CONSERVATIVE ARTHROSIS THERAPY

CONSERVATIVE ARTHRITIS THERAPY

PHYSICAL THERAPY

exercise therapy as the core element of osteoarthritis therapy . Depending on age, comorbidity, pain intensity and movement restrictions, exercise therapy can include exercises for strengthening and mobilization, but it also serves to increase physical endurance. If functional mobility is restricted, the guidelines recommend passive joint mobilization techniques, which they also define as an element of movement therapy. Physiotherapy in particular is an essential component of the treatment. Here, patients learn exercises that, ideally, they can continue their own

Sporting activity, such as cycling or swimming , can reduce pain, improve mobility, increase joint metabolism and strengthen the surrounding muscles and is also considered an important part of conservative therapy.

The decision about the type of sporting activity (hiking, cycling, golf, tennis...) should be individualized and, on the one hand, take into account anatomical requirements (leg axes, accompanying pathologies) and, on the other hand, the current pain and inflammatory reaction to osteoarthritis. Sports-related overload should be avoided. In the case of acute joint pain and swelling, a temporary ban on sports may often be necessary.

ANTI-INFLAMMATORY

PAIN THERAPY

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of medications that have pain-relieving, anti-inflammatory and antipyretic effects. This makes them particularly effective for inflammation-related osteoarthritis pain.

Due to large inter-individual variations in bioavailability and half-life, the effect varies in patients.

NSAIDs should not be used for long-term treatment, but only on a temporary basis (“as needed”) during periods of pain and until the inflammation subsides. The duration of treatment is not always predictable, but should be carried out until the symptoms of inflammation (such as swelling, pain, warmth) subside. The effect of NSAIDs occurs on average around 0.5-1 hour after ingestion, with delayed-release tablets (e.g. prolonged-release tablets) after around 1-3 hours.

NSAIDs have a considerable potential for side effects, which occur particularly in old age and at higher doses. In particular, if used for a long time, they can damage the stomach, kidneys and cardiovascular system.

Systemic COX-2 inhibitors are a special form of NSAIDs that can significantly reduce side effects, particularly in the gastrointestinal tract.

NSAIDs can be combined well with metamizole (Novalgin, Novaminsulfone) for severe pain. However, the exact mechanism of action of metamizole is still unknown.

Paracetamol has no clinically significant pain-relieving effect in patients with osteoarthritis. Numerous studies have come to this conclusion.

Osteoarthritis patients should also be treated very cautiously with opiates. These are purely pain inhibitors and do not work against inflammation in the joints. The benefit of these painkillers is therefore low and there is a high risk of side effects. They also contain a not insignificant potential for addiction.

The different substance groups for pain therapy are used individually, and the benefits and side effects must always be weighed up.

INFILTRATION THERAPY

Infiltrations of the joints are carried out under sterile conditions, but there Skin germs can be carried into the joint, which can trigger joint infection The frequency for this is given in the literature as 1:10,000. An allergic reaction, bleeding or

Despite these risks, joint infiltration is a sensible measure for osteoarthritis. Those administered

Medications act directly in the joint and sometimes have a long-lasting effect. The frequent ones

Stomach problems with anti-inflammatory tablets do not occur.

CORTISONE

Glucocorticoids, often referred to as cortisone, have a strong anti-inflammatory . When injected into the joint, the cortisone can act directly on the irritated and inflamed lining of the joint (synovium). These measures should be carried out as rarely as possible. Although cortisone is highly effective, it can also damage the joint cartilage, especially if used frequently. especially in activated osteoarthritis with swelling . A bulging joint effusion can also be punctured.
By drawing out the effusion, the pressure inside the joint is reduced. However, the effect of the cortisone usually wears off significantly after about 4 weeks.

HYALURONIC ACID

Hyaluronic acid has been used for several decades in the symptomatic treatment of osteoarthritis of various joints. It is a substance that occurs naturally in the joint . Cartilage cells and the synovial membrane in particular produce hyaluronic acid. The water-binding hyaluronic acid and its polymers (long-chain compounds) keep the synovial fluid viscous (thick). This makes hyaluronic acid the actual “lubricant” in the joint, which supports the gliding ability of the joint surfaces. In the case of inflammation or after injuries or as we get older, the availability of hyaluronic acid in the joint decreases. By injecting hyaluronic acid into the affected joint, the adverse consequences of the lack of hyaluronic acid can be compensated for. The aim is to prevent or at least slow down joint wear caused by the increased friction on the joint surfaces.

Despite a large number of scientific studies, the effectiveness of this form of therapy is still controversial in the literature. However, clinically relevant pain inhibition has been described in more recent and high-quality meta-analyses. Therapy with hyaluronic acid is widespread, but it is not yet covered by statutory health insurance companies.

ACP/PRP

Treatment with autologous conditioned plasma (ACP) represents a novel treatment method for treating wear-related joint problems. It is known that the growth factors can positively influence a wide range of healing processes . ACP therapy is based on this knowledge. Using highly concentrated growth factors in the blood (from thrombocytes or platelets), healing and rebuilding processes in damaged joint cartilage and tendon tissue can be stimulated.
Initial clinical results show significant improvements in terms of pain and mobility.

A blood sample is required for this. Using a special separation process using a centrifuge, the part of the blood that contains the body's own regenerative and osteoarthritis-inhibiting components is obtained. The resulting endogenous solution is then injected directly into the affected joint. This is done using a specially developed double syringe that ensures the highest level of patient safety. ACP therapy is recommended for painful, mild to moderate arthrosis (arthrosis grades I-III).
However, in grade IV osteoarthritis, the therapeutic effect is low.