Arthrose – Ursachen und Therapie 2021

Zusammenfassung

Die Arthrose ist eine chronische Erkrankung, die Gelenke wie Schulter, Hand, Hüfte, Knie und Füße betrifft und erhebliche Schmerzen, zunehmende Behinderung und fortschreitende Knorpeldegeneration verursacht. Die Arthrose tritt häufig bei Erwachsenen im Alter von über 50 Jahren auf und ist weltweit eine der Hauptursachen für Behinderungen. Die degenerativen Veränderungen und chronischen kumulativen Schädigungen der Gelenke umfassen Knorpeldenaturierung und -zerstörung, Sklerose und Zystenbildung des subchondralen Knochens, Osteophytenbildung, Synovialisläsionen sowie Veränderungen der umliegenden Strukturen.

Die Inzidenz der Arthrose steigt aufgrund der alternden Bevölkerung und der Zunahme von Adipositas. Aber auch Gelenkfehlstellungen, Verletzungen, Knochenmasse, Muskelmasse und die Genetik sind als Ursachen mittlerweile anerkannt. Die Arthrose hat eine komplexe Pathophysiologie, die bisher nur unvollständig verstanden ist.

Zurzeit gibt es viele aktuelle Leitlinien und Konsens zur Diagnose und Behandlung der Arthrose sowohl im In- als auch im Ausland.

Da es bisher keine etablierte krankheitsmodifizierende Therapie oder Ansätze der Verhinderung der Arthrose gibt, basieren die Behandlung auf einer Kombination von pharmakologischen und nicht-pharmakologischen Therapien, die die Symptome der Arthrose, vor allem Schmerzen und Funktionsverlust, behandeln können, d.h. Analgetika, nicht-steroidale Antirheumatika und physikalische Therapie.

Neben den konventionellen medizinischen und chirurgischen Interventionen gibt es eine zunehmende Anzahl von ‚alternativen‘ Therapien. Diese alternativen Ansätze haben nur eine begrenzte Evidenz und werden aus diesem Grund in aktuellen Leitlinien oft ausgeschlossen. Trotzdem werden gerade diese von vielen Patienten als Nahrungsergänzung eingenommen.

Abstract

Osteoarthritis is a chronic disease that affects joints such as the shoulder, hand, hip, knee and feet, causing significant pain, increasing disability and progressive cartilage degeneration. Osteoarthritis is common in adults over the age of 50 and is a leading cause of disability worldwide.

The degenerative changes and chronic cumulative damage to the joints, include cartilage denaturation and destruction, sclerosis and cyst formation of the subchondral bone, osteophyte formation, synovial lesions and changes in surrounding structures.

The incidence of osteoarthritis is increasing due to the ageing population and the increase in obesity. However, joint deformities, injuries, bone mass, muscle mass and genetics are now also recognized as causes. Osteoarthritis has a complex pathophysiology that is incompletely understood.

Currently, there are many current guidelines and consensus on the diagnosis and treatment of osteoarthritis both domestically and internationally.

As there is as yet no established disease-modifying therapy or approaches to the prevention of osteoarthritis, current treatment before surgery is based on a combination of pharmacological and non-pharmacological therapies that can treat the symptoms of osteoarthritis, primarily pain and loss of function, i.e. analgesics, non-steroidal anti-inflammatory drugs and physical therapy.

In addition to conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative approaches have limited evidence and are therefore often excluded from current guidelines. Nevertheless, many patients take them as dietary supplements.

Schlüsselwörter

Arthrose - Epidemiologie - Ursachen - subchondraler Knochen - pharmakologische Therapie - nicht-pharmakologische Therapie - alternative Therapien

Key words

Osteoarthritis - epidemiology - causes - subchondral bone - pharmacological -therapy - non-pharmacological therapy - alternative therapies

Publication History

Article published online:
09 February 2021

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