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"Fibromyalgie Syndrome ( FMS ) ist ein bei Frauen haeufig vorkommendes Schmerzsyndrom . Die pathophysiologischen Ursachen sind jedoch noch ungeklaert . Veraenderungen im Hormonhaushalt der Monoamine , Neuropeptide und von Stresshormonen werden als Ursachen diskutiert . In der vorliegenden Arbeit haben wir die Plasmakonzentrationen des unlaengst entdeckten Neuropeptid \" Nociceptin \" bei Frauen mit FMS und bei gesunden Kontrollpersonen untersucht . Unsere Resultate zeigen , dass die Konzentration von Nociceptin bei diesen Patienten niedriger waren als bei Kontrollpatienten . Signifikant erniedrigtes Nociceptin fanden wir besonders bei Patienten , die im Vergleich zur Kontrollgruppe Menstruationszyklen mit lutealer Phase hatten . Unsere Resultate deuten also daraufhin , dass gestoerte Nociceptinspiegel bei FMS abhaengig sind von der Sexual- und Stresshormonregulierung . Diese Stoerungen koennten neben anderen moeglichen Faktoren die pathophysiologische Ursache des FMS sein ."
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"Die Symptomatologie des Fibromyalgie Syndroms ( FMS ) gleicht vielfach einer zentralnervoesen Sollwertverstellung , zumindest in drei Systemen : die Patienten leiden an chronischen Schmerzen im Bereich des Bewegungsapparates , vermutlich als Ausdruck einer gestoerten zentralen Schmerzverarbeitung . Nahezu alle vom Hypothalamus regulierten hormonalen Regelkreise sind verstellt . Haeufig praegt eine depressive Verstimmtheit das Krankheitsbild . Um die hormonale Regulation bei FMS-Patienten zu untersuchen , haben wir bei 16 FMS-Patienten und 17 gesunden Kontrollpersonen die Hypophyse durch simultane intravenoese Injektionen der hypothalamischen Releasing Hormone Corticotropin Releasing Hormon ( CRH ) , Growth Hormone Releasing Hormon ( GHRH ) , Thyreotropin Releasing Hormon ( TRH ) und Luteinisierungshormon Releasing Hormon ( LHRH ) stimuliert und die entsprechenden Hormone der Hypophyse und der peripheren endokrinen Druesen bestimmt . Wir fanden bei den FMS- Patienten erhoehte Basalwerte von ACTH , Follikelstimulierendes Hormon ( FSH ) und Kortisol , hingegen erniedrigte Basalwerte von Insulin-like growth factor I ( IGF-I , Somatomedin C ) , Trijodthyronin ( T3) und Oestrogen . Die Simultaninjektion der Releasing-Hormone fuehrte bei FMS-Patienten zu einer hoeheren Sekretion von ACTH und Prolaktin , waehrend die Stimulierbarkeit von TSH , begleitet von nur schwach ansteigenden T3-Werten, herabgesetzt war . Die Stimulierung der Hypophyse mit LHRH von sechs FMS-Patientinnen in deren Follikelphase zeigte beim Vergleich mit sechs gleichaltrigen Kontrollpersonen eine signifikant abgeschwaechte LH-Antwort . Wir erklaeren die fuer FMS-Patienten typischen Sollwertverstellungen der hormonalen Regulation als eine primaer durch den chronischen Schmerz bedingte Stressaktivierung hypothalamischer CRH Neurone . Zusaetzlich zur ACTH-Stimulierung aktiviert CRH auf der hypothalamischen Ebene Somatostatin , welches auf hypophysaerer Ebene die GH- und TSH-Freisetzung hemmt . Die erniedrigten Oestrogenspiegel lassen sich sowohl ueber die hemmende Wirkung des CRH auf die LHRH-Freisetzung erklaeren , als auch ueber eine direkte , CRH-vermittelte Hemmung der FSH-stimulierten Oestrogenproduktion im Ovar ."
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ZfuerRheumatologie.8057s088.ger.abstr | ZfuerRheumatologie.8057s088.ger.abstr | [
{
"id": "ZfuerRheumatologie.8057s088.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Psychosozialer Stress und psychische Auffaelligkeiten werden bei Fibromyalgie Patienten vermehrt beobachtet . In klinischen und epidemiologischen Studien findet sich gehaeuft ein Muster von niedrigem Bildungsgrad , erhoehter Scheidungsrate , Uebergewicht und Nikotinabusus . In gleicher Weise gehaeuft finden sich physische Gewalt und sexueller Missbrauch in der Anamnese . Manifeste Depression als auch erhoehte Raten auf Skalen fuer Depressivitaet , Aengstlichkeit und Somatisierungstendenz werden ueberlicherweise ebenso bei Fibromyalgie gefunden ."
