• 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.

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.