Medikamentöse Therapie der Arthrose

Pharmacological therapy of arthrosis


Die medikamentöse Therapie der Arthrose umfasst reine Analgetika, entzündungshemmende Medikamente und Substanzen, die den Gewebeunterhalt unterstützen und den Knorpelabbau verlangsamen können. Welche Produkte für welchen Patienten eingesetzt werden sollen, richtet sich nach dem betroffenen Gelenk, dem Schweregrad der Arthrose, dem Ausmaß und der Frequenz der entzündlichen Flares sowie dem Risikoprofil des Patienten. Dieser Beitrag gibt eine Übersicht über die aktuellen Behandlungsmodalitäten mit ihren Vor- und Nachteilen.


The pharmacological management of osteoarthritis includes pure analgesia, anti-inflammatory drugs and substances supporting tissue maintenance in osteoarthritic joints. The decision for the treatment modality is made depending on the affected joint, the stage of the disease, the extent and frequency of inflammatory flares and the patient risk profile. This article gives an overview of the current treatment modalities including the advantages and disadvantages.

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  1. 1.

    Zhang W et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 18(4):476–499

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Cohen J (1988) Statistical power analysis for the behavioral sciences. L. Erlbaum Associates, Hillsdale, S xxi, 567

  3. 3.

    Altman RD, Barthel HR (2011) Topical therapies for osteoarthritis. Drugs 71(10):1259–1279

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Freynhagen R, Geisslinger G, Schug SA (2013) Opioids for chronic non-cancer pain. BMJ 346:f2937

    PubMed  Article  Google Scholar 

  5. 5.

    Chappell AS et al (2011) A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee. Pain Pract 11(1):33–41

    PubMed  Article  Google Scholar 

  6. 6.

    Sullivan M et al (2009) A single-blind placebo run-in study of venlafaxine XR for activity-limiting osteoarthritis pain. Pain Med 10(5):806–812

    PubMed  Article  Google Scholar 

  7. 7.

    Chu CR et al (2008) The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 90(6):814–820

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Baker JF, Mulhall KJ (2012) Local anaesthetics and chondrotoxicty: What is the evidence? Knee Surg Sports Traumatol Arthrosc 20(11):2294–2301

    PubMed  Article  Google Scholar 

  9. 9.

    Chu CR et al (2006) In vitro exposure to 0.5 % bupivacaine is cytotoxic to bovine articular chondrocytes. Arthroscopy 22(7):693–699

    PubMed  Article  Google Scholar 

  10. 10.

    Hepburn J, Walsh P, Mulhall KJ (2011) The chondrotoxicity of local anaesthetics: any clinical impact? Joint Bone Spine 78(5):438–440

    PubMed  Article  Google Scholar 

  11. 11.

    Raynauld JP et al (2003) Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 48(2):370–377

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Ahmed I, Gertner E (2012) Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med 125(3):265–269

    PubMed  Article  Google Scholar 

  13. 13.

    Wenham CY et al (2012) A randomized, double-blind, placebo-controlled trial of low-dose oral prednisolone for treating painful hand osteoarthritis. Rheumatology (Oxford) 51(12):2286–2294

    Google Scholar 

  14. 14.

    Abou-Raya A et al (2012) Effect of low dose oral prednisolone on symptoms and systemic inflammation in older adults with moderate to severe knee osteoarthritis: a randomized placebo-controlled trial (Abstract). Ann Rheum Dis 71(Suppl 3):97

    Google Scholar 

  15. 15.

    Yang KG et al (2008) Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial. Osteoarthritis Cartilage 16(4):498–505

    PubMed  Article  Google Scholar 

  16. 16.

    Baltzer AW et al (2009) Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage 17(2):152–160

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Rau H et al (2004) Multicenter study of radiosynoviorthesis. Clinical outcome in osteoarthritis and other disorders with concomitant synovitis in comparison with rheumatoid arthritis. Nuklearmedizin 43(2):57–62

    PubMed  CAS  Google Scholar 

  18. 18.

    Kisielinski K et al (2010) Complications following radiosynoviorthesis in osteoarthritis and arthroplasty: osteonecrosis and intra-articular infection. Joint Bone Spine 77(3):252–257

    PubMed  Article  Google Scholar 

  19. 19.

    Bryant LR, Rosier KF des, Carpenter MT (1995) Hydroxychloroquine in the treatment of erosive osteoarthritis. J Rheumatol 22(8):1527–1531

    PubMed  CAS  Google Scholar 

  20. 20.

    Robertson C, Rice J, Allen N (1993) Treatment of erosive osteoarthritis with hydroxychloroquine (Abstract). Arthritis Rheum 36(Suppl):167

    Google Scholar 

  21. 21.