],
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ZfuerRheumatologie.8057s094.ger.abstr | ZfuerRheumatologie.8057s094.ger.abstr | [
{
"id": "ZfuerRheumatologie.8057s094.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Die Praevalenz der FM wird in der Bevoelkerung mit 2% angegeben . In der rheumatologischen Praxis gehoert diese Erkrankung zu einer der 3 haeufigsten Diagnosen . Wir haben 304 FM Patienten unserer Abteilung einen standardisierten Fragebogen geschickt , um das Ausmass einer Depression , eine familiaere Belastung mit Depression und Fibromyalgie sowie den Umfang einer moeglichen psychischen Belastung zu bestimmen . Von den 100 Patienten , die geantwortet haben , wiesen 27% > 21 ) ( erhoehte Werte im Beck Depressions Inventar auf , die hinweisend auf eine klinisch relevante Depression sind . Bzgl . der psychischen Belastung , gemessen mit dem SCL-90-R, fanden sich erhoehte Skalenwerte sowohl bei der Gesamtbelastung als auch bei den Subskalen . 23% der Patienten hatten eine familiaere Belastung bzgl. einer Depression und 46% bzgl. einer Fibromyalgie . Bei 46% der Patienten wurde in der Vergangenheit eine Depression diagnostiziert ."
],
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]
]
}
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{
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ZfuerRheumatologie.8057s097.ger.abstr | ZfuerRheumatologie.8057s097.ger.abstr | [
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ZfuerRheumatologie.8057s101.ger.abstr | ZfuerRheumatologie.8057s101.ger.abstr | [
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ZfuerRheumatologie.8057s105.ger.abstr | ZfuerRheumatologie.8057s105.ger.abstr | [
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ZfuerRheumatologie.90580021.ger.abstr | ZfuerRheumatologie.90580021.ger.abstr | [
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"Eine 35 Jahre alte Frau wurde aufgrund ploetzlich aufgetretenem Fieber mit Schuettelfrost stationaer aufgenommen . In Blutkulturen konnte Streptococcus pneumoniae nachgewiesen werden . Klinisch fanden sich akrale Nekrosen ; damit lag das Vollbild einer OPSI ( overwhelming post-splenectomy infection ) vor . Die Patientin erholte sich unter hochdosierter Penicillin-G-Gabe . Im Blut konnten Howell-Jolly Koerperchen nachgewiesen werden . Sonographisch und im CT konnte eine normal grosse Milz dargestellt werden . Die Milzarterie blieb angiographisch unauffaellig bei Gefaessrarefizierung der kleinen Milzgefaesse , eine Milzvenenthrombose konnte ausgeschlossen werden . Im MRT konnte mittels Endorem ( Fe ) fehlende Partikelaufnahme der Milz gezeigt werden . Der Nachweis einer funktionellen Asplenie gelang auch szintigraphisch . Erhoehte antinukleaere Antikoerper und der Nachweis eines Sm-Antikoerpers fuehrten zur Diagnose einer undifferenzierten Kollagenose . Nach unserem Kenntnisstand beschreiben wir erstmals eine funktionelle Asplenie als Erstmanifestation einer systemischen Autoimmunerkrankung ."
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ZfuerRheumatologie.90580035.ger.abstr | ZfuerRheumatologie.90580035.ger.abstr | [
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"Das RS3PE-Syndrom ( Remitting Seronegative Symmetrical Synovitis with Pitting Edema , voruebergehende seronegative symmetrische Synovitis mit eindrueckbarem Oedem ) stellt wahrscheinlich eine Manifestation der rheumatoiden Arthritis im Alter mit guter Prognose dar . Es kommt hierbei neben einer ploetzlich auftretenden symmetrischen Polysynovitis zu einem eindrueckbaren Oedem der Hand- und Fussruecken . Unter antiinflammatorischer Therapie mit Kortikosteroiden kommt es in der Regel zu einer raschen Besserung der Symptome . Wir beschreiben den Fall eines 81-jaehrigen Patienten , dessen zunaechst einseitige Manifestation zum Verdacht einer Armvenenthrombose fuehrte . Im Verlauf kam es innerhalb weniger Tage zur Schwellung des zweiten Handrueckens . Weiterhin bestand eine schmerzhafte Bewegungseinschraenkung beider Schulter- und Handgelenke . Unter einer niedrig dosierten Prednisolontherapie kam es zu einer raschen Rueckbildung der Schwellung und der Entzuendungssymptomatik ."
