Osteoarthritis - Symptoms, Consequences & Treatment Options

Hand osteoarthritis, shoulder osteoarthritis, knee osteoarthritis, hip osteoarthritis, spinal osteoarthritis, and foot osteoarthritis are among the most common forms of osteoarthritis

What is osteoarthritis, and which forms can occur?

Osteoarthritis is a disease that causes joint cartilage to wear down more rapidly – much faster and earlier than would be expected for the affected person’s age. It is referred to as a degenerative disease because the degraded cartilage tissue does not regenerate, and as osteoarthritis progresses, the surrounding joint bones are also affected .

Disproportionately high strain – for example, due to heavy physical work, being overweight, or poor posture, can accelerate the deterioration of cartilage and trigger osteoarthritis. Joint injuries can also reduce or damage the existing cartilage and promote the development of osteoarthritis. 

Infections caused by bacterial invasion or joint damage caused by inflammatory rheumatic disease are considered other possible triggers. Since joint degeneration usually progresses over a longer period, osteoarthritis primarily affects older people. On average, women suffer from the disease more often, but typically only at an older age than men.

Lack of movement or one-sided movement plays an important role, because joints must move so that cartilage tissue can be supplied with nutrients. A knee that is stretched and bent through daily movement throughout life is statistically less susceptible to knee osteoarthritis than a knee that remains in the same position under a desk every day. When left unmoved and completely unloaded, articular cartilage can literally dry out and become rough.

This also increases the risk of injury, because cartilage tissue that is inadequately supplied with nutrients can become cracked, like a gummy bear that you stretch lengthwise. Unfortunately, cartilage tissue is not capable of healing such damage on its own. Later, you will learn more about how important exercise is for protecting your joints from gonarthrosis, coxarthrosis, and other types of osteoarthritis.

The known triggers of osteoarthritis are divided into primary and secondary types . Primary osteoarthritis refers to conditions promoted by genetic predisposition, which effectively gives those affected an increased likelihood of developing the disease. Triggers of the disease that are not genetic in origin or that arise only as a result of lifestyle and external influences are referred to as secondary osteoarthritis. Here are some possible triggers of secondary osteoarthritis:

• Excessive or one-sided strain on the joints due to obesity, hard work, or as a result of accidents.

• Misalignments of the joints - congenital, caused by poor posture, or resulting from accidents.

• As a result of other diseases that affect the joints, such as gout or rheumatoid arthritis.

• As a result of diseases or unhealthy habits that affect metabolism and blood circulation. For example, diabetes mellitus can increase the risk of osteoarthritis. A wide range of joint inflammations can also damage the articular cartilage.

• The side effects of some medications could promote osteoarthritis - gyrase inhibitors are suspected of damaging the connective tissue around the articular cartilage and contributing to faster breakdown of cartilage tissue.

Stage 1: Slight superficial fraying of the knee joint cartilage. No symptoms are noticeable yet.

Stage 2: Partial tears and broad fraying of the knee joint cartilage. Osteophytes may begin to appear.

While  early-stage osteoarthritis initially causes relatively mild symptoms ,  serious late effects become apparent when the disease is ignored or goes undiagnosed. In a healthy joint, the opposing bone ends - the joint head and joint socket - are covered by a protective layer of cartilage.

The joint is enclosed by a joint capsule filled with synovial fluid, which acts as a lubricant for the joint cartilage. If the cartilage layer develops cracks or wears away, bone increasingly rubs directly against bone.

The more the cartilage layer is destroyed by osteoarthritis, the greater the pain caused by direct contact between the joint bones during every movement. Worse still: over time, the pressure of the joint head on the joint socket can lead to  bone deformities .

The joint head presses into the socket - in advanced stages, to such an extent that narrow  bone spurs  form along the sides of the joint socket. These bony projections are called  osteophytes . These deformities can severely restrict the joint's mobility.

In advanced osteoarthritis,  fragments or fibers may sometimes break away from the damaged cartilage. These fragments move within the joint capsule, where they cause pain and irritation and may even slip between the joint bones and block the joint. In osteoarthritis of the hand, for example, this could result in the sudden stiffening of a finger joint.

The progression of osteoarthritis can be divided into  several stages :

1. In the early stage of osteoarthritis, the effects are still very minor. The articular cartilage is only beginning to thicken and deform.

2. As a result, the formerly smooth cartilage layer becomes increasingly uneven and begins to fray.

3. As the protective articular cartilage becomes increasingly thin, the space in the joint gap also narrows until the joint bones meet without the protective cushioning of the lubricating film. Initial compression and changes in the bone tissue occur. The joint surfaces begin to flatten due to friction.

