Osteoarthritis

Overview: What is osteoarthritis?

With osteoarthritis, the cartilage layer of the joints wears away more and more with age. It becomes thinner and rougher. Sometimes the cartilage abrasion is so severe that the bone beneath the cartilage is exposed in certain areas of the joint. Due to the progressive loss of cartilage, doctors also refer to osteoarthritis as a degenerative joint disease. Typical signs are, for example, movement-associated pain and brief stiffness (minutes) or stiff joints. However, some sufferers also have few symptoms.

Types of osteoarthritis

Types of osteoarthritis Osteoarthritis is classified according to various criteria, including its cause, the number of joints affected and its location:

By cause:

• Primary osteoarthritis: Occurs without any recognizable previous disease or specific cause. It is often attributed to the natural ageing process and genetic predisposition and has a very typical joint involvement pattern.
• Secondary osteoarthritis: Develops as a result of a known cause or previous damage to the joint. These include joint injuries (e.g. fractures, ligament injuries), deformities (e.g. knock-knees, hip dysplasia), inflammatory joint diseases (e.g. rheumatoid arthritis, crystal arthropathies), metabolic disorders or chronic overloading of the joint.

By number of joints affected:

• Monoarthrosis: Describes joint wear and tear that only affects a single joint.
• Oligoarthrosis: 2-4 joints are affected.
• Polyarthrosis: Occurs when several joints (often five or more) are affected by osteoarthritis at the same time.

By localization: Osteoarthritis can basically affect any joint in the body. The joints with primary osteoarthritis are listed below.

• Gonarthrosis: Osteoarthritis of the knee joint
• Coxarthrosis: Osteoarthritis of the hip joint
• Rhizarthrosis: Osteoarthritis of the thumb saddle joint
• Heberden’s osteoarthritis/Bouchard’s osteoarthritis: Osteoarthritis of the finger joints (Heberden’s osteoarthritis of the end joints, Bouchard’s osteoarthritis of the middle joints)
• Spondylarthrosis/facet joint arthrosis: Arthrosis of the small vertebral joints
• Osteoarthritis of the metatarsophalangeal joint (MTP I)

Frequency and age

Osteoarthritis is the most common joint disease in adults worldwide. It is a normal, age-related sign of wear and tear, which is why it mainly affects older people. Sometimes, however, cartilage wear also occurs in young people who subject their joints to long-term high stress (e.g. during competitive sport).

In addition to age, gender also has an influence on the likelihood of developing osteoarthritis: Up to the age of 55, it is mainly men who suffer from it, with more and more women falling ill over the age of 55.

Osteoarthritis: causes and risk factors

The ends of the bones in the joint are surrounded by an elastic and protective layer of cartilage. With increasing age, the cartilage layer becomes thinner and thinner due to natural wear and tear. Injuries can also lead to irreparable damage to the cartilage.

In any case, if the protective cartilage layer is completely or partially missing, the ends of the bones in the joint lie directly on top of each other. Impacts or other mechanical stresses can no longer be absorbed. Instead, bone material forms at the ends of the bones to compensate for the overload in the joint. As a result, the joints become thick and deformed. The ridges of bone substance that extend around the joint are also called “osteophytes”.

The constant friction can also cause pieces of bone or cartilage to enter the synovial fluid and irritate the synovial membrane. This can lead to temporary inflammation with redness or swelling of the affected joint. Doctors then speak of “activated osteoarthritis”.

Risk factors for osteoarthritis

There are various risk factors that can promote the development of osteoarthritis. These include, for example:

• Obesity
• Constant overload due to work or sport
• Congenital malpositions
• familial predisposition
• Injuries to the cartilage layer
• Unhealed injuries to the joint (e.g. to the ligaments or meniscus)
• Gender (women are generally more frequently affected than men)

Osteoarthritis symptoms

There are various signs of osteoarthritis. People with osteoarthritis feel pain when they move the affected joint again after a long period of rest (e.g. sitting, lying down). However, the pain usually disappears quickly through movement. In this case, doctors also speak of initial pain. Many sufferers generally report that the symptoms are sometimes more severe and then less severe, especially in the early stages of the disease. Sometimes external factors such as physical strain or the weather also play a role.

A characteristic feature of degenerative joint disease, for example, is that the joints are stiff in the morning after waking up. Unlike joint problems caused by inflammation (e.g. rheumatoid arthritis), the so-called morning stiffness in osteoarthritis usually lasts for several minutes.

Particularly in advanced stages of joint degeneration, the mobility of the affected joint can be severely restricted. Sometimes there is also swelling or the feeling that something rubs or cracks when you move. Pain can be felt permanently at this stage.

Osteoarthritis diagnosis

In order to diagnose osteoarthritis, we usually first have a detailed discussion with you (medical history) and ask various questions, such as:

• What complaints do you have?
• Where and when do these complaints mainly occur?
• How long have you had the symptoms?
• Do you suffer from another disease, especially an inflammatory joint disease such as rheumatoid arthritis or gout?

We then examine the affected joint more closely. For example, patients have to move the joint or walk up and down in order to determine possible movement restrictions and abnormalities in the gait pattern. We also check whether the movement causes pain. Swelling, redness or any pressure pain can also be detected during the physical examination. We also check whether the cause of the pain is in the joint or around the joint in the area of the joint capsule and bursa.

