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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-Leitlinie Nr. 060-004. S2e, Stand 2018. www.awmf.org 
  • Deutsche Gesellschaft für Rheumatologie. Management der frühen rheumatoiden Arthritis. AWMF-Leitlinie Nr. 060-002. S3, Stand 2019. www.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: 2016 update. www.bmj.com 
  1. Fiehn C - Deutsche Gesellschaft für Innere Medizin. Rheumatoide Arthritis. e.Medpedia, Zugriff 11.07.20. www.springermedizin.de  
  2. Schneider M, Baseler G, Funken O, et al. Management der frühen rheumatoiden Arthritis - Interdisziplinäre Leitlinie. Z Rheumatol 2020; 79(Suppl 1): S1–S38. doi:10.1007/s00393-020-00775-6 DOI  
  3. Deutsche Gesellschaft für Rheumatologie. Rheuma in Zahlen. Betroffene Menschen in Deutschland. dgrh.de  
  4. Balsa A, Cabezón A, Orozco G, et al.. Influence of HLA DRB1 alleles in the susceptibility of rheumatoid arthritis and the regulation of antibodies against citrullinated proteins and rheumatoid factor. Arthritis Res Ther 2010; 12: 62. www.ncbi.nlm.nih.gov  
  5. McClure A, Lunt M, Eyre S, et al. Investigating the viability of genetic screening/testing for RA susceptibility using combinations of five confirmed risk loci. Rheumatology (Oxford) 2009; 48: 1369-74. PubMed  
  6. Schett G, Firestein GS. Mr Outside and Mr Inside: classic and alternative views on the pathogenesis of rheumatoid arthritis. Ann Rheum Dis 2010; 69: 787-9. PubMed  
  7. Miossec P, Korn T, Kuchroo VK. Interleukin-17 and type 17 helper T cells. N Engl J Med 2009; 361: 888-98. PubMed  
  8. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med 2010; 365: 2205-19. PubMed  
  9. McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol 2007; 7: 429-42. PubMed  
  10. MacGregor AJ, Snieder H, Rigby AS, et al. Characterizing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis Rheum 2000; 43: 30-7. PubMed  
  11. Costenbader KH, Feskanich D, Mandl LA, Karlson EW. Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. Am J Med 2006; 119: 503 e1-9. www.ncbi.nlm.nih.gov  
  12. Bang SY, Lee KH, Cho SK, et al. Smoking increases rheumatoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody status. Arthritis Rheum 2010; 62: 369-77. PubMed  
  13. Karlson EW, Mandl LA, Hankinson SE, et al. Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses' Health Study. Arthritis Rheum 2004; 50: 3458-467. PubMed  
  14. Mikuls TR, Payne JB, Reinhardt RA, et al. Antibody responses to Porphyromonas gingivalis (P. gingivalis) in subjects with rheumatoid arthritis and periodontitis. Int Immunopharmacol 2009; 9: 38-42. PubMed  
  15. Rantapää-Dahlqvist S, de Jong BA, Berglin E, et al. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum 2003; 48: 2741-9. PubMed  
  16. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588 ard.bmj.com  
  17. Winking M. Die rheumatische Wirbelsäule. J Neurol Neurochir Psychiatr 2014; 15: 82-88. www.kup.at  
  18. Baerwald C, Kneitz C, Bach M, et al. Extraartikuläre  Manifestationen  der  rheumatoiden  Arthritis. Z Rheumatol 2012; 71: 841–849. doi:10.1007/s00393-011-0928-x DOI  
  19. Wilson A, Yu HT, Goodnough LT, et al. Prevalence and outcomes of anemia in rheumatoid arthritis. Am J Med 2004; 116(suppl 7A): 50S-57S. www.ncbi.nlm.nih.gov  
  20. Fiehn C, Herzer P, Holle J, et al. Klug entscheiden: . . . in der Rheumatologie. Dtsch Arztebl 2016; 113: A-1154. www.aerzteblatt.de  
  21. Nielsen SF, Bojesen SE, Schnohr P, Nordestgaard BG. Elevated rheumatoid factor and long term risk of rheumatoid arthritis: a prospective cohort study. BMJ 2012; 345: e5244. doi:10.1136/bmj.e5244 DOI  
  22. Nishimura K, Sugiyama D, Kogata Y et al. Meta-analysis: Diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 2007; 146: 797-808. PubMed  
  23. Payet J, Goulvestre C, Biale L, et al. Anticyclic Citrullinated Peptide Antibodies in Rheumatoid and Nonrheumatoid Rheumatic Disorders: Experience with 1162 Patients. J Rheumatol. 2014 Oct 1. pii: jrheum.131375. PMID: 25274898. PubMed  
