HK. Predicting Mortality in Patients With Rheumatoid Arthritis. Arthritis Rheum 2003; 48: 1530-1542
• 8 The Research Sub-Committee of the Empire Rheumatism Council. Gold therapy in rheumatoid arthritis. Report of a multi-centre controlled trial. Ann Rheum Dis 1960; 19: 95-119
• 9 Choi HK, Hernan MA, Seeger JD et al. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 2002; 359: 1173-1177
• 10 Rath R, Sander O, Rubbert A. Conventional Disease-Modifying Antirheumatic Drugs to Treat Rheumatoid Arthritis. Drug Development Research 2011; 72: 657-663
• 11 Allaart CF, Breedveld FC, Dijkmans BA. Treatment of recent-onset rheumatoid arthritis: lessons from the BeSt study. J Rheumatol Suppl 2007; 80: 25-33
• 12 Pincus T, Stein CM. ACR 20: clinical or statistical significance?. Arthritis Rheum 1999; 42: 1572-1576
• 13 Young A, Dixey J, Cox N et al. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS). Rheumatology (Oxford) 2000; 39: 603-611
• 14 Felson DT, Smolen JS, Wells G et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 2011; 70: 404-413
• 15 Puolakka K, Kautiainen H, Pohjolainen T et al. (2010) No increased mortality in incident cases of rheumatoid arthritis during the new millennium. Ann Rheum Dis 2010; 69: 2057-2058
• 16 Smolen JS, Landewé R, Breedveld FC et al. Ann Rheum Dis 2010; 69: 964-975