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"Es wurde die Wirksamkeit der Radiosynoviorthese bei der Therapie chronisch-entzuendlicher Gelenkerkrankungen , insbesondere der chronischen Polyarthritis , untersucht ."
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ZfuerRheumatologie.90580088.ger.abstr | ZfuerRheumatologie.90580088.ger.abstr | [
{
"id": "ZfuerRheumatologie.90580088.ger.abstr-passage-0",
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"Einleitung : Interleukin-1 ist ein wichtiger Faktor in der Pathophysiologie der Osteoporose und moeglicherweise der periartikulaeren Knochenresorption bei rheumatoider Arthritis . Die Nutzung von therapeutischen Proteinen , wie Zytokinen und Wachstumsfaktoren als neue therapeutische Modalitaet beinhaltet ein grosses medikamentoeses Potential . Die konventionelle Applikation rekombinanter Proteine ist jedoch fuer eine klinischen Anwendung aufgrund kurzer Halbwertzeiten ungeeignet . Fragestellung : Es sollte erstens untersucht werden , ob humane osteoblastaere Zellen in vitro retroviral transduziert werden koennen . Zweitens wurde getestet , ob sich die retrovirale Transduktionsrate in vitro optimieren laesst . Methode : Die untersuchten Zellpopulationen wurden aus humanen Spongiosaproben isoliert und in vitro kultiviert . Das -Galactosidase-Gen ( LacZ ) und die cDNA des humanen Interleukin-I-rezeptorantagonistischen Proteins ( IL-1Ra) wurden durch retroviral vermittelten Gentransfer auf die Zellkulturen uebertragen . Die LacZ Aktivitaet wurde durch Xgal-Faerbung bestimmt , IL-1Ra wurde mittels ELISA quantitativ gemessen . Ergebnisse : Die IL-1Ra-Expression erreichte Werte von 8614pg IRAP/50000 Zellen/48h bis 10089pg IRAP/50000 Zellen/48h. Unter Optimierung der Transduktionstechnik liess sich bei der X-gal-Faerbung nach retroviralem Transfer des LacZ Gens eine Transduktionsrate von 60% nachweisen . Schlussfolgerungen : Unsere Ergebnisse demonstrieren , dass eine retrovirale Transduktion von humanen osteoblastaeren Zellen in vitro moeglich ist und zu einer reproduzierbaren Produktion der transgenen Produkte fuehrt ."
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ZfuerRheumatologie.90580095.ger.abstr | ZfuerRheumatologie.90580095.ger.abstr | [
{
"id": "ZfuerRheumatologie.90580095.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Die Heberden-Arthrose betrifft hauptsaechlich das weibliche Geschlecht im mittleren Alter und wird bei Frauen autosomal dominant und bei Maennern autosomal rezessiv vererbt . Wir berichten ueber den Fall eines maennlichen Patienten bei dem bereits im Alter von 12 Jahren eine Heberden-Arthrose der Fingergelenke auftrat . Im Laufe von mehr als 15 Jahren waren diese Veraenderungen bei dem Patienten weder klinisch noch radiologisch progredient . Bei der HLA-Typisierung fand sich der Haplotyp HLA A1, B8 und DR4, passend zu anderen Studien , die eine erhoehte Frequenz von HLA A1, B8 bei familiaerer Polyarthrose berichten ."
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ZfuerRheumatologie.90580100.ger.abstr | ZfuerRheumatologie.90580100.ger.abstr | [
{
"id": "ZfuerRheumatologie.90580100.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Es wird die bildgebende Diagnostik der Manubriosternalgelenksarthritis im Rahmen einer Psoriasisarthritis bei einem 64jaehrigen Patienten beschrieben . Die Mitbeteiligung des Manubriosteranlgelenkes ( Synchondrosis sternalis ) ist eine seltene Manifestation der Psoriasisarthritis . Es werden die Befunde der Skelettszintigraphie , der konventionellen Roentgendiagnostik und der Arthrosonographie der Manubriosternalgelenksarthritis demonstriert und diskutiert ."
