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Der Schmerz
Erschienen in: Der Schmerz 1/2019

17.12.2018 | Arthrosen | Schwerpunkt

Die Rolle der Inflammation bei Arthroseschmerzen

verfasst von: T. A. Nees, N. Rosshirt, T. Reiner, M. Schiltenwolf, PD Dr. B. Moradi

Erschienen in: Der Schmerz | Ausgabe 1/2019

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Zusammenfassung

Die Arthrose ist weltweit eine der häufigsten Ursachen für chronische Schmerzen. Entgegen der ursprünglichen Annahme einer nichtentzündlichen Verschleißerkrankung mit Abnutzung des Gelenkknorpels („wear and tear“) wird immunologisch-inflammatorischen Prozessen inzwischen eine entscheidende Beteiligung an der Pathogenese der Arthrose beigemessen. Im Rahmen der Erkrankung kommt es zu einer chronischen Inflammation des gesamten Gelenks mit Infiltration von mononukleären Zellen (Makrophagen und T‑Zellen) in die Synovialmembran und erhöhten Konzentrationen proinflammatorischer Zyto- und Chemokine in der Synovialflüssigkeit und im Blut. Die vermehrte Freisetzung von Entzündungsmediatoren wie Interleukin (IL) IL-1β, IL-6, IL-8, IL-15 und Tumornekrosefaktor‑α (TNF‑α) induziert die Expression chondrodestruktiver Matrixmetalloproteinasen und damit die enzymatische Gelenkdegeneration. Humorale und zelluläre Mechanismen interagieren zwischen Immun- und Nervensystem auch bei der Entwicklung von Arthroseschmerzen. Entzündungsmediatoren wie IL-6 und TNF‑α führen zur peripheren Sensibilisierung freier Nervenendigungen im Gelenk. Weiterhin können entzündungsassoziierte Wachstumsfaktoren wie nerve growth factor (NGF) die Expression von Schmerzrezeptoren an primären Afferenzen triggern, während inflammatorische Neuropeptide die Erregungsschwelle von Gelenknozizeptoren herabsetzen. Der vorliegende Übersichtsartikel diskutiert den Stellenwert der Inflammation bei arthrosebedingten Gelenkschmerzen unter Berücksichtigung der klinischen Symptomatik und wichtiger inflammatorischer Pathomechanismen.
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Metadaten
Titel
Die Rolle der Inflammation bei Arthroseschmerzen
verfasst von
T. A. Nees
N. Rosshirt
T. Reiner
M. Schiltenwolf
PD Dr. B. Moradi
Publikationsdatum
17.12.2018
Verlag
Springer Medizin
Erschienen in
Der Schmerz / Ausgabe 1/2019
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI
https://doi.org/10.1007/s00482-018-0346-y

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