Osteoarthritis: Diagnosis and Therapy: Proceedings of an International Meeting

70 Pages·1988·2.863 MB·English

by  Dr. med. Rainer Berger (auth.), H. Ralph Schumacher Jr. MD (eds.)

H. R. Schumacher (Ed.)
Osteoarthritis
Diagnosis and Therapy
Proceedings of an International Meeting
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
H. Ralph Schumacher jr., MD, Prof. of Medicine
University of Pennsylvania, Veterans Administration
Medical Center
University & Woodland Avenues
Philadelphia PA 19104, USA
ISBN- 13: 978-3-540-50000-1 e-ISBN-13: 978-3-642-73878-4
DOl: 10.1007/978-3-642-73878-4
This work is subject to copyright. All rights are reserved, whether
the whole or part of the material is concerned, specifically the
rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in other ways, and
storage in data banks. Duplication of this publication or parts
thereof is only permitted under the provisions of the German
Copyright Law of September 9, 1965, in its version of June 24,
1985, and a copyright fee must always be paid. Violations fall
under the prosecution act of the German Copyright Law.
© Springer-Verlag Berlin Heidelberg 1988
The use of general descriptive names, trade names, trade marks,
etc. in this publication, even if the former are not especially
identified, is not to be taken as a sign that such names, as
understood by the Trade Marks and Merchandise Marks Act,
may accordingly be used freely by anyone.
Product Liability: The Publisher can give no guarantee for infor
mation about drug dosage and application thereof contained in
this book. In every individual case the respective user must check
its accuracy by consulting other pharmaceutical literature.
Printing and bookbinding: Druckhaus Beltz, 6944 Hemsbach
2127/3140/543210
IV
Table of Contents
Welcome Address
R. BERGER ... 1
Osteoarthrosis (Osteoarthritis) -
Opening Remarks
G. L. BACH ......... . 3
Osteoarthritis: State of the Art
H. R. SCHUMACHER, Jr. ... 5
Interaction Between Cartilage Metabolism
and Inflammation
H. G. FASSBENDER. . . . . . . . . . . . 11
Basic Mechanisms of Pain and Pain Therapy
Related to Osteoarthritis and Other Disorders
of the Musculoskeletal System
M. ZIMMERMANN .......... . 14
Course of Degenerative Joint Diseases
H. MOLLER-FASSBENDER. . . . . . . 29
Therapeutic Interventions in the Treatment of
Acute and Chronic Pain in Osteoarthrosis
R. W. MOSKOWITZ. . . 38
Round-Table Discussion 47
Concluding Remarks . . 61
v
List of Contributors
BACH,G.L.
Innere Medizin und Rheumatologie, Klinik Herzog
hOhe, Kulmbacher StraBe 103, 8580 Bayreuth
FASSBENDER, H. G.
Zentrum fiir Rheuma-Pathologie, Kleine Windmiih
lenstraBe 2 Yto, 6500 Mainz
MOSKOWITZ, R. W.
Case Western Reserve University, Division of Rheu
matic Diseases, University Hospitals, 2073 Abington
Road, Cleveland, Ohio 44106, USA
MULLER-FASSBENDER, H.
II. Medizinische Klinik des Rheumazentrums Bad
Abbach, Am Markt 2, 8403 Bad Abbach
SCHUMACHER, H. R.
University of Pennsylvania, Arthritis-Immunology
Center, VAMC, University & Woodland Avenues,
Philadelphia PA 19104, USA
ZIMMERMANN, M.
II. Physiologisches Institut der UniversiHit Heidel
berg, 1m Neuenheimer Feld 326,6900 Heidelberg
VII
Participants at the Meeting
Pro!. Dr. H. R. S<:hum.cher
nive~ity or Pennsyl'Jania
Arthritis-Immunology Center
VAMC
University & Woodl.nd A venues
Phil.delphi. PA 191().1. U A
Pri.at·Dozent Dr. K. hlud
OA dcr 2. Medizin. bteiluog
Kaiser·Franz·Joseph·Spital
(Rheuma)
kodagasse 19/6
A·IOSO Wien
Prof. Dr. G. L. Bach
Innere Medlzin
und Rheumatologie
K1inik Herzogh6he
Kulmbaeher traJJe 103
8580 Bayreuth
Pro!. Dr. H. G. Fassbender
Zentrum fur Rheuma-Pathologi.
Breitenbach.r tralle 13
6500 Mainz
IX
Pror. Dr. R. W. loskowitz
Case We lem Reserve UniversilY
Divj ion or Rheumatic Diseases
Universily Hospilal
2073 Abinglon Road
Cleveland. Ohio +1106. U A
Pror. Dr. H. IUllcr-FaJlbendcr
II. Mcdizinischc Klinik
de Rheumazcntrums Bad Abbach
Am Markl2
&103 B.d Abbach
Pror. Dr. M. Zimmermann
11. Physiologischcs InSlilUI der
Univcrsital Heidelberg
