Brief overview
- Treatment: exercise, warm or cold packs, analgesic medication, possibly joint injections ( cortisone, hyaluronic acid); in advanced stages joint replacement (surgery)
- Symptoms: pain on exertion, start-up pain (pain at the beginning of physical activity), reduced mobility, joint thickening; in activated osteoarthritis: redness, constant pain, very warm skin
- Causes and risk factors: Wear and tear of the joints due to age, over- and incorrect stress increase the risk, as do metabolic diseases and injuries.
- Diagnosis: Physical examination, X-rays, computed tomography (CT) or magnetic resonance imaging (MRI)
- Prognosis: Often improvement through exercise and pain therapy and thus surgery can be avoided for a long time; cure usually not possible, only symptom relief and slowing of the progression.
What is osteoarthritis?
Osteoarthritis is the term doctors use to describe the wear and tear of a joint. The joint cartilage is worn and damaged. Cartilage and bone change shape and rub off each other during movement.
Osteoarthritis most commonly occurs in the hands, knees, vertebrae and hips. However, disease is possible in any joint. Accordingly, shoulder, finger, toe and ankle joints are just as often affected. It also affects older people in particular. According to a study by the Robert Koch Institute, a good half of women and a third of men over the age of 60 suffer from osteoarthritis.
Osteoarthritis must be distinguished from so-called arthritis. This is an inflammation of the joint for which several causes are possible. When the joint becomes inflamed as a result of arthrosis, doctors refer to it as osteoarthritis or activated arthrosis.
How does arthrosis develop?
If the joint continues to be subjected to high stress, other structures will change pathologically over time: the synovial membrane, bones and ligaments. Only then do doctors speak of arthrosis.
In the areas subject to the greatest stress, the cartilage coating finally disappears completely. The joint bones are exposed and rub against each other. Doctors refer to this as “bone bruising”. In order to withstand the unusual load, the bone tissue becomes denser. Experts refer to this as subchondral sclerosis.
In addition, bone protrusions (osteophytes) form at the edge of the joint. This changes the shape of the joint (arthrosis deformans).
Often, fluid also accumulates in the joint (joint effusion). In this way, arthrosis that may have been asymptomatic until then quickly turns into joint inflammation (activated arthrosis, arthrosis-arthritis).
Arthrosis stages
Doctors distinguish between different stages of arthrosis depending on the extent of the wear and tear:
- Stage 1: The joint cartilage still looks smooth and relatively healthy, but is thickened and structurally altered. The synovium may be irritated.
- Stage 2: The cartilage surface is uneven and frayed.
- Stage 3: The cartilage layer is thinned, the joint space narrowed. First changes of the adjacent bone are visible.
- Stage 4: The cartilage layer is completely missing in places. The bone shows compaction (subchondral sclerosis) and protrusions (osteophytes).
Severe disability and inability to work
Depending on the occupational activity, recognition as an occupational disease is also possible if the osteoarthritis can be specifically traced back to certain occupational stresses on the joints.
As a rule, the pension offices and their appointed experts are responsible for determining a degree of disability in the sense of a severe disability upon corresponding application. Your doctor will explain and certify whether you are unable to work.
How should you eat when you have arthrosis?
A connection between osteoarthritis and diet is often discussed: Does an unfavorable diet promote osteoarthritis? Is a change in diet therefore worthwhile in osteoarthritis?
In general, it cannot be said that individual foods cause osteoarthritis. Overall, however, it is probably the type of diet that actually influences osteoarthritis: the decisive factor is how much we eat and how our meals are composed.
Fewer calories
Experts therefore advise osteoarthritis patients to eat a low-calorie diet if they are overweight. A healthy body weight relieves the joints, possibly alleviates the discomfort of the disease and slows its progression.
Less animal foods
It is advisable for osteoarthritis patients to eat little meat or other animal foods. The reason: joints damaged by osteoarthritis may become inflamed more easily in connection with animal foods. Animal foods contain a lot of arachidonic acid, a so-called omega-6 fatty acid. The body produces substances from it that promote inflammation.
Instead of meat, osteoarthritis patients are advised to eat foods that contain a lot of omega-3 fatty acids, because these inhibit inflammatory reactions. Omega-3 fatty acids are found, for example, in rapeseed and linseed oil as well as in fatty fish such as herring, mackerel and salmon.
