Rheumatic diseases with their progressive inflammatory systematic nature are important diseases any clinical practising orthopaedic doctor is frequently confronted with. In case of mono- or polyarticular joint swelling, stiffness or inflammatory arthralgia, rheumatoid arthritis has to be deliberated particularly in differential diagnostic considerations. When diagnosed early, a joint treatment by an internal specialist as well as the initiation of a basic medicamentous therapy are highly recommended. Therefore, corticosteroids and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate can be used, in case of failure a treatment with biologicals should follow. The operative therapy depends on the stadium of joint destruction. In early stadiums (LDE 0-3) and in case of therapy resistant inflammation a synovectomy should be performed as a preventive intervention. Given an already advanced destruction, alloarthroplasty or arthrodesis are indicated as reconstructive procedures.
ZusammenfassungDer primäre und sekundäre Entzündungsprozess bei der rheumatoiden Arthritis und bei der Arthrose ist verantwortlich für die Symptomatik, die Progression und die therapeutischen Möglichkeiten bei beiden Erkrankungen. Bei der rheumatoiden Arthritis kann die Entzündung im Frühstadium durch eine suffiziente medikamentöse Therapie aufgehalten werden, bei der Arthrose wurden die Bemügungen um ein besseres Verständnis der pathophysiologischen Vorgänge der sekundären Entzündungsreaktion intensiviert, kurative Therapieansätze fehlen jedoch nach wie vor. Bei beiden Krankheitsentitäten können lokale Therapiemaßnahmen die entzündliche Symptomatik positiv beeinflussen.
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