Arthrose

the Arthrose (v. griech. ἄρϑρον „joint “), also Arthrosis deformans (v. lat. deformare „mutilate “) mentioned, are a chronic, painful, increasingly function-obstructing joint change due to a disproportion between load-carrying capacity and load; this concerns a degenerative joint illness. Contrary to the Arthritis those are with the Arthrose Joints does not ignite, but worn out. From this wear first the cartilage is concerned, later follows then changes in the bone, so-called Geröllzysten forms, it comes to the formation of Osteophyten. Often injury sequences cause a premature wear, one talk about post office trauma tables a Arthrose. Generous operational meniscus distanceslead about 20 years later to the Arthrose of the knee joint concerned.

mediale Gonarthrose

it concerns right a NMR - representation of a arthrotischen knee joint. To see clear the Osteophyten in the centric and lateral range of the joint gap and the wear are or abrasion of the cartilage layer in the leftRange of the picture. The bone of the seeming leg head within the centric range is consolidated, a reaction to the increased mechanical stress. The cartilage layer lost its damping function.

Table of contents

symptoms

Arthrose begins creeping and runs first slowly. Which begins with easy, pain dependent on load, can itself as at the beginning of the illnessput out. Later it comes to changes in the range of the jointnear bones, the joint mucous membrane and the joint cap as well as the musculature. As consequence can appear further: Swelling the joint, Gelenkerguss (then one speaks of the activated Arthrose) and increasing deformation (deformation) of the joint. Are typicalApproach pain, particularly after the night rest. In the further process there can be then also pain in peace. During the investigation are possibly noticeable the changed form, swelling and the joint noises arising during the movement examination. The abrasion procedures lead to the fact that the volume apparatus of the joint is loosened.

develop

for localization most Arthrosen in the joints, which by the force of gravity loaded are, as in knees, Hüft and jump joints. The decreased mobility and maximum stress change attitude and course, which settles in the spinal column statics. Back pain, possibly heavy degenerative changes that Spinal column are the consequence. One-sided stresses can likewise lead to Arthrosen, as example are mentioned the Arthrose of the elbow recognized as occupational illness with humans, who worked long time with a pneumatic hammer…

joint wear,

Arthrosis used terms deformans, Osteoarthritis (English. for Arthrose).Here is referred to the differences in the English and German linguistic usage: The Arthritis in the German literature is a primarily inflammatory happening, with which the destructive abrasion procedures arise only in second line. That is something else as a Arthrose.

emergence

the beginninga Arthrose is a cartilage damage, whereby however each cartilage damage does not have to lead to kind trousers. The reason for this is probably the individual development of the immune system. The joint cartilage of humans is a so-called. „immunologically privileged region “, i.e., the cartilage contains so many potential autoantigens thatit in the evolution was more favorable to hold out to immune cells to a large extent from the joints. By a mechanical injury the autoantigens step, mostly Proteoglykane (protein sugar connections) from the cartilage out and cause an immune answer approximately (see IL-1 under „therapy “). Thus the cartilage apart from the mechanical damage becomes additionalbiochemical attacked. This damage leads to an increased abrasion of the joint-forming surface, it comes to a loss at cartilage substance, in the radiograph diminishes itself the joint gap. The mechanical damping function of the cartilage layer is exposed worse, the bone which was under the cartilage to increased mechanical stress. On theseStress reacts the bone with a compression of his Binnenstruktur, one designates as „Eburnisation “, which bones here compared withivory “. If the purge of the joint progressed so far, the bone begins itself to deform. The body tries, the bearing surface of the joint toowiden, it form Osteophyten. By mechanical overloading the bone within structure breaks down in parts below the cartilage layer, it forms holes, which are called Geröllzysten. One differentiates between the primary and the secondary Arthrose. The literature indicates that it itself with 80%the cases around primary Arthrosen (D. h. A cause unknown) and with the remaining 20% around secondary Arthrosen (D. h. Emergence as consequence of a primary cause). Some specialists are the view that primarily and 80% secondarily originate in to 20%.

