THERAPEUTISCHE UMSCHAU最新文献

Reactive arthritis Abstract. Reactive Arthritis is a sterile, inflammatory arthritis that is typically preceded by a bacterial gastrointestinal or urogenital infection occurring one to four weeks previously. The typical pattern is an asymmetric oligoarthritis most common affecting the lower extremities. Similar to other spondyloarthropathies, enthesitis, dactylitis, and sacroiliitis can occur as well as extra-articular manifestations, such as conjunctivitis, anterior uveitis, oral ulcers, circinate balanitis, and keratoderma blennorrhagicum. The treatment of "triggering" infection with antibiotics is the first therapeutic goal, especially for Chlamydia trachomatis. For arthritis NSAIDs are the treatment of first choice, followed by intraarticular or oral glucocorticosteroids. DMARDs (Sulfasalzine, TNF-alpha inhibitors) are reserved for refractory cases. Over 50% of the patients have a self-limited course lasting two to six months, 30% have recurrent episodes, and 10-20% have a chronic course requiring immunosuppressive therapy.

Osteoarthritis - Therapy and Management Abstract. Osteoarthritis as the most prevalent degenerative joint disorder is a leading cause of disability and source of substantial societal cost in older adults. With the ageing and increasingly obese population, this disorder and its associated problems become much more prevalent than in previous decades. It is a problem that every general practitioner and rheumatologist will encounter in daily practice. The current therapeutic guidelines provide a good overview over the existing treatment modalities. Special focus should be placed on core treatments, including self-management and education, exercise, and weight loss as relevant. But it's important that management is tailored to the presenting individual. Besides the existing routine medications there have been many trials in the last years that showed a negative outcome. Nevertheless, there are potential candidates on the horizon that could fill the existing gap as a "Disease modifying Osteoarthritis Drug".

Rheumatoid Arthritis Abstract. Rheumatoid Arthritis (RA) is the most frequent chronic inflammatory joint disease with a prevalence of approximately 1% worldwide. The pathogenesis is a complex interplay of genetic, epigenetic, and environmental factors, which are still incompletely understood. The disease is characterized by a polyarticular synovitis with symmetrical involvement of small and large joints. The majority of patients has detectable autoantibodies in the serum, rheumatoid factor and anti-CCP antibodies which are specific for RA. The uncontrolled chronic joint inflammation results in destructive changes of joint cartilage and bone. An early diagnosis and initiation of treatment is therefore of central importance. Disease-modifying anti-rheumatic drugs (DMARD) are able to inhibit joint destruction and should be started as soon as possible. Therapy should be targeted to reach a state of remission. The introduction of highly effective biologic and targeted synthetic DMARD has allowed to reach this goal of therapy in many patients and to prevent disability. However, risks of medication need to be considered, as well as comorbidities.

Periarthropathies Abstract. The term "periarthropathy" stands for various pathologies "around" the joint and its structures, without a clear and generally accepted definition. This article tries to outline this theme and offers some examples in the section "ausgewählte Krankheitsbilder".

Update Gout Abstract. Gout, the most frequent arthritis worldwide, is seldomly considered a serious chronic disease. Cardiovascular morbidity and allover mortality are increased in gout patients. Prevalence of gout is very variable in different countries and is estimated to be 2.6% overall. Men are overrepresented (3:1 to 4:1). Environmental factors, such as diet and alcohol intake, are still important, but the genetic influence, e.g., in early-onset gout, gets more and more attention. Despite the broad range of therapeutic options outcomes are poor, and the disease often leads to disabling structural damages, not only in joints. Patients' education, and the involvement of trained general practitioners and nurses will hopefully improve the outcomes of this treatable disease.

Septic arthritis Abstract. A painful, red, and swollen joint may have different causes. Septic arthritis is one of the most serious conditions and should be diagnosed and treated right away. In the native joint, an infection can damage the cartilage within the first 24 hours with impacts on joint function including lingering joint problems leading to possible future joint destruction. An interdisciplinary approach is essential for achieving optimal results. Most infections are caused by bacteria from the patient's own microbiome. In general, the incidence of native joint infections is growing, whether it is due to more appropriate diagnostics, or an actual increase cannot be determined at this point. In case of an acute infection, the patients usually describe a relatively short and acute period of pain, redness, and swelling of the affected joint. For diagnostic purposes the common blood serum laboratory work-up serves as a basis, complemented by puncture of the affected joint. Cell count and cell differentiation in the synovial liquid, microbiological and histopathological workup serve as gold standard in detecting septic arthritis. Septic arthritis lacks a distinctive presentation and other inflammatory conditions, like CPPD and gout must be considered. Prior to antibiotic therapy, joint lavage is the most important method to reduce bacterial load, leading to an improved outcome. Prognosis is determined by a swift diagnosis and initiation of therapy. The patient's comorbidities are significant, especially immunocompromising factors such as rheumatoid arthritis, diabetes or immunomodulating therapy. In case of a second focus of infection, chronic kidney disease or older age, patients are at greater risk for an inferior outcome.

The Master of Advanced Studies in Insurance Medicine, a Postgraduate Program at the University of Basel Abstract. The MAS Insurance Medicine, a multi-faceted, interdisciplinary postgraduate program at the University of Basel, currently offers the most comprehensive qualification for insurance physicians on three levels (Master, Diploma, and Certificate of Advanced Studies). Individual learning formats allow for optimal alignment with individual professional needs. In addition to specific insurance medicine topics, the course content includes important disease patterns, evidence-based insurance medicine and public health, as well as health economics, ethical and legal topics.

Instruments and Tools in the Medical Evaluation of Work Capacity Abstract. In the event of absence from work due to illness or accident, the attending physician is responsible for confirming the connection between absence from work (or, if applicable, reduced performance) and a health disorder (illness or accident) and subsequently issuing a certificate of incapacity for work. The certificates have the legal status of a deed and must accordingly satisfy certain legal requirements. This article presents suitable tools and instruments for this important medical task.