Osteoarthritis, rheumatism, gout: Joint diseases are not only annoying, they can also significantly restrict everyday life. Patients often suffer from persistent joint pain, which often cannot be adequately controlled even with medication. But what is really good for the joints and what alternative healing methods exist for those affected is revealed by the orthopaedist and author of "Gelenke im Glück", Dr. Meike Diessner, in an interview with ntv.de.

ntv.de: How do the joints develop over the course of life?

dr Meike Diessner: In principle, a joint consists of at least two bone partners, which usually fit well together anatomically in terms of shape. Overlying the bones is a layer of articular cartilage. A joint changes as a result of previous injuries, trauma, but also as a result of excessive pressure, poor nutrition or a disproportion between the load and the actual resilience of the cartilage. As a result, the cartilage layers continue to detach over the course of life. This means that microflakes are continuously abraded from the cartilage by these friction processes and pressure loads until there is less and less cartilage substance over the bone. This is how the cartilage loses its protective function. The joint partners are getting closer and closer to each other. The more wear and tear, the more arthrosis progresses.

What are the most common joint diseases and how do they develop?

The most common joint disease is osteoarthritis. Osteoarthritis of the hip and knee are the frontrunners. Then we have the group of arthritis. While arthrosis progresses mainly through mechanical wear and tear of the joint surfaces, arthritis is an inflammatory systemic disease that primarily affects the joints. Arthritis takes the opposite course to osteoarthritis: it starts with inflammation of the joint, which eventually leads to joint damage. Classic signs of arthritis include pain, swelling, redness, and warmth. So arthritis is a red hot box.

But: not all arthritis is the same as rheumatism. There are also other arthritises, for example after infections. Responsible are, for example, respiratory, gastrointestinal, or genital pathogens that can trigger inflammatory changes in joint surfaces. A classic are chlamydia infections after a visit to the whirlpool. Or you were visited by a tick that gave you a bouquet of Borrelia as a gift. A tick bite can also lead to such reactive inflammatory changes in joints. If you suddenly develop pain and swelling in different joints, if the pain is moving from joint to joint, or if you have recently been feeling tired and drained for no apparent reason, then you should consider whether you have caught an infection in the past few weeks, from one have been bitten by a tick or may have gout.

Among other things, your doctor will order a blood test to differentiate reactive arthritis from other joint diseases. Living like God in France can make your body leave the party before you do. Sudden severe pain in the big toe with reddening, swelling and overheating indicate a gout attack. Typical triggers are grilled meat excesses washed down with a good amount of barley juice. Here, too, a blood test provides diagnostic certainty, since there is an increased uric acid level in the patient's blood.

What do you think of painkillers and cortisone to combat joint pain?

Anyone who struggles through life in constant pain rightly wants to hear a little more than “move more and eat healthier”. So a pill is by no means the last will, because lifestyle changes do not immediately help you out of a bind, especially in the case of acute inflammation of the joints or spine. When using painkillers, it is crucial that the drug is adapted to the individual situation. There is no such thing as a "miracle pill" for everything. Especially in the case of activated arthrosis or rheumatic diseases, the drug should not only eliminate the pain, but also work against the inflammation. Because it is important to understand that it is not the wear and tear that causes the pain, but the resulting inflammation. If the inflammation is not eliminated, movement restrictions and a relieving posture develop due to further incorrect loading, which then leads to complaints in neighboring joints. The same applies to the short-term use of cortisone injections in acute situations.

Cortisone is used when, for example, there are neurological symptoms in the case of a herniated disc or pronounced joint swelling due to activated arthrosis, since cortisone has even stronger anti-inflammatory properties. Cortisone works where it burns. But that doesn't mean that we should immediately take the pill with every pinch, as if it were throat drops, or give cortisone shots as a flat rate. Unfortunately, the excellent anti-inflammatory properties come with a whole portfolio of side effects. But through the targeted and short-term use of such measures, the patient gets back on his feet faster and consequential damage can be prevented. The motto is: as much as necessary, as little as possible. In other words, once the acute fire has been extinguished, you can continue treatment with alternative therapies.