  24. Ford JA, Marshall AA, Liu X, et al. Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to Rheumatoid Arthritis in Clinically Tested Cyclic Citrullinated Peptide Antibody–Positive Patients Without Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019; 71: 1583-92. pmid:30570827. pubmed.ncbi.nlm.nih.gov  
  25. Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66: 34-45. PubMed  
  26. Fiehn C, Holle J, Iking-Konert C, et al. für die Deutsche Gesellschaft für Rheumatologie. Leitline Therapie der rheumatoiden Arthritis mit krankheitsmodifizierenden Medikamenten. AWMF-Nr. 060-004. Stand 2018. www.awmf.org  
  27. Stoffer M, Schoels M, Smolen J, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update . Ann Rheum Dis 2016; 75: 16-22. doi:10.1136/annrheumdis-2015-207526 DOI  
  28. Ärztezeitung online. Treat-to-Target-Prinzip ist bei RA Behandlungsstrategie der Wahl. 12.07.17, Zugriff 25.11.19. www.aerztezeitung.de  
  29. Smolen J, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017; 76: 960–977. doi:10.1136/ annrheumdis-2016-210715 www.ncbi.nlm.nih.gov  
  30. arznei-telegramm. ERHÖHTES KREBSRISIKO UNTER JAK-HEMMER TOFACITINIB (XELJANZ). a-t 2021; 52: 15-6. www.arznei-telegramm.de  
  31. Mottonen T, Hannonen P, Korpela M, Nissila M, Kautiainen H, Ilosen J, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 2002; 46: 894-8. PubMed  
  32. Boers M. Rheumatoid arthritis. Treatment of early disease. Rheum Dis Clin North Am 2001; 27: 405-14,x. www.ncbi.nlm.nih.gov  
  33. Donahue KE, Gartlehner G, Jonas DE, et al. Systematic review: Comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med 2008; 148: 124-34. PubMed  
  34. Nam JL, Ramiro S, Gaujoux-Viala C, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2014;73:516-28. doi: 10.1136/annrheumdis-2013-204577 DOI  
  35. Verschueren P, de Cock D, Corluy L et al. Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial. Ann Rheum Dis. 2014 doi: 10.1136/annrheumdis-2014-205489. www.ncbi.nlm.nih.gov  
  36. Scott DL, Ibrahim F, Farewell V, et al. Tumour necrosis factor inhibitors versus combination intensive therapy with conventional disease modifying anti-rheumatic drugs in established rheumatoid arthritis: TACIT non-inferiority randomised controlled trial. BMJ 2015; 350: h1046. doi:10.1136/bmj.h1046 DOI  
  37. O'Dell JR, Mikulus TR, Taylor TH, et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med 2013. doi:10.1056/NEJMoa1303006 DOI  
  38. Lopez-Olivo MA, Siddhanamatha HR, Shea B, Tugwell P, Wells GA, Suarez-Almazor ME. Methotrexate for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD000957. DOI: 10.1002/14651858.CD000957.pub2 DOI  
  39. Emery P, Breedveld FC, Hall S, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet 2008; 372: 375-82. PubMed  
  40. Lopez-Olivo MA, Siddhanamatha HR, Shea B, et al. Methotrexate for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2014;6:CD000957. doi: 10.1002/14651858.CD000957.pub2 DOI  
  41. Shea B, Swinden MV, Tanjong Ghogomu E, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000951. DOI: 10.1002/14651858.CD000951.pub2 DOI  
  42. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med 2004; 350: 2167-79. PubMed  
  43. Scott DL. Leflunomide improves quality of life in Rheumatoid Arthritis. Scand J Rheumatol 1999; suppl.112:23-9. www.ncbi.nlm.nih.gov  
  44. Suarez-Almazor ME, Belseck E, Shea B, Homik J, Wells GA, Tugwell P. Antimalarials for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD000959. DOI: 10.1002/14651858.CD000959. DOI  
  45. Kirwan JR, Bijlsma JWJ, Boers M, Shea B. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006356. DOI: 10.1002/14651858.CD006356. DOI  
  46. 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  
  47. Leumbruno JP, Einarson TR, Keystone EC. The safety of anti-tumour necrosis factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse events. Ann Rheum Dis 2009; 68: 1136-45. PubMed  
  48. Singh JA, Cameron C, Noorbaloochi S, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet 2015. doi: 10.1016/S0140-6736(14)61704-9. DOI  