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ZfuerRheumatologie.90580130.ger.abstr | ZfuerRheumatologie.90580130.ger.abstr | [
{
"id": "ZfuerRheumatologie.90580130.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Das Forschungsgebiet Tissue Engineering verbindet die Bereiche Zellbiologie Biomaterialforschung und Chirurgie . , Wichtigstes Ziel ist ein Gewebe- und Organersatz mit Hilfe gezuechteter Zellen des Patienten . Unsere Arbeit konzentriert sich auf die Therapie schwerer Gelenkknorpeldefekte und die Geweberekonstruktion in der plastischen Chirurgie mit Hilfe in vitro hergestellter Knorpeltransplantate . Dieser praktische Ansatz erfordert zunaechst Techniken zur dreidimensionalen Zellverteilung und Einbettung sowie einer temporaeren mechanischen Stabilisierung . Die Knorpelzuechtung basiert auf einer biokompatiblen Einbettung der Zellen in Agarose , Fibrin , Alginat oder Hyaluronsaeure in Verbindung mit einer Gerueststruktur aus resorbierbaren Polymerfaservliesen ( PLLA/PGLA ) . In interagierenden dreidimensionalen Kulturen koennen unterschiedliche Zellpopulationen wie z.B. BMP-transfizierte Zellen eingesetzt werden . Gezuechtete Gewebe wurden vorgeformt und in Perfusionskammern kultiviert . Anschliessend wurden sie subkutan in Nacktmaeuse und in Gelenkknorpeldefekte bei Kaninchen implantiert . Die Transplantate zeigen eine knorpeltypische Histologie und Matrixentwicklung . Etwa 20% der Gewebe wurden teilweise resorbiert oder durch fibroeses Bindegewebe ersetzt . Die Ergebnisse zeigen , dass die Technologie des Knorpel-Tissue-Engineerings vielversprechend fuer die plastische Geweberekonstruktion ist . Die Behandlung grossflaechiger Gelenkknorpeldefekte erfordert jedoch zunaechst die Loesung einiger wichtiger Probleme : ( a ) die Verankerung eines gezuechteten Gewebeersatzes im Gelenk , ( b ) ein Schutz der Transplantate vor chronischen Entzuendungsvorgaengen und Degradation , ( c ) die enorm hohe mechanische Druckbelastbarkeit ."
],
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]
}
] | [
{
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"Die Knorpeldestruktion bei der Arthritis und der Arthrose ist an eine ueberschiessende Expression von Zytokinen und Wachstumsfaktoren im betroffenen Gewebe gebunden . Es wird offenkundig , dass das Gleichgewicht zwischen protektiven und destruktiven Zytokinen wichtiger fuer die resultierende Zerstoerung ist , als die absoluten Spiegel destruktiver Mediatoren . IL-1 ist ein destruktiver Schluessel-Mediator bei der Arthritis und moeglicherweise auch bei der Arthrose . Die Bildung des knorpelzerstoerenden Enzyms Stromelysin ist an IL-1 gebunden . Bei der Arthrose kann die ueberschiessende Bildung des Wachstumsfaktors TGF zur Knorpelzerstoerung und besonders zur Osteophytenbildung beitragen . Die Therapie sollte auf die Neutralisation von IL-1 und die Stimulation sicherer anaboler Wachstumsfaktoren fuer den Gelenkknorpel gerichtet sein , wie beispielsweise IGF-1 ferner auf neue , dem Knochen und Knorpel entstammende morphogene Proteine ."
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ZfuerRheumatologie.90580142.ger.abstr | ZfuerRheumatologie.90580142.ger.abstr | [
{
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"In der vorliegenden Studie untersuchten wir den Einfluss gestoerter peripherer sensorischer Afferenzen auf die Ausbildung arthrotischer Kniegelenksveraenderungen in einem Rattenmodell . Dazu fuehrten wir bei insgesamt 16 maennlichen Wistarratten eine sensible Teildenervierung der linken Kniegelenke mittels Capsaicin ( 8-Methyl-N-vanillyl-6-noneamide) durch , waehrend 12 Ratten ohne gestoerte sensible Gelenkinnervation als Kontrollgruppe dienten . Anschliessend erfolgte bei jeweils der Haelfte der denervierten und der nichtdenervierten Tiere eine exzessive Laufbelastung ( Gesamtlaufleistung 20km ) im Laufrad mittels intrakranialer Selbstimmulation . Die verbleibenden Tiere beider Gruppen wurden keiner Laufbelastung unterzogen . Die histologische Beurteilung der Kniegelenke mit Hilfe des Mankin-Scores erbrachte bei den Versuchstieren ohne Laufbelastung , unabhaengig davon , ob eine sensible Teildenervierung erfolgt war oder nicht , keinerlei arthrotische Veraenderungen . Im Gegensatz dazu zeigten alle Tiere mit 20km Laufbelastung deutliche Gonarthrosezeichen . Waehrend es sich bei den Tieren ohne sensible Teildenervierung fast ausschliesslich um leichte bis maessiggradige Veraenderungen handelte , zeigte sich in den Kniegelenken der Tiere mit sensibler Teildenervierung vorzugsweise schwere arthrotische Veraenderungen . Insgesamt gibt diese Arbeit deutliche Hinweise auf eine potenzierende Wirkung sensorischer artikulaerer Defizite auf die Entwicklung osteoarthrotischer Gelenkveraenderungen ."
