Knorpelschaden und Gonarthrose, Teil III

Zusammenfassung

Voraussetzung für den Erfolg einer konservativen und operativen Behandlung der Gonarthrose ist, dass der Patient den Charakter der Erkrankung versteht und in der Lage und Willens ist, seine Lebensweise darauf einzustellen. Neben dem ärztlichen Gespräch bieten hier Aufklärungsmaterialien und die Mitarbeit in Selbsthilfegruppen eine gute Hilfe. Die konservative Gonarthrosebehandlung umfasst im Wesentlichen 3 Säulen: medikamentöse Behandlung, Physiotherapie und die Versorgung mit Hilfsmitteln. Bei den Medikamenten handelt es sich in erster Linie um analgetisch-antiphlogistische Medikamente. Neben reinen Analgetika (Nichtopiat- und Opiatanalgetika) werden in der Regel NSAR (nichtsteroidale Antirheumatika) eingesetzt. Der Effekt der NSAR beruht auf der meist unselektiven Hemmung der Prostaglandinsynthese (Hemmung der Cyclooxygenase). Zu beachten ist dabei die nicht unerhebliche Nebenwirkungsrate, vor allem auf den Gastrointestinaltrakt. Obwohl die Behandlung mit Externa (NSAR-haltig bzw. auf phytotherapeutischer Basis) umstritten ist, bewirken diese Medikamente beim Patienten häufig eine deutliche Beschwerdelinderung. Weiterhin kommen SADOA (slow acting drugs in osteoarthritis) bzw. DMOAD (disease modifying osteoarthritis drugs) zum Einsatz. SADOA sind einerseits oral applizierbares D-Glucosaminsulfat, Vitamin E, Selen oder i. a. Hyaluronsäure. In Zukunft sind sicherlich Fortschritte in der Behandlung der Gonarthrosebehandlung durch DMOAD (z. B. Interleukinantagonisten, Gentherapie) zu erwarten. Für alle Behandlungen obligatorisch ist eine begleitende Physiotherapie. Dabei sind erlernte Übungsbehandlungen im Rahmen von Heimtrainingsprogrammen durch den Patienten konsequent durchzuführen. Zusätzlich können individuell auf die Bedürfnisse des Patienten abgestimmte Hilfsmittel wie Gehstützen, Bandagen, Schuhzurichtungen usw. häufig die Lebensqualität erheblich verbessern.

Abstract

Patients suffering from gonarthritis have to understand the character of this chronic disease. This is an important presupposition for success in conservative or operative treatment. The patient has to understand that gonarthritis mostly means long-life changes in lifestyle. The intensive talk with the physician but also information brochures as well as participation in self-care-groups can be helpfully. Conservative treatment of gonarthritis based on three main directions: drugs, physical therapy and supports. The mainly drugs which are used in treatment of gonarthritis have analgetic and antiphlogistic effects. Pure analgetic drugs (non-opiate or opiate analgetic) are seldom required. It is generally accepted that NSAID (non-steroidal anti-inflammatory drugs) are method of choice in arthritis therapy today. The mainly effect of NSAID is an inhibition of the prostaglandin synthesis by inhibition of the cyclooxigenase activity. Disadvantageously are side effects especially within the gastro-intestinal tract. No significantly effects produce topical drugs (containing NSAID or phytotherapeutics). But in some cases these externa effect a decrease of the patients complaints. Other drugs called as SADOA (slow acting drugs in osteoarthritis) or DMOAD (disease modyfying osteoarthritis drugs) can be usefull in gonarthitis treatment. SADOA are f. e. D-glucosamine-sulfate, vitamin E, selen or i. a. application of hyolonic acid. Surely in future better results are possible by using DMOAD (antagonists against interleukins or genetic therapy). Physical therapy is one of the most important parts of therapy in gonarthritis. Above all, the patients have to learn self-administrated home training programs for consequently daily use. Finally in same cases adjuvants (crutches, tapes, insoles) can be helpfully to improve the patients quality of life.

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