  49. Ramiro S, Sepriano A, Chatzidionysiou K, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 2017; 76(6): 1101-1136. pmid:28298374 PubMed  
  50. Førre Ø, Haugen M, Hassfeldt WG. New treatment possibilities in rheumatoid arthritis. Scand J Rheumatol 2000;29:73-84. PubMed  
  51. Michaud TLRho YHShamliyan TKuntz KMChoi HK. The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med. 2014 Dec;127(12):1208-32 . doi:10.1016/j.amjmed.2014.06.012 DOI  
  52. Askling J, Fahrbach K, Nordstrom B, et al. Cancer risk with tumor necrosis factor alpha (TNF) inhibitors: meta-analysis of randomized controlled trials of adalimumab, etanercept, and infliximab using patient level data. Pharmacoepidemiol Drug Saf 2011; 20:119-30. PubMed  
  53. Diel R, Hauer B, Loddenkemper R, et al. Empfehlungen für das Tuberkulosescreening vor Gabe von TNF-α-Inhibitoren bei rheumatischen Erkrankungen. Pneumologie 2009; 63: 329-334. doi:10.1055/s-0029-1214673 DOI  
  54. Lethaby A, Lopez-Olivo MA, Maxwell LJ, Burls A, Tugwell P, Wells GA. Etanercept for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD004525. DOI: 10.1002/14651858.CD004525.pub2. DOI  
  55. Paul Emery, Mohammed Hammoudeh, Oliver FitzGerald, et al. Sustained Remission with Etanercept Tapering in Early Rheumatoid Arthritis. NJEM 2014; 371: 1781-92. doi:10.1056/NEJMoa1316133 DOI  
  56. Weinblatt ME, Westhovens R, Mendelsohn AM, et al. Radiographic benefit and maintenance of clinical benefit with intravenous golimumab therapy in patients with active rheumatoid arthritis despite methotrexate therapy: results up to 1 year of the phase 3, randomised, multicentre, double blind, placebo controlled GO-FURTHER trial. Ann Rheum Dis 2013 Sep 3 www.ncbi.nlm.nih.gov  
  57. Smolen JS, Emery P, Fleischmann R, et al. Adjustment of therapy in rheumatoid arthritits on the basis of achievement of stable low disease activity with adalimumab plus methotrexate og methotrexate alone, the randomised controlled OPTIMA trial. Lancet 2013. doi:10.1016/S0140-6736(13)61751-1 DOI  
  58. Deutsche Gesellschaft für Rheumatologie. Empfehlungen zum Einsatz von Abatacept bei Patienten mit rheumatoider Arthritis. Stand 2015. dgrh.de  
  59. Arznei-Telegramm: Nebenwirkungen. TOCILIZUMAB (ROACTEMRA): SCHWERE LEBERSCHÄDIGUNG. a-t 7/2019b. www.arznei-telegramm.de  
  60. Nuki G, Breshnihan B, Bear MB, McCabe D. Long-term safety and maintenance of clinical improvement following treatment with anakinra (recombinant human interleukin-1 receptor antagonist) in patients with rheumatoid arthritis: extension phase of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2002; 46: 2838-46. PubMed  
  61. Lopez-Olivo MA, Amezaga Urruela M, McGahan L, Pollono EN, Suarez-Almazor ME. Rituximab for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD007356. DOI: 10.1002/14651858.CD007356.pub2 DOI  
  62. Deutsche Gesellschaft für Rheumatologie. Empfehlungen zum Einsatz von Rituximab bei Patienten mit rheumatoider Arthritis. Stand 2014. dgrh.de  
  63. Emery P, Deodhar A, Rigby WF, et al. Efficacy and safety of different doses and retreatment of rituximab: A randomised, placebo-controlled trial in patients who are biological naive with active rheumatoid arthritis and an inadequate response to methotrexate (study evaluating rituximab's efficacy in mtx inadequate responders (serene)). Ann Rheum Dis 2010; 69: 1629-35. PubMed  
  64. Perrot S, Javier RM, Marty M, Le Jeunne C, Laroche F; CEDR (Cercle d'Etude de la Douleur en Rhumatologie France), French Rheumatological Society, Pain Study Section. Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies. Rheumatology 2008; 47: 1117-23. pubmed.ncbi.nlm.nih.gov  
  65. Hurkmans E, van der Giesen FJ, Vliet Vlieland TPM, Schoones J, Van den Ende ECHM. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006853. DOI: 10.1002/14651858.CD006853.pub2. DOI  
  66. Brodin N, Eurenius E, Jensen I, et al. Coaching patients with early rheumatoid arthritis to healthy physical activity. Arthritis Rheum 2008; 59: 325-31. PubMed  
