Zusammenfassung
Glukokortikoide (GC) zählen zu den effektivsten und am häufigsten in der Rheumatologie angewandten Medikamenten. Der Einsatz ist jedoch limitiert durch ihr Potenzial, häufig und manchmal erhebliche Nebenwirkungen auszulösen. Sie vermitteln ihre Wirkungen sowohl rezeptorvermittelt (spezifisch) als auch rezeptorunabhängig (unspezifisch) auf genomischer und nichtgenomischer Ebene. Viele unerwünschte Arzneimittelwirkungen werden durch den Mechanismus der Transaktivierung, die erwünschten Effekte vorwiegend durch Transrepression verursacht. Bezüglich der Anwendung wird die Low-dose-Therapie von der Behandlung mit mittleren, hohen und sehr hohen Dosen sowie der Pulstherapie unterschieden. Unterscheidungskriterien sind neben der Dosis die Anwendungsgebiete, Behandlungsdauer und die Risiken unerwünschter Arzneimittelwirkungen. Nebenwirkungen können u. a. das muskuloskelettale, gastrointestinale, neuroendokrinoimmunologische, ophthalmologische und neuropsychiatrische System betreffen.
Abstract
Glucocorticoids (GC) are effective drugs which are often used in rheumatology. However, they have a considerable potential for frequent and sometimes serious side effects that restrict their use. Their mechanisms of action are either receptor dependent (specific) or independent (unspecific) on the genomic as well as the non-genomic level. Many adverse effects are predominantly caused by transactivation while the desired effects are mostly mediated by transrepression. Treatment strategies are sub-classified into low, medium, high, very high dose and pulse therapy based on criteria such as dose, indication, duration of treatment and potential risk of adverse events. The musculoskeletal, gastrointestinal, neuro-endocrino-immunological, opthalmological and neuropsychiatric systems are examples where adverse effects may occur.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Frank Buttgereit hat Referenten- und/oder Konsultationshonorare und/oder Forschungsgelder erhalten von: Abbott GmbH & Co. KG, Amgen, Bristol-Myers Squibb, Medac GmbH, Merck Pharma GmbH, Nitec Pharma GmbH, Organon, Pfizer GmbH, Roche, Wyeth GmbH, der DFG und dem BMBF. René Dziurla: kein Interessenkonflikt.
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Dziurla, R., Buttgereit, F. Glukokortikoide in der Rheumatologie. Z. Rheumatol. 67, 583–592 (2008). https://doi.org/10.1007/s00393-008-0365-7
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DOI: https://doi.org/10.1007/s00393-008-0365-7