The treatment includes first of all the information and thus the understanding of the clinical picture based on patient brochures and the medical consultation.
If the course of the disease is typical, the diagnosis can be made solely on the basis of the symptoms and the findings on physical examination. If there is any doubt about the diagnosis or if the course of the disease is not as expected, imaging can be insightful.
X-rays provide a good assessment of the bone and show indications of calcification, which may be partly responsible for the symptoms. Ultrasound shows the inflammation component, as well as joint effusion and thickening of the synovial membrane. Finally, MRI is the only imaging technique that allows assessment of the internal structures of the joint (e.g., cruciate ligaments and menisci on the knee) and the bone as a potential source of pain (bone oedema associated with pain that is not visible on X-ray).
Routine blood tests are usually unremarkable. The laboratory tests serve rather to exclude concomitant diseases. If there is a suspicion of a source of pain located in the bone, the bone metabolism should be examined in the blood, which is not usually part of the routine clarification in the general practitioner’s office.
The examination of the synovial fluid also serves to exclude a primary inflammatory disease of the joint, such as rheumatoid arthritis, gout, or a bacterial joint infection.
Everyday activities should be carried out in a way that is easy on the joints, using aids that are capable of reducing the mechanical stress on the joints. Occupational therapy can provide instruction and advice. If there are deficiencies or tensions in the muscles associated with the joints, physiotherapy is helpful for building up strength and providing pain-relieving physical measures. Regular, moderate physical activity is very important.
In addition, cartilage preparations can be used, such as chondroitin and glucosamine sulfate, 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.
The so-called non-steroidal anti-inflammatory drugs (NSAIDs) help best against the pain. If the problem is primarily ligament overuse as part of osteoarthritis, NSAID gels can help. If the pain is deeper-seated, NSAID tablets should be used. For acute irritation with joint swelling and hyperthermia that cannot be controlled with NSAIDs, a depot cortisone preparation directly administrated into the affected joint is a very successful treatment.
Hyaluronic acid injections might have more long-term effects but are less fast acting. Still little researched but promising are autologous blood treatments, above all the so-called 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, 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 givers that prompt the body to heal.
If the focus is on an excessive inflammatory reaction, as is typically the case in the aggressive erosive form of finger osteoarthritis, a so-called basic therapy can be used on a trial basis as in inflammatory polyarthritis.
If mechanical instability increases, stabilizing splints are used with good success rates. The last therapeutic step is joint surgery. Depending on the individual circumstances, this may involve osteotomies, joint stiffening or joint replacement surgery. Arthroscopies for diagnosis and removal of joint components should no longer be performed. In particular, meniscus resection should not be performed on the knee if possible, as this promotes the development or the progression of knee osteoarthritis. In individual cases, especially in the case of sports injuries in younger patients, cartilage transplantation can be performed by means of arthroscopy in the case of very circumscribed cartilage defects.
The choice of therapy is based on a completely individual assessment, according to the degree of suffering, a thorough physical examination, any imaging and the accompanying circumstances.
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