  67. Baillet A, Payraud E, Niderprim VA, et al. A dynamic exercise programme to improve patients' disability in rheumatoid arthritis: a prospective randomized controlled trial. Rheumatology (Oxford) 2009; 48: 410-15. PubMed  
  68. Durcan L, Wilson F, Cunnane G. The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study. J Rheumatol. 2014 Aug 15. pii: jrheum.131282 www.ncbi.nlm.nih.gov  
  69. Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, et al. Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis. Arthritis Care Res (Hoboken) 2015; 67: 1054-62. doi:10.1002/acr.22561 DOI  
  70. Stolt P, et al. Quantification of the influence of cigarette smoking on rheumatoid arthritis: results from a population based case-control study, using incident cases. Ann Rheum Dis 2003; 62: 835-41. PubMed  
  71. Westhoff G, Rau R, Zink A. Rheumatoid arthritis patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group. Rheumatology 2008; 47: 849-54. pubmed.ncbi.nlm.nih.gov  
  72. Mattey DL, Brownfield A, Dawes PT. Relationship between pack-year history of smoking and response to tumor necrosis factor antagonists in patients with rheumatoid arthritis. J Rheumatol 2009; 36: 1180-7. PubMed  
  73. Gonzalez A, Maradit Kremers H, Crowson CS, et al. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients?. Ann Rheum Dis 2008; 67: 64-9. PubMed  
  74. Riemsma RP, Kirwan JR, Taal E, Rasker HJJ. Patient education for adults with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003688. DOI: 10.1002/14651858.CD003688 DOI  
  75. Welch V, Brosseau L, Casimiro L, Judd M, Shea B, Tugwell P, Wells GA. Thermotherapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002826. www.cochrane.org  
  76. Egan M, Brosseau L, Farmer M, Ouimet MA, Rees S, Tugwell P, Wells GA. Splints and Orthosis for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD004018. DOI: 10.1002/14651858.CD004018 DOI  
  77. Goldacker S, Gause A, Warnatz K. Impfung bei erwachsenen Patienten mit chronisch entzündlichen rheumatischen Erkrankungen. Z Rheumatol 2013; 72: 690-704. doi:10.1007/s00393-013-1155-4 DOI  
  78. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD002948. DOI: 10.1002/14651858.CD002948.pub2 DOI  
  79. Kassenärztliche Bundesvereinigung (KBV). DMP künftig auch für Behandlung rheumatoider Arthritis. 25.03.21. Zugriff 08.12.22. www.kbv.de  
  80. Gemeinsamer Bundesausschuss (G-BA). DMP Rheumatoide Arthrits. Beschluss 18.03.21. www.g-ba.de  
  81. Lindhardsen J, Ahlehoff O, Gislason GH, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 2011; 70: 929-34. PubMed  
  82. Roubille C, Richer V, Starnino T, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2015; 74: 480-9. doi: 10.1136/annrheumdis-2014-206624 DOI  
  83. Rubbert-Roth A, Bittenbring J, Assmann G. Lymphome bei rheumatischen Erkrankungen. Z Rheumatol 2017; 76: 46-56. doi:10.1007/s00393-017-0383-4 DOI  
  84. Turesson C, O'Fallon WM, Crowson CS, et al. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 2003; 62:722-7. PubMed  
  85. Chung CP, Sokka T, Arbogast PG, Pincus T. Work disability in early rheumatoid arthritis: higher rates but better clinical status in Finland compared with the US. Ann Rheum Dis. 2006; 65: 1653-7. PubMed  
  86. Reinhold-Keller E. Rheumatoide Arthritis (RA): Frühe Diagnose und Therapie sind entscheidend. Arzneiverordnung in der Praxis 2016; 43: 137-143. www.akdae.de  
  87. Meune C, Touze E, Trinquart L, et al. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 2009; 48: 1309-13. www.ncbi.nlm.nih.gov  
  88. Deutsche Gesellschaft für Rheumatologie. Management der frühen rheumatoiden Arthritis. AWMF-Leitlinie 060-002. Stand 2011. www.leitliniensekretariat.de  
  89. Anderson J, Liron C, Yazdany J, et al. Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice. Arthritis Care & Research 640-647; 64: 2012. doi:10.1002/acr.21649 DOI  
  • Michael Handke, Prof. Dr. med., Facharzt für Innere Medizin, Freiburg
  • Günther Egidi, Dr. med., Arzt für Allgemeinmedizin, Bremen (Review)