4. In the late stage of osteoarthritis, the cartilage layer is partly or completely worn away. Bony spurs form along the sides of the joint sockets, while the bone becomes highly densified at the pressure points. The affected joints are severely restricted in their mobility and function.

Compared with a healthy knee joint, the arthritic damage caused by gonarthrosis is clearly visible

Gonarthrosis, coxarthrosis, and other types of osteoarthritis at a glance

Osteoarthritis can, in principle, affect any joint in the body. In practice, clearly defined areas of the body are usually affected first. The condition may begin, for example, in the knees, hips, or fingers. The affected limbs have often previously been subjected to one-sided stress for a long time. If, for example, the knees are heavily stressed throughout a person's working life, the risk of developing knee osteoarthritis in old age increases.

Depending on the stresses to which different parts of the body are exposed, incipient osteoarthritis in other joints may not yet be noticed because it has not caused any symptoms. If several of the forms of osteoarthritis described below occur together, this is referred to as polyosteoarthritis.

• Gonarthrosis - knee osteoarthritis: Gonarthrosis is one of the most common forms of osteoarthritis. The knees bear a large proportion of the body's weight and are also subjected to stress from rotation and flexion. Injuries to the ligaments or cartilage in the knee area are therefore among the most common sports injuries. For example, meniscus injuries may result in torn pieces of cartilage having to be surgically removed. Knee osteoarthritis can be caused by the effects of injuries or by long-term wear in the knee joint. Malalignments such as bow legs or knock knees are also thought to promote gonarthrosis. As knee osteoarthritis progresses, it eventually also affects the bones in the thigh and lower leg.

• Coxarthrosis - hip joint osteoarthritis: Wear and tear of the hip joints often leads to coxarthrosis, especially in old age. In addition to excessive strain, various hip conditions that cause deformities in the joint are considered risk factors for hip osteoarthritis. Conditions such as Perthes disease or hip dysplasia may be congenital or develop during childhood, only to cause coxarthrosis many years later.

• Finger osteoarthritis:Osteoarthritis can also affect various joints in the fingers. In addition to the effects of injuries or very strenuous work, it is repeatedly observed that the fingers are particularly susceptible to damage caused by poor posture and the effects of monotonous office work. Osteoarthritis in the fingers can therefore also result from persistent underuse - when typing on a keyboard, for example, the joints remain in the same position for a long time and are not moved enough to receive an adequate supply of nutrients. One of the most common forms of finger osteoarthritis is thumb osteoarthritis (rhizarthrosis), which affects the base of the thumb.

• Spondyloarthrosis - vertebral joint osteoarthritis: Our spine owes its mobility to small joints that connect the individual vertebrae. These joints are exposed to heavy loads throughout life, which is why spondyloarthrosis is one of the most common forms of osteoarthritis in old age. The extent to which the spine has been subjected to stress is important here - jobs involving the carrying of heavy loads therefore entail a higher risk of developing spondyloarthrosis. The condition is often accompanied by problems with the intervertebral discs. In addition to physical strain and poor back posture, being overweight is also a risk factor for vertebral joint osteoarthritis.

• Omarthrosis - shoulder joint osteoarthritis: The shoulder joint often has to bear heavy loads. Since it is an extremely mobile joint with a high range of rotation, the risk of shoulder injuries is also high if it is overloaded, for example, in an unfavorable position. Incorrectly performed sports exercises with weights can also lead to wear of the joint cartilage or damage to tendons and ligaments. Omarthrosis often develops as a late consequence of shoulder joint injuries. Rheumatism is also considered a possible trigger of shoulder joint osteoarthritis.

• Osteoarthritis in the feet and toes: Since our entire body weight rests on our feet, it is not surprising that they are susceptible to osteoarthritis. Being overweight is an important factor, but unsuitable footwear also plays a role in its development. Osteoarthritis of the base joint of the big toe is therefore common. The ankle joints are also frequently affected, as they absorb our body weight with every step and are exposed to significant wear and tear.

• Osteoarthritis in the hands and arms: Hands and fingers perform a wide variety of complex movements. The consequences of injuries or overuse can increase the risk of osteoarthritis in the numerous small joints and areas of cartilage. However, it has been shown that insufficient physical strain also increases wear and tear, particularly in the hands. For example, office work such as typing, in which the hands and fingers remain in just a few positions and perform only monotonous movements, leads to reduced nutrient supply to the cartilage tissue. Finger osteoarthritis can occur in any finger joint, but usually begins in only one or a few joints. The thumb joint (rhizarthrosis) is also often affected. Since arthritic finger joints swell considerably over time, this form of osteoarthritis is also very noticeable visually. Osteoarthritis in the arms can occur both in the wrist and in the elbow joint.