With the secondary Arthrose are the following causes admits:

  • mechanical
  • inflammatory
  • metabolic
  • chemical
  • trophische
  • hormoneal
  • neurological

Arthroseformen

the following Arthroseformen refers in particular to the betroffenene in each case joint:

the following Arthrosebezeichnungen describes the status and/or. the origin of the Arthrose:

  • Präarthrose - preliminary stage of the Arthrose e.g. due to a Hüftgelenksdysplasie
  • of post office trauma tables Arthrose - from an injury resulting bad position of a joint, those to premature purge leads
  • Polyarthrose, multiple Arthrose - if the Arthroseat many joints Pseudoarthrose arises
  • at the same time - is a wrong joint developed from a not healed fracture.

cartilage damage degrees

an important criterion for the evaluation of the process and the therapy options of a Arthrose is the cartilage damage degree. The objectively determined damage degree must however inevitably not correspondingComplaints cause. Already strong pain has some concerning, during others with degrees IV - hardly complaints to have with a damage degree of II. The effect is thus different from individual case to individual case.

  • Degree of I: yield cartilage surface, still no damage of the cartilage layer
  • degree of II: there is only superficial cartilage layers concerned, easy damage in the cartilage cell structure, surface degree
  • of III aufgeraute: deep cartilage breaks with the naked eye recognizably, cartilage damage up to the bone degree of IV
  • being under it: Cartilage destruction with lying exposed bone. Heavy joint damages, with those it to a complete destruction of the cartilage layer alsolying exposed bone came

diagnostics

the patient reported with the anamnesis over joint pain, afterwards must be still clarified, with which opportunities this pain arises. The clinical investigation of the joint outline, the function, follows volume stability, the surrounding musculature and then closes,depending upon requirement, a picture-giving diagnostics on, thus Roentgen, CT or March. If findings for a minimalinvasive intervention offer themselves, a Arthroskopie can become necessary. The development of the Arthroskopie in the last years has some joints for this elegant form of the operationalInterference accessible made. Most frequently Arthroskopien at the knee joint are accomplished to also clarify in order präoperativ for example which type is in individual cases meaningful endoprosthesis. Arthroskopien are mostly used however, in order to be able to make at the same time with the diagnostics also the necessary reorganization of the joint.

, knows

Vorbeugung to Vorbeugung of the Arthrose one at present only the sufficient movement without overloading, which protection from joint injuries and the prevention of predominance list as recommendable. Medicines and food auxiliary means cannot prove so far with humans chondroprotektiven (a cartilage-protecting) effect, even if this is frequently maintained.

therapy

in the majority of the cases is only begun a therapy if the Arthrose already caused a clear joint change. Then it is the goal of the therapy of receiving despite the joint wear a sufficient mobility and maximum stress of the joint.

The effectiveness proof ofTherapys measure with Arthrose is not simple, since in the process of the illness painless phases with painful phases alternate. Also the joint mobility can vary in the process of the illness. At the same time the proof is inevitable of humans concerned by effective therapys measure with the multiplicity with one older becoming population.

Within the range of the Hüft or knee joint one knows the Arthrose on the basis the pain-free go-strains and the joint mobility to document. If a therapy measure is effective, it must go-strains and the joint mobility to improve. This improvement should be provable also still after one or more years.

Work on []

Effectiveness proven or well occupies

  • sound of the medicament commission of the German medical profession (AkdÄ) is with Arthrose only the effectiveness by analgesics (pain means) occupied. In addition belong those not steroidalen to Antirheumatika (NSAR) like for example Paracetamol, Diclofenac or Ibuprofen, and those betterstomach-compatible Cyclooxygenase 2-Hemmer (COX2-Hemmer, because of accumulated cardiac infarcts and impact accumulations come into the discussion) as well as the strongly effective analgesics of morphine - type.
  • For function improvement patient gymnastic is often used. With ill knee joints a shoe side dressing and absorbing shoe inserts can help the further purge to brake. With attraction conditions thatJoints with over warming and pain bring refreshing measures a Linderung. The popular ointments have probably no effectiveness, since they not until to the joint are taken up.
  • Movement without load: The majority of the Arthrosepatienten reports agreeing that movement with reduced load helps you, thoseTo receive mobility. Thus by most Gonarthrosepatienten bicycle driving and swimming are recommended, rejected Joggen rather.
  • To the operational therapies of the Arthrose belongs and. A. beside the operational joint conversion - the abrasion (also joint toilet called) - and the joint reinforcement (Arthrodese) also the artificialJoint replacement endoprosthesis. In the FRG about 160000 endoprothetischen operations at the hip and about 80000 at the knee joints are accomplished at present.
  • If an activated Arthrose leads again and again to continuing attraction condition of the joint with arising, heavy Ergüssen, the Radiosynoviorthese can bring noticeable improvement. Into thatprovoked joint is injected a mostly colloidal suspended beta emitter to kill with the goal, the hyper+active cells of the Synovialmembran. This procedure is scientifically recognized, execution requires a substantial technical expenditure, there the used emitters short-lived to be must and to that extent the time between production of the emitterand is closely limited for the injection. The procedure has its firm place in the therapy of heavy and heaviest Reizustände with Arthritiden and activated Arthrosen, if the other therapy options without substantial success are exhausted. The strict indication position applies also here.