In summary, the following tips apply to a suitable osteoarthritis diet:
- Eat fish twice a week (such as salmon, mackerel, herring).
- Use vegetable oils such as canola oil, linseed oil, sunflower oil or olive oil.
- Eat plenty of fruits and vegetables.
- Give preference to whole grains and legumes.
- Drink at least 1.5 liters of water or unsweetened tea daily.
- Calcium from low-fat dairy products strengthens your bones.
- Avoid caffeine (such as in coffee or black tea), alcohol and nicotine (from smoking tobacco).
Such an osteoarthritis diet does not replace other therapeutic measures, but it usefully supplements them. That is, it does not heal Arthrose, affects it however favorably. It helps with all Arthrose forms, whether in the knee joint or in the finger. However, patients must adhere to the diet on a permanent basis in order to alleviate the symptoms.
What forms of osteoarthritis are there?
Osteoarthritis of the knee
The knee joint is particularly prone to osteoarthritis. Doctors refer to this form as gonarthrosis. It is caused, for example, by an axial malposition, as in the case of knock-knees or bow-legs. Other possible causes are inflammations or previous damage due to accidents (such as meniscus injuries). Sometimes there is no specific cause (primary gonarthrosis).
Read more about causes, consequences and treatment of osteoarthritis of the knee in the article Gonarthrosis.
Osteoarthritis in the hip joint
Wear and tear in the hip joint is another common form of osteoarthritis. Doctors refer to it as coxarthrosis. In most cases, the cause is known: Deformities or malformations of the hip joint are often the reason. Rheumatic diseases, bacterial inflammations of the hip joint and bone fractures in the joint area are also among the possible triggers of secondary hip joint arthrosis.
Osteoarthritis of the small vertebral joints
A joint wear of the small vertebral joints in the spine is called spondylarthrosis by physicians. It occurs in almost all people at an advanced age. In addition, under certain circumstances, overweight or a slipped disc can promote wear and tear of the vertebral joints. Certain sports and professions also promote wear and tear of the vertebral joints.
If you would like to know more about the causes, symptoms and treatment of this form of arthrosis, please read the article Spondylarthrosis.
Finger osteoarthritis
The hand is made up of many small bones, each connected by a joint: the eight bones of the carpal bones, the five metacarpal bones, the two finger bones of the thumb, and the three finger bones of each of the remaining fingers.
You can read more about its development and treatment in the article Rhizarthrosis.
If the arthrosis affects the joints of the fingers, doctors distinguish between Heberden’s arthrosis in the end joints and Bouchard’s arthrosis in the middle joints.
The joints in the area of the small carpal bones also wear out under certain circumstances. The bones usually affected are called the scaphoid and polygonal bones (trapezium), so doctors refer to them as scaphoid or STT osteoarthritis. Patients often have pain below the thumb and the wrist then often cannot be moved properly.
Arthrosis in the shoulder joint
Joint wear and tear in the shoulder joint is called osteoarthritis. It usually occurs as a result of old injuries or diseases (such as rheumatism). Only in rare cases is there no known cause.
You can read more about the causes, symptoms and treatment of osteoarthritis in the shoulder joint in the article Omarthrosis.
Other forms of arthrosis
- Arthrosis of the ankle joint: An arthrosis of the ankle joint affects the lower (USG arthrosis) or the upper ankle joint (OSG arthrosis).
- Osteoarthritis of the toe: Often the metatarsophalangeal joint of the big toe wears out (hallux rigidus).
- Osteoarthritis of the temporomandibular joint: The temporomandibular joint is the most used joint in the body and therefore also susceptible to overuse.
- Sacroiliac joint osteoarthritis (ISG osteoarthritis): In the posterior pelvic region, the joint between the iliac crest and sacrum wears out
- Radiocarpal arthrosis: Arthrosis in the wrist joint
- Cubital arthrosis: Arthrosis in the elbow
- Poly-arthrosis: wear and tear in several joints at the same time
How is osteoarthritis treated?