Imaging techniques

We can normally detect osteoarthritis from the symptoms. If they have doubts about the diagnosis, imaging procedures can help. As a rule, a conventional X-ray examination is sufficient to detect typical abnormalities such as a narrow joint space or damage to the bone.

Other methods are also available for a more detailed examination. These include, for example, a joint ultrasound, magnetic resonance imaging and computer tomography. The latter provide very precise images that can make osteoarthritis visible even at an early stage.

Blood test

A blood test is useful to rule out other joint diseases that could also be the cause of the symptoms. Certain blood values such as the concentration of uric acid, inflammation values (e.g. C-reactive protein, erythrocyte sedimentation rate) or the so-called rheumatoid factor can indicate gout or rheumatoid arthritis, for example.

Early detection of osteoarthritis

As a rule, osteoarthritis is diagnosed when the cartilage is already irreparably damaged. There are also some methods for early detection. This diagnosis is based on medical history, clinical examination and imaging (usually X-ray).

Prevent osteoarthritis

There are no direct measures to reliably prevent the development of osteoarthritis. However, you can still do a lot to slow down joint disease:

• Regular exercise: People who exercise regularly also do a lot for the health of their joints. Pay attention to sports that do not put one-sided strain on the joints. Cycling, Nordic walking or swimming, for example, are good options.
• Avoid being overweight: Being overweight puts additional strain on the joints. Try to lose excess kilos by changing your diet and exercising regularly.
• Correct misalignments: If you suffer from deformities such as knock-knees, you may need to have them corrected orthopaedically. This prevents one-sided strain on the joints and can therefore reduce the risk of osteoarthritis.
• Don’t overdo it when exercising: Exercise is good for your joints, but only if you don’t overdo it. The following applies to training, especially for beginners: it’s better to do it moderately but regularly! This will help you avoid overloading and injuries, which can promote the development of osteoarthritis.
• Pay attention to your diet: Foods that can promote inflammation are mainly meat and animal fats. These should be enjoyed in a balanced way. This can have a positive effect on the inflammatory processes associated with osteoarthritis.
• Avoid alcohol and cigarettes: Alcohol and nicotine can also promote inflammation in the body. You should therefore not drink alcohol excessively and avoid cigarettes altogether if possible.

Progression and prognosis of osteoarthritis

The course of osteoarthritis is different for every patient. This means that it can only progress slowly and cause problems from time to time, which then disappear again. Some sufferers feel very little of the joint disease, even in the advanced stages of the disease, while others experience severe symptoms very quickly. Many sufferers avoid exercise, especially when pain occurs. However, this can also cause the muscles to become weak over time. As a result, osteoarthritis usually worsens, mobility in the joint decreases even more and instability can increase.

As the condition progresses, the ends of the bones in the joint may become partially or completely exposed. Over time, this can lead to changes in the bone, so that the mobility of the joint is even more restricted and those affected suffer from permanent pain. If the unprotected joint surfaces rub against each other, noise can occur. Sometimes this rubbing together can also be felt. At this stage of osteoarthritis, often only a joint replacement can alleviate the symptoms.

To this day, osteoarthritis cannot be cured. Nevertheless, the right treatment can delay the progression of the joint disease and have a positive influence on its course.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Osteoarthritis: Treatment

Osteoarthritis treatment aims to relieve pain, maintain or improve joint function and slow down the progression of the disease. As osteoarthritis cannot be cured, the focus is on reducing symptoms and improving quality of life. An individual, often multimodal treatment plan takes into account the affected joint, stage of osteoarthritis, symptoms and personal needs. A distinction is made between conservative (non-surgical) and surgical measures.

Conservative therapy approaches: Conservative therapy is the basis and aims to provide relief, reduce pain and promote mobility. Important pillars are:

• Patient education and counseling: education about the clinical picture and joint-friendly behavior to positively influence the course of the disease.
• Exercise therapy and physiotherapy: Targeted exercises and joint-friendly sports (e.g. swimming, cycling) strengthen muscles, improve mobility and relieve pain.
• Physical therapy: heat, cold, electrotherapy or ultrasound therapy for local pain relief.
• Weight management: Weight reduction in the case of obesity relieves the joints and can reduce pain and the progression of osteoarthritis.
• Occupational therapy: learning everyday movements that are easy on the joints and adapting the environment if necessary.
• Orthopaedic aids: Aids such as supports, orthoses or walking aids stabilize, relieve and alleviate pain.

Drug therapy: Medication is used to combat pain and inflammation, adapted to the intensity and accompanying circumstances.

• Painkillers (analgesics): For the symptomatic treatment of pain.
• Anti-inflammatory drugs(e.g. NSAIDs): Used orally or locally, they reduce pain and inflammation. Medical supervision is advisable for long-term use.
• Cartilage-protective medication: e.g. chondroitin sulphate, can also have a pain-relieving effect.
• Intra-articular injections: Injections with glucocorticoids for acute inflammatory active osteoarthritis (e.g. swollen, reddened and/or overheated joint). Injections for persistently chronic mechanically decompensated joints, e.g. with hyaluronic acid or autologous blood therapy (PRP). Although autologous blood therapy has not been clearly scientifically proven, a positive effect has often been observed, e.g. for knee osteoarthritis.

Surgical therapy: If conservative therapies are not effective enough and the quality of life is severely impaired, surgery may be considered. The aim is to reduce pain and improve function. The spectrum ranges from joint-preserving procedures to artificial joint replacement (endoprosthetics).

The choice of therapy is made individually after medical consultation.