effectiveness proof stands stillfrom

  • a new therapy option offers the Interleukin to 1 antagonist therapy: From the blood of the patient a IL-1 antagonist is won and injected into the joint concerned. Thus the IL-1 in its damaging function, taken part in the disease happening, is restrained. The effectiveness of this therapy could up to nowyet not to be proven. According to data of the manufacturers in May 2005 a German phase iii study were accomplished, results are not present in listed magazines however. The costs of the therapy are not taken over at present by the cash.
  • A further possibility of treatment exists with the Radonthermalstollen - treatment, z. B. in Gasteiner the welfare-mad. In principle cells involved concern a nondirectional elimination of all at the emergence of pain and Entzündungsmediatoren. A so nondirectional therapy should, ifit around radioactive substances acts, with caution to be regarded. With each radiograph is paid attention to the radiation dose. In bath Gastein does not ask anybody for the more precarious whole-body dose. Often „the Roentgen attraction irradiation is accomplished by radiologists “, afterwards the pain mostly is in the joint for some timeless strongly, the purge of the joint is however still accelerated often.
  • Highly proportioned Vitamin E (500 to 1000 I.E. daily) antiinflammatorischer Mediator (regularization of the Arachidonsäure - metabolism) can help to positively affect inflammation processes in the joint and the cartilage purge by influence in its characteristic as anti-oxide to andfree oxygen radicals (wg. to moderate exceeding immune reaction).
  • Medically secured, but reported of concerning partly, do not help the daily income of millet, particularly the game form of millet, so-called brown millet. Further natural cures with assumed therapeutic effect are excerpts from the South African plant devil claw (Harpagophytum)and silica.

nutrition

some physicians (*) recommend the oral income of Glucosamin. The effect proof free of doubts is pending however. Glucosamin is a natural substance, which can be found in nearly all fibers of the body. It affects the biosynthesis of a molecule, which calls itself Glycosaminoglycans, that thatMain part of the joint lubricant and the cartilage represents. Glucosamin occurs not in food, becomes however of the body naturally manufactures. If the body does not manufacture this material from any reasons or in not sufficient quantity, this could probably lead to the formation of the Arthrose.

It could recently to be shown the fact that the substances Glucosamin and Chondroitin Sulphat improve the symptoms of the Arthrose and retards their further progressing (Poolsup N et al., 2005). However newer proofs show also that Glucosamin is not effective with reversal of the Arthrose in the knee (McAlindon et al. 2004).A further food addition, which seems promising, is S-Adenosyl Methionin. Smaller studies have shown that it is just as effective with the Schmerzlinderung as nichtsteroidale, antiinflamatorische (entzündungshemmende) pain means (Ibuprofen, Diclofenac, etc.), even if it takes about four weeks, before this effect begins.

(*) Translation of an excerpt of the English Wiki article, therefore no German physicians are here meant.

commerce and illness

a degenerative Arthrose are not welfarable. Only the operational joint replacement offers the chance of a re-establishment of the pain-free joint mobility with favorable complicationless process, over several years. Besides many working methods become- are over 200 - in this market offered. Many of it - from food auxiliary means to the application of physical methods („modulated magnetic fields “) - have no scientific voucher of their effectiveness. They are not taken over by the legal health insurance companies, provide however for Geschäftemacher - also somePhysician - as self payer achievements (hedgehog) an important source of income. As apparent treatment successes thereby temporarily fading away complaints which can be typical however for the wavy returning process of the Arthrose inflammations, count. Under the generic term „Wellness “is marketed a whole pallet by food auxiliary means, those mainly theirVertreiber use. The prices for these materials are mostly strengthen superelevated. Also the magnet bracelets, which are sold in great quantities by pharmacies, serve similar purposes. If consumer protection organizations test these offered substances, it is mostly stated that „no health risks assume that “. The offerer refers these test results (… „with goodevaluated “) into its advertisement also, without referring to it, which characteristics were evaluated there.

literature

  • Klaus Dieter Thomann: Effective assistance with Arthrose. TRIAS publishing house, Stuttgart 2003, ISBN 3-83043-094-9
  • Gerhard body old: Arthritis and Arthrose. Jopp Oesch publishing house, 2003, ISBN 3-03505-037-6

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