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  • 1
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Therapieprinzipien ; Rheumatoide Arthritis ; Gonarthrose ; Musterpatienten („paper patients“) ; Key words Therapeutic approaches ; rheumatoid arthritis ; osteoarthritis of the knee ; paper patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Mit Hilfe von Musterpatienten „paper patients“ verglichen wir die Therapieprinzipien von Hausärzten und Rheumatologen bei rheumatoider Arthritis und Gonarthrose. Unsere Umfrage bestand aus drei Fallbeispielen mit verschiedenen Schweregraden der rheumatoiden Arthritis (RA) und einem Fall einer Gonarthrose. Von randomisiert ausgewählten 252 Hausärzten antworteten 111 und von 132 Rheumatologen 78 Kollegen. Wir stellten fest, daß Rheumatologen bei der Therapie von RA vermehrt nichtsteroidale Antirheumatika (NSAR), Basistherapeutika, Steroide und physikalische Therapie einsetzten. In Fall 4 (Gonarthrose) wählten die Rheumatologen vermehrt Schmerzmittel, lokale Steroide, Krankengymnastik, Ergotherapie, Operationen und Orthesen. Hausärzte dagegen verordneten mehr Chondroprotektiva. Patienten mit RA und Gonarthrose werden von Hausärzten und Rheumatologen unterschiedlich behandelt. Um ein einheitliches Therapiekonzept zu entwickeln und dadurch eine bessere Versorgung des Rheumapatienten zu gewährleisten, ist eine enge Zusammenarbeit zwischen beiden Ärztegruppen erforderlich.
    Notes: Summary 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.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Arthrose –¶Weidenrinde –Salix– WOMAC ; Key words Osteoarthritis –¶willow bark –Salix– WOMAC
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Objective: To assess the clinical efficacy of a chemically standardized willow bark extract in the treatment of osteoarthritis. Methods: Willow bark extract, in a dose corresponding to 240mg salicin/day, was compared to placebo in a 2-week, double-blind, randomized controlled trial. The primary outcome measure was the pain dimension of the WOMAC Osteoarthritis Index. Secondary outcome measures included the stiffness and physical function dimensions of the WOMAC, daily visual analogue scales (VAS) on pain and physical function, and final overall assessment by both patients and investigators. Results: 78 patients (39 willow bark extract, 39 placebo) participated in the trial. A statistically significant difference between active treatment and placebo group was observed in the WOMAC pain dimension (d=6.5mm, 95%¶C.I.=0.2–12.7mm, p=0.047); the WOMAC pain score was reduced by 14% from baseline level after two weeks of active treatment, compared to an increase of 2% in the placebo group. Patient diary VAS confirmed this result, and likewise the final overall assessments showed superiority of willow bark extract over placebo ¶(patients assessment, p=0.0002; investigators assessment, p=0.0073). Conclusion: Willow bark extract shows a moderate analgesic effect in osteoarthritis.
    Notes: Zusammenfassung Studienziel: Untersuchung der analgetischen Wirksamkeit eines chemisch standardisierten Weidenrindenextraktes bei der Behandlung von Arthrose. Methoden: Weidenrindenextrakt, in einer Dosis entsprechend 240mg Salicin pro Tag, wurde in einer¶2-wöchigen, doppelblinden, randomisierten Studie gegen Placebo geprüft. Hauptzielparameter war die Schmerzdimension des WOMAC-Arthrose-Indexes. Als Nebenzielparameter dienten die WOMAC-Teilscores zu Steifigkeit und Funktionsfähigkeit, tägliche visuelle Analogskalen (VAS) zu Schmerz und Bewegungseinschränkung und das abschließende Gesamturteil sowohl des Patienten als auch des Arztes. Ergebnisse: 78 Patienten (39 Weidenrindenextrakt, 39 Placebo) nahmen an der Studie teil. Ein statistisch signifikanter Unterschied zwischen Verum- und Placebogruppe wurde für die WOMAC-Schmerzdimension beobachtet (d=6,5mm, 95% C.I.=0,2–12,7mm, p=0,047); während der Behandlung verringerte sich der WOMAC-Schmerzscore gegenüber dem Ausgangswert um 14% in der Verumgruppe, verglichen mit einem Anstieg von 2% in der Placebogruppe. Dieses Ergebnis wurde durch die VAS der Patiententagebücher bestätigt. Die abschließenden Gesamturteile zeigten eine deutliche Überlegenheit des Weidenrindenextraktes gegenüber Placebo (Patientenurteil, p=0,0002; Arzturteil, p=0,0073). Schlussfolgerung: Weidenrindenextrakt zeigt eine moderate analgetische Wirksamkeit bei Arthrosepatienten.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1434-9949
    Keywords: Rheumatology Practice ; Paper Patients ; Rheumatoid Arthritis ; Osteoarthritis of the Knee
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 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.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Basic research in cardiology 42 (1963), S. 45-63 
    ISSN: 1435-1803
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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