Zusammenfassung
Bei einem Großteil der Patienten mit rheumatoider Arthritis (RA) führen die chronisch-entzündlichen Prozesse bereits in frühen Erkrankungsstadien zu Gelenkveränderungen und zum Funktionsverlust. Der frühe Einsatz von krankheitsmodifizierenden Medikamenten (DMARDs, „Biologicals“) kann das Risiko eines aggressiven Krankheitsverlaufes und irreversibler Gelenkschäden erheblich verringern. Von großer Bedeutung für die Prognose des Patienten und die Therapieentscheidung ist daher die frühe Identifikation von krankheitstypischen Prozessen der Gelenkentzündung und -destruktion. Dies gelingt heutzutage mit dem Einsatz moderner bildgebender Verfahren wie Arthrosonographie und MRT. Die Initiative REMISSIONPLUS hat das Anliegen, moderne bildgebende Verfahren als Standard in die Versorgung und das Management von RA-Patienten zu integrieren. Schwerpunkte dieser Initiative sind die Konzeption und Durchführung von Fortbildungen und Trainingskursen zur Sonographie und Magnetresonanztomographie (MRT), die Entwicklung und Etablierung von Dokumentationsbögen zur standardisierten Befunddokumentation und das systematische Monitoring von Patienten unter Therapie, mit dem Ziel strukturelle Veränderungen im Rahmen der RA sehr genau zu erfassen und wenn möglich auch die radiologische Remission bzw. die vermeintliche Progression zu erfassen. Das Projekt REMISSIONPLUS umfasst bundesweit ferner den Aufbau von spezialisierten Zentren, welche netzwerkartig die Implementierung und den Zugang zu den verschiedenen bildgebenden Verfahren an Kliniken, Rheumazentren und rheumatologischen Praxen unterstützen sollen.
Abstract
In a large number of patients with rheumatoid arthritis (RA), chronic inflammatory processes cause joint changes and loss of function even in the early stages of disease. Early, targeted use of disease-modifying antirheumatic drugs [DMARDs and TNF-α blockers (“biologicals”)] can significantly reduce the risk of aggressive progression and irreversible joint damage. Hence, early identification of disease-specific processes of joint inflammation and erosion – at the onset of disease or later – is of key importance for the patient’s prognosis and therapeutic strategy. This can be achieved today with great precision and reliability through the use of modern imaging methods like arthrosonography and magnetic resonance imaging (MRI). The REMISSIONPLUS initiative aspires to integrate modern imaging technologies as standard methods in the care and management of RA patients. The main areas on which this initiative will be focusing are the conceptualization and implementation of educational programs and training seminars on sonography and MRI, the development and establishment of case report forms for standardized documentation of findings, and the systematic monitoring of patients on treatment, with the aim of producing very precise documentation of structural change processes in RA and also, if possible, to document radiological remission or even progression. The REMISSIONPLUS project also includes the setting up of specialized centers of excellence, which will network to support the implementation and access to the various imaging procedures at hospitals, rheumatology clinics and rheumatology practices nationwide.
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Ostendorf, B., Scherer, A., Kellner, H. et al. Projekt REMISSIONPLUS: klinische und radiologische Remission. Z. Rheumatol. 67, 707–715 (2008). https://doi.org/10.1007/s00393-008-0369-3
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DOI: https://doi.org/10.1007/s00393-008-0369-3
Schlüsselwörter
- REMISSIONPLUS
- Bildgebende Verfahren
- Arthrosonographie
- Magnetresonanztomographie
- Niederfeld-MRT
- Scoring
- Rheumatoide Arthritis