It is not easy, the treatment of the widespread disease osteoarthritis – after all, there are many different types and causes. However, instead of simply waiting for a prosthesis, it is often worthwhile to delay the progression of the disease. And sometimes arthrosis can even be cured! Here are some tips on the subject.
In order to treat osteoarthritis elegantly, you need to know the causes of the disease. Osteoarthritis is basically the abrasion of joint cartilage, resulting in painful bone-on-bone friction. This is accompanied by inflammation with swelling and redness of the joint – a particularly painful side effect. Please note, this is the final phase of osteoarthritis. The begin of the disease can vary greatly and affect cartilage, bone, meniscus or synovial membrane.
In osteoarthritis, the pain does not always originate in the joint. In about 10% of all cases, irritations of bursae, tendons or ligaments are the cause of the pain – and not the arthrosis (even if signs of arthrosis are visible on the X-ray). Recognizing this so-called “extra-articular” pain and treating it locally with anti-inflammatory gels and sprays or with physiotherapy and physical therapy such as ultrasound would be the first step in smart osteoarthritis treatment.
A second tip targets joint-specific treatment. After all, it is usually the weight-bearing joints (knee, hip, back) or even the joints that are subject to high mechanical stress that are affected by osteoarthritis.
In knee and hip osteoarthritis, biomechanical factors are particularly important: abnormal forces acting on the joint. Due to overweight or even false positions such as severe knock knees or bow legs, the forces are no longer properly distributed, and the cartilage wears out more quickly. So, the third tip is to identify biomechanical false positions. Treatment will then take place with the help of physiotherapy, insoles or orthoses. In rare cases, surgery can also be performed to prevent an abrasion of the cartilage.
A bone fracture that affects the joint – for example, while skiing – also changes the biomechanics and is still a risk factor for the development of osteoarthritis years later. Another factor is joint instability: normally, ligaments keep joints in their tracks. If they are loose due to constitution or after a ligament tear, osteoarthritis can also develop. The muscles also play a major role in joint stability. Remember: A joint is only as stable as the muscles and ligaments around it. Thus, the fourth tip is to take care of the muscular strengthening of the joint in a targeted manner! Stable footwear supports the foot, and bandages and orthoses can be used to support the knee.
In the meantime, science has recognized very clearly that not only the cartilage plays an important role in osteoarthritis, but that it is rather a disease of the entire joint. In the leg, for example, the meniscus plays a crucial role as a shock absorber. If it is injured or if it is removed during a knee endoscopy, this is a risk factor for arthrosis. And there is also a certain risk potential with the synovium. This inner part of the capsule, also called synovium, produces and filters the synovial fluid. Similar to classic rheumatism, this skin can also become inflamed, leading to increased production of fluid and eventually swelling of the joint. The fifth tip, therefore, is to perform an MRI in the presence of knee osteoarthritis to look for tears in the meniscus. If they are present and if the underlying bone is also swollen (“bone marrow edema”), there is usually a biomechanical problem that needs to be fixed mechanically. If, on the other hand, calcifications are seen in the meniscus on an X-ray or computer tomography, these may be the effects of previous meniscal damage, which can culminate in osteoarthritis. Therefore, the sixth tip is to recognize such calcifications (which, by the way, do not only appear in the knee, but can also affect all other joints) and to specifically improve their metabolic causes – such as iron excess or magnesium deficiency – through diet.
All attempts to inhibit cartilage degradation with medication, for example by administering chondroitin sulfate, have so far had very little effect. Very importantly, a distinction must be made between pure pain therapy and a disease-modifying effect in the case of osteoarthritis drugs.
Pain treatment is relatively simple, anti-inflammatory drugs such as ibuprofen usually work better than paracetamol. However, even these “simple” painkillers are associated with side effects; they can cause stomach problems, kidney damage and others.
Joint injections usually contain cortisone, local anesthetics, or hyaluronic acid. Cortisone injections are effective for joint swelling and acute severe pain; they should be given no more than two or three times a year because of long-term side effects. Hyaluronic acid shows positive effects in some cases, probably due to its anti-inflammatory effect rather than its function as a joint lubricant.
An interesting new concept in the treatment of osteoarthritis is osteoporosis medications. Although at first glance osteoarthritis has nothing to do with osteoporosis, bone loss is observed at a very early stage of osteoarthritis. If osteoporosis medication is used specifically and early enough, it may be possible that osteoarthritis does not develop in the first place: Initial studies from Australia show good effects in finger joint osteoarthritis, for example. So, the seventh tip is to include the structure and quality of the bones in the treatment of osteoarthritis. Even if there is no direct linear connection between osteoporosis and arthrosis, an osteoporotic bone in individual joints such as fingers enables bone thickening or so-called osteophytes. By the way, a too high cholesterol level in the blood seems to support this process even more.
The eighth and altogether most general tip is therefore the correct nutrition – with certain forms of the arthrosis it plays undoubtedly an important role. For example, poor nutrition, combined with obesity, leads not only to local surcharge, but also to a systemic inflammatory response. Fiber-rich diets seem to counteract this process and have been shown to be effective in the fight against osteoarthritis. For example, carbohydrates and too much gluten should be reduced when possible. In addition, antioxidants such as berries and nuts, as well as omega-3 fatty acids, are very likely to help improve joint homeostasis and alleviate osteoarthritis.
CONCLUSION: Treating osteoarthritis elegantly does not mean waiting for prosthesis, but rather taking early and active countermeasures. This can be done by biomechanical corrections, by a healthy lifestyle, and if necessary, by medication and surgery. To obtain the greatest possible effect with the fewest possible side effects, the therapy should be individually adapted.