Osteoarthritis is wear and tear of the articular cartilage. It can be accompanied by pain and restricted movement, but it can also be completely symptom-free. Osteoarthritis can occur in one or more joints at the same time. Osteoarthritis most commonly affects the knee joint, followed by the hip and thumb saddle joint, which is the joint between the ball of the thumb and the wrist. Osteoarthritis of the shoulder joints is also common. In principle, it can affect any joint, including the spinal and jaw joints.
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| Osteoarthritis |
Causes, risk factors and frequency
Articular cartilage is actually one of the strongest body tissues. It easily withstands pressure loads of up to 2000 kilopascals – equivalent to ten times the pressure in a car tire. However, since human life expectancy has been increasing continuously for over a hundred years, it now exceeds the durability of articular cartilage. Damaged articular cartilage is very slow to regenerate, and this ability diminishes with age. The gliding ability of the cartilage-protecting synovial fluid also decreases with age. In addition, today's lifestyle is not exactly joint-friendly: lack of exercise, overeating and malnutrition and especially the resulting overweight drive the gradual wear and tear of the joints. Injuries also increase the risk of osteoarthritis. Long-term incorrect loads also contribute to this, for example in the case of tilers, because they constantly work on their knees and thus overload their knee joints. The stability and the ability to regenerate articular cartilage are probably due to genetic factors. However, inherited forms of arthrosis with pronounced joint damage at a young age are very rare. Whether congenital malformations, such as the hip joint, or misalignment of the bones increase the risk of osteoarthritis is controversial.
A lot of people have osteoarthritis. The frequency increases with age. For example, seven out of ten people in the 40 to 49 age group and practically all over 80 year olds have osteoarthritis of the knee.
Symptoms
Do you always have pain in one or more joints?
Are the joints sometimes stiff, difficult to move?
Does pain and stiffness peak when you use the joint from rest, such as getting up in the morning, and subside with continued movement?
These symptoms can indicate osteoarthritis, but are not proof of it. Many people with advanced articular cartilage wear do not have any pain or restricted mobility. Others suffer from severe pain and stiffness in the joints with largely intact articular cartilage.
Joint pain is often difficult to interpret
What feels like joint pain usually does not come from the joints at all, but from neighboring parts of the musculoskeletal system, such as muscles, tendons and ligaments. Joint pain, like pain in other parts of the musculoskeletal system, such as back or neck pain, is often caused by stress and burnout or is a physical expression of depression. This is also referred to as a somatoform pain disorder. Because there are so many potential causes of joint pain, it's a good idea to see a doctor.
Primary and secondary osteoarthritis
Arthrosis that is purely due to age and wear and tear is referred to as primary arthrosis. If another disease is present that accelerates joint wear and tear, the resulting cartilage damage is called secondary osteoarthritis. Injuries to the joint, such as those caused by an accident, can also cause secondary arthrosis.
Conditions associated with arthritis (inflammation of the joints) that promote secondary osteoarthritis include:
- Rheumatoid arthritis, the most common chronic inflammatory joint disease
- Gout, a metabolic disorder in which the blood contains too much uric acid
- Psoriatic arthritis, inflammation of joints and tendons that occurs in some people with psoriasis in addition to skin involvement
- Joint infections, for example with Borrelia (borreliosis) after a tick bite or a gastrointestinal infection, for example with salmonella
- Chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, which can also be associated with arthritis
Even with primary arthrosis, the affected joint can become temporarily inflamed. In addition to increased pain, this can then manifest itself in swelling, reddening or heating of the joint.
Treatment
The only measure that has been proven without a doubt to delay the progressive loss of cartilage is to say goodbye to excess pounds. The knee joints in particular are badly affected by permanent obesity. Anyone who normalizes their weight through endurance sports and an adapted diet protects their articular cartilage directly. All other osteoarthritis treatment measures are aimed at relieving pain and restoring mobility.
Movement is key
Regular exercise makes the joints and ligaments more robust and elastic, reduces pain and promotes the renewal of synovial fluid. This is why movement is key in osteoarthritis, and all other treatments only serve to enable movement again, for example by relieving pain.
Reduced mobility is gradually restored as part of physiotherapy. Regular physical exercises such as Pilates, yoga, qigong and tai chi have a supporting effect. Swimming and aqua fitness (physical exercises in water), which are offered by most bathing establishments today, are particularly recommended for people suffering from joint disorders, because the joint can be moved almost weightlessly in the buoyancy of the water. Cycling, equipment training in the gym, hiking, Nordic walking and jogging on soft ground are also suitable sports for osteoarthritis.
