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 what types 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 strenuous physical work, excess weight, or poor posture, can accelerate cartilage wear 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, which are caused by inflammatory rheumatic disease, are considered other possible triggers. Since joint wear and tear 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.

Insufficient or one-sided movement plays an important role, because joints need to move so that the cartilage tissue is 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 completely still and unloaded, joint cartilage can literally dry out and become rough.

This also increases the risk of injury, because undernourished cartilage tissue can become brittle, like a gummy bear that you stretch. Unfortunately, cartilage tissue is not able to heal such damage on its own. You will learn more later about how important movement 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 clinical conditions promoted by genetic predisposition, essentially giving those affected a higher likelihood of developing the disease. Disease triggers that are not genetic 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 physical work, or as a result of accidents.

• Misalignments of the joints - congenital, caused by incorrect 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 variety of joint inflammations can also damage the joint cartilage.

• The side effects of some medications could promote osteoarthritis - gyrase inhibitors, for example, are suspected of damaging the connective tissue around the joint cartilage and contributing to faster cartilage degradation.

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

Stage 2: Tears and broad fraying of the knee joint cartilage. The first osteophytes may appear.

While  early osteoarthritis initially tends to cause mild symptoms ,  serious late effects become apparent when the disease is ignored or goes undetected. In a healthy joint, the opposing ends of the bones - the joint head and 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 articular 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 with every movement. Worse still: over time, the pressure of the joint head on the socket can lead to  bone deformities .

The head of the joint presses into the socket - in advanced stages, so far that narrow  bone spurs  form on the sides of the joint socket. These bony protrusions are called  osteophytes . These deformities can severely restrict the mobility of the joint.

In advanced osteoarthritis,  fragments or fibers may sometimes break away from the damaged cartilage. These fragments move around in 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 only begins to thicken and deform.

2. As a result, the once-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 come into contact 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 heavily hardened at the pressure points. 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 essentially affect all the joints 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 strain for a long time. If, for example, the knees are heavily strained 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 consequences of injuries or by long-term wear in the knee joint. Misalignments 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 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 malformations 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 causing 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 repeatedly becomes apparent that the fingers are particularly susceptible to damage caused by poor posture and the effects of monotonous office work. Finger osteoarthritis can therefore also result from consistently insufficient use - when typing on a keyboard, for example, the joints remain in the same position for long periods 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.

• Spondylarthrosis - facet joint osteoarthritis: Our spine owes its mobility to small joints that connect the individual vertebrae. These joints are exposed to heavy strain throughout life, which is why spondylarthrosis is one of the most common forms of osteoarthritis in old age. In this context, it is important how heavily the spine has been strained - jobs that involve carrying heavy loads, for example, entail a higher risk of developing spondylarthrosis. The condition is often accompanied by disc problems. In addition to physical strain and poor posture, being overweight is also a risk factor for facet joint osteoarthritis.

• Omarthrosis - shoulder osteoarthritis: The shoulder joint often has to bear heavy loads. Since it is an extremely mobile joint with a wide range of rotation, the risk of shoulder injury 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 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 big toe's base joint is therefore common. The ankle joints are also frequently affected, as they absorb our body weight with every step and are exposed to a high degree of 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 use also increases wear and tear, particularly in the hands. Office work such as typing, for example, in which the hands and fingers remain in a few positions and perform only monotonous movements, leads to a reduced supply of nutrients to the cartilage tissue. Osteoarthritis of the fingers can occur in any finger joint, but usually begins in only one or a few joints. The thumb joint (rhizarthrosis) is also often affected. Because arthritic finger joints swell significantly 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 significant portion of the forces exerted on the pelvis during hip movements. Sacroiliac joint osteoarthritis, which affects these joints, is one of the most difficult forms to treat.

• Osteoarthritis of the temporomandibular joint: Hardly any joint moves as much over the course of a lifetime as the temporomandibular joint. Consequently, osteoarthritis can develop there too, especially in old age.

What symptoms indicate osteoarthritis?

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

During its early development,  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 most intense when movement begins and then gradually subsides. These are known as start-up pains.

If 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. Coxarthrosis, for example, makes it more difficult for affected people to bend forward and causes 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 difficulty sleeping peacefully through the night. If the  joints feel unusually warm to the touch , this may indicate  inflammation in the tissue . These symptoms can, for example, be caused by detached cartilage or worn bone fragments. There is also a risk that such inflammation may develop into secondary diseases.

In the late stage , osteoarthritis often leads to an inability to work and severely limits 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  have this suspicion medically assessed in any case. Doctors have various options for confirming the disease or assessing how high your personal risk of osteoarthritis is.

Osteoarthritis can often only be definitively diagnosed 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 diseases such as gout. The diagnosis therefore initially involves an  in-depth interview with the patient . It is important to clarify exactly when the pain occurs.

