Retrospektive Analyse des Therapieverlaufs und kardiovaskulären Risikoprofils bei Patienten mit Rheumatoider Arthritis unter immunsuppressiver Therapie

Gebauer, Katrin

dc.contributor.advisor	Blaschke, Sabine Prof. Dr.
dc.contributor.author	Gebauer, Katrin
dc.date.accessioned	2018-05-28T10:09:42Z
dc.date.available	2018-06-19T22:50:19Z
dc.date.issued	2018-05-28
dc.identifier.uri	http://hdl.handle.net/11858/00-1735-0000-002E-E3F9-E
dc.identifier.uri	http://dx.doi.org/10.53846/goediss-6884
dc.language.iso	deu	de
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.ddc	610	de
dc.title	Retrospektive Analyse des Therapieverlaufs und kardiovaskulären Risikoprofils bei Patienten mit Rheumatoider Arthritis unter immunsuppressiver Therapie	de
dc.type	doctoralThesis	de
dc.title.translated	Retrospective analysis of the course of therapy and cardiovascular risk profile in patients with rheumatoid arthritis under immunosuppressive therapy	de
dc.contributor.referee	Blaschke, Sabine Prof. Dr.
dc.date.examination	2018-06-12
dc.description.abstracteng	Objective: Previous studies have shown that the cardiovascular risk in patients with rheumatoid arthritis (RA) is higher than among the general population. This study assesses the prevalence of cardiovascular events such as myocardial infarction and stroke in RA patients treated with a DMARD or a biologic. In contrast to many studies that use a preselected group of patients this study specifically aims to reflect the typical RA patient with a variety of comorbidities and comedication. Methods: In this retrospective analysis data from 275 patients who received immunosuppressive RA treatment between April 1994 and August 2016 were evaluated for disease progression, comorbidities, cardiovascular risk factors and scores and occurrence of cardiovascular events. Subgroups were formed according to the leading basic medication. This involved the use of the classic DMARDs methotrexate and leflunomide and the biologics adalimumab, etanercept, rituximab and tocilizumab. Results: All six basic therapeutics studied achieved a significant reduction in DAS28 (average baseline 4.67) by about one point after 6 months (3.65) and towards the end of observation (3.78). This trend was reflected in the analysis of the erythrocyte sedimentation rate (20.1; 13.1; 15.6 [mm/1h]) and the C-reactive protein level (11.1; 5.7; 6.9 [mg/l]). All three calculated scores for the evaluation of cardiovascular risk increased during the course of the study. The Framingham score rose by 0.9 points, the PROCAM score for calculating the risk of myocardial infarction by 0.4 points. The risk of stroke increased by 0.5 points according to the PROCAM score. During the observation period 13 cardiovascular events occurred, eight of them related to a myocardial infarction, five to a stroke. Discussion and conclusion: The analysis of rheumatological parameters can prove good efficacy for all six drugs studied. The result of cardiovascular risk calculation is in contrast to this. According to the results of previous studies an optimized cardiovascular risk profile could be expected from the successful treatment of the underlying rheumatic disease. However, the present work cannot prove this tendency. It must be questioned whether the current score systems for the evaluation of cardiovascular risk in RA patients are suitable. Ultimately, none of them are directly correlated with disease activity. Further investigations could be carried out at this point.	de
dc.contributor.coReferee	Czepluch, Frauke Stefanie PD Dr.
dc.contributor.thirdReferee	Oppermann, Martin Prof. Dr.
dc.subject.ger	Rheumatoide Arthritis	de
dc.subject.ger	Kardiovaskuläres Risiko	de
dc.subject.eng	rheumatoid arthritis	de
dc.subject.eng	cardiovascular risk	de
dc.subject.eng	DAS28	de
dc.subject.eng	DMARD	de
dc.subject.eng	biologic	de
dc.subject.eng	myocardial infarction	de
dc.subject.eng	stroke	de
dc.subject.eng	Framingham score	de
dc.subject.eng	PROCAM score	de
dc.identifier.urn	urn:nbn:de:gbv:7-11858/00-1735-0000-002E-E3F9-E-0
dc.affiliation.institute	Medizinische Fakultät	de
dc.subject.gokfull	Medizin (PPN619874732)	de
dc.subject.gokfull	Rheumatologie (PPN619875887)	de
dc.description.embargoed	2018-06-19
dc.identifier.ppn	1023361051

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