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DOI: 10.1055/s-2002-34005
Infektionen des Bewegungsapparates bei der chronischen Polyarthritis während einer Kombinationstherapie mit Methotrexat und Leflunomid
Infections of the musculoskeletal system with chronic polyarthritis during a combination therapy with Methotrexate and LeflunomidePublikationsverlauf
Publikationsdatum:
12. September 2002 (online)
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Zusammenfassung
Ziel: Die Langzeitergebnisse bei der rheumatoiden Arthritis sind trotz der Mono- oder Kombinationstherapie mit herkömmlichen „Basistherapeutika” unbefriedigend. In der jüngeren Vergangenheit erfolgt daher häufiger der Einsatz einer Kombinationsbehandlung von Methotrexat mit dem, 1999 in Deutschland eingeführten, Leflunomid. In welchem Ausmaß die perioperative Infektionsrate durch die einzelnen immunmodulierenden Medikamente beeinflusst wird, ist bis heute umstritten und sollte anhand des rheumaorthopädischen Patientenkollektives einer orthopädischen Universitätsklinik quantifiziert werden. Methode: Die klinischen Verläufe von Patienten, die sich seit Einführung des Leflunomids einer operativen Behandlung in der orthopädischen Klinik unterzogen, wurden dokumentiert und hinsichtlich perioperativer Infektionen ausgewertet. Ergebnisse: Von 16 Patienten, die während des Zeitraumes von 1,5 Jahren unter einer Kombinationstherapie von MTX/Leflunomid beobachtet wurden, wiesen drei eine schwere Infektion des Bewegungsapparates auf. Schlussfolgerung: Die Kombination der beiden o. g. Medikamente führt zu einer Modulation verschiedener pathophysiologischer Prozesse. Synergistische Effekte in der Therapie aber auch bezüglich der Nebenwirkungen können hierdurch erwartet werden. Erste vorliegende Berichte über diese Kombinationstherapie weisen nicht auf ein erhöhtes Infektionsrisiko hin. Die Beobachtung von drei schwerwiegenden Infektionen unter dieser Kombinationstherapie gibt jedoch Anlass, auf das Risiko aufmerksam zu machen. Insbesondere bei infektionsanfälligen knochenchirurgischen Operationen sollte die Indikation für eine derartige Kombination immunmodulierender Medikamente zurückhaltend gestellt werden. Die aktuell zur Verfügung stehende Literatur wird diskutiert.
Abstract
Aim: The long-term results of rheumatoid arthritis are unsatisfactory despite the mono or combination therapy of conventional “disease-modifying antirheumatic drugs”. Therefore in the recent past the administration of a combination of Methotrexate with Leflunomide takes place more frequently. To what extent the perioperative infection rate is influenced by the individual immune-modulating drugs, is still disputed and should quantified on the basis the rheumatism orthopaedic patient collective of an orthopaedic university clinic. Method: The clinical progresses of patients after operative treatment in the orthopaedic hospital, since introduction of the Leflunomide, were evaluated with regard to perioperative infection. Results: Of 16 patients, who were observed during a period of 1,5 years under a combination therapy by MTX/Leflunomide, three exhibited a heavy infection of the musculoskeletal system. Conclusion: The combination of the two above mentioned drugs affects different pathophysiological processes. Synergistic effects in therapy but also with regard to side effects must be expected. First available reports on this combination therapy do not refer to a increased infection/risk. The observation of three serious infections under the combination MTX/Leflunomide prompted us to call attention to this risk. In particular with infection-susceptible bone-surgical operations such a combination of immune-modulating medicines should be employed with caution. The recent literature is discussed.
Schlüsselwörter
Rheumatoide Arthritis - Methotrexat - Leflunomid - Kombinationstherapie - Infektion
Key words
Rheumatoid arthritis - methotrexate - leflunomide - combination therapy - infection
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Dr. med. K.-S. Delank
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