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ZfuerRheumatologie.90580173.ger.abstr | ZfuerRheumatologie.90580173.ger.abstr | [
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"Die NSA-Gastropathie ist eine haeufige und wichtige Nebenwirkung einer Medikation mit NSA in der Rheumatologie . Ein erhoehtes Risiko hierfuer haben Patienten hoeheren Alters , mit Ulkusanamnese und gleichzeitiger Prednisolon-Medikation . Vornehmlich bei diesen sollte eine den Magen schuetzende medikamentoese Prophylaxe durchgefuehrt werden . Hierfuer stehen Protonenpumpenhemmer Prostaglandinanaloga und H2-Blocker , zur Verfuegung , die in unterschiedlicher Intensitaet ( etwa in dieser Reihenfolge ) symptomatisch und vorbeugend wirksam sind . Mit 20mg Omeprazol/die , dem teuersten Praeparat , lassen sich in den meisten Faellen GI-Komplikationen verhindern ; eine hoehere Dosis ist nicht wirksamer . Das Praeparat wirkt haeufig auch , aber nicht immer , wenn die NSA-Behandlung fortgefuehrt werden muss . Bislang nur fuer eine Prophylaxe mit 800µg Misoprostol/die wurde gezeigt , dass die Anzahl von schweren GI-Nebenwirkungen innerhalb eines Jahres signifikant verringert werden konnte . Eine Verringerung des GI-Risikos ist auch durch Ueberpruefen der Indikation , Auswahl des NSA und bessere Patienteninformation moeglich . Die Entdeckung von zwei Isoformen der COX wird moeglicherweise schon in naher Zukunft zur Entwicklung von COX-2-selektiven bzw. COX-2-spezifischen besser vertraeglichen NSA mit weniger unerwuenschten GI-Effekten fuehren ."
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ZfuerRheumatologie.90580185.ger.abstr | ZfuerRheumatologie.90580185.ger.abstr | [
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"Es werden eine Patientin mit einer chronischen myeloischen Leukaemie ( CML ) und ein Patient mit Haarzell-Leukaemie in haematologischer Remission der Leukaemie unter -Interferon geschildert , die im Verlauf eine seropositive symmetrische Polyarthritis entwickelten , die die Kriterien fuer eine rheumatoide Arthritis formal erfuellte . Wegen der guten Effektivitaet des Interferons fuer die haematologische Erkrankung wurde diese Therapie nicht abgesetzt und die Arthritis mit niedrigdosiertem Prednisolon bzw. nichtsteroidalen Antirheumatika behandelt . Es handelt sich hier um die 19. und 20. Fallbeschreibung einer symmetrischen Polyarthritis unter -Interferon-Therapie , die die Kriterien fuer eine rheumatoide Arthritis erfuellt . Moegliche Ursachen des gehaeuften Auftretens von Autoimmunerkrankungen unter Interferontherapie werden diskutiert ."
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"Die offene Fruehsynovektomie des Kniegelenks ist ein etabliertes Standardverfahren der operativen Rheumaorthopaedie . Anhand von Langzeitergebnissen soll gezeigt werden , dass auch die Spaetsynovektomie ein sinnvoller Eingriff mit langfristig haeufig gelenkerhaltendem Effekt ist . In einer Studie konnten 93 spaetsynovektomierte Kniegelenke von 74 Patienten nachuntersucht werden . Der Nachuntersuchungszeitraum betrug durchschnittlich 10,1 6,4-12,7) Jahre . ( Von 93 mussten 37 ( 39,8% Kniegelenke ) erneut operiert werden , sie wurden in der Studie in Bezug auf den Ersteingriff als Versager gewertet ; bei 56 ( 60,2% ) war keine weitere Operation notwendig . Bei den 37 erneut operierten Kniegelenken konnten 12 gelenkerhaltende Eingriffe durchgefuehrt werden , so dass nach ueber 10 Jahren bei insgesamt 73,1% ( n=68) ein Gelenkersatz vermieden werden konnte . Da der durchschnittliche Zeitraum zwischen Primaeroperation und Zweiteingriff 7,1 1,5-12,8) Jahre ( betrug , ist auch dieser Zeitgewinn der relativ jungen Patienten ( Durchschnittsalter : 48,7 Jahre ) als positiv zu werten . Weiterhin zeigte sich bleibend eine deutliche Reduktion von Schmerz und Schwellung bei hoher Akzeptanz des Eingriffs durch die Patienten , jedoch eine hochsignifikante radiologische Progression ( Larsen-Stadium 2,2 : auf 3,7 ) . Die Spaetsynovektomie erscheint so als ein sinnvoller Eingriff mit langfristigem gelenkerhaltendem Effekt ."
