Osteoarthritis treatment

Diagnostics

The diagnosis can be made solely on the basis of the symptoms and the findings in the physical examination. If there is any doubt about the diagnosis or if the course of the disease is not as expected, imaging can be informative. X-rays provide a good assessment of the bone and reveal evidence of calcification, which may be partly responsible for the symptoms. The irritation component can be easily visualized by ultrasound on the basis of joint effusion and thickening of the synovial membrane. Finally, MRI is the only imaging technique that allows an assessment of the internal joint structures (e.g. cruciate ligaments and menisci in the knee) and of the bone as a source of pain (bone edema associated with pain that is not visible on X-ray).

Routine blood tests are usually unremarkable. The signs of inflammation may be slightly elevated in an acute irritation. Rather, the laboratory tests serve to rule out concomitant diseases. If a source of pain in the bone is suspected, the bone metabolism should be examined in the blood, which is not usually part of the routine clarification in the family doctor’s practice. The examination of the joint fluid also serves to rule out a primary inflammatory disease of the joint, such as rheumatoid arthritis, gout or a bacterial joint infection.

Treatment

Everyday activities should be carried out in a way that is easy on the joints, using aids that can reduce the mechanical strain on the joints. Occupational therapy can provide professional instruction and advice. If there are deficits or tension in the joint muscles, physiotherapy is helpful to build up strength and thanks to pain-relieving physical measures. Regular moderate physical activity is needed to support tissue maintenance. Cartilage supplements can also be used, such as chondroitin and glucosamine sulphate, and care should be taken to ensure an adequate supply of vitamins C and D, which are important for the connective tissue, as well as calcium. So-called non-steroidal anti-inflammatory drugs (NSAIDs), or “rheumatic painkillers”, are the best way to combat pain. If the main problem is ligament overload in the context of osteoarthritis, NSAID gels help very well. If the pain is deeper, NSAID tablets should be used. In the case of acute irritation with joint swelling and overheating that cannot be controlled with NSAIDs, the administration of a depot cortisone preparation directly into the affected joint is very successful. Hyaluronic acid injections help somewhat more sustainably but less quickly. There is still little research into autologous blood treatments, especially platelet-rich plasma (PRP), which is also injected directly into the joint. The concentrated blood plasma is obtained by centrifuging the patient’s own blood and separating the red blood cells from the plasma. Platelet-rich plasma is characterized by a high content of growth factors, which stimulate cell growth and collagen production. The growth factors are a kind of small command transmitter that prompt the body to heal. If the focus is on an excessive inflammatory reaction, as is typically the case with the aggressive erosive form of finger osteoarthritis, a so-called basic therapy can be used on a trial basis as with inflammatory polyarthritis. If mechanical instability increases, stabilizing splints are used with good results. The final therapeutic stage is joint surgery. Depending on the individual circumstances, so-called repositioning osteotomies, joint stiffening or joint replacement surgery can be considered. Arthroscopies to diagnose and remove worn joint components should no longer be performed. In particular, no meniscus resection should be performed on the knee if possible, as this favors the development but also the progression of knee osteoarthritis. In individual cases, particularly in the case of sports injuries in younger patients, a cartilage transplant can be carried out using arthroscopy for very localized cartilage defects. Which form of therapy is suitable is decided individually on the basis of the level of suffering, a thorough physical examination, any imaging and the accompanying circumstances.