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Rheumatoide Arthritis (RA)

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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.
  • Deutsche Gesellschaft für Rheumatologie. Therapie der rheumatoiden Arthritis mit krankheitsmodifizierenden Medikamenten. AWMF-Nr. 060-004. S2e, Stand 2018. www.awmf.org 
  • Deutsche Gesellschaft für Rheumatologie. Management der frühen rheumatoiden Arthritis. AWMF-Nr. 060-002. S3, Stand 2019. www.awmf.org 
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  • European League Against Rheumatism (EULAR): Recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 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)