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ZfuerRheumatologie.90580207.ger.abstr | ZfuerRheumatologie.90580207.ger.abstr | [
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"Die bei entzuendlich-rheumatischen Erkrankungen bewaehrte Radiosynoviorthese wird inzwischen zunehmend ambulant durchgefuehrt . Zudem wird sie immer haeufiger zur Erfolgsverbesserung mit der arthroskopischen Synovektomie kombiniert . In beiden Faellen ist gegenueber der urspruenglich stationaer durchgefuehrten Therapie eine Zunahme des lymphogenen Radionuklidabtransportes und damit der Strahlenexposition denkbar . Der Aktivitaetsabtransport wurde bei 35 Patienten mittels Ganzkoerperszintigraphie bestimmt , insgesamt liess sich bei 17 Patienten ein Abtransport nachweisen . Die Patienten wurden in drei Gruppen unterteilt , die sich in den oben genannten Therapiemodalitaeten unterschieden . Hierbei ergab sich kein statistisch wertbarer Unterschied des Aktivitaetsabtransportes ( p > 0,05 ) und der daraus resultierenden Strahlenexposition . Die 50%-Perzentile mit 68,27%-Vertrauensbereich des zu erwartenden lymphogenen Aktivitaetsabtransportes ergab sich zu 1,8 ( 0,45-4,78)% der injizierten Yttrium-90-Aktivitaet. Daraus errechnete sich unter Beruecksichtigung der vom therapierten Kniegelenk ausgehenden Bremsstrahlung eine Gonadenexposition von 0,1 ( 0,05-0,18) mSv fuer Frauen und von 0,2 ( 0,1-0,38) mSv bei Maennern . Fuer Lymphknoten , Leber , Milz und Ganzkoerper ergab sich eine Strahlenexposition von 619 ( 154-1644 ) mSv , 62 ( 15-165 ) mSv , 62 ( 15-165 ) mSv und 37 ( 9-99 ) mSv . Das aus der Gonadenexposition resultierende genetische Risiko ist vernachlaessigbar klein . Das aus der Ganzkoerperexposition resultierende Tumormorbiditaetsrisiko ist mit 0,4 Promille ebenfalls gering . Somit ergibt sich auch unter Beruecksichtigung bisher fehlender Berichte ueber Tumorerkrankungen in Zusammenhang mit der Radiosynoviorthese keine generelle Notwendigkeit , die Anwendung altersabhaengig bzw. abhaengig von der Therapiemodalitaet zu beschraenken ."