In principle, osteoarthritis treatment includes conservative and surgical procedures. The attending physician selects the most suitable methods for each patient. He takes into account, among other things, which joint is affected, how pronounced the joint wear is, and how severe the symptoms are. You yourself also have many options for doing something about osteoarthritis.
Conservative treatment
Conservative osteoarthritis treatment is primarily aimed at relieving pain, fighting inflammation and strengthening muscle strength and coordination. Stiff joints become more mobile again and incorrect stresses are compensated for.
Move joints
Less suitable for osteoarthritis are sports with abrupt, high joint loads, extreme movements or a high risk of injury. These include, for example, tennis, ice skating, soccer, handball, karate and boxing.
Relieving strain on joints
Bandages, elastic supports, soft shoe soles and crutches take pressure off joints. Orthoses also help in a similar way. These are special positioning splints for joints. They prevent painful movements. However, orthoses are not very flexible. As a rule, they are only worn for a short time to prevent the joint from stiffening.
If patients are overweight, they are advised to try to lose some weight. This way, the joints have to bear less weight. Regular exercise and a healthy diet help with weight loss.
Physical osteoarthritis therapy
The active principle of physical therapy is based on using external stimuli such as heat, cold, pressure or tension to induce natural reactions in the body.
In addition, physiotherapy is helpful because it strengthens the muscles. Massages are also recommended: they relieve tension and improve circulation.
Medication for pain and inflammation
Painful arthritic joints can be treated with pain-relieving ointments, creams or gels from the pharmacy.
As painkillers, the doctor usually prescribes non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (ASA), diclofenac or ibuprofen. They often already help in the form of an ointment or gel (topical NSAIDs). If that is not enough, NSAIDs are available as tablets to swallow (oral NSAIDs). It is important to take the painkillers only in consultation with the doctor. Side effects often occur, especially in older patients.
In the case of prolonged use, the doctor prescribes additional agents to protect the stomach lining, so-called proton pump inhibitors. He also monitors kidney function and blood pressure.
Some patients do not tolerate NSAIDs, or the painkillers do not work sufficiently. In such cases, the doctor may use hyaluronic acid as an alternative. This is a so-called glycosaminoglycan and a natural component of joint lubricant. The doctor injects it directly into the affected joint to relieve the pain. How well the hyaluronic acid ultimately works also depends on the particular preparation.
Other active ingredients may also relieve pain and improve joint structure, such as chondroitin sulfate and glucosamine (natural components of joint cartilage, available as dietary supplements or drugs). However, their effectiveness has not been clearly proven. Therefore, the doctor uses these substances only when classical therapy is not possible.
Magnetic field therapy
Osteoarthritis treatment using magnetic therapy is designed to relieve pain, decongest the joints, and increase the patient’s sense of well-being. The therapist places the diseased joint in a tube that generates a magnetic field or places an electric coil on the joint.
Some studies have shown that magnetic field therapy is particularly helpful for osteoarthritis of the knee. But patients with chronic symptoms in multiple joints (polyarthritis) may also benefit. However, other studies did not clearly demonstrate these effects, which is why there is no guideline recommendation for this method.
X-ray pain irradiation (X-ray stimulation irradiation)
Surgical treatment of osteoarthritis
Surgery can correct deformities in osteoarthritis patients and stabilize joints. Surgery also relieves pain and prevents inflammation. In some cases, the doctor replaces the damaged cartilage. Overall, osteoarthritis patients should move better and perform better after surgery.
There are various surgical procedures for osteoarthritis. Which one is used in a particular case depends on several factors. For example, the type of joint involved and the degree of joint degeneration play a role. The doctor also takes into account the patient’s age, general condition and treatment goal when selecting the surgical method.
Lavage and debridement
During lavage, the doctor flushes the diseased joint with a saline solution. This removes cartilage and tissue fibers as well as other particles floating in the joint fluid. In addition, the lavage is able to soothe an inflamed joint.
In a procedure called debridement, he smoothes rough cartilage surfaces in the arthritic joint with a scalpel. In addition, he removes free joint bodies, cartilage or bone parts. This may allow the joint to become more mobile again. In addition, debridement relieves acute pain, at least temporarily.lavage and debridement are usually performed by the doctor during a joint endoscopy (arthroscopy). In this procedure, the doctor inserts the surgical instruments into the joint through small incisions in the tissue.
