Zusammenfassung
Die Zuwanderung von Menschen aus anderen Ländern oder sogar von anderen Kontinenten stellt auch Rheumatologen vor neue Herausforderungen. Obwohl alle entzündlich-rheumatischen Erkrankungen die hierzulande vorkommen, auch in den Heimatländern der Immigranten existieren, sind die Häufigkeiten unterschiedlich. Bei uns seltene Krankheitsbilder wie familiäres Mittelmeerfieber (FMF) oder Behçet-Syndrom (BS) sind vor allem in Nordafrika und im Mittelmeerraum oft häufiger als Spondyloarthritiden oder gar die rheumatoide Arthritis. Das FMF ist zudem mit dem Auftreten einer Spondyloarthritis assoziiert, die dann häufig negativ für das humane Leukozytenantigen B27 (HLA-B27) ist. Ebenso gibt es eine Assoziation mit dem BS. Auch das rheumatische Fieber kommt vor allem in den afrikanischen Ländern noch häufig vor, während es in Europa fast ausgerottet ist. Zu beachten sind auch mögliche Differenzialdiagnosen wie rheumatische Symptome bei genetisch determinierten Anämien oder bei Infektionen wie Human-immunodeficiency-virus-Infektionen, Hepatitiden, der Tuberkulose und Parasitosen, die allesamt in den Herkunftsländern der Migranten viel häufiger sind als in Nordwesteuropa. Nicht zuletzt ist die Versorgungssituation mit zeitgemäßen diagnostischen und therapeutischen Möglichkeiten in den Herkunftsländern der Zuwanderer unterschiedlich, entweder weil diese Möglichkeiten aufgrund begrenzter Ressourcen ohnehin nicht vorhanden sind oder weil sich die Situation durch akute Ereignisse wie zuletzt den Ukraine-Krieg dramatisch verschlechtert hat.
Abstract
The immigration of people from other countries or even from other continents represents new challenges even for rheumatologists. Although all inflammatory rheumatic diseases that occur in this country also exist in the countries of origin of immigrants, the frequencies are different. Diseases such as familial Mediterranean fever (FMF) or Behçet syndrome (BS) are rare in western Europe but are often more frequent than rheumatoid arthritis (RA) and spondylarthritis (SPA) in North Africa and Mediterranean countries. Furthermore, FMF is associated with the occurrence of spondyloarthritis, which is then frequently negative for the human leucocyte antigen B27 (HLA-B27). There is also an association with BS. Rheumatic fever also still occurs relatively frequently especially in African countries, whereas it is almost eradicated in Europe. Possible differential diagnoses such as rheumatic symptoms in genetically determined anemia or infections such as human immunodeficiency virus (HIV) infections, hepatitis, tuberculosis and parasitosis need to be considered as they are all much more frequent in the countries of origin of immigrants than in northwestern Europe. Last but not least, the treatment situation with modern diagnostic and treatment modalities is different in the countries of origin of the migrants, either because these possibilities are unavailable due to limited resources or because the situation has dramatically deteriorated due to acute events, such as the recent war in Ukraine.
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Elisabeth Märker-Hermann, Wiesbaden
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Aktualisierte Version der Originalpublikation: Kötter I (2018) Rheumatische Erkrankungen bei Migranten. Aktuelle Rheumatologie 43(02):135–142, https://doi.org/10.1055/s-0043-123464. Nachdruck mit freundl. Genehmigung © Georg Thieme Verlag KG Stuttgart
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Kötter, I., Krusche, M. Entzündlich-rheumatische Erkrankungen bei Migranten. Innere Medizin 64, 426–434 (2023). https://doi.org/10.1007/s00108-023-01514-0
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DOI: https://doi.org/10.1007/s00108-023-01514-0
Schlüsselwörter
- Familiäres Mittelmeerfieber
- Behçet-Syndrom
- Rheumatisches Fieber
- Spondyloarthritis
- Systemischer Lupus erythematodes