Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2020
[German guidelines for the treatment of rheumatoid arthritis with disease modifying anti-rheumatic drugs - What is new?]
The new guidelines for the treatment of rheumatoid arthritis with disease modifying antirheumatic drugs are based on a systematic literature research and consensus process. They define the current standard of the treatment of rheumatoid arthritis. Although they are related to the current European guidelines, in some points they are more detailed and place further emphasis. ⋯ If no improvement has been achieved, treatment shall be continued with either a second DMARD strategy with conventionally synthetic DMARD (csDMARD) or an alternative with biological or targeted synthetic (b or ts) DMARD - depending on whether there are risk factors for a severe disease progression. Glucocorticoids are given initially, however they should be tapered and stopped after 3-6 months or at least reduced to a maximal dose of 5 mg/d prednisone. Both a change within b and tsDMARD as well as therapeutic de-escalation are possible measures in the further course of treatment.
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Dtsch. Med. Wochenschr. · Apr 2020
Review[Is There Still a Need for Medical Antiarrhythmic Therapy?]
The use of medical antiarrhythmic therapy apart from beta-blockers has been steadily decreasing in the recent past. This can partly be attributed to technological progress that has rendered the ablation of complex cardiac arrhythmias like atrial fibrillation, focal atrial tachycardias and ventricular arrhythmias feasible and efficacious. ⋯ Nevertheless, medical antiarrhythmic therapy still plays a fundamental role in acute therapy of arrythmias as well as certain indications for long-term therapy. This review comprehensively summarizes the current role of medical antiarrhythmic therapy in daily clinical practice focusing on mechanisms and therapies of the most common cardiac arrythmias.
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Dtsch. Med. Wochenschr. · Apr 2020
[Sequential Natriuretic Peptide Measurements to Monitor Treatment and Prognosis During Heart Failure Therapy].
Natriuretic peptide serum levels (NP) are the most robust predictors of heart failure (HF) diagnosis and prognosis. Therefore, international HF guidelines give highest evidence and recommendation on their clinical usage, particular in patients with dyspnea. Key message of this review is to inform about the concept of sequential NP measurements as quantifiable plasma biomarker to objectify sodium-water-dynamics and clinical therapy response during recompensation of HF patients. Essentially, three clinical scenarios result of sequential NP measurements and might have a valuable role in HF risk stratification, prognosis and need of therapy optimization of in- and outpatient care.
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Dtsch. Med. Wochenschr. · Apr 2020
[Elective Endovascular Versus Open Repair of Abdominal Aortic Aneurysm - Current Long-Term Data].
Four randomized clinical trials prospectively compared endovascular (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA): Chronologically these are EVAR 1 (UK), DREAM (Netherlands), OVER (USA) and ACE (France). All of them investigated whether the superior early postoperative outcome of endovascular repair is maintained in the long-term. ⋯ Indication for invasive treatment has not changed and should - apart from exceptions - only be given for men with a diameter of 5,5 cm or more. Furthermore, current studies on prophylactic mesh reinforcement after open repair of AAA show that incisional hernias can be safely avoided.
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Dtsch. Med. Wochenschr. · Apr 2020
[Interstitial lung disease in rheumatic diseases - new therapeutic approaches].
Pulmonary involvement is an important aspect in the management of rheumatic diseases. Connective tissue disease-associated interstitial lung diseases (CTD-ILD) are of particular importance, as their occurrence is often decisive for patient outcome. We use corticosteroids, immunosuppressants and eventually also biologicals in the therapy of CTD-ILD. ⋯ Currently a number of other studies regarding the effectiveness of antifibrotics in CTD-ILD are expected to be published. The studies in this field bring new aspects in the understanding of interstitial diseases and have the potential of expanding treatment options in CTD-ILD. The topic of CTD-ILD is a difficult, but at the same time exciting field.