Cartilage-improving arthrosis treatment
For some years now, it has also been possible in certain cases to remove cartilage cells from a healthy joint and transplant them into the damaged joint. The properties of the new cartilage are then almost the same as those of the original.
Corrective osteotomy
In a corrective osteotomy (repositioning osteotomy), the doctor operates on the joint bone. He cuts it and repositions it so that the load is distributed more evenly over the joint surfaces: part of the load shifts from the osteoarthritis zone to healthy cartilage and bone areas. Most often, the doctor also operates on the joint capsule and ligaments to improve the mobility of the joint.
Doctors perform corrective osteotomy not only for existing osteoarthritis. It can also be used to correct misalignments and thus prevent osteoarthritis.
Endoprosthetic joint replacement
During this operation, the doctor removes the worn parts of the joint. Then he replaces them with prostheses made of metal, plastic or ceramic (alloarthroplasty). There are prostheses that replace only individual parts of the joint and those for the entire joint. The doctor anchors them in the existing bone with cement or screws. If necessary, he also corrects the position of the joint.
With any prosthesis, it is possible that it will become loose after some time. With the help of regular X-rays, loosening can be detected in good time. In most cases, the doctor then has to replace the prosthesis.
Arthrodesis
In an arthrodesis, the doctor stiffens the joint. He removes destroyed parts of the joint and firmly connects the bones of the joint.
These include finger end joints, other finger joints, and small joints in the region of the carpus. Arthrodesis is also sometimes performed on the metatarsophalangeal joint of the big toe. Only in cases of advanced osteoarthritis does the doctor perform arthrodesis on other joints as well.
Resection arthroplasty
In this form of arthrosis surgery, the doctor removes the damaged joint surface, changing its shape. Sometimes he also removes entire bones. The joint is then less functional, but it also hurts less.
Resection arthroplasty is rarely used today. It is mainly considered for arthrosis of the thumb (rhizarthrosis) when conservative arthrosis treatment is unsuccessful. In this case, the physician removes one of the affected metacarpal bones and replaces it with the patient’s own tendons, such as the tendons of the long thumb muscle or the short hand flexor. However, this form of rhizarthrosis therapy is not considered the standard method.
Alternative arthrosis treatment
What helps with osteoarthritis apart from conventional medical procedures? Many patients ask themselves this question. They want to support the treatment of osteoarthritis with the help of alternative therapies. Although the effectiveness of some alternative methods is not scientifically proven, some patients report that they would help them. Homeopathy, herbal substances, magnetic field therapy and acupuncture are said to alleviate arthrosis symptoms. Some sufferers also use Schüßler salts.
Schüßler salts and homeopathy
Some osteoarthritis patients rely on Schüßler salts and homeopathy. Proponents of these concepts say that both healing methods have no side effects and are therefore suitable for self-treatment of osteoarthritis.
Schüßler salts are said to relieve osteoarthritis symptoms and prevent osteoarthritis. Suitable Schüßler salts for osteoarthritis are considered to be:
- No. 1 Calcium fluoratum
- No. 2 Calcium phosphoricum
- No. 8 Sodium chloratum
- No. 11 Silicea
- No. 16 Lithium chloratum
If patients observe that exercise relieves their arthritis pain, homeopaths recommend Rhus toxicodendron D12, for example. If cold weather makes joint pain worse, Dulcamara D12 is said to help.
The concepts of homeopathy and the Schüßler salts, as well as their specific effectiveness, are controversial and so far cannot be proven with conventional medical-scientific methods in the sense of evidence-based medicine.
Plant substances
For centuries, osteoarthritis treatment has also relied on medicinal plants. These include African devil’s claw, nettle, comfrey, willow, dandelion, cayenne pepper, turmeric and rosehip.
Arthrosis complaints improve however usually only, if one uses the welfare plants over a long period. Your doctor or pharmacist will advise you on the exact application and dosage.
Acupuncture
Especially in the case of joint wear in the knee, acupuncture probably reduces chronic pain. According to studies, however, the effect usually lasts only a limited time.