• Sacroiliac joint osteoarthritis: The sacroiliac joint connects the sacrum and ilium - meaning it is located in the pelvic region. These joints absorb a considerable proportion of the forces exerted on the pelvis during hip movements. So-called sacroiliac joint osteoarthritis, which affects these joints, is one of the most difficult forms to treat.

• Temporomandibular joint osteoarthritis: Hardly any joint moves as much over the course of a lifetime as the temporomandibular joint. Osteoarthritis can therefore also develop there - especially in old age.

What symptoms indicate osteoarthritis?

Because osteoarthritis develops very slowly, it is often not diagnosed until late. Many early symptoms can also be caused by numerous other conditions, injuries, or unusual physical strain. Sometimes the development of osteoarthritis appears to progress more slowly over extended periods, causing those affected to become accustomed to occasional pain and miss the opportunity for early detection of the joint disease.

In its early stages osteoarthritis announces itself through pain, stiffness, or a feeling of tension in the joints. People affected by knee osteoarthritis often already complain of knee pain during this phase when the weather is damp and cold. It is particularly noticeable when the pain is strongest when movement begins and then gradually subsides. This is known as so-called start-up pain.

If the osteoarthritis is still in its early stages, the pain is usually only felt when the joints have to absorb impacts. Osteoarthritis in the knee, for example, would become noticeable when you jump or walk down stairs.

Changes in gait or restricted movement  are further warning signs of osteoarthritis. Hip osteoarthritis, for example, can make it more difficult for those affected to bend forward and cause problems when tying their own shoes.

Over time,  swelling in the affected joints develops. The  pain no longer subsides even at rest. People with severe osteoarthritis therefore often have trouble sleeping through the night. If the  joints feel unusually warm to the touch , this may indicate  inflammation in the tissue . These symptoms can be caused, for example, by detached cartilage or worn bone fragments. There is also a risk that such inflammation may develop into secondary conditions.

In the late stage , osteoarthritis often leads to occupational disability and severely restricts quality of life due to the extreme pain. Osteoarthritis in the fingers and hand, for example, can lead to  joint deformities  that make it impossible to grasp and hold objects.

If you believe you have osteoarthritis, you should  definitely have this suspicion medically evaluated. Doctors have various options for confirming the disease or assessing how high your personal risk of osteoarthritis is.

Osteoarthritis can often only be diagnosed conclusively using X-rays, CT scans, or MRI

Ways to diagnose osteoarthritis

How can it be established that osteoarthritis is present? Joint pain can also be caused by minor injuries or other conditions such as gout. The diagnosis therefore initially involves a  thorough interview with the patients . It is important to clarify exactly when the pain occurs.

This means that start-up pain can be a sign indicating osteoarthritis. In addition, the  circumstances of the affected individuals  are assessed. What  strains occur in everyday life and at work, do they participate in competitive sports, or is there already a  history  of previous injuries or operations?

The affected joints are palpated to look for swelling or deformities. However, an accurate diagnosis is usually only possible using imaging techniques. Modern medicine has various technologies available for diagnosing osteoarthritis:

• X-rays: The X-ray image shows bones very clearly and in great detail, while softer tissue is difficult to see. X-rays can be used to examine the joints for misalignments, deformities, and damage. For example, a severely narrowed joint space is a clear indication of osteoarthritis. If necessary, more elaborate procedures can be used to verify the diagnosis.

• Computed tomography: CT is also an X-ray procedure. Patients are pushed into a scanning tube on a table. A large number of X-ray images are taken inside this tube and can then be layered over one another to create a highly precise image of the joints in question.

• Magnetic resonance imaging: So-called nuclear magnetic resonance imaging, or MRI, is an imaging procedure that does not use X-rays. The technology is new and more expensive than a simple X-ray. However, it enables precise examination of both the bones and the surrounding tissue. This examination also takes place in a scanning tube.

Since these modern diagnostic technologies have become available, physical examinations in which the joint is surgically opened are rarely performed. The risk of infection during such procedures is simply too high. The only exceptions are minimally invasive procedures such as aspiration, in which joint fluid is taken for laboratory analysis, or arthroscopy - the so-called joint endoscopy.

