Entzündliche Fingergelenkspolyarthrose – 
Herausforderungen in der Diagnostik und Therapie

P. Klaus; J. Detert

doi:10.1055/s-0034-1369951

DMW - Deutsche Medizinische Wochenschrift, Table of Contents

Dtsch Med Wochenschr 2014; 139(17): 898-904
DOI: 10.1055/s-0034-1369951

Übersicht | Review article

Rheumatologie

Entzündliche Fingergelenkspolyarthrose – Herausforderungen in der Diagnostik und Therapie

Inflammatory osteoarthritis of the hands – challenges in diagnosis and therapy

P. Klaus

¹Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, CC12 Charité – Universitätsmedizin Berlin

,

J. Detert

¹Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, CC12 Charité – Universitätsmedizin Berlin

› Author Affiliations

Abstract

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

Full Text

References

Literatur
1 Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 2007; 15 Suppl A A1-56
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
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
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
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
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
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
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
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
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
11 Garnero P, Delmas PD. Biomarkers in osteoarthritis. Curr Opin Rheumatol 2003; 15: 641-646
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
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
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
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
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
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
18 Jacobs BJ, Verbruggen G, Kaufmann RA. Proximal interphalangeal joint arthritis. J Hand Surg Am 2010; 35: 2107-2116
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
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
21 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16: 494-502
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
23 Kloppenburg M, Kwok W. Hand osteoarthritis – a heterogeneous disorder. Nat Rev Rheumatol 2012; 8: 22-31
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
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
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
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
28 Loughlin J. Osteoarthritis year 2010 in review: genetics. Osteoarthr Cartil 2011; 19: 342-345
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
30 Massengale M, Lu B, Pan JJ et al. Adipokine hormones and hand osteoarthritis: radiographic severity and pain. PloS one 2012; 7: e47860
31 Michou L. Genetics of digital osteoarthritis. Joint Bone Spine 2011; 78: 347-351
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
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
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
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
36 Punzi L, Frigato M, Frallonardo P et al. Inflammatory osteoarthritis of the hand. Clin Rheumatol 2010; 24: 301-312
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
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
39 Punzi L, Ramonda R, Sfriso P. Erosive osteoarthritis. Clin Rheumatol 2004; 18: 739-758
40 Ramonda R, Lorenzin M, Modesti V et al. Serological markers of erosive hand osteoarthritis. Eur J Intern Med 2013; 24: 11-15
41 Ramonda R, Modesti V, Ortolan A et al. Serological markers in psoriatic arthritis: promising tools. Exp Biol Med 2013; 238: 1431-1436
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
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
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
45 Smelter E, Hochberg MC. New treatments for osteoarthritis. Curr Opin Rheumatol 2013; 25: 310-316
46 Valdes AM, Spector TD. The clinical relevance of genetic susceptibility to osteoarthritis. Best Pract Res Clin Rheumatol 2010; 24: 3-14
47 Valdes AM, Spector TD. The genetic epidemiology of osteoarthritis. Curr Opin Rheumatol 2010; 22: 139-143
48 Van Heest AE, Kallemeier P. Thumb carpal metacarpal arthritis. J Amer Acad Orthopaed Surg 2008; 16: 140-151
49 Verbruggen G, Veys EM. Numerical scoring systems for the anatomic evolution of osteoarthritis of the finger joints. Arthr Rheum 1996; 39: 308-320
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
51 Walsh DA, Chapman V. Bisphosphonates for osteoarthritis. Arthritis Res Ther 2011; 13: 128
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
53 Wilder FV, Barrett JP, Farina EJ. Joint-specific prevalence of osteoarthritis of the hand. Osteoarthr Cartil 2006; 14: 953-957
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