Chondroprotectives

Synonyms in a broader sense

• Cartilage-building substances
• Cartilage build-up
• Hyaluronic acid
• Cartilage build-up
• Cartilage protection substances

Manufacturer

The manufacturers of chondroprotectives mentioned below are exemplary, other suppliers may have been forgotten.

• Synvisc®
• Suplasyn®
• Ostenil®
• Hyalart®
• Durolane®
• Go on®
• Hya-GAG®
• Orthovisc®
• Fermathron®
• Hya Ject®
• Hyalubrix®
• and many more

definition

Chondroprotectives are cartilage protectants that - according to the manufacturer - to stop the cartilage destruction. The chondroprotective agents are intended to inhibit substances that break down cartilage cartilage rebuild. In addition, the Chondroprotectives attributed to an anti-inflammatory effect.

The effect of this Medication is scientifically assessed differently. However, many patients express one significant reduction in pain awarenesswhich are proven by studies.
One Cartilage build-upAs described in part by advertising, these chondroprotectives can certainly not do.

effect

The effect of the Chondroprotectives has been proven in clinical studies that demonstrate a decrease in pain and swelling and an improvement in joint mobility.

The highest rate of effectiveness of chondroprotectives is under direct injection of Hyaluronic acid especially in large joints like that Knee joint, hip joint or Ankle joint expected.
But also small joints like that Finger joints or Facet joint the spine benefit from targeted infiltration.
The effectiveness varies greatly from person to person. The duration of effectiveness also varies considerably. An improvement is in the area of Months to several years is realistic. The duration of the Chondroprotectives depends crucially on the stage of the arthrosis from.

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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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For more information about myself, see Lumedis - Orthopedists.

Figure cartilage structure

1. superficial layer of cartilage
2. middle layer of cartilage
3. calcifying layer of cartilage
4. bone

Chondroprotectives are mainly composed of Hyaluronic acid and Glucosamine.

Glucosamine is a highly concentrated amino sugar that is used as a basic building block for cartilage, Tendons, Tapes and Bone structures, also for connective tissue, Arterial walls and the skin is of vital importance.
It is also used to repair and rebuild cartilage in the joints Spine, as well as bone formation via the so-called "chondral ossification". Glucosamines are produced by a healthy and young organism synthesized directly from food. However, with increasing age the organism loses the ability to synthesis (= Manufacturing) from food. This is reinforced by the fact that our modern diet usually does not offer any foods that contain these substances. cartilage and connective tissue are, for example, very few people on the menu these days.
Glucosamine serves as "Hyaluronic acid" (special form of glucosamines) the formation of Synovial fluid, the so-called "Synovial fluid". Hyaluronic acid as a chondroprotective agent is, for example, in skin and bone tissue, im Vitreous from eye as well as in the umbilical cord of unborn children.

The chondroprotective agents are called "intercellular cement substance“And is considered an important part of the basic substance of the connective tissue.

The body lacks it insulin, and / or corticosteroids (cortisone), so is the body's own production Hyaluronic acid partially or completely disturbed. As a direct consequence of a lack of these chondroprotective agents resulting from these circumstances, the viscous synovial fluid becomes thin and watery and the cartilage of the joint capsules also shrinks and becomes brittle. This ultimately leads to erosion of the layers of cartilage in the joints, causing inflammation, swelling, stiffness, and pain.

Glucosamine and Hyaluronic acid as chondroprotectives belong to the Mucopolysaccharides. They are also called "Glycosaminoglycans". That is one of them, for example Chondroitin, another sugar compound with a giant molecular structure and the main component of all cartilage, which is made from glucosamine. Since the glucosamine molecule is around 250 times smaller than chondroitin, it can be im Digestive tract better absorbed and thus supplied to the organism faster.

The bio-active form of both Chondroitin, as well as from Glucosamine is chondroitin sulfate or glucosamine sulfate. Only the connection with the salt of sulfuric acid forms substances (Chondroprotectives), which can be absorbed and used by the organism.

Living matter, such as Cartilage, ligaments, tendons and connective tissue, are in principle capable of regeneration. The connective tissue substance is of particular importance because it is present in all ligaments, tendons and blood vessels. It is the basic substance of the entire skeleton, most of the organs and connects the two with each other or with the surrounding body tissue.
However, the prerequisite for the regenerative ability of living matter is that the necessary materials are available in sufficient quantities. The most important building materials of chondroprotectives are those mentioned above Glycosaminoglycans: hyaluronic acid, glucsoamine and chondroitin. They ensure that the tissues mentioned are continuously built up and broken down (= converted).

in the cartilage, a special form of "condensed" connective tissue, the cells are anchored in a compact and solid base substance (= matrix).
Cartilage belongs to the skeletal structure and consists mainly of the above Glycosaminoglycans. In addition, it also contains a high proportion of water and collagen. The main problem with the regeneration of cartilage, however, is that it is not supplied with blood and the necessary building material can only be transported to the cartilage cells with difficulty.
If the supply of the cartilage cells with glucosaminoglycans is not guaranteed, they lose their ability to store fluids and absorb nutrients. The cells dry out, shrink and eventually die. This then leads to cartilage erosion (wear and tear) and the associated symptoms.
Chondroitin sulfate binds most of the water in the connective tissue and gives it its elasticity and shock-absorbing properties. The water binding of the chondroprotectives occurs through an electrical charge, with the help of which a viscous mass of gel-like material is formed, which both binds the tissue cells to one another and also lubricates the bursa and joints. This viscous mass contains besides Chondroitin sulfate a high proportion of Hyaluronic acid. The chondroitin sulphate is partly absorbed through food and partly produced by the body itself from glucosamine sulphate.

