Download PDF
Dtsch Med Wochenschr 2014; 139(17): 898-904
DOI: 10.1055/s-0034-1369951
Übersicht | Review article
Rheumatologie
© Georg Thieme Verlag KG Stuttgart · New York

Entzündliche Fingergelenkspolyarthrose – Herausforderungen in der Diagnostik und Therapie

Inflammatory osteoarthritis of the hands – challenges in diagnosis and therapy
P. Klaus
1   Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, CC12 Charité – Universitätsmedizin Berlin
,
J. Detert
1   Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, CC12 Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

16 December 2013

13 March 2014

Publication Date:
23 April 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Eine symptomatische Fingergelenkspolyarthrose (HOA) tritt bei 5–20 % der Bevölkerung ≥ 40 Jahre auf. Die Diagnosestellung erfolgt primär anhand der klinischen Symptomatik mit Schmerzen, knöcherne Verdickungen der Fingergelenke und geringer Morgensteifigkeit. Laboruntersuchungen und Röntgenaufnahmen der Hände können in der Differenzialdiagnostik anderer entzündlicher Gelenkerkrankungen, insbesondere der rheumatoiden Arthritis und Psoriasis-Arthritis notwendig werden. Nicht-pharmakologische Therapieoptionen umfassen Patientenschulung zur Kräftigung der Muskulatur und Mobilisation als auch physio- und ergoherapeutische Behandlungsverfahren. Bei leichten bis mäßigen Schmerzen können topische nicht-steroidale Antirheumatika (NSAR) oder Capsaicin effektiv sein. Zur systemischen Therapie kommen in erster Linie Paracetamol, NSAR und Coxibe in Frage. Innovative Therapieoptionen werden derzeit in klinischen Studien erforscht.

Abstract

Symptomatic osteoarthritis of the hand occurs in 5–20 % of the population ≥ 40 years. The diagnosis is made based on the clinical appearance, e. g. bony enlargements of small finger joints, pain and short morning stiffness. Laboratory or X-ray examinates can however be useful to exclude other rheumatic diseases. Non-pharmacological therapy options include patient education, physio- and occupational therapeutic exercise to strengthen the muscles and mobilisation. Topical non-steroidal anti-inflammatory drugs (NSAID) or capsaicin can be effective for mild to intermediate pain. Systemic therapeutics are paracetamol, NSAID or coxibs. Innovative therapy options are currently under investigation in clinical trials.

