RESUMO
Polymyalgia rheumatica (PMR) occurs almost exclusively in persons aged 50 years or older and it is the second most common inflammatory rheumatic disease in older people after rheumatoid arthritis. Since there are no specific tests for PMR, the exclusion of clinically similar differential diagnoses is essential to ascertain the diagnosis. These recommendations for the management of PMR assume an already established diagnosis of PMR. It is recommended to initiate treatment with glucocorticoids immediately after diagnosis and to provide appropriate patient information and education about the impact of the disease and its treatment. Methotrexate should be considered in patients at high risk for relapse and/or glucocorticoid-related adverse events. These guidelines have been elaborated because there is significant heterogeneity in the management of PMR in clinical practice in Germany (but also Europe and worldwide), despite the large number of patients with this disease. These guidelines are primarily based on the 2015 EULAR-ACR recommendations for the management of PMR, which were updated by the guideline committee and adapted to the German speaking countries.
Assuntos
Glucocorticoides , Polimialgia Reumática , Idoso , Idoso de 80 Anos ou mais , Áustria , Europa (Continente) , Alemanha , Glucocorticoides/uso terapêutico , Humanos , Pessoa de Meia-Idade , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/terapia , ReumatologiaRESUMO
An appropriate treatment of elderly rheumatic patients implements comprehensive diagnostics and exclusion diagnostics of e.g. coronary heart disease, osteoporosis, renal failure, diabetes mellitus type 2 and thyroid gland dysfunction. Furthermore, the complex disease situation might require the integration of other faculties or might be a reason for inpatient treatment. The complexity in the treatment of multimorbid elderly patients suffering from rheumatism not only rises with increasing age but also constitutes a considerable challenge due to existing incapacities and preceding as well as currently performed immunosuppressive therapies. The necessary treatment framework is outlined from the perspective of rheumatologists and geriatricians. Typical geriatric symptoms, such as malnutrition, immobility and frailty might be enhanced if multimorbidity is simultaneously present.
Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Avaliação Geriátrica/métodos , Nefropatias/diagnóstico , Nefropatias/terapia , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Feminino , Humanos , Nefropatias/complicações , Masculino , Doenças Reumáticas/complicaçõesRESUMO
While diseases, such as cardiovascular diseases and osteoporosis in the elderly are categorized as comorbidities of rheumatoid arthritis, elderly rheumatic patients are often additionally affected by thyroid dysfunctions and diabetes mellitus type 2, so that the risk of multimorbidity (coexistence of at least two chronic and/or acute diseases) will increase significantly in elderly patients already suffering from systemic rheumatic diseases. Restricted cognition, adherence or compliance may additionally complicate the treatment of elderly rheumatic patients. Furthermore, the pharmacokinetics of the elderly is another challenging task. Referring to selected aspects of geriatric pharmacotherapy, the use of certain substance classes is described in this context.
Assuntos
Doenças Cardiovasculares/terapia , Diabetes Mellitus Tipo 2/terapia , Nefropatias/terapia , Osteoporose/terapia , Doenças Reumáticas/terapia , Doenças da Glândula Tireoide/terapia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Avaliação Geriátrica/métodos , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/diagnósticoAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Crônica/tratamento farmacológico , Fatores Etários , Idoso , Artrite Reumatoide/tratamento farmacológico , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Contraindicações , Humanos , Falência Renal Crônica/induzido quimicamente , Falência Renal Crônica/prevenção & controle , Osteoartrite/tratamento farmacológico , Úlcera Péptica/induzido quimicamente , Úlcera Péptica/prevenção & controle , RiscoRESUMO
Osteoarthritis (OA) is the most common cause of functional disability in the elderly. Pain and loss of motion induce a vicious circle, leading to instability, frailty and ultimately invalidity. Currently, there is no treatment to reverse or slow the disease progression to a clinically meaningful extent. Thus, the primary goal of OA treatment in the elderly is pain relief and preservation of joint function. For this, pharmacological, non-pharmacological and if necessary surgical treatment regimes must form an integrated concept. However, the real challenge is polymorbidity and other age-related or age-associated factors, which influence the course of disease and its therapy unfavorably. The changes in pharmacokinetics and -dynamics in the elderly can be compensated for the nonopioid and opioid-analgesics by the well known "start low, go slow" approach. More problematic are non-steroidal anti-inflammatory drugs (NSAIDs), which are most often used for symptomatic treatment of OA: Patients over 65 have an enhanced susceptibility to the gastrointestinal and renal side effects of NSAIDs; all NSAIDs, not only coxibs, increase the cardiovascular risk in patients with such a disease; number and severity of drug interactions is elevated due to age-associated polypharmacy. Thus, NSAIDs, including coxibs, should be used with great caution for treatment of OA in the elderly.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Artralgia/prevenção & controle , Geriatria/métodos , Osteoartrite/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Artralgia/etiologia , Humanos , Osteoartrite/complicações , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Resultado do TratamentoRESUMO
In a randomized, double blind parallel group comparison the antiphlogistic and analgetic efficacy of high-dosed vitamin E (3 x 400 mg RRR-alpha-Tocopherolacetat/d) versus diclofenac-sodium has been investigated in hospitalized patients with established chronic rheumatoid arthritis. After 3 weeks of treatment the vitamin E group (n = 42) as well as the diclofenac group (n = 43) showed a significant improvement of all assessed clinical parameters. Duration of morning stiffness could be reduced under vitamin E treatment from 90 min to 68 min and under diclofenac treatment from 68 min to 30 min. The joint index according to Richie declined from 56 to 46 (vitamin E) and 49 to 34 (diclofenac). Grip strength increased in the vitamin E group as well as in the diclofenac group. In addition, the degree of pain, assessed by a 10 cm visual analogue scale, reduced significantly under vitamin E as well as under diclofenac. Regarding the therapeutical result both, physicians and patients, considered both drugs to be similarly effective. Especially regarding the risk profile of NSAR in long-term treatment of chronic rheumatoid arthritis intake of high-dosed vitamin E is a possible alternative in the treatment of inflammatory rheumatoid diseases.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antioxidantes/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Diclofenaco/uso terapêutico , Vitamina E/uso terapêutico , Adulto , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Antioxidantes/efeitos adversos , Artrite Reumatoide/diagnóstico , Diclofenaco/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vitamina E/efeitos adversosRESUMO
Cat scratch disease (CSD) is a rarely recognized infectious disease in Germany. Only a few years ago the causative agent, Bartonella henselae, could be isolated. The typical clinical manifestations of CSD consist of skin changes at the inoculation site and a benign lymphadenopathy; other manifestations are rare. We report the case of a 47 year old woman, who developed a reactive spondylarthropathy with synovitis of finger joints, polyarthralgias of large- and medium-sized joints, and inflammatory spinal pain after a cat bite. The rheumatic manifestations resolved after 10 months by treatment with non-steroidal antirheumatic drugs. Only a few cases of rheumatic manifestations associated with CSD have been described in the literature. Because the prevalence of Bartonella henselae infection of cats is high in Europe, rheumatic manifestations might be more frequent. Diagnosis of CSD is now improved by the development of serological tests. We provide an overview of the clinical manifestations and the diagnostic criteria.