HIV Foundation Health What really helps against joint pain

What really helps against joint pain

Natural active ingredients such as devil’s claw or NSAID drugs and opioids: These drugs are supposed to relieve joint pain in osteoarthritis. But what helps whom? FOCUS Online explains which treatments work for joint pain caused by osteoarthritis and what side effects they have.

  • Osteoarthritis results from wear and tear on bones and joint capsules.
  • Five million Germans suffer from the consequences.
  • Briefly explained: which osteoarthritis treatment helps whom?

If the joints hurt, it is usually osteoarthritis : it is the most common of all joint diseases. About five million Germans suffer from it. Osteoarthritis occurs when bones, ligaments, tendons and joint capsules wear out.

This is important to differentiate the disease from rheumatoid arthritis. Inflammation is the cause here.

This is important for osteoarthritis treatment

“Arthrosis is a disease that runs in waves,” explains Johannes Flechtenmacher, President of the Professional Association of Orthopedists and Trauma Surgeons. Less painful phases alternate with those that torment those affected.

The aim of the treatment is to relieve the pain on the one hand and to maintain or restore the ability to move on the other.

Osteoarthritis needs combination treatments

Ideally, the doctor combines non-drug treatments such as physiotherapy, nutritional recommendations, and hot or cold applications with medication. These are mainly used in the acute pain phase.

“In the less painful episodes, patients should try to avoid medication,” explains Flechtenmacher. In principle, movement in particular is an important component of therapy. His motto: “Move a lot, load little.”

Five osteoarthritis treatments put to the test:

1. NSAIDs: cortisone-free pain relievers

This is how the drug works: The non-steroidal anti-inflammatory drugs (NSAIDs) are the classic all-rounders in pain relief. They have both anti-inflammatory and analgesic effects, but do not contain cortisone.

Medicines include ibuprofen, diclofenac, or naproxen. They block two important enzymes that play a role in the sensation of pain: Cyclooxygenase (COX) isoenzymes I and II.

The so-called Cox II inhibitors are therefore well suited to treat acute joint pain associated with osteoarthritis.

NSAIDs also have an antipyretic effect.

Side effects: Gastrointestinal complaints and an increased risk of cardiovascular diseases are among the risks of NSAIDs. “That is why it is particularly important to tailor the osteoarthritis treatment to the patient,” explains orthopedist Flechtenmacher.

For example, ibuprofen is not suitable for patients with kidney problems, and diclofenac hits the liver. Both drugs also have a negative effect on the cardiovascular system. Naproxin is therefore better suited for heart disease patients with osteoarthritis.

2. Opioids

This is how the drug works: Opioids are effective remedies that are used against severe joint pain. By attacking the opioid receptors, they prevent pain from developing and being transmitted.

Tramadol is one of the morphine-like drugs. “Morphines are not suitable for treating acute phases of pain in osteoarthritis,” says Flechtenmacher. This is especially true for plasters. Morphine should only be used for chronic treatment if no other therapy is helping the patient.

Side effects: Many sufferers suffer from the exhaustion caused by morphine. Especially in older people, opioids aggravate many age problems. These include, for example, constipation and dizziness. This also increases the risk of frail patients falling.

3. Hyaluronic acid

In addition to drugs that directly combat pain, there are active ingredients that intervene in the mechanism of the disease. A typical representative is hyluronic acid.

This is how the drug works: Doctors inject hyaluronic acid into the joint to treat osteoarthritis. That’s the only way it works. “In contrast, it is pointless in tablet form, as is sometimes offered,” explains Flechtenmacher. Only in the joint does the drug help the knees or fingers move more smoothly.

With regard to evidence-based studies, hyaluronic acid should be viewed critically, adds the doctor. For example, the relief of osteoarthritis on knock knees or bow legs, where it is biomechanically induced, works less well than on straight legs.

Nevertheless, medical professionals have high hopes for hyaluronic acid. They are currently researching the structure of cartilage: “There are actually very promising developments in which hyaluronic acid is combined with stem cells or other molecules,” says Flechtenmacher. Damaged cartilage structures could be rebuilt.

Side effects: As a rule, osteoarthritis patients tolerate hyaluronic acid very well. Since it is injected directly into the joint, there is the usual risk of infection from the method.

4. Natural medicine

This is how the treatment works: Natural active ingredients such as nettle leaves, willow bark or devil’s claw should also relieve pain. The latter contains, among other things, harpagoside. Similar to the non-steroidal anti-inflammatory drugs, they are supposed to inhibit the formation of the pain messenger prostaglandin.

“So far, however, nothing has been identified in evidence-based studies that proves the effectiveness of the natural active ingredients,” explains Flechtenmacher.

