How should the therapy of arthrosis be designed?
There is no causal therapy for osteoarthritis, i.e. there is no therapy that eliminates the cause of the osteoarthritis. Although a large number of “cartilage-building preparations” are available, ranging from gelatine to herbal agents which may contain a wide variety of things, there is still no scientific proof of their effect (in terms of their cartilage-building properties). In particular, an influence on the progression of cartilage loss cannot be proven with certainty.
For many preparations that claim to have this influence, studies are available that have been able to prove a positive effect on arthrosis. In other, independent control studies, this effect could not be reproduced. Ultimately the result is open.
Too many things are still unanswered. Since most of the preparations on the market are relatively harmless, it is up to the experience of the doctor and the patient himself to decide whether such a therapy should be used. The alternatives are at least limited and are aimed primarily at treating the symptoms, not at causal arthrosis therapy.
However, various therapeutic measures can bring about a significant alleviation of the symptoms of osteoarthritis:
- Physical therapy (heat, electricity, etc.) and physiotherapy (including maintaining strength and mobility) are often effective. – Joint injections with rinsing of the joint and instillation of cortisone preparations in inflammatory phases of arthrosis or application of local anaesthetics as pain therapy.
- Administration of hyaluronic acid into the knee joint, which acts as “synovial fluid” and improves the quality of the existing cartilage. – Hyaluronic acid relieves pain and improves mobility. – Orthopaedic technology (hand cane, buffer heels, elevation of the outer or inner edges of shoes)
- Painkillers: especially anti-inflammatory preparations such as dicofenac or ibuprofen are effective, but have the disadvantage of attacking the stomach lining.
For better tolerability, a combination with a “stomach protection preparation” (e.g. Pantozol®) can be useful. Alternatively, the so-called “COX 2 inhibitors” such as Celebrex or Arcoxia® can be used, which are said to have a low complication rate for the dreaded gastric bleeding. Painkillers from the morphine group can be prescribed in particularly severe cases to relieve the symptoms.
- Homeopathic medicines: In arthrosis therapy, various homeopathic medicines can alleviate symptoms. The general therapeutic measures for arthrosis consist mainly of reducing any existing excess weight so that the previously damaged joints can be relieved. This is achieved by changing the diet, which in itself can also have a positive influence on the symptoms of osteoarthritis.
Furthermore, the stress and relief of the joints should be in a reasonable proportion to each other. Sports that place particular stress on a particular joint group should be avoided. When choosing footwear, care should be taken to use shoes with soft heels.
Joints should be warmed and protected from cooling and moisture. Swimming should be in the form of crawling and backstroke and in thermal baths, and regular aqua-gym is also recommended. In the therapy of arthrosis, it is recommended that regular physiotherapeutic exercises be performed at regular intervals.
Furthermore, the patient is informed about damaging movements and protective measures in the form of patient training. If the patient has arthrosis without an inflammatory component, heat applications can provide relief (e.g. ointments, plasters, red light, fango). If it is an activated arthrosis with a strong inflammatory component, cooling therapies are mainly induced, as well as electro- and ultrasound therapy.
A further component of physical therapy is muscle building and muscle training in order to protect and relieve the previously damaged joints. In addition, the patient should receive training with advice on the correct joint load when walking. and knee osteoarthritis, which sport is advisable?medicinal measures aim to reduce the inflammation and pain in the joints.
Drug therapy is mainly used for activated inflammatory arthrosis. Paracetamol is often used to treat pain, while drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce the inflammation. The use should be limited in time and only if there are acute periods of pain or inflammation.
No NSAIDs should be combined and only one preparation should be used at a time. The dosage should be as low as possible. Always start with low doses and increase them if necessary in case of pain.
Substances with a short half-life should be taken which act quickly. Parallel to the drug administration, the kidney function should be examined and the integrity of the stomach should be checked beforehand. In older patients, the dose should be adjusted accordingly and the dosage should rather be chosen even lower.
To protect the stomach, a so-called proton pump inhibitor should be used in parallel. In severe cases, a cortisone preparation can also be injected into the affected joint space. This also leads to an inhibition of inflammation in acute attacks.
An injection should only be given if no success could be achieved with the previously given medication. There are numerous orthopaedic aids that are designed to help put the right amount of strain on joints and make everyday movements more physical. There are special shoes and rolling aids that are designed to ensure this and can be adapted to the patient.
In the case of progressive arthrosis or therapy-resistant processes, surgical therapy is often the only alternative. In most cases this is an artificial joint replacement. The most commonly used are knee endoprostheses (so-called knee TEP) or hip TEP (hip prosthesis), and for some time now also joint replacements of the shoulder joints.
Today, the surgical treatments are everyday routine procedures. (see: Surgery for knee arthrosis)It must be noted, however, that after the corresponding operations, a rehabilitation phase, sometimes lasting weeks, is necessary to restore the corresponding movements of the joints. Recently, other surgical procedures and approaches have been tested, but most of them are still in the testing phase.
These include cartilage cultivation and cartilage transplantation. In cartilage transplantation, a piece of articular cartilage is removed from an undamaged area of the joint and inserted into the area whose cartilage has degenerated or already disappeared. The joint is then closed again, and the inserted cartilage should then grow into the joint and form a new joint surface.
Another procedure is the growth of cartilage outside the body. In this procedure, a piece of cartilage is also removed from the patient and cultivated outside the body. As soon as a corresponding amount of cartilage has been formed, the cartilage is inserted in a second surgical session.
Afterwards, the patient also waits for the cartilage to grow in. A prerequisite for the cartilage transplantation procedure is that no malposition of the joint is to blame for the arthrosis or that the malposition has been corrected. If a joint continues to be incorrectly loaded, the newly inserted cartilage will also degenerate again.
The symptoms then reoccur. Furthermore, the procedures are only applicable if the cartilage is damaged and the rest of the joint is still undamaged. In advanced cases, total joint replacement is the only treatment option.
The causes of osteoarthritis and the development of new treatment options have also focused attention on nutrition in recent years. Thus, unofficial guidelines and recommendations have been issued on how nutrition could be associated with the development of osteoarthritis or how a change in diet can prevent the progression of osteoarthritis. The basis of the connection between nutrition and arthrosis is the assumption that an acid-base environment of the body, which is in the acidic range, could favour the development of arthrosis.
Therefore, the first priority is to prevent the absorption of acidifying foods by the body. Foods that draw the acid-base environment of the body into the acidic region are Furthermore, smoking should be avoided altogether. On the other hand, foods which are recommended for osteoarthritis or which are intended to prevent the development of osteoarthritis: Drinking herbal tea is also recommended.
Of course, nutrition cannot completely prevent arthrosis. Nor can it cure it. At best it can have a supportive effect.
However, it should be critically noted that the theories are hardly or not at all scientifically proven. – Red wine
- Animal fats
- Saturated fats, which include butter, cream, nuts and fatty fish
- Vegetable fats which are hardened
- Pork and beef
- Acidifying fruits, such as citrus fruits
- Black tea and coffee
- Alcohol. – Salads
- Non-acidifying fruits
- Spelt products
- Seawater fish
- Rapeseed oil
- Spelt oil
- Sesame oiland
- Lean dairy products (skimmed milk, skimmed cheese, skimmed curd cheese).