Thus, start-up pain is a sign that may indicate osteoarthritis. In addition, the  circumstances of the affected person’s life are assessed. What  strains occur in everyday life and at work, do they engage in competitive sports, or is there already a  history of previous injuries or surgeries?

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

• X-rays: The X-ray image shows bones very clearly and in a high level of 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 complex procedures can be used to verify the diagnosis.

• Computed tomography: CT is also an X-ray procedure. Patients are moved on a table into a scanning tube. Inside this tube, a large number of X-ray images are taken, which can then be layered over one another to create a highly precise image of the affected joints.

• 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 allows both the bones and the surrounding tissue to be examined precisely. This examination also takes place inside 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 with such procedures is simply too high. The only exceptions are minimally invasive procedures such as aspiration, in which joint fluid is removed for laboratory analysis, or arthroscopy - the so-called joint endoscopy.

The 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 often to diagnose osteoarthritis and more often to treat its symptoms. For example, detached cartilage fragments can be removed with the arthroscope.

Water aerobics is a joint-friendly way to exercise with osteoarthritis and help 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 risk groups with incurable diseases such as diabetes mellitus, your lifestyle can make a significant contribution to ensuring that you develop osteoarthritis only at an advanced age or never at all.

Activity instead of avoidance – sport & 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 joint 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 strained, they are not nourished either. Inactive joints therefore 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 joint cartilage receives an adequate supply of nutrients.

• Strengthen your muscles to provide your joints with better support. All joints are surrounded by muscles, which absorb a large part of the forces acting on the joints.

• Prevent or reduce excess weight – many types of osteoarthritis, such as gonarthrosis or coxarthrosis, are promoted by severe excess weight. Every additional kilogram increases the pressure placed on the joints that support the body's weight.

Suitable sports for osteoarthritis prevention are those that move the joints without placing excessive strain on them:

• Swimming: The water supports much of our body weight, which is why the joints are subjected to minimal strain when 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: Gymnastics can also be performed in water in a way that is particularly gentle on the joints. Water aerobics is therefore also recommended for 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 flowing movement in which most of the weight is supported by the bicycle seat rather than the joints. This allows the knees in particular to move freely without pressure. Cycling therefore primarily helps prevent knee osteoarthritis.

• (Nordic) walking: The good old activity of walking remains one of the best things we can do for our bodies. Humans are naturally designed to cover long distances upright every day. When we walk - preferably at a somewhat brisker 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 if osteoarthritis is already present. In the case of knee or hip osteoarthritis, walking sticks can be used to distribute body weight further.

• Gentle strength training: Muscles can also be built up through targeted strength training, which allows individual muscle groups to be activated specifically. Resistance bands are recommended for joint-friendly training with osteoarthritis. With a fitness or resistance band, the load 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 capabilities. You can also order fitness and resistance bands at low cost from the Medicalcorner24® online shop.

Avoid sports in which the joints are exposed to high pressure or strong 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 paving stones.

Even if you jog in ideal footwear on soft forest ground, you put more strain on your joints than you would by walking briskly. 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 can 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 development 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. In addition, animal proteins - when consumed in excess - are considered risk factors because 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 you eat to help prevent osteoarthritis? A vegetarian or vegan diet can provide the body with all the essential proteins and nutrients without promoting inflammatory processes or causing excess weight. Vegetables should make up the main part of meals, while fruit 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-rich diet. It is also advisable to avoid alcohol and quit smoking.

How is osteoarthritis treated?

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

Which treatment methods are suitable and how high the chances of success are also depends 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 rarely.

According to current medical knowledge destroyed cartilage tissue cannot be replaced or healed. Until research can provide a solution (for example, through cartilage tissue grown in a laboratory), 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 abilities,  sports, therapeutic exercise, or physical therapy  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 . Being overweight 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 exercise therapy can help to  make already arthritic joints more mobile again. To relieve strain in hip osteoarthritis, knee osteoarthritis, or osteoarthritis of the foot, aids such as  walking sticks,  walking canes , or even  walking frames and rollators  can be used. Sports in which heavy weight is placed on the joints or in which they must absorb impacts and blows should be avoided.

Physical therapy can also contribute to  pain relief for osteoarthritis . From massages and mud or peat 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. However, 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 cases,  radiation therapy may be considered. The short-term, targeted radiation 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 the metabolism, relieving pain, and reducing swelling. However, the effectiveness of magnetic field therapy for osteoarthritis has not been sufficiently proven 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 non-steroidal 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 because of its side effects either. If cortisone is administered too often, it can have negative effects on blood pressure, blood sugar, or cholesterol levels, among other things. Cortisone also causes bouts of intense hunger, 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 risks, as germs can enter the joint during the procedure and cause inflammation.