Side effects: They are dependent on the natural medicine product. The instruction leaflet of the devil’s claw, for example, warns of possible gastrointestinal complaints such as diarrhea, nausea, flatulence, vomiting as well as dizziness and headaches or rashes.

5. Acupuncture

This is how the treatment works: As with natural active ingredients, evidence of how acupuncture works for osteoarthritis has not yet been provided in scientific studies.

On the contrary. An Australian study looked at the effects of acupuncture. The results published in the “JAMA” magazine showed: Acupuncture with needles or laser has no relevant effect on pain and function in patients over 50 with knee osteoarthritis and moderate or severe chronic pain.

However, acupuncture helps some osteoarthritis sufferers. Johannes Flechtenmacher, for example, relies on the alternative form of treatment

  • light and irregular pain
  • when many illnesses in the affected person rule out other drugs.

In addition, there are many patients who benefit from the doctor’s attention and empathy alone.

Side effects: The symptoms can get worse at first, writes the German Pain Society on acupuncture . And adds: “Occasionally there are slight bruises or bruises, and brief circulatory reactions can also occur during acupuncture treatment.”

In any case, those affected should not treat their joint pain independently, but should always have it checked out by a specialist.

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Vitamin A deficiency is blind: which foods protect them – and which are no-gosVitamin A deficiency is blind: which foods protect them – and which are no-gos

Vitamin A is a generic term for several vital substances, including beta-carotene. A deficiency is rare, but there are risk groups, for example with liver or intestinal diseases. The signs of A-deficiency, how to avoid it and how dangerous an overdose can be.

Carrots are high in vitamin A and beta carotene, hence their name, and are important for the eyes and the immune system. Most of them do not know more about these vital substances – and this statement is sometimes even incorrect.

Vitamin A, provitamin A and beta carotene – what are they?

Because vitamin A is a complex of vitamins that includes retinol and retinyl esters . These forms are mainly found in animal foods.

There is also provitamin A as a precursor, which is found in plant-based foods. “There are also various representatives of provitamin A, the best known is beta carotene,” explains Andrea Henze, nutritionist at the University of Potsdam. The body has to convert provitamin A such as beta carotene into vitamin A so that it can be used. This processing takes place mainly in the intestines and liver.

Beta carotene – like all provitamins A – in turn belongs to the large group of carotenoids, of which there are more than 600 different ones. All of them have the property, as a natural coloring agent, of coloring plants yellow, orange, red and are therefore found in many orange-red vegetables. “But green vegetables such as spinach can also contain a lot of carotenoids,” adds the scientist, who is also researching the subject of vitamin A. In green vegetables, however, the orange-red color of the carotenoids is masked by the green plant substance chlorophyll.

The function of vitamin A.

Vitamin A is vital. “We need vitamin A for almost all body functions because it enables cells to differentiate,” explains Andrea Henze. This means that under the influence of this vital substance, the cell can become a skin cell, a mucous membrane or nerve cell. The other functions of vitamin A:

  • Immune system: Vitamin A primarily promotes the development of lymphocytes and thus a strong immune response to foreign substances and pathogens.
  • Skin and mucous membranes: It ensures healthy cell growth and cell integrity, thus preventing cracks and other damage, improving wound healing, i.e. regenerating. In this sense, vitamin A also acts on the lung epithelium and supports the constant renewal of the fine cilia that line the lung surface. It is similar in the intestine with the intestinal epithelium. Vitamin A is responsible for this constant renewal.
  • Blood formation: Vitamin A promotes the formation of red blood cells (erythrocytes) and thus improves the transport of oxygen into every cell.
  • Bones: It influences the storage of calcium phosphate in the bones.
  • Reproduction and fertility: Vitamin A is extremely important for the formation of healthy egg cells and sperm as well as for embryonic development. “We know from studies that vitamin A deficiency in animals often causes infertility or, if fertilization does take place, the offspring can have deformities of the limbs,” adds the scientist.
  • Seeing: Vitamin A is important in the eye as a pigment that enables the process of vision. It plays a key role in the nerve impulse that is triggered by the incidence of light and sent to the brain. Vitamin A, so to speak, mediates this signal cascade during the visual process.

Vitamin A does not have an antioxidant effect

From a purely chemical point of view, vitamin A is an antioxidant, but it does not play a role in the body in this context, for example because of its binding to transport proteins and its intracellular localization. As is often assumed, it is not a radical catcher and does not protect against “cell rust”, i.e. oxidation. “Vitamin A has no direct effect in this context, only an indirect one,” explains Andrea Henze more precisely: Vitamin A increases the absorption of vitamin E and selenium in the intestine, which have an antioxidant effect.