 Arthroscopy is performed using an arthroscope - a special endoscope. This is a medical probe equipped with a camera, a lamp, and irrigation devices or medical grasping and cutting instruments. However, due to modern non-invasive procedures, arthroscopy is now used less for diagnosing osteoarthritis and more for treating its symptoms. For example, detached cartilage fragments can be removed using the arthroscope.

Water aerobics is one of the joint-friendly ways to exercise with osteoarthritis and prevent it

How can you prevent osteoarthritis?

The risk of developing osteoarthritis increases with age - making it all the more important to take preventive measures as early as possible. Even if you belong to a risk group with incurable diseases such as diabetes mellitus, you can do a great deal through your lifestyle to avoid developing osteoarthritis until old age or never developing it at all.

Activity instead of avoidance - sports & exercise for osteoarthritis

When their joints hurt, many people tend to adopt protective postures and avoid exertion. But that is not the best way to counter osteoarthritis. Regular movement is necessary so that the articular cartilage receives nutrients and remains supple for a long time.

That is why sitting for long periods also contributes so much to joint wear and tear - although the joints are not stressed, they are not nourished either. Inactive joints literally “dry out.” This also reduces the cartilage tissue's ability to withstand stress and increases the risk of injury.

If you want to exercise to prevent osteoarthritis, it is advisable to train neither too much nor too little. Especially if you have been inactive for a long time, you should begin training carefully with light exercises. You essentially have three important goals:

• Move your joints so that the articular cartilage receives an adequate supply of nutrients.

• Train your muscles to provide your joints with better support. All joints are surrounded by muscles, which absorb a considerable portion of the forces acting on the joints.

• Prevent or reduce excess weight - many types of osteoarthritis, such as knee osteoarthritis or hip osteoarthritis, are encouraged by being severely overweight. Every excess kilogram increases the pressure placed on the joints that bear the body's weight.

Suitable sports for osteoarthritis prevention are those in which the joints are moved but not subjected to excessive stress:

• Swimming: The water supports much of our body weight, which means that the joints are subjected to minimal stress while swimming. If you regularly swim a few laps in the pool, you give your entire body a valuable workout. Swimming movements also engage many small muscles in the movement sequences.

• Water aerobics: Exercise can also be performed in water in a way that is particularly gentle on the joints. Water aerobics is therefore also recommended for people with already advanced osteoarthritis. People with restricted mobility or weakened by age can also exercise in the water without any risk of falling.

• Cycling: Pedaling is a fluid movement in which most of the weight is borne by the bicycle saddle rather than the joints. This allows the knees in particular to move freely without pressure. Cycling therefore primarily helps prevent gonarthrosis.

• (Nordic) walking: The good old activity of walking is still one of the best activities we can give our bodies. Humans are naturally designed to cover long distances every day while walking upright. When we walk - preferably at a slightly faster pace - our circulation and metabolism get moving, muscles are used and supplied with blood, and joints are moved and supplied with nutrients. Walking is important even when osteoarthritis is already present. In cases of gonarthrosis or coxarthrosis, walking sticks can be used to distribute body weight additionally.

• Gentle strength training: Muscles can also be built through targeted strength training, in which individual muscle groups can be specifically activated. To train in a way that is gentle on the joints when you have osteoarthritis, resistance bands are recommended. With a fitness or therapy band, the resistance increases in proportion to the force applied. This puts less strain on the joints than weight training. The weight of a dumbbell always remains the same - a band adapts to your abilities. You can also order fitness and therapy bands at an affordable price from the Medicalcorner24® online shop.

Avoid sports in which the joints are exposed to high pressure or heavy impacts. Squash, for example, is considered particularly harmful to the joints. Jogging can also cause more harm than good to the knees and ankles. Unfortunately, many people do not jog on soft, springy ground, but on unyielding cobblestones.

Even if you jog in ideal footwear on soft forest ground, you put more strain on your joints than you would by walking at a brisk pace. Choose walking or extended walks if you want to protect your foot, knee, and hip joints.

If you have been diagnosed with osteoarthritis, you should first seek medical or therapeutic advice about which sports are suitable for you and which you should avoid. In many cases, you may be recommended therapies specifically tailored to the different forms of osteoarthritis.

The right diet for osteoarthritis

It is suspected that diet has a strong influence on the onset and progression of osteoarthritis. However, this influence is difficult to attribute to individual foods - it is more about which nutrients we consume and whether we consume too much or too little of them.