How can a change in diet help the joints?

Nutrition is very important for the whole body. It is always said "You are what you eat" and this also applies to our musculoskeletal system. We can feed our joints fit again. Chronic inflammatory processes play a major role in arthrosis. By omitting animal foods in particular, especially pork, as well as industrially highly processed foods that are pumped full of chemical additives, trans fats and table sugar, inflammatory processes can be effectively extinguished. All of these foods fuel chronic inflammation in our bodies. So let the sow out of your diet.

What is the best thing to eat to do something good for your joints?

A plant-based diet can effectively prevent chronic inflammatory processes and joint pain. There are numerous foods, herbs and spices that have anti-inflammatory properties while strengthening our joints and reducing muscle tension. Omega-3 fatty acids play a special role, as do antioxidants such as vitamins A, B2, C and E, as well as the minerals glutathione and sulfur compounds. And the best thing is: For all these anti-inflammatory active ingredients from nature, we don't have to stray far into the distance and squander our money on overpriced exotic superfoods: we find vitamin B2 and C, for example, in our local kale, glutathione in potatoes and sulfur compounds in leeks.

Sufficient exercise is also important for diseased joints. Which sports are good for the joints and which are not?

Movement is really that important, even if it gets on the nerves of many people. However, in the case of joint problems, "close your eyes and keep going". I always advocate moving with brains. That means: Please don't "run into" the pain. To put it bluntly, always turn on your head before you get started and then make sure that your training is gentle on the joints. Our joints love everything that is uniform, if possible without compression stress. Cycling, aqua aerobics, but also walking is easy on our joints. Movements with quick changes of direction and stop-and-go movements are rather unsuitable for previously damaged joints. Training works, but also on the side, for example at the desk. It doesn't have to be complicated things. Just get up from your office chair, turn on the radio and roll your shoulders to the music. That brings relief for the shoulder and neck area. But exercises for stabilizing the spine can also be done from the desk. Quickly pinch your butt in the office chair and hold the tension for ten seconds. Because training the pelvic floor is an excellent way to stabilize the lower back.

In your practice you also work with treatment methods from orthobiology. What exactly is behind it?

Nowadays there are a number of so-called orthobiological therapies such as ACP, procedures, hybrid or fat cell therapy. All procedures have one goal: to regenerate gently instead of operating. We take blood from the patient, put it in a centrifuge and thus isolate the body's own growth factors and anti-inflammatory messenger substances from the patient's blood. These are then injected into the joints affected by osteoarthritis or into injured ligaments, tendons and muscles. In the case of very advanced findings, the growth factors can also be enriched with hyaluronic acid or resort to fat cell therapy. This is the most modern approach to arthrosis therapy. I go into more detail on this in my book. The fascinating thing about orthobiology is that the tissue can be gently regenerated using the body's own material, the patients have an excellent quality of life again and operations are no longer necessary or can be postponed for years.

In which cases is an operation the best solution in your opinion?

There are injuries or findings in which conservative therapy reaches its limits and which undoubtedly require surgery. It is always important to avoid subsequent complaints and to treat them in accordance with the findings. But before the scalpel is polished, one should be aware that a joint replacement is always the last stop in a therapeutic chain, because everything we replace is irreversible. In general, if you want to prevent an operation, it is important to attack in good time from different sides. Because it is not the one injection, the one painkiller or just the diet that brings the greatest possible success, but the combination of all available treatments and your own motivation not to give up.

How to mentally cope better with joint pain?

The most important thing is always the motivation of the patient. Because he can significantly and actively influence his healing process. It is crucial to realize that arthrosis does not develop overnight. In this respect, it would be illusory to think that one injection or one painkiller will bring complete freedom from symptoms in no time at all. You always have to keep that in mind. So patience is the order of the day. It is also important to set small goals and work your way forward step by step. When the patients notice the first successes, the motivation to keep going increases.

with dr Meike Diessner spoke to Isabel Michael

(This article was first published on Tuesday, April 26, 2022.)