Pro-vitamins A such as beta carotene, on the other hand, can develop an antioxidant effect in the body before they are converted into vitamin A.

Why is this distinction important? Andrea Henze explains why it is best to use both animal and vegetable sources of vitamin A: Only then can the full spectrum of activity of these vital substances be used to the full.

Foods that are high in vitamin A and beta carotene

Among the foods of animal origin, the following are particularly rich in vitamin A:

  • Beef liver
  • Pork liver
  • poultry
  • butter
  • cheese
  • Eggs

When it comes to plant-based fruits and vegetables, these are good provitamin A suppliers:

  • Carrots
  • Cabbage
  • spinach
  • Apricots
  • paprika

Store and prepare foods rich in vitamin A correctly

Vitamin A is sensitive to light, so food should be stored in the dark. In addition, the vital substance is relatively heat-stable and fat-soluble. This means that it is bound to fat and can therefore best be absorbed by the body.

In the case of animal sources, this is usually given or due to the preparation, for example the extremely low-fat liver is fried in oil. For the preliminary stage vitamin A, however, the corresponding vegetables should be prepared together with fat. “Studies have shown that it is particularly well absorbed by the body when it is crushed and steamed with a little fat,” reports Andrea Henze. Grinding is important so that the provitamin is released from the cellular structures.

An example: carrot vegetables, chopped up and steamed with a little safflower oil, provide the body with the vitamin better than nibbling raw carrots.

This is how much vitamin A you need every day

According to the reference value of the German Nutrition Society, the daily requirement for vitamin A is around one milligram per day. However, this is a bit simplified. Other units are used in nutritional science, the requirement is given as so-called retinol equivalents (RE) or retinol activity equivalents (RAE), explains the scientist and explains in more detail. 1 milligram of retinol corresponds to 1 milligram of RE or RAE. For provitamin A carotenoids, the calculation is more complex because additional factors have to be taken into account:

  • Efficiency of absorption in the intestine (this is generally lower for carotenoids than for retinol or retinyl ester and depends on the food matrix)
  • Conversion efficiency of provitamin A into vitamin A (this differs greatly between the provitamin A carotenoids, it is highest for beta carotene)

When using RAE, a conversion factor of 12: 1 is assumed for beta carotene and 24: 1 for all other provitamin A carotenoids. This means that 12 milligrams of beta carotene or 24 milligrams of other provitamin A carotenoids must be ingested with food to meet the requirement of 1 milligram of RAE. If, on the other hand, the intake takes place in the form of retinol or retinyl esters (i.e. from animal foods), the required intake is correspondingly lower.

According to this calculation, the daily requirement for vitamin A is covered with 150 grams of carrots, for example, or with a mixed diet: 1 egg, 100 grams of Gouda cheese and 75 grams of carrots.

Vitamin A deficiency affects certain risk groups

Because these foods are so rich in vitamin A, there is virtually no deficiency in this vital substance in Germany and other industrialized nations. However, that’s only true at first glance. Because experts differentiate between primary deficiency and secondary causes when it comes to undersupply.

Primary means that too few foods rich in vitamin A are eaten. This is almost never the case in this country. Even those who only eat fast food are adequately supplied with vitamin A. Vegans and vegetarians also get enough vitamin A from the preliminary stage.

It is different, however, with a secondary deficiency. In this context, secondary is used when the deficiency arises as a result of illnesses. Digestive diseases that affect absorption, such as:

  • inflammatory bowel disease such as Crohn’s disease
  • Celiac disease
  • chronic liver disease, because vitamin A can then no longer be stored
  • Diseases of the pancreas, because the digestive enzymes that are important for the absorption of the vitamin are not sufficiently produced.

In addition, there is a risk of undersupply if the vitamin A requirement is increased, this is the case with:

  • pronounced inflammatory processes
  • massive injuries such as burns when much of the skin surface is destroyed
  • Kidney disease, which causes vitamin A to be excreted in the urine without being used
  • Alcohol abuse because liver function is impaired
  • pregnancy

Vitamin A Deficiency: Symptoms can be dramatic

As a rule, these risk groups are well looked after by a doctor, so that symptoms of deficiency rarely occur. Exception: alcoholics and very overweight people with massive fatty liver who do not seek medical advice. Apart from these patients, little is known about vitamin A deficiency in Germany. “Vitamin A deficiency occurs mainly in developing countries, where it is the main cause of blindness,” adds the scientist. Because one of the signs of vitamin A deficiency is night blindness, which can increase to complete blindness and is then no longer treatable.