Home remedies and alternative healing approaches have their limits. If the complaints persist over a longer period of time and do not improve or even get worse despite treatment, you should always consult a doctor.
Symptoms
At first, joint wear and tear often causes no discomfort at all. Over time, however, pain sets in when patients move or put weight on the affected joint. In late stages of osteoarthritis, the joints often hurt permanently and even at rest. Many patients also hear or feel rubbing or grinding in the joint.
Osteoarthritis joints also often feel “stiff” and have limited mobility. In addition, the position of the joint often changes pathologically over time.
You can read more about the signs of joint wear and tear in the various stages of osteoarthritis in the article Osteoarthritis symptoms.
Causes and risk factors
Most people develop osteoarthritis as they age, because the tissues then no longer regenerate as well. Other possible causes are:
- Overload: for example, if you are overweight or put an unusually high load on your joints (for example, in competitive sports or when working with a jackhammer).
- Incorrect loading: for example, due to joint malpositions such as bow legs or knock-knees
- Metabolic diseases such as gout (deposition of uric acid crystals in joints promotes cartilage damage)
- Injuries: for example, cartilage trauma (post-traumatic arthrosis) or bone fractures that heal in a malpositioned state
- Congenital joint weakness (thus to some extent heritability)
Examinations and diagnosis
A specialist in orthopedics is in most cases the right contact person for osteoarthritis. Complaints in the temporomandibular joint, on the other hand, are usually better assessed by a dentist or orthodontist.
To take your medical history (anamnesis), the doctor will first ask you some questions, such as:
- Does your joint have a history of injury or disease?
- Does your pain occur at the beginning of movement or only after prolonged exertion?
- Does the pain improve with movement or at rest?
- Does the pain occur more frequently in certain situations?
Physical examination
The anamnesis is followed by a physical examination. The doctor will assess the position and function of the affected joint. To do this, he will ask you to move your joint. If you have complaints in your legs or spine, for example, he will ask you to walk a few steps. This is the best way to assess the course of movement.
Imaging
Even in early stages of osteoarthritis, X-rays show that the joint space between the ends of the bones becomes narrower. In addition, the bone structure under the joint cartilage becomes denser (subchondral sclerosis), which appears white in the X-ray image. Bony attachments (osteophytes) usually appear similar in color to the bones themselves. Rubble cysts, on the other hand, leave a dark cavity in the light-colored bone on the x-ray. In addition, the X-ray image shows malpositions and changes in the bone structure.
Visible changes in the X-ray image do not allow a conclusion to be drawn as to whether and how severely someone is suffering from symptoms. Sometimes serious changes can be seen on the X-ray, but the patient has no complaints at all.
Arthroscopy
With the help of joint endoscopy (arthroscopy), the doctor examines mainly larger joints. He makes a small incision in the skin and inserts a thin tube with a video camera (arthroscope) into the joint. This allows him to see if the joint is worn. If he finds osteoarthritis, it can be treated during the arthroscopy by using special instruments.
Read all about arthroscopy, how it is performed and the risks involved in our article “Arthroscopy”.
Excluding other causes
Joint pain can also be caused by other reasons than osteoarthritis. Rheumatoid arthritis, for example, is another common cause. This inflammatory disease affects the entire body. However, it mainly manifests itself as painful joint inflammation.
Course of the disease and prognosis
A frequent question from sufferers is: “Is osteoarthritis curable?”. The answer: since joint cartilage regenerates at most in children, osteoarthritis does not usually disappear. The disease is therefore not curable. However, effective arthrosis treatment alleviates the symptoms and slows down the progression of the disease.
Prevention
Osteoarthritis can be prevented with regular physical exercise. Sports that place an even load on the joints are particularly suitable. This is the case, for example, with cycling and swimming. Experts also recommend these types of sports for existing arthrosis. But there are other tips against arthrosis:
First, it is advisable not to overload or underload your joints. For example, being overweight puts a lot of stress on the joints. Anyone who weighs too much is therefore well advised to lose weight for the sake of their joints.
Unsuitable footwear may also promote joint wear. This includes especially shoes with high heels. Osteoarthritis then affects the metatarsophalangeal joint of the toes or other joints of the foot.
If you have a joint malposition, the orthopedist often corrects it to prevent arthrosis.
