Avtor/Urednik		Kos-Golja, Mojca
Naslov		Smernice za zdravljenje osteoartroze
Prevedeni naslov		Recommendations for the medical management of osteoarthritis
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 41, št. Suppl 3
Leto izdaje		2002
Obseg		str. 23-8
Jezik		slo
Abstrakt		Osteoarthritis is one of the most common, socially and economically important chronic rheumatic diseases among adults, especially seniors. The management of osteoarthritis and the role of the general practitioner, who is sufficiently qualified to diagnose and treat patients with osteoarthritis, are described. In the year 2000, the American College of Rheumatology adopted and published Recommendations for the Medical Management of Osteoarthritis of the Hip and Knee, which are taken into account by the author of this paper. Currently there are three basic pillars of therapy: nonpharmacologic, pharmacologic and surgical treatment, a proper combination of which can alleviate the symptoms of this disease and improve the patient's quality of life. General (nonpharmacologic) measures are also described, such as patient education, self-treatment, lifestyle changes, physical therapy, and various medical devices, including walking aids. The pharmacotherapy, which is stage-adjusted and individually customized, is presented. Analgesics, mainly nonopioid, are used for treating osteoarthritis without inflammatory changes. For osteoarthritis with inflammation, nonsteroidal anti-inflammatory drugs and intra-articular injections of corticosteroids are preferred. It is stressed that the main problem of administering nonsteroidal anti-inflammatory drugs is their gastrointestinal toxicity. Therefore, a prophylactic medication or switching to a safer or COX-2 selective anti-inflammatory drug should be considered for high-risk groups. Patients with advanced stages of osteoarthritis, severe pain and functional disability require surgical treatment.
Izvleček		Osteoartroza je ena najpogostejših kroničnih revmatičnih bolezni odraslih, zlasti starejših, ki predstavlja tudi velik socialni in ekonomski problem. V prispevku so opisane smernice za zdravljenje osteoartroze in vloga družinskega zdravnika, ki lahko v večini primerov bolezen ugotavlja in zdravi sam. Ameriško revmatološko združenje je leta 2000 sprejelo smernice za zdravljenje osteoartroze kolka in kolena, ki so upoštevane tudi v tem sestavku. Pri osteoartrozi so na voljo trije temeljni stebri zdravljenja: nefarmakološki, farmakološki in operacijski, ki jih praviloma kombiniramo med seboj in ki zmanjšajo simptome ter izboljšajo kakovost življenja. Opisani so splošni (nefarmakološki) ukrepi, kot so poučevanje bolnika o bolezni, njegovi vlogi v zdravljenju, vplivu življenjskega sloga na nastanek in napredovanje sprememb, uporaba fizikalnih postopkov, pripomočkov in pomagal. Opisano je tudi farmakološko zdravljenje, ki je stopenjsko in prilagojeno posameznemu bolniku: pri osteoartrozi brez vnetja uporabljamo analgetike, predvsem neopioidne, pri bolezni z vnetnimi znaki nesteroidne antirevmatike in vbrizganje kortikosteroida v obolel sklep. Prispevek opozarja na možne neželene učinke nesteroidnih antirevmatikov, predvsem na prebavilih, ki so pogostejši prav pri starejših. Navedeno je, da bolnikom z dejavniki tveganja za pojav neželenih učinkov na prebavilih predpisujemo varnejše ali novejše, COX-2 selektivne nesteroidne antirevmatike. Če je potrebno, jih kombiniramo še z zaviralci protonske črpalke. Pri napredovali osteoartrozi, s hudimi bolečinami in funkcionalnimi motnjami, je potrebno operacijsko zdravljenje.
Deskriptorji		OSTEOARTHRITIS PHYSICAL THERAPY OCCUPATIONAL THERAPY ANALGESICS, NON-NARCOTIC ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL ANALGESICS, OPIOID PRACTICE GUIDELINES