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rheuma plus
Erschienen in:

02.10.2018 | Schmerz

Pharmakotherapie bei Arthroseschmerzen

verfasst von: Dr. med. T. A. Nees, M. Schiltenwolf

Erschienen in: rheuma plus | Ausgabe 4/2019

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Zusammenfassung

Ein hoher Anteil insbesondere der älteren Bevölkerung leidet unter Gelenkschmerzen aufgrund einer Arthrose, die zu einer wesentlichen Beeinträchtigung des Alltags und der Lebensqualität sowie zur Behandlung führen. Unzählige medikamentöse Gelenkschmerztherapien werden in der klinischen Praxis angeboten. Der vorliegende Artikel präsentiert die aktuelle Studienlage zur pharmakologischen Therapie bei Arthroseschmerzen unter Berücksichtigung von Leitlinien und umfasst topische, orale und intraartikulär injizierte Arzneimittel. Bei geringfügigen Gelenkschmerzen bietet sich die topische Anwendung von nichtsteroidalen Antirheumatika (NSAR) an. Die lokale Applikation von Capsaicin beschränkt sich auf Patienten, bei denen andere Therapiemöglichkeiten nicht angeschlagen haben oder kontraindiziert sind. Bei stärkeren Schmerzen kann die zeitlich begrenzte orale Einnahme von NSAR empfohlen werden, sofern das unerwünschte Arzneimittelwirkungsprofil des Präparats und patientenbezogene gastrointestinale, kardiovaskuläre und renale Komorbiditäten streng berücksichtigt werden. Bei Patienten mit Polyarthrose und Komorbiditäten, die einen oralen NSAR-Einsatz risikoreich machen, kann die Einnahme von Duloxetin erwogen werden. Für die orale Anwendung von Metamizol, Chondroprotektiva und Nahrungsergänzungsmitteln liegt keine klare Evidenz in der Therapie von Arthroseschmerzen vor. Der standardmäßige Einsatz von Opioiden wird nicht empfohlen. Bei starken Gelenkschmerzen können intraartikuläre Glukokortikoidinjektionen zu kurzfristiger Schmerzlinderung führen. Für intraartikuläre Injektionen von Hyaluronsäure oder autologem konditioniertem Plasma gibt es keine eindeutige Evidenz. Die Effizienz der Effekte einer Pharmakotherapie bei Arthroseschmerzen ist oft widersprüchlich und mögliche schwerwiegende unerwünschte Arzneimittelwirkungen müssen beachtet werden. Ein kritischer Umgang mit diesen therapeutischen Optionen unter Einbezug patientenbezogener Komorbiditäten und nichtpharmakologischer Therapie ist deshalb unerlässlich.
Vorheriger Artikel Sport kann langfristig Analgetika ersetzen
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Metadaten
Titel
Pharmakotherapie bei Arthroseschmerzen
verfasst von
Dr. med. T. A. Nees
M. Schiltenwolf
Publikationsdatum
02.10.2018
Verlag
Springer Vienna
Erschienen in
rheuma plus / Ausgabe 4/2019
Print ISSN: 1868-260X
Elektronische ISSN: 2191-2610
DOI
https://doi.org/10.1007/s12688-018-0215-x

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