Under the influence of vitamin C Chondroitin sulfate also controls the production and stabilization of collagen, a fibrous protein, which is also required for the internal binding of connective tissue and cartilage substance.

Tablets, medicines

Chondroprotectives, i.e. drugs that inhibit cartilage degradation, are available as injection, as well as in Tablet form: The active ingredient chondroitin sulfate, which supports the cartilage during compression, exists in capsule form with the trade name Gepan instill (Germany), or Chondrosulf (Austria, Switzerland). Chondroitin sulfate is an important structural and regulatory protein. Together with agrecan, it forms a large part of the cartilage mass. Chondroitin sulfate also has a water-binding component - So it is supposed to increase the ability of the cartilage to bind water, and thereby Dampen frictional resistance, such as elasticity increase.

After being taken orally in tablet form, it is broken down enzymatically in the intestine, and so it can pass through the intestinal wall in a reduced size. Hence certain undesirable side effects such as diarrhea and Loss of appetite. However, therapy with chondroitin sulfate only makes sense as long as there is still cartilage that can be built up - i.e. at Patients with osteoarthritis, or juvenile ("youthful") Growing pains. It is taken over 3 months, once or twice a year. The cost of 100mg chondroitin sulfate capsules is around € 30 and is freely available from pharmacies. Also available in tablet form Vitamin E., or also Tocopherol. Food like fish, Mangoes, or also sunflowers- and olive oil contain a lot of vitamin E.

Application / administration

In principle, can Chondroprotectives (Hyaluronic acids) either by injections directly into the Knee joint and administered three to eight times a week as therapy or given orally in tablet form.

A Hyaluronic acid therapy is usually not covered by the statutory health insurance. But it's always worth it Cost estimate to be submitted to the statutory health insurance. In individual cases, the treatment is then subsidized by the health insurance company.

A good effect can only be expected after an intra-articular injection (injection directly into the affected joint) of the chondroprotective agent / hyaluronic acid.
Scientific studies on the success of oral preparations have been published in renowned journals. The extent and duration of the success need further investigation.

To a Cartilage build-up in the sense of a regeneration it does not occur.

therapy

Therapy can be carried out in different ways:

In addition to taking medication in Tablet form, the active ingredient can also be used directly injected into the cartilage of the respective joint become. This is more difficult with some joints than with others, but in principle it is possible with all joints. The injection should be given by a doctor. The knee joint is particularly suitable for this therapy because it (unlike the hip joint, for example) is particularly accessible for injection therapy using a syringe. The Injection takes place several times a week over an extended timespan. Since the active ingredient is not metabolized in the body - i.e. processed, there are no undesirable side effects. These are in when taking tablets rare cases of allergic reactions, up to Loss of appetite, nausea, diarrhea and stomach pain.

Side effects

Injected chondroprotectives are now relatively low in side effects. Newer preparations are made as pure substances, so that allergic reaction only occur in exceptional cases.

Orally taken preparations in capsule form preferentially cause problems in the stomach - Intestines - area like:

• stomach pain
• nausea
• diarrhea
• Loss of appetite

costs

The costs of therapy with chondroprotectives have been estimated to date (2015) not covered by the statutory health insurance, and must therefore be paid for yourself. This is because studies have so far not proven the effectiveness of the therapy. In a scientific study from 2010, 3800 patients were treated with placebos and chondroprotectives over a longer period of time. The chondroprotectives showed no demonstrable benefit. In the course of this, it was also criticized that sales of such preparations have increased by more than 60% in the last 10 years. Other scientific studies could, however, demonstrate effectiveness. Accordingly, the knee function could be improved and the pain reduced. As is so often the case, the camps are of divided opinion. One thing is certain, however: Chondroprotective therapy is not a “miracle cure”, but it can in the initial stage in combination with rehab or physiotherapy an improvement in the symptoms can be achieved.

indication

Theoretical one can Hyaluronic acid therapy / Treatment with chondorprotective agents on each damaged person joint be carried out and benefit accordingly.

This is suitable due to the anatomical conditions Knee joint and Ankle joint especially for this form of therapy, as it can be easily reached with a syringe.
The hip joint is without roentgen or Ultrasound control Difficult to meet even by experienced doctors. The cheapest method is therefore to inject the hip joint under ultrasound control.
Each through arthrosis Altered knee joint can theoretically benefit from chondroprotective therapy.
However, the successes vary greatly from person to person (from none to very good). In general, the successes are beginning Arthrosis stages cheaper.
Good efficacy results especially in the Arthritis stage 1 (I) and 2 (II).