In every day life, being independent and active as we grow older is an ideal that most of us strive for. Joint pain and back pain interfere with our ability to go about our daily activities and to participate in sports and other recreational and professional activities. Many sports, such as jogging, golf or skiing, put a great deal of stress on the joints. It is therefore extremely important that our joints continue to function smoothly and without pain into advanced age. Mobility is a major determinant of our quality of life.
Joint problems are frequently caused by the degeneration of cartilage. As the cartilage breaks down, pain and restricted mobility ensue. Osteoarthritis, one of the most widespread causes of pain and disability in the Western world, has set in.
As common as degenerative joint disease is, little is known about the underlying causes. Conventional treatment, in a nutshell, has been limited to reducing the pain for as long as possible. Finally, when pain control is no longer effective, the damaged joint is surgically replaced with an artificial one.
Is it possible to influence the disease mechanisms that cause osteoarthritis? What can be done to slow or even stop the degenerative processes altogether?
These are the problems Molecular Orthopedics is concerned with. The goal of this discipline is to decode the language of the cells, to better understand diseases of the musculoskeletal system and to develop new treatment approaches based on knowledge of the biological causes underlying them.
One of these treatment approaches is the Orthokine®-therapy, which was developed by two German medical researchers, orthopedist Dr. Peter Wehling and molecular biologist Dr. Julio Reinecke of Düsseldorf, in collaboration with Prof. Chris Evans of Harvard University and Prof. Paul Robbins of the University of Pittsburgh. In Orthokine®-therapy, immune proteins that fight pain and inflammation are produced from the patient’s own blood. They are referred to as endogenous immune proteins, meaning that they are derived from or originate within the patient’s own body.
These immune proteins – blood proteins that play a role in the functioning of the immune system – have the ability to protect cartilage and improve joint mobility. While this treatment is used primarily for osteoarthritis of the knee, hip and other joints, the same approach can also be used to treat back pain, with excellent results.
University hospitals both in Germany and abroad have had positive results with these new therapies. Clinical studies show that treatment of arthritis and back pain with Orthokine® is safe and effective.
The purpose of this brochure is to give patients up-to-date and accurate information about modern treatment options for osteoarthritis. The more patients know about the rationale for various methods of treating their disease, the better the treatment outcomes. If you have recently been diagnosed with osteoarthritis, we hope that the information herein will allow you to face the future more optimistically and look forward to enjoying good health, vitality and an active lifestyle into old age.
Osteoarthritis is part of the natural aging process that affects us all, as it is normal for the cartilage in the joints to break down over time. Osteoarthritis often develops very slowly over many years, and only becomes painfully debilitating when damage to the joint has already occurred. Osteoarthritis can affect any of the body’s joints, particularly the knee, hip and hand joints, as well as the joints of the spine.
Up to 10% of the population in the developed countries suffer from osteoarthritis, with the knee being the most frequently affected joint. In recent studies, ten percent of people over the age of 55 reported pain and stiffness in their knees, and had x-rays which showed signs of degeneration of the knee joint.
Osteoarthritis of the knee and hip joints are among the top ten complaints diagnosed by orthopedists. They are among the 30 most frequent disorders for which hospitalization is required. In 2004, more than seven billion euros were spent in Germany alone for the treatment of osteoarthritis. Degenerative joint and spine disease also accounts for a considerable portion of all cases of disability, early retirement and rehabilitation, and as such is one of the greatest contributors to lost productivity out of all chronic diseases.
Osteoarthritis can be triggered by a variety of factors such as excessive stress on joints due to over-use, poor posture, musculoskeletal misalignment or sports injuries.
It affects mainly older people or people whose work involves hard physical labor or repetitive actions, as well as athletes and people who are overweight. In the case of athletes, wear and tear on the joints is caused by pushing the body to its limits repeatedly; in the case of obese people, it is caused carrying by excess weight. Deformations such as bowlegs and knock-knees can also lead to chronic strain, which in turn leads to joint degeneration. Furthermore, as we age, the layer of cartilage that cushions the joint generally loses water and elasticity.
Along with these mechanical processes, inflammation also plays a role. Pieces of cartilage may break off and float around in the joint, irritating the synovial membrane that forms the inner lining of the joint capsule. This causes the joint to become inflamed and swell up. This is sometimes referred to as “inflammatory arthritis.” The inflammatory changes to the synovial membrane prevent nutrients from entering the cartilage, thereby further accelerating the disease process.
Thus, there are risk factors that may contribute to osteoarthritis. In the early stages at least, osteoarthritis is in many cases a natural result of the body’s aging process. But since not everyone ages in the same way, onset and severity of the condition vary widely from one person to another.
Although we are not consciously aware of it, our knee joints move thousands of times a day, absorbing abrupt shocks and sudden turns, carrying our body weight and keeping us stable. Given the multi‑directional stresses and strains to which they are subjected, it is hardly surprising that the knees are more likely to be injured or wear out than any other joint in the body.
So it makes sense to take a closer look at this hardworking joint.
The knee joint works like a hinge: it can bend (flex) and straighten (extend), and it also rotates slightly to allow the lower leg to turn in or out. The joint is formed by the ends of the femur (thigh bone) and the tibia (shin bone). The bone ends are covered by a layer of elastic cartilage (articular cartilage) that acts both as a bearing, allowing the bones to slide freely on one another, and as a shock absorber.
The ends of the bones and the cartilage are enclosed by an articular capsule. The inner layer of the capsule, the synovial membrane, contains many nerves and blood vessels. It produces a fluid (synovial fluid) that lubricates the joint and nourishes the cartilage.
Injuries to cartilage, even small ones, weaken the cartilage and mean that even normal, everyday movements tend to cause additional strain on the remaining healthy cartilage. As a result, once the process of cartilage breakdown has begun, it has a tendency to spread.
Articular cartilage is unusual in that normal, healthy cartilage contains no blood vessels. This means that cartilage does not obtain vital nutrients from the blood as other body tissues do. It also means that cartilage cannot repair itself. Cartilage cells are supplied with nutrients solely from the synovial fluid that fills the spaces between the bones of the joint. In order to “feed” the layer of cartilage that covers the ends of the bones, it is vital that compression or stress on the joint be alternated with decompression or release of stress. This is why exercise is so important for keeping joints healthy. When pressure is exerted on the joint, used or waste matter is pressed out of the cartilage, and during the decompression phase, the cartilage is bathed in new synovial fluid containing “fresh” nutrients. Also, because the “highways” of the blood vessels do not reach the cartilage, the immune system also has no direct contact with cartilage. Consequently, antigens and antibodies can only reach the joint indirectly. Drugs such as painkillers also cannot reach the cartilage by the normal route of the blood supply, and therefore higher concentrations are generally needed to be effective. However, substances that are injected directly into the joint itself circumvent this difficulty and are able to act directly on the tissues, including cartilage.