Joint diseases, especially degenerative changes (wear and tear diseases), represent the most common impairment of the musculoskeletal system in Germany. Almost every second person over the age of 45 is affected by joint pain. Medically, these diseases are summarized under the term arthropathy.
What are joint diseases?
Infographic of pain regions and affected joints in rheumatoid arthritis. Click image to enlarge. If the degenerative joint changes go beyond the average age-appropriate level, it is called a joint disease. Mostly the joints of the lower extremities (knee joints, hip joints) are affected. But also the joints of the upper extremities (finger joints, thumb saddle joint, shoulder joint, elbow joint) can be degeneratively changed and cause complaints. Joint diseases belong to the spectrum of arthropathies. These are generally divided into inflammatory (arthritides) and non-inflammatory (arthroses) forms. In addition, a distinction can be made between infectious (reactive arthritis), inflammatory polyarthropathies (Felty syndrome, gout), arthroses (knee joint arthroses), and other joint diseases (protrusio acetabuli).
Causes
Joint diseases are often multifactorial. Triggering factors include traumatic or growth-related deformities (including hip dysplasia, hallux valgus, bow or knock knees) as well as metabolic diseases (gout), connective tissue diseases (lupus erythematosus), and inflammatory rheumatic diseases (chronic polyarthritis, Reiter’s disease). In addition, individual or work-related risk factors such as obesity and heavy physical and one-sided loads (lifting or carrying heavy loads, static muscle work, repetitive movements) can cause overuse of the joint and accelerate wear processes. The articular cartilage increasingly has reduced elasticity and can no longer adequately compensate for mechanical loads. This leads to the splintering of small cartilage particles into the joint fluid. The joint is no longer sufficiently “lubricated”. The floating cartilage particles irritate the synovial membrane and lead to acute inflammation. The inflamed synovium produces more synovial fluid. Joint effusions with severe pain develop. In the further course, the bone located under the damaged cartilage forms so-called osteophytes (newly formed marginal attachments) to compensate for the increased mechanical load and hardens on the surface (subchondrial sclerosis). The normal movement pattern of the joint is impaired and the synovium is further irritated.
Typical and common joint diseases
- Osteoarthritis, arthritis, rheumatism
- Knee joint arthrosis
- Hip joint arthrosis, hip joint inflammation
- Joint pain
- Shoulder joint inflammation
Symptoms, complaints and signs
Diseases of the joints can cause different symptoms. Common to diseases such as arthritis and osteoarthritis is that they cause joint pain. Most sufferers primarily experience fatigue, start-up and exertion pain. As the disease progresses, night and muscle pain eventually set in, which can cause secondary symptoms such as sleep complaints and a general feeling of malaise. As the disease progresses, the pain is accompanied by movement restrictions of the affected joints. During movements, crunching noises occur or the typical cracking sound is heard. The joints become increasingly unstable and bend more often, resulting in fractures. In most cases, bony thickening and swelling also develop. Some joint diseases (such as osteoarthritis) are manifested by externally visible joint effusions and malpositions. Those affected can usually also notice muscle atrophy or local redness and overheating. In the later course, the bone substance thickens and deformities and deformities occur. Joint diseases represent a considerable burden for the persons affected, since they usually run chronically and increase in severity as they progress. The physical capacity decreases strongly. In the late stages, the affected joints can no longer be moved without pain.
Diagnosis and course
In the early stage of the disease, joint disease manifests itself in the clinical picture on the basis of pain on onset, fatigue, and exertion (so-called early triad). As the disease progresses, constant pain, night pain and muscle pain become apparent (so-called late trias). Physical examination may reveal limited range of motion, bony thickening of the joint contours, crepitation (“grinding joint motion”), instability, malposition, muscle atrophy and contracture, and local hyperthermia and joint effusion. Radiographs can show a frayed, rough surface, joint space narrowing, subchondral sclerosis (compaction of surrounding bone tissue), and boulder cysts (recesses of bone substance) and osteophytes, especially in the late phase. In chronic polyarthritis, specific inflammatory parameters can also be detected in the blood during the acute phase. In severe cases, there may be marked joint deformity and/or secondary chondrocalcinosis (deposits of calcium pyrophosphates in cartilage tissue).