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"Das Ziel der vorliegenden Arbeit war die transkulturelle Adaptation des Bath Ankylosing Spondylitis Functional Index \" ( \" BASFI ) und des Dougados Funktionsindex \" ( \" D-FI ) . Nach der Uebersetzung und Rueckuebersetzung erfolgte die Testung der Verteilungsmuster der Frageboegen , der internen Konsistenz ( Cronbach`s Koeffizient alpha ) , der Test-Retestzuverlaessigkeit ( Intraklassen Korrelationskoeffizient , ICC ) , der Konstruktvaliditaet ( Testung der hypothetischen Assoziation der Indizes mit anderen klinischen Erkrankungsparametern : lumbaler Schobertest , Finger-Boden-Abstand , Hinterhaupt-Wand-Abstand , Anzahl und Laenge naechtlicher Wachphasen und einer visuellen Analogskala Schmerz ) und der Empfindlichkeit gegenueber Therapieveraenderungen ( standardized response mean , SRM ) an 72 Patienten einer randomisierten kontrollierten Doppelblindstudie ( Diclofenac versus Placebo ) . Die visuelle Untersuchung des Verteilungsmusters ergab bei beiden Instrumenten einen Deckeneffekt . Die Frageboegen zeigten eine hohe interne Konsistenz ( Cronbach alpha 0,81 [ BASFI ] bzw. 0,85 [ D-FI ] und eine gute Test-Retestzuverlaessigkeit ( ICC 0,92 [ BASFI ] bzw. 0,89 [ D-FI ] ) . Die limitierte Empfindlichkeit beider Indizes gegenueber Diclofenacmedikation ( SRM : 0,46 [ BASFI ] bzw. 0,33 [ D-FI ] ) ist u.a. im Zusammenhang mit der durchgefuehrten Patientenselektion zu interpretieren . Der BASFI ist mit allen getesteten klinischen Erkrankungsparametern signifikant korreliert , der D-FI nur mit Finger-Boden-Abstand , Hinterhaupt-Wand-Abstand und der Laenge naechtlicher Wachphasen . Zusammenfassend stellen sich der BASFI und der D-FI als valide , reliable und intern konsistente Messinstrumente dar . Aufgrund der psychometrischen Eigenschaften erscheint gegenwaertig der BASFI besser fuer die Anwendung im Rahmen klinischer Studien geeignet ."
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"Die Rheumatoide Arthritis ( RA ) ist eine chronisch-entzuendliche , multisystemische Autoimmunerkrankung unklarer Genese . Klinisch ist die Erkrankung durch eine chronisch-rezidivierende Entzuendung der Gelenke/Synovia und meist progrediente Gelenkdestruktion durch Knorpel- und Knochenzerstoerung charakterisiert . Da bisherige Therapeutika die Erkrankung meist nicht zum Stillstand bringen koennen und durch ihre Nebenwirkungen teilweise erheblich zur erhoehten Morbiditaet der Patienten beitragen , gewinnen auf der Suche nach effektiveren Behandlungsformen mit guenstigeren Nebenwirkungsprofilen direkte immunologische Interventionstherapien gegen proinflammatorische Zytokine zunehmend an Bedeutung . In-vitro und tier-experimentelle in-vivo Untersuchungen sowie Therapiestudien belegen die zentrale Bedeutung von TNF und IL-1 als proinflammatorische Zytokine in der RA . Zahlreiche Therapiestudien zeigen , dass die Behandlung der akuten RA mit TNF-Antikoerpern/-Rezeptorfusionsproteinen oder IL-1-Antagonisten ein klinisch sowie immunologisch sehr effizientes , erfolgreiches Therapiekonzept darstellt , welches bei zeitlich begrenzter Therapiedauer relativ gut vertragen wird . Ferner erscheint eine Kombinationsbehandlung von TNF-Antikoerpern mit Methotrexat ebenfalls erfolgreich zu sein . Langfristig koennen jedoch schwerwiegenden Nebenwirkungen ( schwere Infektionen , Induktion von Autoantikoerpern , allergischer Schock , moeglicherweise Induktion von Tumoren ) sowie abnehmende Therapieeffizienz ( Verkuerzung des rezidivfreien Intervalles zwischen den Therapiezyklen ) unter der Behandlung auftreten , so dass die derzeit verfuegbaren TNF- oder IL-1-Rezeptor-Antagonisten nur unter kontrollierten Studienbedingungen und strenger Indikationsstellung eingesetzt werden sollten . Aufgrund der moeglichen schwerwiegenden Langzeit-Nebenwirkungen sollte eine engmaschige Nachbeobachtung der Patienten insbesondere die Nutzen-/Risiko-Relation weiter abklaeren . Ueber die direkte TNF- oder IL-1-Inhibition hinaus bestehen zahlreiche weitere Moeglichkeiten der indirekten immunologischen Interventionstherapie durch Synthese-Hemmung oder Rezeptormodulation von Zytokinen , deren Stellenwert zukuenftig noch weiter geklaert werden muss . Auch muss der Nutzen einer Kombination von immunologischer Interventionstherapie mit etablierten Behandlungsoptionen der RA weiter abgeklaert werden ."
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"Ziele : Die Symptomatik der rheumatischen Handflexorensehnenerkrankung in Abhaengigkeit vom Laesionsort und von der Art der Sehenaffektion festzustellen , um durch eine verbesserte klinische Diagnostik eine fruehzeitige operative Therapie mit Erhalt der Handfunktion zu ermoeglichen ."
