Non-surgical treatments are called “conservative” therapies. They include physiotherapy and physical therapy as well as medication. Physiotherapy and physical therapy aim to relieve symptoms and restore the mobility of the joints. Useful treatments include iontophoresis, ultrasound and magnetic field therapy. Treatment also includes building up the muscles (through physiotherapy and independent training such as cycling and swimming), which prevents the joints from being overloaded.
Treatment of the pain and the inflammatory components of osteoarthritis often begins with so-called traditional NSAIDs (non-steroidal anti-inflammatory drugs). NSAIDs can effectively relieve pain, but can also cause a number of side effects. COX-2 inhibitors, which are also often used, are a special form of NSAID that particularly reduce side effects in the gastrointestinal tract, but can also be associated with cardiovascular problems when taken long term. The whole group of NSAIDs, however, only acts against the symptoms of osteoarthritis and does not help to stop it. So-called chondroprotective agents are therefore often recommended, which are said to stop the destruction of joint cartilage and stabilise existing cartilage. However, as these are mostly food supplements and not medicines, their effectiveness has not yet been scientifically proven. Only for glucosamine sulphate, which is approved as a medicine at a dose of 1500 mg, are there medical studies indicating that joint cartilage is preserved. Long-term studies over three years of treatment have shown that the active substance D-glucosamine sulphate intervenes in the osteoarthritis process in the knee and inhibits further cartilage loss. Positive results have now also been presented for the follow-up period: treatment with D-glucosamine sulphate for at least 12 months reduces the risk of later surgery by 73%.
Anti-rheumatic ointments are often used for osteoarthritis complaints. There are many active substances for rubbing in. The effectiveness of products absorbed through the skin is limited compared with tablets or injections. However, massaging in the ointment, the accompanying warmth of an ointment dressing or the cold of cooling gels can have a positive effect on osteoarthritis complaints. Warmth helps with chronic complaints, but be careful: in acute irritation, which can be recognised by the joint feeling warm, it should be cooled.
If conservative treatment with painkillers and anti-inflammatory substances or chondroprotective agents does not bring the desired success, the next step recommended is treatment with injections into the affected joint. Local anaesthetics and steroid preparations are often injected into the joint. Local anaesthetics relieve pain quickly, but the effect usually lasts only a few days. Steroid preparations, often called cortisone, have a strong anti-inflammatory effect. Cortisone is used when acute irritation is accompanied by a joint effusion. If there is no inflammation in the joint, i.e. the osteoarthritis is in an inactive stage, treatment with steroids makes little sense. First, the pressure inside the joint is reduced by drawing off the effusion (so-called aspiration). Then the steroid preparation is injected into the joint, where it acts directly on the irritated synovial membrane (synovialis). Steroid injections should be given as rarely as possible. Although cortisone has a strong anti-inflammatory effect, it can also damage joint cartilage, especially if used frequently. Cortisone also reduces the production of hyaluronic acid, an essential component of cartilage. In addition, frequent cortisone injections increase the risk of infection. As a rule, no joint injections should be given if a joint replacement is planned in the next few months.
Hyaluronic acid has been approved for the treatment of osteoarthritis for a long time. Hyaluronic acid (hyaluronate) is a substance found in practically all organs and tissues. It used to be obtained from rooster combs; today it is mainly produced biotechnologically. In the joint, its main feature is that it binds large amounts of water and is responsible for “lubricating” the joint surfaces. Another function seems to be to supply the joint cartilage with more nutrients. Injections of hyaluronic acid are intended to supplement the hyaluronic acid naturally present in the joint. According to current research, pain and joint function improve significantly with hyaluronic acid therapy, especially in younger patients with moderate osteoarthritis. In older patients with advanced cartilage defects, the effects are smaller.
Alternative methods
Alternative therapies can be useful as a supplement:
- Acupuncture improves vegetative functions and relieves pain
- Vitamins C and E and trace elements such as zinc, selenium and copper neutralise oxygen radicals released during inflammatory processes
- Enzymes support tissue healing after sports injuries and operations
- Injections of homeopathic substances relieve inflammatory joint processes
- Magnetic field therapies stimulate joint metabolism (increased cartilage synthesis has been shown in the laboratory)