Complications
The complications and symptoms of joint disease depend greatly on the joints involved and, for this reason, cannot be universally predicted. However, in most cases, there is relatively severe pain in the affected regions and limitations in movement. The movement restrictions can also lead to psychological discomfort and depression in many people. Often, in addition to the pressure pain, there is also pain at rest, which makes everyday life more difficult and reduces the patient’s quality of life. Many sufferers also experience pain at night, which can lead to significant sleep disturbances. Joint diseases can also lead to inflammation and infections. If these spread to other regions of the body, this can have serious consequences and complications. Furthermore, joint disease can also lead to amputation of the affected limb. The treatment of joint diseases depends on the underlying disease and is usually carried out with the help of creams, painkillers or by surgical intervention. Therapies are also often used to relieve pain and promote movement of the affected joints. Life expectancy is not usually altered by joint disease.
When should you see a doctor?
Joint complaints should be presented to a physician if they do not occur immediately after a fall or accident. In addition, medical clarification is necessary as soon as the complaints persist for several days or weeks. If they increase in intensity or if there are further symptoms, a doctor should be consulted. If the joint disease leads to reduced drive, a loss of zest for life, or if everyday tasks can no longer be performed as usual, a visit to the doctor is advisable. If there is poor posture of the body, discomfort of the muscles, tendons or nerves, a doctor must be consulted. If there are changes in the skeletal system, pain, tension or hardening due to joint disorders, a doctor is needed. If natural movements can no longer be carried out without problems, action is required. A doctor must be consulted so that after the cause has been determined, relief can be provided. In the case of psychological impairments, mood swings or behavioral problems, a visit to the doctor is necessary. If there is social withdrawal, depressive or melancholic phases and apathy, a visit to the doctor is necessary. Aggressive behavioral tendencies, choleric conspicuousness or inner restlessness should be discussed with a doctor. If sleep disturbances occur or there are concentration and attention deficits, a doctor should also be consulted. Consultation with a physician is required before taking a pain medication.
Treatment and therapy
Therapeutic measures depend on the underlying cause as well as the stage of the disease. For example, asymptomatic, painless joint disease usually does not require therapy. Drug therapy with non-steroidal anti-inflammatory drugs (e.g. ibuprofen, diclofenac in the first stage) or opioids (tramadol, tilidine in the second stage) aims to reduce pain symptoms. In some cases, so-called chondroprotectives (hyaluronic acid) are used.These have an anti-inflammatory effect and inhibit enzymes that have a cartilage-degrading effect. If joint effusions are present, they are usually punctured to relieve the affected joint. In the case of recurrent joint effusions, a drug containing cortisone can be injected into the joint to reduce the inflammatory processes over the long term. If an underlying rheumatic disease is present, it must be treated with medication (basic rheumatic drugs such as chloroquine, D-penicillamine, among others). In addition, immunosuppressants (methotrexate) or tumor necrosis factor alpha inhibitors (infliximab, etanercept) can be used in chronic polyarthritis. Occupational therapy and orthopedic measures are aimed at teaching activities that are gentle on the joint, avoiding incorrect stresses, and relieving pressure on the affected joint by means of forearm supports, cushioning and/or corrective insoles, or shoe fittings. With the help of physiotherapeutic measures, the characteristic cycle of muscle degeneration, increasing pain symptoms, decrease in muscle activity and further reduction in muscle circumference in joint diseases should be broken. Particularly in the early stages, an improvement of the degeneratively altered joints and surrounding soft tissues can be achieved by increasing joint mobility, stretching shortened muscle and ligament structures, and building muscle. In the case of chronic pain, electrotherapy (short wave, galvanization) can lead to pain relief and relaxation of the surrounding tissue. In addition, various surgical therapy methods can be applied. During arthroscopy (joint endoscopy), the joint can be flushed and the cartilage smoothed. Cell transplants and cartilage bone transplants can be used to repair small cartilage defects. Congenital or traumatic deformities are treated by surgical correction of the axis to prevent or inhibit arthritic processes. If there is severe joint destruction with permanent pain symptoms as well as mobility restriction, artificial joint implantation (especially knee and hip joint) may be indicated.