Schlüsselwörter

Fingerpolyarthrose - Osteoarthritis - erosive Osteoarthritis

Keywords

osteoarthritis - osteoarthritis of the hand - erosive osteoarthritis
 

  • Literatur

  • 1 Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 2007; 15 Suppl A A1-56
    CrossrefPubMedGoogle Scholar
  • 2 Bhala N, Emberson J, Merhi A et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382: 769-779
    CrossrefPubMedGoogle Scholar
  • 3 Bijsterbosch J, Kloppenburg M, Reijnierse M et al. Association study of candidate genes for the progression of hand osteoarthritis. Osteoarthr Cartil 2013; 21: 565-569
    CrossrefPubMedGoogle Scholar
  • 4 Brown JP, Boulay LJ. Clinical experience with duloxetine in the management of chronic musculoskeletal pain. A focus on osteoarthritis of the knee. Ther Adv Musculoskelet Dis 2013; 5: 291-304
    CrossrefPubMedGoogle Scholar
  • 5 Bruyère O, Burlet N, Delmas PD et al. Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system. BMC Musculoskelet Disord 2008; 9: 165
    CrossrefPubMedGoogle Scholar
  • 6 Cheung PP, Gossec L, Dougados M. What are the best markers for disease progression in osteoarthritis (OA)?. Best Pract Res Clin Rheumatol 2010; 24: 81-92
    CrossrefPubMedGoogle Scholar
  • 7 Conaghan PG, Hunter DJ, Maillefert JF et al. Summary and recommendations of the OARSI FDA osteoarthritis Assessment of Structural Change Working Group. Osteoarthr Cartil 2011; 19: 606-610
    CrossrefPubMedGoogle Scholar
  • 8 Deberg M, Labasse A, Christgau S et al. New serum biochemical markers (Coll 2-1 and Coll 2-1 NO2) for studying oxidative-related type II collagen network degradation in patients with osteoarthritis and rheumatoid arthritis. Osteoarthr Cartil 2005; 13: 258-265
    CrossrefPubMedGoogle Scholar
  • 9 Dolzani P, Assirelli E, Pulsatelli L et al. Systemic inflammation and antibodies to citrullinated peptides in hand osteoarthritis. Clin Exp Rheumatol 29: 1006-1009
    PubMedGoogle Scholar
  • 10 Filková M, Senolt L, Braun M et al. Serum hyaluronic acid as a potential marker with a predictive value for further radiographic progression of hand osteoarthritis. Osteoarthr Cartil 2009; 17: 1615-1619
    CrossrefPubMedGoogle Scholar
  • 11 Garnero P, Delmas PD. Biomarkers in osteoarthritis. Curr Opin Rheumatol 2003; 15: 641-646
    CrossrefPubMedGoogle Scholar
  • 12 Garnero P, Peterfy C, Zaim S et al. Bone marrow abnormalities on magnetic resonance imaging are associated with type II collagen degradation in knee osteoarthritis: a three-month longitudinal study. Arthritis Rheum 2005; 52: 2822-2829
    CrossrefPubMedGoogle Scholar
  • 13 Garnero P, Rousseau JC, Delmas PD. Molecular basis and clinical use of biochemical markers of bone, cartilage, and synovium in joint diseases. Arthritis Rheum 2000; 43: 953-968
    CrossrefPubMedGoogle Scholar
  • 14 Guidelli GM, Morozzi G, Simpatico A et al. Rheumatoid factor isotypes in patients with erosive osteoarthritis of the hand. Int J Rheum Dis 2011; 14: e49-50
    CrossrefPubMedGoogle Scholar
  • 15 Haugen IK, Bøyesen P. Imaging modalities in hand osteoarthritis – and perspectives of conventional radiography, magnetic resonance imaging, and ultrasonography. Arthritis Res Ther 2011; 13: 248
    CrossrefPubMedGoogle Scholar
  • 16 Haugen IK, Ostergaard M, Eshed I et al. Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System. J Rheumatol 2013; 41: 386-391
    PubMedGoogle Scholar
  • 17 Hochberg MC, Altman RD, April KT et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012; 64: 465-474
    PubMedGoogle Scholar
  • 18 Jacobs BJ, Verbruggen G, Kaufmann RA. Proximal interphalangeal joint arthritis. J Hand Surg Am 2010; 35: 2107-2116
    CrossrefPubMedGoogle Scholar
  • 19 Karsdal MA, Bay-Jensen AC, Lories RJ et al. The coupling of bone and cartilage turnover in osteoarthritis: opportunities for bone antiresorptives and anabolics as potential treatments?. Ann Rheum Dis 2014; 73: 336-348
    PubMedGoogle Scholar
  • 20 Keen HI, Wakefield RJ, Hensor EMA et al. Response of symptoms and synovitis to intra-muscular methylprednisolone in osteoarthritis of the hand: an ultrasonographic study. Rheumatology 2010; 49: 1093-1100
    CrossrefPubMedGoogle Scholar
  • 21 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16: 494-502
    CrossrefPubMedGoogle Scholar
  • 22 Kingsbury SR, Tharmanathan P, Adamson J et al. Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis (HERO): study protocol for a randomized controlled trial. Trials 2013; 14: 64
    CrossrefPubMedGoogle Scholar
  • 23 Kloppenburg M, Kwok W. Hand osteoarthritis – a heterogeneous disorder. Nat Rev Rheumatol 2012; 8: 22-31
    PubMedGoogle Scholar
  • 24 Kvien TK, Fjeld E, Slatkowsky-Christensen B et al. Efficacy and safety of a novel synergistic drug candidate, CRx-102, in hand osteoarthritis. Ann Rheum Dis 2008; 67: 942-948
    CrossrefPubMedGoogle Scholar
  • 25 Kwok WY, Kloppenburg M, Rosendaal FR et al. Erosive hand osteoarthritis: its prevalence and clinical impact in the general population and symptomatic hand osteoarthritis. Ann Rheum Dis 2011; 70: 1238-1242
    CrossrefPubMedGoogle Scholar
