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Rheumatoide Arthritis (RA)

Zuletzt revidiert:
Zuletzt revidiert von:
Definition:
Entzündliche Systemerkrankung mit vorwiegendem Befall von Gelenken und anderen Strukturen des Bewegungssystems. Leitbefund ist eine überwiegend symmetrische Arthritis.
Häufigkeit:
In Deutschland liegt die Prävalenz bei 0,5–1 % der erwachsenen Bevölkerung.
Symptome:
Die typischen Symptome sind Schmerz, Schwellung und Morgensteifigkeit. Initial vor allem im Bereich kleiner Gelenke, es können aber auch große Gelenke betroffen sein. Häufig liegen auch Allgemeinsymptome vor (Abgeschlagenheit, Appetitlosigkeit, leichtes Fieber).
Befunde:
Sichtbare Schwellung typischerweise der Hand-, Fingergrund- und Fingermittelgelenke sowie der Zehengrundgelenke. Prall-elastisch bei Palpation. Druckschmerzhaftigkeit der Gelenke.
Diagnostik:
Die Diagnosestellung beruht auf Anamnese, klinischem Befund und Labor (BSG, CRP, Rheumafaktor, evtl. auch ACPA).
Therapie:
Medikamentöse Therapie mit Basistherapeutika, initial auch Glukokortikoide. Primäres Basistherapeutikum ist Methotrexat. Je nach Verlauf kommen auch Biologika wie TNF-Alpha-Inhibitoren zum Einsatz. Ergänzung durch unterstützende Maßnahmen wie Physiotherapie.
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  • Deutsche Gesellschaft für Rheumatologie. S3-Leitlinie Management der frühen rheumatoiden Arthritis. AWMF-Leitlinie Nr. 060-002, Stand 2019. register.awmf.org 
  • Dachverband Osteologie e. V. (DVO). Prophylaxe, Diagnostik und Therapie der Osteoporose. Leitlinie des Dachverbands der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften e. V. Stand 2017. www.dv-osteologie.org
     
  • European League Against Rheumatism (EULAR): Recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. www.bmj.com 
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  • Michael Handke, Prof. Dr. med., Facharzt für Innere Medizin, Freiburg
  • Günther Egidi, Dr. med., Arzt für Allgemeinmedizin, Bremen (Review)