Outlook and prognosis
Joint diseases can have various causes. They are caused by inflammation or wear and tear of the affected joints. Knees, arms, legs, feet, shoulders or hands may be affected. If left untreated, the initially mild pain will visibly increase. Those who initially only felt pain under appropriate strain will later feel it even when resting. Pain also occurs when sitting or lying down. Movement disorders and impairments in everyday life occur. Due to a variety of treatment options, the prognosis for joint disease is generally very good. Mobility can be restored and pain subsides. Physiotherapy, massage, chiropractic or osteopathy are just a few possibilities. In advanced joint diseases with a comparatively poor prognosis, only surgery can help. Those who do not act here will hardly manage without painkillers, will be dependent on a walking aid or will later be in a wheelchair. Inflammations in the joints subside with appropriate treatment and the patient is pain-free again. Wear and tear of the joints is associated with great pain and cannot be cured. Treatment is always necessary to improve the prognosis for the patient and relieve the pain.
Prevention
Joint disease and its progression can be prevented by minimizing individual and occupational risk factors. These include reducing any existing excess weight, avoiding one-sided joint stress, engaging in sports activities that are easy on the joints, and strengthening the muscles that support the joints. Joint diseases caused by systemic diseases such as gout or chronic polyarthritis cannot be prevented. However, their progression can be decisively slowed by early therapy.
Follow-up care
In most cases of joint disease, the options for aftercare are severely limited. The disease itself cannot be treated in this case, so that the complaints can only be examined and alleviated purely symptomatically. A complete cure can also not be achieved in this case, since joint disease is a natural condition of the body, which can not be avoided in old age.In general, a healthy lifestyle with a healthy diet and sports activities has a positive effect on joint diseases and can alleviate them. Even at an older age, sports activities are recommended to move the affected muscles and joints. Furthermore, taking medication is also helpful in alleviating the symptoms of joint disease and stabilizing the joints and bones. Patients should always ensure that they take their medication regularly and be aware of possible interactions. The discomfort can also be alleviated with the help of physiotherapy, whereby the exercises from this therapy can often be repeated in the patient’s own home in order to increase the mobility of the body. As a rule, joint disease does not negatively affect the life expectancy of the affected person.
What you can do yourself
The self-help measures that sufferers of joint disease can take depend on their cause. The best form of self-help for degenerative joint disease is prevention. First, a sufferer should identify and manage both individual and occupational risks in a timely manner. The former group includes, for example, severe obesity, chronic lack of exercise, or the opposite, exaggerated athletic activity that places a heavy load on the joints. In the workplace, it is essential to comply with regulations on occupational safety, in particular on lifting heavy loads. In the case of activities with one-sided joint stress, work breaks used to loosen the affected muscles are very important. At the first signs of pathological wear of the joints, a specialist, preferably an orthopedist, must be consulted immediately. Targeted treatment in conjunction with physiotherapy can usually halt the progression of degenerative processes. In the case of systemic diseases of the joints, such as gout, a change in lifestyle, especially diet, can contribute to an improvement. Those suffering from acute joint pain often benefit from temperature stimuli, with some patients responding positively to heat and others to cold. Those who respond positively to heat can irradiate the affected joints with red light or bathe regularly in warm salt water. Those who respond well to cold can resort to ice compresses from the pharmacy.