Osteoarthritis: What to do if painful joint wear?


Osteoarthritis is a joint disease caused by signs of wear. This wear of the articular cartilage may be due to normal aging or injury. If osteoarthritis is not treated early, joint inflammation may result, leading to instability of the affected joint and loss of mobility. So that it does not come to that, you can do a lot.

Osteoarthritis makes the joints stiff and causes severe pain. It is one of the rheumatic diseases. Overall, more than a hundred different clinical pictures that lead to excessive degradation processes in the joint, summarized under the collective term arthritis . In the initial stage, only the articular cartilage is affected. The joints are the junction between two adjacent bones. To prevent them rubbing against each other, they are surrounded by a layer of cartilage – it acts like a shock absorber. As the cartilage mass decreases, its sliding and buffering function is also increasingly lost. In the course of arthritis, bone and articular surfaces are also affected.

Osteoarthritis is the most common joint disease

Osteoarthritis is a typical signs of old age and the most common joint disease. Women are more likely to suffer from it than men. In almost every person over the age of 70 years, it is particularly noticeable in the hip and knee joint – but not everyone notices. Because an arthrosis does not always mean pain or a noticeable restriction of movement for the person affected. Mostly, however, it causes these complaints.

Osteoarthritis is distinct from rheumatoid arthritis . In the former, wear and tear of the joints occurs in the first place, while in rheumatoid arthritis an inflammatory disease is responsible for the joint complaints. These inflammatory changes can affect not only the joints but also the surrounding muscles, ligaments and tendons.

Causes: How arthrosis develops and what favors it

Anyone who gets osteoarthritis is wondering what is to blame for this painful condition. For the causes one must differentiate between an investment-related (primary) and acquired (secondary) osteoarthritis.

Often several osteoarthritis causes come together

The primary form is formed by a genetic predisposition and the natural aging process. With advancing age, the cartilage mass in the joints becomes more or less exhausted in every human being.

The cartilage tissue is very sensitive. It is not penetrated by blood vessels, but gets all the nutrients from the synovial fluid . Disorders in this health care system result in cartilage damage . Even small injuries or injuries add up over the years.

Arthrosis – no matter in which joint – is often triggered by excessive stress (malposition, increased use of the joint). The cartilage loses its elasticity, it becomes thinner. Partly smallest parts are shed off and repelled into the synovial fluid. There, they lead to a painful inflammatory reaction, which is also expressed by swelling, overheating, redness and reduced joint function. In this case we speak of activated osteoarthritis . A dormant arthritis is mentioned, although the articular cartilage is broken down, but there are no signs of inflammation.

If articular cartilage was abraded, the resulting defect is repaired, but not with the very lubricious original cartilage, but with a rough fibrocartilage.

The sliding properties of the joint deteriorate, the now rougher surface accelerates wear. As a balance, the bone beneath the cartilage accumulates more mineral matter and thickens – the shape becomes plumper, which further restricts the optimal joint mobility.

Risk factors: accidents, gout, diabetes and obesity

Causes of a secondary osteoarthritis can be

  • Accidents ,
  • Malpositions (for example X-legs), wrong footwear
  • overweight
  • a strong one-sided load or
  • certain pre-existing conditions such as gout or diabetes mellitus

Often, osteoarthritis also has several causes, for example, if an overweight diabetic also has deformities of the legs. Then the joint disease can progress very fast.

Typical symptoms of osteoarthritis

The signs of osteoarthritis can be very different. Typical symptoms that indicate osteoarthritis in a joint are

  • Pain: pain onset or persistent pain
  • pressure sensitivity
  • overheat
  • deformation
  • thickening
  • restriction of movement

Signs of wear: first onset pain, later on long-term pain

When it comes to complaints of osteoarthritis, it is initially pain that occurs during exercise , fatigue, or when movement begins in the joint. This is the typical starting pain . Later, this can cause a permanent or muscle pain. Often there is also nocturnal pain and weather sensitivity. Increasingly, the mobility is restricted.

Osteoarthritis changes the joints

Arises arthrosis by an inflammation in the joint, it is called a so-called activated osteoarthritis. The affected joint is overheated, sensitive to pain and pressure . In addition, an articular effusion with swelling may occur. In this advanced stage, there is a pathological change in the joint, such as thickening or deformation. The joint becomes immobile and is no longer stable. Injuries can occur more quickly as a result of osteoarthritis.

Important: There is no inevitable symptom . Often, osteoarthritis is discovered accidentally, such as X-rays . For every second affected person does not notice anything of the disease (so-called clinically silent arthritis).

Course of osteoarthritis: From inflammation to joint stiffness

Osteoarthritis usually begins unnoticed. Only when pain occurs, a joint damage is usually found. The cartilage layer can then be worn away so far that the bone ends are exposed and rub directly on each other.

Joint inner skin becomes inflamed

As a result, the sensitive inner skin is irritated, causing pain. Even abraded cartilage or periosteum may have this effect. The consequence of this advanced stage is often inflammation of the artificial skin or articular effusion (activated osteoarthritis).

