Rheumatic orthopedics
The Orthopedic Rheumatology , also briefly rheumatism orthopedics called, is concerned with the impact of rheumatic diseases on the musculoskeletal system. Local tissue destruction can occur as a result of these inflammatory systemic diseases (e.g. rheumatoid arthritis ). Of these are u. a. Power transmitters such as joints and tendons are affected. If left untreated, such destructive processes lead to loss of function of the musculoskeletal system and, in pronounced cases, to disability of the person concerned.
The aim of rheumatic orthopedic therapy methods is primarily to avoid such a loss of function by means of suitable local, i. H. preventive measures to be taken at the point of ignition. If a loss of function has already occurred, the joint function can often be restored through a suitable surgical procedure.
Forms of treatment
Among the conservative, i.e. H. Non-surgical, measures include drug and physical treatments. There are also operative procedures.
Medical therapy
Drug therapy is often carried out in cooperation with internal rheumatological doctors who specialize in certain aspects of the treatment of inflammatory rheumatic diseases.
Anti-inflammatory (and therefore pain-relieving) drugs are used: substances containing cortisone ( corticosteroids ) and cortisone-free anti-inflammatory drugs (so-called " anti-inflammatory drugs " or "non-steroidal anti-inflammatory drugs"). Cortisone is the most potent anti-inflammatory substance known. It is used both as a general body drug and as a drug injected (or applied as an ointment) topically into inflammatory tissue. Cortisone-free anti-inflammatory drugs contain substances such as diclofenac , ibuprofen or etoricoxib .
In addition to anti-inflammatory drugs, long-acting drugs (so-called basic therapeutic agents or Disease Modifying Antirheumatic Drugs - DMARDs) are used: This group of drugs aims to normalize the activity of the inflammation in those affected as much as possible while also keeping the required amount of cortisone as low as possible hold or even make completely dispensable. Very often the DMARDs, the NSAIDs and cortisone (then each in the lowest possible dose) are used simultaneously for treatment. The group of DMARDs mainly includes the active ingredients methotrexate and leflunomide .
So-called “ biologicals ” ( biopharmaceuticals ) work by inhibiting important inflammatory messengers and thus reducing the damage to joints or tissue that is associated with the inflammation. They affect the development process of the disease. These include active ingredients such as adalimumab , etanercept or infliximab .
Physical therapy
A distinction is made in physical therapy :
- active measures (i.e. involving the patient, such as physiotherapy and occupational therapy ) and
- passive measures (e.g. the use of cold and heat as well as electric power in various forms).
Operative therapy
The operational measures are divided into preventive interventions to prevent local destruction and restorative interventions in the event of impairment. The removal of aggressive, rheumatic inflammatory changes in the mucous membrane prevents the local destruction of the joints and tendons from progressing. Such operations are often only possible in the early stages of the disease. Serious damage is corrected as far as possible, e.g. B. through joint and tendon restoring interventions such as replacing a joint with an artificial joint or restoring the gripping function of the hand through tendon replacement.
further reading
- S. Sell, S. Rehart: Operation Atlas Orthopedic Rheumatology. Thieme 2013. ISBN 9783131640017