There are also many other causes of night blindness, which are primarily age-related. The adaptive ability of the eye declines, for example as a result of cataracts, macular degeneration or retinopathia pigmentosa (hereditary disease). In any case, a doctor should always clarify if twilight vision deteriorates.

The other signs are a bit unspecific

  • Susceptibility to infection
  • dry skin and eyes
  • brittle hair
  • Loss of appetite
  • Muscle weakness
  • Fertility disorders

Vitamin A deficiency is best compensated for naturally

Anyone who thinks they are undersupplied with vitamin A should simply use more of the corresponding fruits and vegetables. Overdosing is not possible because the body only converts as much provitamin as it needs and it still makes sense to store it.

Over-the-counter supplements are the next step. It is best to get advice from a doctor and trust products from Germany. “Over-the-counter products only contain provitamin A, so overdosing is difficult, and absorption in the intestine is reduced if there is sufficient quantity,” explains Andrea Henze in more detail.

Beware of vitamin A supplements

Vitamin A supplements, on the other hand, can be more problematic, and poisoning is possible if overdosed. In Germany such products are therefore not freely available, but in other countries they are. “Vitamin A supplements should only be used under medical supervision and not for self-medication,” warns Andrea Henze.

Vitamin A poisoning – the first signs

The excess supply of vitamin A does not slow down the body, as is usually the case with provitamin A. The excess vitamin A is mainly stored in the liver; if it becomes too much, the detoxification organ can no longer work. “It leads to intoxication,” says the scientist. In pregnant women, this can also have negative consequences for the embryo.

The signs of vitamin A hypervitaminosis:

  • Nausea and headache ,
  • the bone tissue becomes porous.

If the oversupply lasts longer, it can even lead to death.

Incidentally, high doses of vitamin A supplements also led to the increase in lung cancer among smokers, previous studies warn.

There is no risk of intoxication from vitamin A through food – with one exception

What is certain is that over-the-counter supplements, which mainly contain beta-carotene, are usually harmless even if taken regularly. It is different with products that contain vitamin A, such as retinol. With them, intoxication is quite possible and can occur with a daily intake of 3 milligrams or more. By the way, retinol can also be found in many care products to keep the skin young and firm. “In this context, there is no need to fear overdosing, the substance does not pass from the skin into the bloodstream,” reassures the expert.

And hypervitaminosis A is hardly to be feared with food either. “Unless you eat liver several times a week,” warns Andrea Henze. Liver can contain over 30 milligrams per 100 grams of goods and thus exceeds the daily requirement by more than 30 times!

A historical anecdote shows how tragic this can end: More than 100 years ago, three researchers set out on an Antarctic expedition, Douglas Mawson, Belgrave Ninnis and Xavier Mertz. The expedition was not a lucky star, the men had to gradually eat the sled dogs in their distress in order not to starve to death. Mertz is said to have eaten the livers as well, subsequently complained of stomach pain, and his skin was partially peeling. After he fell into delirium, he passed away. Experts suspect that it was vitamin A poisoning from the dogs’ liver .

Therefore do not demonize the liver

Nobody knows for sure whether the story is really true. However, it is scientifically proven that hypervitaminosis A from natural foods is not to be feared, unless one eats a liver daily. Apart from that, the liver is an extremely valuable food from a nutritional point of view, contains vitamin A, iron, zinc , copper, vitamin B12 and folic acid, the supply of which is sometimes critical.

The most sensible recommendation: A lack of vitamin A can best be prevented with a balanced mixed diet, i.e. eat a lot of fruit and vegetables, whole grain and low-fat dairy products, sometimes a little fish or poultry.

Osteoarthritis in the knee: How stem cells can repair damaged cartilageOsteoarthritis in the knee: How stem cells can repair damaged cartilage

It crunches and cracks, and some movements during exercise are really painful. When the knee shows signs of wear and tear, those affected want a miracle cure that rebuilds the cartilage. Hope rests on stem cells.

  • The body’s own stem cells have a positive effect on osteoarthritis-related inflammation in the knee.
  • A study now wants to clarify whether they actually build up permanent cartilage.
  • A transplant can repair minor cartilage damage in young patients.

After a certain age, signs of wear and tear become noticeable in the knee . After the age of 30, the risk increases linearly. The painful, inflammatory breakdown of cartilage in the operating room and with an artificial knee ends 150,000 times a year. Then smooth metal has to replace the cartilage layer, which allows round, painless movements in a healthy knee.

The idea frightens many people suffering from osteoarthritis. They hope for new methods to rebuild lost cartilage: stem cells should help.