Once damaged, cartilage rebuilds itself only marginally. Instead, the body often forms increased bone substance that forms spurs around the joint ( osteophytes ). This leads to deformations and thickening of the affected joints.

Injuries hit unstable joints

In the final stage of osteoarthritis joints are little or no longer mobile and ultimately unstable. Then, injuries can occur more quickly, which are typical of the advanced stage of the disease.

How the doctor determines the arthrosis

Contact for joint complaints is the family doctor or the orthopedist. As a first step in the diagnosis of osteoarthritis, he will have a detailed conversation with you ( anamnesis ). It is important that you describe your symptoms exactly: when they occur, under what conditions, when they are lighter and heavier. In addition, they should name existing underlying diseases.

Reveal joint wear with ultrasound

After that, the doctor will examine the potentially affected joint. He checks the range of motion and controls the joint for possible swelling. Injuries in the joint can be visualized by imaging techniques such as ultrasound (sonography) X-ray examination, computed tomography (CT) or magnetic resonance imaging ( MRI ). The diagnosis of osteoarthritis is usually not difficult.

Possibilities to detect even small joint changes

Sometimes, however, the doctor uses further investigation possibilities for a more detailed clarification:

  • Blood test to detect if there is arthritis or rheumatism .
  • Joint puncture – with a needle synovial fluid is withdrawn and examined.
  • Arthroscopy ( arthroscopy ) to already determine early minor cartilage changes that are difficult to identify on the radiograph.

Treatment of osteoarthritis

Osteoarthritis is not curable. So there is no therapy that can reverse the joint disease. That’s why it’s so important to start treatment as early as possible. In this way, joint damage can be limited and the quality of life of those affected can be largely restored. The therapy of joint wear has the goals,

  • to stop or delay the progression of the disease,
  • to relieve the pain
  • to cure any inflammation and
  • to improve or maintain the function of the joint.

Which therapy helps against joint wear?

If osteoarthritis has been caused by other illnesses or injuries, these causes are treated as part of the therapy. Which method of treatment the doctor chooses depends on the stage and the type of osteoarthritis. In principle, physical, medical, orthopedic, physiotherapeutic and surgical measures may be required.

  • Physical therapy for osteoarthritis: The physical therapy measures differ depending on the type of joint wear. Activated osteoarthritis, in which inflammation has occurred in the joint, uses chilling, electrical and ultrasound therapy. If no inflammation accompanies the joint disease, heat applications are suitable, for example in the form of ointments, plasters, red light or fango .
  • Drug therapy of osteoarthritis: Light painkillers (for example, acetaminophen ) can be used against the pain that occurs during joint wear . When osteoarthritis is activated, anti-inflammatory drugs called non-steroidal anti-inflammatory drugs (NSAIDs) are given.
  • Alternative remedies for joint wear: Since osteoarthritis medications are usually taken over a long period of time, side effects are not uncommon, for example in the gastrointestinal tract. As an alternative or to the combined therapy to offer herbal remedies. Especially for rosehip powder and ginger in studies was an effectiveness in osteoarthritis complaints : The pain was reduced, the mobility of the joint improved.
  • Hyaluronic Acid: It is normally produced in articular cartilage where it acts as a lubricant. In some arthrosis patients, hyaluronic acid injections improve the symptoms, sometimes over a period of years. According to doctors of the Orthopedic Joint Clinic Sindelfingen therapy successes are very different. Refresher injections take place approximately every nine to twelve months, but should only be given if the initial treatment has proven to be effective.
  • Orthopedic therapy: To protect the damaged joints as much as possible, there are a number of orthopedic aids. If knees or ankles are affected, sturdy footwear with buffer heels, footbeds or roll-off aids can be recommended. So-called orthoses help to stabilize the joints.
  • Physiotherapy : Through physical therapy (physiotherapy) is to improve the mobility of joints. In addition, exercise stimulates the nutrient supply of the cartilage. This may slow the progression of osteoarthritis.
  • Movement: Even Exercise helps to relieve pain caused by osteoarthritis . However, not every sport is suitable: Jerky movements such as tennis or squash should be avoided. In contrast, sports with gentle and regular movements have a favorable effect.
  • Surgery: Whether an osteoarthritis requires surgery depends on how severely the illness limits the patient’s quality of life, how old he is and whether comorbidities are present. Surgery can be used to maintain the joint or use an artificial joint if it is severely damaged.
  • Correct misalignments: In joint arthroscopy , bone particles that have arisen due to abrasion are rinsed out. At the same time, the cartilage tissue can be stimulated by various arthroscopic techniques for self-healing. If the arthrosis has been caused by malpositions such as X-legs (joint-near osteotomies), this malposition can be repaired surgically.
  • Artificial joints (prostheses) as a replacement: If there is no other option, destroyed joint parts must be replaced by artificial joint parts or by complete artificial joints (endoprostheses). Since artificial joints do not last a lifetime despite the latest technology and materials, younger patients will try to defer joint replacement as long as possible. However, artificial joints have new surgical techniques that are minimally invasive and therefore particularly gentle – a good option for patients with joint wear and tear.