    Kingsbury SR et al (2013) Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis (HERO): study protocol for a randomized controlled trial. Trials 14(1):64

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Pavelka K, Olejarova M, Pavelkova A (2006) Methotrexat in the treatment of erosive osteoarthritis of the hands (Abstract). Ann Rheum Dis 65(Suppl II):402

    Google Scholar 

  23. 23.

    Wenham CY et al (2013) Methotrexate for pain relief in knee osteoarthritis: an open-label study. Rheumatology (Oxford) 52(5): 888–892

    Google Scholar 

  24. 24.

    Abou-Raya S, Abou-Raya A., Sallam N (2012) Methotrexate: a therapeutic option in symptomatic knee osteoarthritis: randomized placebo-controlled trial. Ann Rheum Dis 71(Suppl3):415

    Article  Google Scholar 

  25. 25.

    Magnano MD et al (2007) A pilot study of tumor necrosis factor inhibition in erosive/inflammatory osteoarthritis of the hands. J Rheumatol 34(6):1323–1327

    PubMed  CAS  Google Scholar 

  26. 26.

    Verbruggen G et al (2012) Tumour necrosis factor blockade for the treatment of erosive osteoarthritis of the interphalangeal finger joints: a double blind, randomised trial on structure modification. Ann Rheum Dis 71(6):891–898

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Michel BA et al (2005) Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial. Arthritis Rheum 52(3):779–786

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Kahan A et al (2009) Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 60(2):524–533

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Wildi LM et al (2011) Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis 70(6):982–989

    PubMed  Article  Google Scholar 

  30. 30.

    Pavelka K et al (2002) Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 162(18):2113–2123

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Reginster JY et al (2001) Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 357(9252):251–256

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Gabay C et al (2011) Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center. Arthritis Rheum 63(11):3383–3391

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Clegg DO et al (2006) Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 354(8):795–808

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Wandel S et al (2010) Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 341:c4675

    PubMed  Article  Google Scholar 

  35. 35.

    Hochberg MC et al (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 64(4):455–474

    Google Scholar 

  36. 36.

    Balazs EA, Denlinger JL (1993) Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl 39:3–9

    PubMed  CAS  Google Scholar 

  37. 37.

    Van Den Bekerom MP et al (2006) Viscosupplementation in symptomatic severe hip osteoarthritis: a review of the literature and report on 60 patients. Acta Orthop Belg 72(5):560–568

    Google Scholar 

  38. 38.

    Merolla G et al (2011) Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg 95(3):215–224

    PubMed  Article  Google Scholar 

  39. 39.

    Ingegnoli F, Soldi A, Meroni PL (2011) Power Doppler sonography and clinical monitoring for hyaluronic acid treatment of rhizarthrosis: a pilot study. J Hand Microsurg 3(2):51–54

    PubMed  Article  Google Scholar 

  40. 40.

    Bannuru RR et al (2009) Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum 61(12):1704–1711

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Guidolin DD et al (2001) Morphological analysis of articular cartilage biopsies from a randomized, clinical study comparing the effects of 500–730 kDa sodium hyaluronate (Hyalgan) and methylprednisolone acetate on primary osteoarthritis of the knee. Osteoarthritis Cartilage 9(4):371–381

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Kim NH et al (1991) Effect of sodium hyaluronate on prevention of osteoarthritis. Yonsei Med J 32(2):139–146

    PubMed  CAS  Google Scholar 

  43. 43.

    Wang Y et al (2011) Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial. BMC Musculoskelet Disord 12:195

    PubMed  Article  Google Scholar 

  44. 44.

    Goldberg VM, Buckwalter JA (2005) Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage 13(3):216–224

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Navarro-Sarabia F et al (2011) A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. Ann Rheum Dis 70(11):1957–1962

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Rutjes AW et al (2012) Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med 157(3):180–191

    PubMed  Article  Google Scholar 

  47. 47.

    McAlindon TE, Bannuru RR (2012) Osteoarthritis: is viscosupplementation really so unsafe for knee OA? Nat Rev Rheumatol 8(11):635–636

    PubMed  Article  Google Scholar 

  48. 48.

    Patel S, Dhillon MS, Aggarwal S et al (2013) Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med 41(2):356–364

    PubMed  Article  Google Scholar 

  49. 49.

    Bruyere O et al (2008) Effects of strontium ranelate on spinal osteoarthritis progression. Ann Rheum Dis 67(3):335–339

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Reginster JY et al (2013) Efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: results of a double-blind, randomised placebo-controlled trial. Ann Rheum Dis 72(2):179–186

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    McAlindon T et al (2013) Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. JAMA 309(2):155–162

    PubMed  Article  CAS  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. L.M. Wildi gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Wildi, L. Medikamentöse Therapie der Arthrose. Z. Rheumatol. 72, 885–895 (2013).

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  • Analgetika
  • Entzündungshemmung
  • Viskosupplementation
  • Therapie
  • Regeneration


  • Analgesics
  • Inflammation inhibition
  • Viscosupplementation
  • Treatment
  • Regeneration