Frühdiagnose der Arthrose: klinische Realität und experimentelle Pipeline

Zusammenfassung

In der Frühphase der Arthrose wird das Ausmaß des strukturellen Schadens noch als gering und als theoretisch reversibel angesehen. Daher sind Entwicklungen zur Frühdiagnose der Arthrose für unser Fachgebiet von großer Bedeutung. Der vorliegende Review richtet sich an den klinisch tätigen Orthopäden und Unfallchirurgen und stellt anhand von 3 Fallbeispielen den gegenwärtigen Stand der klinischen Routineversorgung sowie experimentelle Strategien mit translationalem Charakter dar. Im Einzelnen werden nicht invasive bildgebende Verfahren wie die quantitative Magnetresonanztomografie (MRT), die MRT-Fusionsbildgebung, die Ultraschalltechnik sowie Ultraschallfusionsbildgebungen, die optische Kohärenztomografie (OCT), die Szintigrafie und das sog. Diffraction-Enhanced Synchrotron Imaging (DEI) sowie biochemische Verfahren und die Proteomik berücksichtigt. Anschließend werden minimalinvasive Verfahren wie die Arthroskopie sowie Fusionen der Arthroskopie mit Indentationstechniken, der Spektrometrie und der Multiphotonenmikroskopie und invasive Verfahren wie die Makroskopie und die Histologie in Bezug auf die Frühdiagnose der Arthrose diskutiert. Zuletzt werden Veränderungen in der räumlichen Organisation humaner Chondrozyten als Beispiel eines bildbasierten Biomarkers dargestellt. Dieser beruht nicht auf dem Nachweis struktureller Schäden, sondern berücksichtigt frühe Veränderungen der Gewebearchitektur potenziell vor dem Auftreten erster Schäden und außerhalb von Arthroseläsionen. Zusammenfassend sind viele relativ kliniknahe (translationale) Techniken bereits jetzt in der Lage, frühe strukturelle Schäden experimentell zu erkennen. Allerdings ist das Abschätzen der klinischen Relevanz dieser vielen Techniken aufgrund fehlender Daten noch nicht möglich und eine vergleichende Bewertung der einzelnen Verfahren ist derzeit kaum möglich. Diese vielen relativ kliniknahen Techniken werden unser Verständnis frühester Arthroseprozesse deutlich verbessern, was wiederum als Katalysator für die Entwicklung effektiver Strategien für die Frühdiagnose, Frühtherapie oder gar Prävention wirken kann. Nichtsdestotrotz bleibt die klinische Diagnose der Früharthrose eines der großen Ziele unseres Fachgebiets. Die Verwirklichung dieses Zieles ist am Horizont sichtbar, aber der Weg dorthin wird noch durch viele weiße Flecken auf der Karte führen.

Abstract

It is considered that the structural damage in early osteoarthritis (OA) is potentially reversible. It is therefore particularly important for orthopaedic and trauma surgery to develop strategies and technologies for diagnosing early OA processes. This review presents 3 case reports to illustrate the current clinical diagnostic procedure for OA. Experimental techniques with translational character are discussed in the context of the detection of early degenerative processes relevant to OA. Non-invasive imaging methods such as quantitative MRI, ultrasound, optical coherence tomography (OCT), scintigraphy and diffraction-enhanced synchrotron imaging (DEI), as well as biochemical methods and proteomics, are considered. Early detection of OA is reviewed with minimally invasive techniques, such as arthroscopy, as well as the combination of arthroscopic techniques with indentation, spectrometry, and multiphoton microscopy. In addition, a brief summary of macroscopic and histologic scores is presented. Finally, the spatial organisation of joint surface chondrocytes as an image-based biomarker is used to illustrate an early OA detection strategy that focusses on early changes in tissue architecture potentially prior to damage. In summary, multiple translational techniques are able to detect early OA processes but we do not know whether they truly represent the initial events. Moreover, at this point it is difficult to judge the future clinical relevance of these procedures and to compare their efficacy, as there have been comparative studies. However, the expected gain in knowledge will hopefully help us top attain a more comprehensive understanding of early OA and to develop novel methods for its early diagnosis, therapy, and prevention. Overall, the clinical diagnosis of early OA remains one of the greatest challenges of our field. We still face uncharted territory.

Schlüsselwörter

Arthrose - Früharthrose - Frühdiagnose Osteoarthritis

Key words

early osteoarthritis - early diagnosis - early detection

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