1m euenheimcr Feld 326
6900 Heidelberg
Dr. 1.- I. Engel
Rhcumaklinik Tegorosee
der L A 'db-OpL
Bahnhof l,"flo 13
I Tegerosee
Pror. Dr. D. A. Kalbhen
InstilUI fUr Pharmakologie
und Toxikologie
Univcrsitat Bonn
Reulerstrafle 2 b
5300 Bonn I
Pror. Dr. P. Orienle
Palologia Medica III
Policlinica niversitario
Via crgio Pan ini
I- 131 Napoli
x
Dr. sc. B. Vrhov.c. MD
Head. cetion of Clinical
Phannacology
Department of Medicine
Medical School
Clinical H pital Center
14. KiSpati~cva
YU .. I1000 Z.'greb
Prof. Dr. H. Zeidler
Mcdwnische Einrichtungcn der
Univc"it.t Dusseldorf
ledizinische Klinik und Poliklinik
Abteilung fUr Endokrinologie und
Rheumatologi.
Moorcnslra6e 5
4000 Dusseldorf
Dr. med. R. Berger
AST A Phanna AG
AbL mcd. \Vissenschaften
Wei mOlle"traJJe 45
6000 Frankfurt I
XI
Welcome Address
Dr. med. RAINER BERGER, ASTA Pharma AG
On behalf of ASTA Pharma AG I would like to welcome you to our
international discussion on osteoarthritis in Munich.
I am very glad that you accepted our invitation to come and work
together under the chairmanship of Dr. SCHUMACHER, Professor of
Medicine and Director of the Arthritis Immunology Center at the
Veterans Administration Medical Center and of the University of
Pennsylvania in Philadelphia.
The purpose of this meeting is to discuss the terminology as used in the
field of osteoarthritis - such as inflammation, pain, course dynamics,
and possibilities of adequate treatment. Therefore, an expert in clinical
pharmacology, Prof. VRHOVAC from the Department of Medicine,
Section of Clinical Pharmacology, University of Zagreb, will lead us
through the first session - the presentation of invited papers.
After an introduction by Dr. BACH, Professor of internal medicine
and rheumatology at Klinik Herzogh6he in Bayreuth, Dr. RALPH
SCHUMACHER will give a lecture on the state of the art in osteoarthritis
and the role of crystals in pain and inflammation. Then Prof. HANS
GEORG FASSBENDER from the WHO Collaboration Center for the
Development of Histopathological Classification and Diagnostic Crite
ria of Rheumatoid Arthritis and Allied Diseases will speak about the
interactions between cartilage metabolism and inflammation.
As we know, pain in osteoarthritis can be multicausal, showing
various symptoms and clinical characteristics. Prof. ZIMMERMANN from
the Institute of Physiology of the University of Heidelberg will tell us
something about the mechanisms of pain, with emphasis on joint pain.
Prof. ZIMMERMANN is a member of several international associations
for the study of the pain.
The course dynamics of degenerative joint diseases is presented by
Professor MULLER-FASSBENDER, head of the Second Medical Depart
ment of the Rheumazentrum in Bad Abbach.
Finally, Dr. MOSKOWITZ, Professor of Medicine and Director of the
Division of Rheumatic Diseases of Case Western Reserve University,
1
Cleveland, Ohio, will lecture on the treatment of osteoarthritis during
the acute and chronic phase of the disease. Along with Prof. SCHUMA
CHER, Prof. MOSKOWITZ is one of the most distinguished rheumatolo
gists in the United States of America, and we are anticipating informa
tion about how osteoarthritis is treated there.
At 12.15 a round table discussion will take place under the chairman
ship of Dr. CHLUD form the Second Medical Department of Kaiser
Franz-Joseph-Spital in Vienna. Dr. CHLUD is a renowned rheumatolo
gist not only in Austria, but also in the Federal Republic of Germany.
I also welcome the other participants of the round table discussion;
Dr. KALBHEN, Professor of Pharmacology of the University of Bonn;
Dr. ORIENTE, Professor of Rheumapathology of the University of
Naples; Dr. ZEIDLER, Professor of Internal Medicine and Rheumato
logy of the University of Dusseldorf; and Dr. ENGEL, head of a
beautifully situated hospital for rheumatology, Klinik Tegernsee.
We will close with remarks by Prof. SCHUMACHER.
Let me thank you again for coming to Munich. I am looking forward
to interesting presentations and discussions.
2