Die intraartikuläre Therapie der Arthrose mit Hyaluronsäure – Stellenwert 2007

Zusammenfassung

Die epidemiologischen Daten unterstreichen die Bedeutung derArthrosekrankheit. Obwohl in den letztenJahren erheb- licheAnstrengungenin immunologischerund pathophysio- logischer Hinsicht unternommen wurden, steht eine zufriedenstellende konservative Behandlungsoption weiterhin aus. Anders als in der internistischen Rheumatologie, wie am Beispiel der Biologicals ersichtlich, fehlt dem Orthopäden im Fall der Arthrose eine zuverlässige Möglichkeit, den Krankheitsverlauf nachhaltig zu beeinflussen. Arthrotische Gelenke zeigen u. a. eine deutlich erniedrigte Hyaluronan- Konzentration. Neben der Möglichkeit derVerbesserung der viskoelastischen Eigenschaften sind inzwischen auch zahlreiche immunmodulatorische Mechanismen im Zusammenhang mit der Gelenkhomöostase unter dem Einfluss von Hyaluronan (überwiegend ex vivo) nachgewiesen. Trotzdem ist unter Berücksichtigung einer umfassenden Übersicht über die zahlreichen Publikationen zu diesem Thema im Sinne eines Evidenzgrades Level 1 eher nur ein moderater Effektfür die allerdings risikoarme intra-artiku- läre Hyaluronan-Therapie abzuleiten. Für eine valide Aussage im direkten Vergleich mit i.a.-Kortikosteroid reicht dagegen die aktuelle Datenlage nicht aus.

Summary

Epidemiologic data emphasise the impact of osteoarthritic disease. Although a lot of effort hasbeen made from an immunologic and pathophysiologic view, there is still no satisfactory conservative treatment option. Differentto rheum- athologists, as can be seen from biologicals, orthopedic surgeons have no reliable means to influence the course of disease in osteoarthritic disease. For example, osteoarthritic joints have a significantly lower hyaluronan concentration. In addition to the possibility to improve the viscoelastic characteristics, a number of immunomodulatory mechanisms of hyaluronan have been proven in joint homeostasis (mainly ex vivo). Yet, after extensive review of publications on this topic, it must be concluded that, while being a low-risk treatment, intraarticular hyaluronan therapy has only a moderate effect (evidence-based level 1). Currently, there is not sufficient available for a valid comparison with intraarticular corticoids.

Schlüsselwörter

Hyaluronan - Arthroseprogress - Immunmodulation

Keywords

Hyaluronan - osteoarthritis - immunmodulatory mechanism

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