Physical processes
Anyone who is plagued by joint pain often finds heat applications in the form of hot baths, heat patches or heating pads beneficial. Others swear by cooling, for example with Kneipp treatments, cold packs or cooling gels. Basically, the rule of thumb applies: In the case of acute pain - such as a recent injury or inflammation - cold has a pain-relieving and decongestant effect; heat is more beneficial for chronic, non-inflammatory joint pain. Other popular treatment methods for osteoarthritis, in which targeted skin stimuli play an important role, are acupuncture, cupping and the application of leeches. Radon applications such as breathing the air in a radon tunnel or bathing in radon-containing water have proven to be effective for various joint diseases. Electrotherapy such as TENS (transcutaneous electrical nerve stimulation) can also be used successfully. To ensure the safe use of electricity, expert guidance is essential. Treatments with pulsating magnetic fields can also relieve joint pain.
Orthopedic aids
For walking aids, from walking sticks to walkers and wheelchairs, the following applies: as little as possible – so as not to forget how to walk without support – but as much as necessary, for example to temporarily relieve an acutely inflamed or recently operated joint and, in the case of severely restricted mobility, to prevent falls to avoid. The same applies to joint-supporting and guiding aids such as bandages and orthoses as well as shoes that are easy on the joints, for example with special heels or insoles.
Relaxation, stress reduction, psychotherapy
Prolonged stress can increase pain and increase the risk of pain becoming chronic. Conversely, pain causes stress. Good pain therapy therefore always goes hand in hand with stress reduction. Physical procedures such as baths and manual therapies such as massages not only have a direct effect on the body, but also have relaxing and stress-reducing effects. Classic relaxation methods that have proven themselves in pain therapy are progressive muscle relaxation, autogenic training, imagination, meditation and MBSR (Mindfulness-Based Stress Reduction) as well as the Feldenkrais method. In the case of chronic pain, discussions with a psychotherapist can help to gradually practice a different attitude towards the pain. This not only has a mentally relieving effect, but usually also relieves pain.
Oral medication
Medication can also be used temporarily as part of pain therapy. As a rule, the use of an anti-inflammatory painkiller such as ibuprofen, celecoxib, acetylsalicylic acid (ASA) and paracetamol is sufficient. If this is not effective enough or is not an option for other reasons, or in the case of acute, severe pain, prescription drugs similar to morphine (opioids) such as tramadol may also be indicated. Herbal remedies such as willow bark, ginger and devil's claw root are an effective alternative to conventional painkillers with few side effects. It is unclear whether chondroprotective agents, i.e. cartilage-protecting agents, such as chondroitin sulfate or hyaluronic acid live up to their name.
Medicines for external use
Medicinal substances can be used directly in the affected body region via ointments, gels or medicinal plasters. Gels are cooling and thus have an additional pain-relieving and decongestant effect. The penetration depth of the active substance can be increased by iontophoresis, a form of electrotherapy. The shorter the route from the surface of the skin to the joint, the higher the chance that enough active ingredient will get there. Therefore, externally applied anti-inflammatory painkillers are particularly suitable for the treatment of hand and finger joints as well as tendon attachments. Active ingredients such as diclofenac and salicylate (chemical relatives of acetylsalicylic acid) and herbal remedies such as wallwort and arnica are used. Skin stimulants such as capsaicin, the arousing agent found in chili peppers, are said to have similar pain-relieving effects as other stimulating treatments such as reflexology and electrotherapy. Rubbing alcohol, peppermint and eucalyptus oil as well as menthol initially have a cooling effect, then stimulate blood circulation and thus often also relieve pain.
Injection into the joint
Medication can be injected directly into the joint as part of the medical treatment of osteoarthritis. Cortisone-like active ingredients (glucocorticoids), which have an anti-inflammatory, decongestant and pain-relieving effect, can be used for this. Hyaluronic acid is an agent that is supposed to support the lubricity of the synovial fluid. Injected into the joint, it can relieve pain and improve joint function.
Operations
Surgical treatment of arthrosis can be particularly useful if there are pronounced movement restrictions or mechanical obstacles in the joint. Then the surgeon removes, for example, detached pieces of cartilage that are blocking the knee joint. In the case of advanced arthrosis, treatment with an artificial joint can be considered.
Prevention
Those who avoid obesity slow down the increasing loss of cartilage; This not only applies to people who are already suffering from osteoarthritis, but also as a preventive measure. Presumably, plenty of exercise and a balanced diet also help to keep the joints healthy. If you drink enough, it promotes the formation of synovial fluid. This is important to protect the cartilage from friction damage and to supply it with nutrients.