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Aktuelle Aspekte zur Ätiologie und Therapie des Arthroseschmerzes

Pain symptoms of osteoarthritis—aspects of etiology and therapy

  • Schwerpunkt: Orthopädische Schmerztherapie
  • Published:
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Zusammenfassung

Die Osteoarthrose gewinnt aufgrund der demographischen Entwicklung und damit verbundenen sozioökonomischen Problemen zunehmend an Bedeutung. Gleichzeitig besteht der Wunsch, auch in höherem Lebensalter sportlich aktiv zu sein.

Zur Therapie des Osteoarthroseschmerzes sollte einem Stufenschema gefolgt werden. Mit Paracetamol und den NSAR, in Kombination mit orthopädischen Hilfsmitteln und balneophysikalischen Maßnahmen, lassen sich die Schmerzsymptome der Arthrose in frühen Erkrankungsstadien erfolgreich beeinflussen.

Neben diesen etablierten schmerztherapeutischen Verfahren sowie ersten Resultaten arthrosemodifizierender Medikamente existieren hoffnungsvolle Ansätze gentherapeutischer Behandlungsstrategien, die sich jedoch klinisch erst bestätigen müssen. Bei Versagen konservativer Therapiemaßnahmen stehen gelenkerhaltende sowie gelenkersetzende operative Maßnahmen zur Verfügung. Während die arthroskopische Chirurgie symptomorientiert zumeist nur in einem überschaubarem Zeitraum eine Schmerzreduktion bietet, lässt sich bei richtiger Indikationsstellung durch Achskorrektur- und Umstellungsosteotomien die Arthroseprogression nachhaltig beeinflussen.

Als ultima ratio besteht mit dem künstlichen Gelenkersatz im Bereich der großen Gelenke eine zuverlässige und erfolgreiche Behandlungsoption.

Abstract

Due to demographic changes and associated socioeconomic problems osteoarthritis is of increasing value. Simultaneously there are more and more older people who want to practice sports.

Pain symptoms of osteoarthritis can be positively influenced by paracetamol and NSAR, in combination with orthopedic aids and physical therapy in early stages.

Apart from these established pain-therapeutic procedures as well as first evident results of osteoarthritis modifying drugs, gene-therapy offers promising approaches that will have to be confirmed in further studies.

In case of failure of conservative treatment there are several surgical options. Arthroscopic surgery mostly offers pain reduction only for a short period of time. A slower progression of osteoarthritis in the long run can only be achieved by osteotomy provided the right indication.

Ultimately joint replacement exists as a reliable and successful treatment option in hip, knee and shoulder surgery.

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  1. Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Mannheim

    L. Lehmann & J. Stöve

  2. Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum, Theodor-Kutzer-Ufer 1–3, 68167 , Mannheim

    L. Lehmann

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Correspondence to L. Lehmann.

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Lehmann, L., Stöve, J. Aktuelle Aspekte zur Ätiologie und Therapie des Arthroseschmerzes. Schmerz 18, 453–462 (2004). https://doi.org/10.1007/s00482-004-0328-0

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