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"Die Praezision osteodensitometrischer Messungen mit der dual energy X-ray absorptiometry ( DEXA ) haengt von verschiedenen bekannten Faktoren , wie Lagerung , Aortenverkalkung oder Wirbelkoerperfrakturen ab . Ziel der Untersuchung war , den Einfluss verschiedener Erkrankungen bzw. der Knochendichte auf die Reproduzierbarkeit der Messungen an der Lendenwirbelsaeule und am Femur zu ueberpruefen . Insgesamt wurden 100 Patienten an der LWS p.a. , LWS lat . und am Ward`schen Dreieck doppelt gemessen , wobei zwischen den Messungen neu positioniert wurde . Um den Einfluss unterschiedlicher Erkrankungen festzustellen zu koennen , wurden zusaetzlich 4 Gruppen à 25 Patienten mit den Diagnosen : Arthrose Osteoporose und chronische Polyarthritis , im Vergleich zur Kontrollgruppe gebildet . Als Mass fuer die Reproduzierbarkeit wurde jeweils die mittlere prozentuale Differenz und der Variationskoeffizient der beiden Messungen berechnet . In den vier Gruppen ergaben sich an den drei Messorten mittlere prozentuale Differenzen von 0,18 bis 2,6% . Nach Berechnung der Variationskoeffizienten fand sich fuer die LWS p.a. ein Wert zwischen 1,2 und 2,7% fuer die LWS lat . zwischen 7,1 und 15,7% und am Ward`schen Dreieck zwischen 4,1 und 9,9% . Auffaellig war zudem ein nahezu doppelt so hoher Variationskoeffizient der Patienten mit Osteoporose im Vergleich zur Kontrollgruppe an allen gemessenen Regionen . Ergebnis : Die laterale LWS-Messung beim DEXA-Verfahren ist derzeit nicht zu empfehlen . Die LWS p.a. -Messung und mit Einschraenkung auch die Messung am Ward`schen Dreieck koennen bei guter Praezision zur Verlaufsdokumentation der Knochendichte herangezogen werden ."
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ZfuerRheumatologie.90580333.ger.abstr | ZfuerRheumatologie.90580333.ger.abstr | [
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"id": "ZfuerRheumatologie.90580333.ger.abstr-passage-0",
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"Bei der rheumatoiden Arthritis ist die urspruengliche Struktur einer Synovialmembran durch Entzuendungsinfiltrate , Vermehrung von Synoviozyten ( SZ ) und Gefaessen sowie Ablagerung extrazellulaerer Matrixproteinen nicht mehr erkennbar . Eine entscheidende Rolle bei der Entwicklung dieser pathologischen Veraenderungen spielen die Adhaesionsmolekuele . In diesem Uebersichtsartikel wird die Rolle der Selektine , Integrine , Immunglobulin-Superfamilie und des CD44-Molekueles in der Zell-Zell- und Zell-Matrix-Interaktion am Beispiel der entzuendlichen Veraenderungen bei der rheumatoiden Arthritis diskutiert ."
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"Bei 25 pensionierten landwirtschaftlichen Arbeitern , welche durchschnittlich 51 Jahre eine Schwerarbeit als Knechte \" \" verrichtet hatten , erfolgte eine eingehende klinische und radiologische Untersuchung der Haende , Hueft- und Kniegelenke , wobei das Schwergewicht im Bereich der Haende lag . Das im Bereich der Haende gefundene Arthrosemuster zeigte eine auffaellige Verteilung mit einem ueberproportionalen Befall der Metacarpophalangealgelenke und weniger ausgepraegt der Intercarpalgelenke . Die Arthrosen der Metacarpophalangealgelenke betrafen gehaeuft Strahl I-III , diejenigen der Intercarpalgelenke gehaeuft die peritrapezialen Gelenke . Insbesondere im Bereich der proximalen Interphalangealgelenke bestaetigte sich eine Diskrepanz zwischen den klinisch z.T. eindruecklichen hypertrophen Veraenderungen ( welche durchaus den Eindruck von Bouchardarthrosen erwecken konnten ) und den selten vorkommenden , leichten radiologischen Zeichen der Arthrose . Die Ergebnisse betonen die Bedeutung des Belastungsmusters fuer die Entwicklung arthrotischer Veraenderungen an den Haenden . Die Untersuchung zeigt zudem im Bereich der proximalen Interphalangealgelenke , dass eine Hypertrophie der periartikulaeren Strukturen als Anpassung an die jahrzehntelange manuelle Belastung im Kraftgriff auftreten kann . Mit einer Ausnahme wiesen zudem saemtliche Teilnehmer mindestens eine unilaterale Coxarthrose auf ."
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