The most common joint destructive chronic inflammatory diseases in orthopedic rheumatology are rheumatoid arthritis, psoriatic arthritis and spondyloarthropathy. They usually have a multilocular, characteristic progressive joint destructive course, which must be taken into account when planning surgical treatment. The establishment of a sequence of surgical procedures with equivalent indications follows special rheumatologic orthopedic principles. The choice of surgical procedure depends on the joint, the surrounding soft tissues and stage of destruction but the increased surgical risk and complications caused by the disease, specific medications and frequent comorbidities also have to be considered. Due to numerous perioperative characteristics close interdisciplinary cooperation especially with internist rheumatologists, anesthetists and physiotherapists is essential for a successful rheumatologic orthopedic therapy.

Die h?ufigste Erkrankung des rheumatischen Formenkreises ist die rheumatoide Arthritis. Sie bef?llt ?berwiegend die Gelenke des Bewegungsapparats und f?hrt dort zu schmerzhaften Gelenkschwellungen mit Funktionseinschr?nkungen und im Verlauf zu typischen Deformierungen und Destruktionen. Als entz?ndliche Systemerkrankung kann die rheumatoide Arthritis aber auch Sehnenscheiden, Schleimbeutel, Gef??e, Augen und die inneren Organe betreffen. Dieser Artikel ist mit der Diagnostik befasst und beschreibt die medikament?sen und die begleitenden konservativen Therapieoptionen der rheumatoiden Arthritis. Versagt dieser konservative Ansatz, kommen operative Therapiema?nahmen zum Einsatz. Ein weiterer Artikel, der zu einem sp?teren Zeitpunkt erscheinen wird, stellt diese chirurgischen Therapiem?glichkeiten dar.

Involvement of tendons and tendon sheaths is frequently found in the most common inflammatory systemic diseases, rheumatoid arthritis and spondyloarthritis. In rheumatoid arthritis tendon manifestations occur as tenosynovitis, with swelling and pain of the tendons mainly on the hands and feet. In spondyloarthritis the involvement of tendons presents as enthesitis with pain and swelling directly at the attachment points of tendons to the bony structures and more commonly in the lower extremities. Pathological alterations of tendons can be normally visualized by sonography and only sometimes with magnetic resonance imaging (MRI) or scintigraphy. Furthermore, it is important for diagnostics and effective therapy to detect all joints involved by means of clinical, sonographic and radiological examination as well as laboratory parameters of inflammation, antibody serology (e.g. anti-CCP antibodies) and HLA-B27. The histopathological alterations of tendinopathy in rheumatic diseases differ from degenerative/posttraumatic tendinopathy in their expression of the changes; however, a clear differentiation of the different rheumatic inflammatory systemic diseases is histopathologically not possible. Therapeutically, systemic medication is the most important part of treatment in rheumatic diseases. Local therapeutic measures can be employed in the treatment of tenosynovitis and enthesitis. In the case of failure or lack of efficacy of the medication and conservative therapy, tenosynovectomy is performed for persistent tenosynovitis and reconstructive surgical procedures are necessary for tendon ruptures.

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