[Therapeutic approaches of general practitioners and rheumatologists in South Germany in rheumatoid arthritis and gonarthrosis]. / Therapieprinzipien von Hausärzten und Rheumatologen in Süddeutschland bei rheumatoider Arthritis und Gonarthrose.

Using "paper patients" we compared the therapeutic approaches of general practitioners and rheumatologists to rheumatoid arthritis and to osteoarthritis of the knee. The mailed survey contained a mild, a moderate and a severe case of rheumatoid arthritis (RA) and a case of osteoarthritis (OA) of the knee. 111 out of 252 general practitioners and 78 out of 132 rheumatologists selected at random participated in the study. We found that rheumatologists would choose more non-steroidal anti-inflammatory drugs (NSAID), disease modifying antirheumatic drugs (DMARD), steroids and physical therapy. In case 4 (OA of the knee) rheumatologists would more frequently recommend analgesics, local steroids, occupational therapy, surgery and ortheses. Primary care physicians on the other hand prescribed more chondroprotective agents. Patients with RA and OA of the knee would be treated differently by primary care physicians and rheumatologists. In order to develop a more uniform therapeutical concept and therefore to reach a better management of the rheumatic patient, a close co-operation of the two physician groups is needed.

Therapeutic approaches of German and Turkish physicians to rheumatoid arthritis and to osteoarthritis of the knee.

Our objective was to compare the therapeutic approaches of German and Turkish physicians to rheumatoid arthritis (RA) and to osteoarthritis (OA) of the knee, by means of a mailed survey. The survey contained four case histories representing a mild, a moderate and a severe case of RA and a case of OA of the knee. One hundred and thirty-two physicians from Germany (internal medicine based (IR) and orthopaedics based (OR) rheumatologists) and thirty-three from Turkey (rheumatologists and physical medicine and rehabilitation specialists (PT)) participated in the study. German respondents would give more disease-modifying drugs (DMARD) in early RA (48.7% vs 18.2%, p < 0.05), whereas their Turkish colleagues would prescribe more analgesics, ultrasound and kryotherapy in OA of the knee (63.6% vs 22.1%, 30.3% vs 6.5% and 24.2% vs 0.0% respectively p < 0.05). German physicians chose more exercise, physical and occupational therapy, radiation synovectomy and surgery in all cases. In OA of the knee German OR's would recommend less analgesics, but more local steroids, chondroprotective agents and surgery than the other groups. We may conclude that clinical practice of RA and OA of the knee differs considerably in Germany and Turkey. Cultural, social, educational and economic factors could influence the decisions of the physicians.

The frequency of transition of chronic low back pain to fibromyalgia.

In a retrospective study, the outcome of the chronic low back pain syndrome was investigated in a group of 53 patients. Average time since the diagnosis was established was 18 years. 25% of the patients--all female but one--developed fibromyalgia. The criteria of Yunus and Wolfe, modified by Müller and Lautenschläger, were applied to establish the diagnosis of fibromyalgia. In 60% of the patients chronic low back pain persisted at the time of final examination, while 8 patients were asymptomatic. Predictive parameters for the chance of getting fibromyalgia were sex and postural disorders such as scoliosis. Other radiological findings, for example degenerative changes of the spine, did not coincide with the group of patients who developed fibromyalgia. The predictive value of pain localisation, number of tender points, presence and severity of functional and vegetative symptoms, and the psychosocial situation is uncertain and should be investigated in further long term prospective studies.

[Synoviorthesis--an alternative to synovectomy?]. / Synoviorthese--eine Alternative zur Synovektomie?

In the treatment of inflammatory rheumatic diseases with chronic course, operative and respectively arthroscopic synovectomy on the one hand and synoviorthesis on the other hand come into question. Synoviorthesis by corticosteroids has a very large indication if the corresponding measures of precaution are heeded. Chemical synoviorthesis, mainly by osmium tetroxide, is applied above all in exudative inflammatory diseases, whereas radiosynoviorthesis with the nuclides used at present is mainly applied in proliferative diseases; as a rule, synovectomy should be preferred in young patients. Likewise, synovectomy is the method of choice, respectively, in tenosynovitis and if reconstructive measures at the joint are necessary.