One thing is certain: a diet that leads to excess weight increases the strain on the joints and therefore also the risk of osteoarthritis. Animal proteins consumed in excess are also considered risk factors, as the omega-6 fatty acids they contain promote the development of inflammation. Inflammation of the joints can in turn lead to osteoarthritis.

So how should one eat to prevent osteoarthritis? A vegetarian or vegan diet can provide the body with all the important proteins and nutrients without promoting inflammatory processes or causing excess weight. Vegetables should make up the main part of meals - fruit, on the other hand, should be eaten in moderation because of its calories. It is better to cook with vegetable oil than with butter or animal fat.

Fish and other seafood, as well as various whole-grain products, contain anti-inflammatory omega-3 fatty acids. So choose whole grains and wheat, and consider eating fish several times a week. Fish can sometimes also make it easier to switch from a meat-heavy diet. It is also advisable to avoid alcohol and stop smoking.

How is osteoarthritis treated?

In addition to exercise and physical therapy, which help keep the joints moving and strengthen the muscles, various medication-based or surgical treatment methods are used to treat osteoarthritis. Osteoarthritis treatment aims to eliminate or relieve pain and stop damage to the cartilage and joints from progressing.

Which treatment methods are suitable and how high the chances of success are also depend on the stage at which the osteoarthritis is detected. So it is better to have an orthopedic check-up once too often than once too seldom.

According to current medical knowledge destroyed cartilage tissue cannot be replaced or healed. Until research can provide a solution (for example, through laboratory-grown cartilage tissue), osteoarthritis treatment aims to stop the disease from progressing.

Conservative osteoarthritis treatment with exercise and targeted stimuli

In the early stages of osteoarthritis  - as long as sufficient healthy joint cartilage is still present - it can often still be treated conservatively  without the use of medication . Exercise plays an important role in this. Depending on the patients' age and capabilities,  sports, therapeutic exercise, or physiotherapy  can be used to keep the joints moving and thus  supply the remaining cartilage with nutrients.

At the same time, the  strain on arthritic joints must be minimized . Excess weight is particularly harmful in conditions such as knee osteoarthritis, hip osteoarthritis, or osteoarthritis of the feet. In addition to controlling body weight, harmful habits such as smoking and excessive alcohol consumption should also be avoided.

Targeted movement therapy can help  make already arthritic joints more mobile again. To relieve strain in cases of hip osteoarthritis, knee osteoarthritis, or osteoarthritis of the feet, aids such as  walking sticks,  walking canes , or even  walking frames and rollators  can be used. Sports that place heavy loads on the joints or require them to absorb impacts and blows should be avoided.

Physical therapy can also contribute to  pain relief for osteoarthritis . From massages and mud or moor packs to the targeted use of heating pads, cherry-pit pillows, or hot-water bottles, there are various methods for  improving blood circulation in the tissue.

The heat also helps to  relax tense muscles caused by protective postures. In contrast, cold therapy is often used for severely damaged or inflamed arthritic joints. The short-term, intense cooling of affected joints reduces swelling, relieves pain, and is intended to counteract inflammation.

In some circumstances,  X-ray irradiation may be considered. The short-term, targeted irradiation is also intended to combat inflammation and stimulate blood circulation. Alternatively,  magnetic field therapy for osteoarthritis is now used more frequently.

This exposes the joint to a magnetic field - in the hope of stimulating metabolism, relieving pain, and reducing swelling. However, the effectiveness of magnetic field therapy for osteoarthritis has not been sufficiently established scientifically.

Drug treatment of osteoarthritis

Osteoarthritis symptoms such as pain or inflammation can be treated with medication. Painkillers that may be considered for this purpose belong to the group of nonsteroidal anti-inflammatory drugs (NSAIDs).

Ibuprofen and diclofenac are examples of NSAIDs. However, long-term use of painkillers can cause harmful side effects. The use of any medication should therefore always be discussed with a doctor .

Cortisone injections can soothe severely swollen and inflamed joints. However, cortisone cannot be a long-term solution either because of its side effects. If cortisone is administered too often, it can have a negative effect on blood pressure, blood sugar, or cholesterol levels, among other things. Cortisone also causes cravings, which counteract efforts to lose weight.

Hyaluronic acid injections are intended to “lubricate” arthritic joints and thus stop or slow the wear of the articular cartilage. Our bodies actually produce hyaluronic acid as a kind of lubricant for the joints.

The method therefore promises at least temporary relief from osteoarthritis. However, the injection itself is not without risk, as germs can enter the joint during the procedure and cause inflammation.