Belly fat provides the best stem cell material

The doctor uses the patient’s belly fat as a starting material. The idea behind it: stem cells can be obtained particularly easily and in relatively large numbers from vascular fat tissue. Injected at the location of the defect, they learn from the microenvironment into which cell type they should develop.

According to this principle, the doctor and stem cell researcher Eckhard Alt uses the undifferentiated cells : Stem cells from the patient’s fat tissue are processed in the operating room within an hour and injected into the patient where he needs them – for example into the osteoarthritis knee.

The founder of the “Interdisciplinary Stem Cells Research Center” in Houston and a private clinic in Munich sees stem cells as the future therapy for chronic inflammatory diseases of the musculoskeletal system – among other things.

The cell extract in the knee does not guarantee success

Some orthopedic practices that offer the procedure honestly state that it is a not generally recognized attempt at healing with no guarantee of success. Rather, it is a final experimental attempt to remedy knee problems without a joint replacement.

“In this so-called ‘point-of-care’ application, a cell extract is injected that not only consists of stem cells,” explains Oliver Pullig from the Fraunhofer Translational Center for Regenerative Medicine in Würzburg. How many stem cells that are supposed to develop into cartilage material actually get into the knee is just as little regulated as the preparation of the suctioned off belly fat.

Development of osteoarthritis

Osteoarthritis most commonly occurs on the fingers, thumbs, knees, hips and big toes.

Arthrosis is always preceded by cartilage damage. Cartilage is considered to be a “shock absorber” for the joints. Initially, the damage to the cartilage is often superficial and limited to a small area. In the advanced stage, the symptoms worsen. Tension pain occurs and the joints change.

The joints react to the cartilage damage with pain, swelling or inflammation.

Stem cells instead of knee prostheses

A Europe-wide study is currently looking for scientific evidence of the anti-osteoarthritis potential of the body’s own stem cells.

A small one with six patients in Würzburg and twelve in Montpellier, France, led to success in 2013: Almost all participants canceled their previously unavoidable operation for a knee prosthesis. “Your complaints had improved throughout,” explains Oliver Pullig. “A reconstruction of cartilage was unlikely with such a large damage.”

The follow-up study that has just begun with 153 participants at ten European locations therefore fulfills a requirement that the German study director Ulrich Nöth from the Evangelical Forest Hospital Berlin-Spandau formulated back then: Stem cell therapy is best suited for patients with middle and middle-aged osteoarthritis. You are no longer eligible for a cartilage transplant, but you are too young to have an artificial joint.

New cartilage from stem cells? A study should show it

Like the pilot study, the ADIPOA2 study uses so-called mesenchymal stem cells from the abdominal fat of each subject. These precursor cells of the connective tissue have the ability to develop into cartilage, bone or fat cells.

Biologist Oliver Pullig explains: “We take 100 milliliters of belly fat from each participant. The stem cells obtained from this are multiplied millions of times in special laboratories. That takes a good two weeks. 51 patients then receive two million of these pure stem cells injected into the joint, 51 patients receive an injection with 10 million cells and 51 patients receive a placebo. “

Results should be available by the end of 2018, and thus scientific proof of whether stem cells fulfill the hope of permanently building cartilage. The scientist is optimistic: “If successful, the therapy with stem cells as a drug could be ready for the market at the next study level. It doesn’t take five years. “

Cartilage transplant only helps to a limited extent

Another method to restore lost cartilage is transplantation, which has been tried and tested for 20 years. So far, however, it has only been successful in the case of centimeter damage in an otherwise intact knee. The operation is laborious and the healing process long.

In the first keyhole surgery, the doctor removes a small piece of healthy cartilage, hardly larger than a grain of rice. These cartilage cells are propagated in the laboratory in three to four weeks. In a second operation, the surgeon places these cells or the cartilage patch on the defective area in the knee.

After that, the knee must not be subjected to any load for six weeks, then only lightly for another six weeks. Only after a year is the joint stable enough for sport to be possible.

Cartilage from the laboratory is expensive

The transplant is only suitable for younger knee patients whose cartilage and joints are free from osteoarthritis. If this therapy is successful, it can prevent further cartilage damage and a later threatened knee prosthesis.

Then, in the long term, the costs of several thousand euros for cells grown in a laboratory will pay off.

Hyaluronic acid can at least relieve pain

If these methods are out of the question, another remedy can help: synthetic hyaluronic acid is often misunderstood as a substance for building up cartilage. However, it cannot produce worn cartilage, but serves as a lubricant and for joint care.

Orthopedic surgeons inject the moisture-retaining gel three to five times at weekly intervals. Hyaluronic acid relieves pain and promotes mobility – permanently for some patients, at least for a year or two for others. Then the treatment can be repeated.