  • 26 Kwok WY, Vliet Vlieland TP, Rosendaal FR et al. Limitations in daily activities are the major determinant of reduced health-related quality of life in patients with hand osteoarthritis. Ann Rheum Dis 2011; 70: 334-336
    CrossrefPubMedGoogle Scholar
  • 27 Leong DJ, Choudhury M, Hirsh DM et al. Nutraceuticals: potential for chondroprotection and molecular targeting of osteoarthritis. Int J Molec Sci 2013; 14: 23063-23085
    CrossrefPubMedGoogle Scholar
  • 28 Loughlin J. Osteoarthritis year 2010 in review: genetics. Osteoarthr Cartil 2011; 19: 342-345
    CrossrefPubMedGoogle Scholar
  • 29 Marshall M, Dziedzic KS, van der Windt DA et al. A systematic search and narrative review of radiographic definitions of hand osteoarthritis in population-based studies. Osteoarthr Cartil 2008; 16: 219-226
    CrossrefPubMedGoogle Scholar
  • 30 Massengale M, Lu B, Pan JJ et al. Adipokine hormones and hand osteoarthritis: radiographic severity and pain. PloS one 2012; 7: e47860
    CrossrefPubMedGoogle Scholar
  • 31 Michou L. Genetics of digital osteoarthritis. Joint Bone Spine 2011; 78: 347-351
    CrossrefPubMedGoogle Scholar
  • 32 Olejarova M, Kupka K, Pavelka K et al. Comparison of clinical, laboratory, radiographic, and scintigraphic findings in erosive and nonerosive hand osteoarthritis. Results of a two-year study. Joint Bone Spine 2000; 67: 107-112
    PubMedGoogle Scholar
  • 33 Oliveria SA, Felson DT, Reed JI et al. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthr Rheum 1995; 38: 1134-1141
    CrossrefPubMedGoogle Scholar
  • 34 Pereira D, Peleteiro B, Araujo J et al. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartil 2011; 19: 1270-1285
    CrossrefPubMedGoogle Scholar
  • 35 Punzi L, Bertazzolo N, Pianon M et al. Soluble interleukin 2 receptors and treatment with hydroxychloroquine in erosive osteoarthritis. J Rheumatol 1996; 23: 1477-1478
    PubMedGoogle Scholar
  • 36 Punzi L, Frigato M, Frallonardo P et al. Inflammatory osteoarthritis of the hand. Clin Rheumatol 2010; 24: 301-312
    PubMedGoogle Scholar
  • 37 Punzi L, Ramonda R, Deberg M et al. Coll2-1, Coll2-1NO2 and myeloperoxidase serum levels in erosive and non-erosive osteoarthritis of the hands. Osteoarthr Cartil 2012; 20: 557-561
    CrossrefPubMedGoogle Scholar
  • 38 Punzi L, Ramonda R, Oliviero F et al. Value of C reactive protein in the assessment of erosive osteoarthritis of the hand. Ann Rheum Dis 2005; 64: 955-957
    CrossrefPubMedGoogle Scholar
  • 39 Punzi L, Ramonda R, Sfriso P. Erosive osteoarthritis. Clin Rheumatol 2004; 18: 739-758
    PubMedGoogle Scholar
  • 40 Ramonda R, Lorenzin M, Modesti V et al. Serological markers of erosive hand osteoarthritis. Eur J Intern Med 2013; 24: 11-15
    CrossrefPubMedGoogle Scholar
  • 41 Ramonda R, Modesti V, Ortolan A et al. Serological markers in psoriatic arthritis: promising tools. Exp Biol Med 2013; 238: 1431-1436
    CrossrefPubMedGoogle Scholar
  • 42 Rau H, Lohmann K, Franke C et al. Multizenterstudie zur Radiosynoviorthese: klinische Ergebnisse bei aktivierten Arthrosen und anderen Gelenkerkrankungen mit chronischer Synovialitis im Vergleich zur rheumatoiden Arthritis. Nuklearmedizin 2004; 43: 57-62
    PubMedGoogle Scholar
  • 43 Reginster JY, Beaudart C, Neuprez A et al. Strontium ranelate in the treatment of knee osteoarthritis: new insights and emerging clinical evidence. Ther Adv Musculoskeletal Dis 2013; 5: 268-276
    PubMedGoogle Scholar
  • 44 Saviola G, Abdi-Ali L, Campostrini L et al. Clodronate and hydroxychloroquine in erosive osteoarthritis: a 24-month open randomized pilot study. Mod Rheumatol 2012; 22: 256-263
    CrossrefPubMedGoogle Scholar
  • 45 Smelter E, Hochberg MC. New treatments for osteoarthritis. Curr Opin Rheumatol 2013; 25: 310-316
    CrossrefPubMedGoogle Scholar
  • 46 Valdes AM, Spector TD. The clinical relevance of genetic susceptibility to osteoarthritis. Best Pract Res Clin Rheumatol 2010; 24: 3-14
    CrossrefPubMedGoogle Scholar
  • 47 Valdes AM, Spector TD. The genetic epidemiology of osteoarthritis. Curr Opin Rheumatol 2010; 22: 139-143
    CrossrefPubMedGoogle Scholar
  • 48 Van Heest AE, Kallemeier P. Thumb carpal metacarpal arthritis. J Amer Acad Orthopaed Surg 2008; 16: 140-151
    PubMedGoogle Scholar
  • 49 Verbruggen G, Veys EM. Numerical scoring systems for the anatomic evolution of osteoarthritis of the finger joints. Arthr Rheum 1996; 39: 308-320
    CrossrefPubMedGoogle Scholar
  • 50 Villeneuve E, Nam JL, Bell MJ et al. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Postgrad Med J 2013; 89: 231-240
    CrossrefPubMedGoogle Scholar
  • 51 Walsh DA, Chapman V. Bisphosphonates for osteoarthritis. Arthritis Res Ther 2011; 13: 128
    CrossrefPubMedGoogle Scholar
  • 52 Wenham CY, Hensor EM, Grainger AJ et al. A randomized, double-blind, placebo-controlled trial of low-dose oral prednisolone for treating painful hand osteoarthritis. Rheumatology 2012; 51: 2286-2294
    CrossrefPubMedGoogle Scholar
  • 53 Wilder FV, Barrett JP, Farina EJ. Joint-specific prevalence of osteoarthritis of the hand. Osteoarthr Cartil 2006; 14: 953-957
    CrossrefPubMedGoogle Scholar
  • 54 Zhang W, Doherty M, Leeb BF et al. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66: 377-388
    CrossrefPubMedGoogle Scholar