Deutsche medizinische Wochenschrift
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The publication of the new ACR/EULAR classification criteria for systemic lupus erythematosus (SLE) and the revision of the EULAR recommendations for the management of SLE last year include many important novelties that will change the classification and care of lupus patients. This refers to both general basic treatment principles and specific therapy recommendations. For example, SLE can only be classified as such if antinuclear antibodies (ANA) are present, independently of titer height and fluorescence pattern. ⋯ All patients should receive antimalarials in the absence of contraindications. If the response is inadequate or in case of moderate to severe organ manifestations, steroid pulses over a few days and the early use of immunosuppressive drugs (IM) are recommended. With the inclusion of biologicals, especially belimumab and rituximab, new substance classes made their way into the recommendations.
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CKD-MBD (chronic kidney disease - mineral and bone disorder) describes a complex syndrome of renal osteodystrophy, mineral disturbances and cardiovascular disease in patients with chronic kidney disease. The present articles intends to provide an up-to-date summary of recent clinically important developments in the field of CKD-MBD. ⋯ The summary also comments on which grade of evidence novel aspects and innovative developments in CKD-BMD are based. The author concludes that nephrologists should strive after more high-quality, large-scale randomized-controlled interventional trials in order to optimize the evidence behind CKD-MBD therapy.
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Dtsch. Med. Wochenschr. · Aug 2020
Review[Current diagnosis and treatment of chronic lymphocytic leukaemia].
Two major advances were made in the treatment of chronic lymphocytic leukaemia (CLL): the addition of the antibody rituximab to chemotherapy two decades ago and the introduction of the targeted agents during the last few years. Four targeted drugs with different mechanisms of action were added to the armamentarium of CLL treatment: the anti-CD20 antibody obinutuzumab, the two kinase inhibitors ibrutinib and idelalisib, which target the Bruton tyrosine kinase (BTK) and Phosphatidylinositiol-3-Kinase (PI3K) respectively in the B-cell receptor signalling pathway, as well as the Bcl2-antagonist venetoclax. Recently, the combination of venetoclax/obinutuzumab was approved for the first-line treatment of all CLL patients based on a phase-III trial in elderly unfit patients. ⋯ Patients with the high-risk parameters deletion 17p or TP53mutation are known to poorly respond to chemo(immuno)therapy and should receive either ibrutinib or venetoclax/obinutuzumab. Thus, a choice has to be made between a continuous monotherapy with ibrutinib or a time-limited combination with either venetoclax/obinutuzumab (12 months) or chemoimmunotherapy (usually 6 months). In addition to disease-related factors (e. g. presence of deletion 17p/TP53 mutation, IgHV mutational status, prior therapies), comorbidities, co-medication and the specific side effects of the CLL therapies (myelosuppression, infections and secondary malignancies for chemoimmunotherapy; cardiac toxicity, bleeding and autoimmune disease for ibrutinib; tumour-lysis syndromes and infections for venetoclax) the patient's expectations need to be considered.
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In case of obstructive, interstitial and malignant respiratory and lung diseases, occupational causes must always be searched for. The sensitivity and specificity of specific IgE determinations in the diagnosis of occupational asthma are only slightly above 70 %, even for high-molecular allergens. If the patient's medical history is positive, further diagnostics must be carried out, if necessary up to specific exposure testing in specialised institutions. ⋯ Patients with lung carcinoma should also be investigated for occupational causes. Here too, questionnaires and tables are available in simple language. In future lung cancer caused by long-term exposure to passive smoke will be considered an occupational disease.
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Diabetes is a very important comorbidity in patients with heart failure. When both diseases are present, mortality is greatly increased. Therefore, it is important to sufficiently diagnose and treat patients with diabetes and heart failure to improve outcome. This article provides an overview on epidemiology, pathogeneses, diagnostic and therapeutic options.