arthrosis

Arthrosis: short overview

• Most commonly affected joints: Knee, hip, shoulder, spine, finger and toe joints, hocks
• Main signs: Painful exercise, tensing pain (pain at onset of physical activity), reduced mobility, joint thickening, arthritis activated: overheating, redness, persistent pain
• Diagnosis: physical examination, x-rays, computed tomography (CT) or magnetic resonance imaging (MRI)
• Treatment: Exercise, warm or cold packs, analgesic drugs, if necessary joint injections (hyaluronic acid, chondroitin sulfate), in advanced stages: joint replacement (surgery)
• Watch out: Many arthroses do not have to be operated on for a long time, but improve sufficiently by exercise / physiotherapy and possibly pain therapy

Osteoarthritis: treatment

What helps with osteoarthritis? For most patients this is the central question. The clear answer: So far, there is no arthritis treatment that can restore damaged cartilage. The osteoarthritis treatment can only alleviate the symptoms of the disease. In addition, it should prevent the joint wear continues to progress. Because the disease also leaves its mark in the vicinity of the worn joint over time: It causes damage in the joint capsule, on the bone and on the muscles.

In principle, osteoarthritis treatment includes conservative and surgical procedures. The attending physician will choose the most appropriate methods for each patient. Among other things, he considers which joint is affected, how pronounced the joint wear is and how severe the symptoms are.

Osteoarthritis: conservative treatment

Conservative osteoarthritis treatment is designed to relieve pain, fight inflammation and strengthen muscle strength and coordination. Rigid joints should be compensated again movable and wrong loads.

Move joints

Regular exercise keeps the joints flexible. Therefore, people with osteoarthritis should incorporate sports into their daily lives, for example swimming. Especially suitable are crawls and backstroke. It trains the joints, without burdening them too much. For the same reason, hiking in the plain and cycling in osteoarthritis are also recommended.

Less suitable for osteoarthritis are sports with abrupt, high joint loads, extreme movements or a high risk of injury. These include, for example, tennis, ice skating, football, handball, karate and boxing.

Relieve joints

Bandages, elastic bandages, soft soles and crutches relieve the joints. Similarly, orthoses also help. These are special bearing rails for joints. They prevent painful movements. However, orthoses are not very flexible and should only be worn for a short time so that the joint does not stiffen.

If you are overweight you should try to lose weight. So your joints need to carry less weight. Regular exercise and healthy diet help with weight loss.

Physical Osteoarthritis Therapy

Heat from heating pads, moor packs, fango, baths or infrared light can be used to treat chronic pain in osteoarthritis. On the other hand, acute swelling and discomfort are alleviated with cold ice packs or cool moor packs.

Physiotherapy is also helpful as a physical arthrosis treatment because it strengthens the muscles. Massages are also recommended: they relieve tension and improve blood circulation.

Medicines for pain and inflammation

Painful osteoarthritis joints can be rubbed with pain relieving ointments, creams or gels from the pharmacy.

As an analgesic, acetaminophen is often recommended for osteoarthritis. Also local anesthetics are used for pain relief: they are injected in or around the affected joints.

Osteoarthritis is usually a non-inflammatory joint disease. However, an inflammatory process can “take over”. Then one speaks of arthritis of the arthrosis or activated arthritis. For treatment, the doctor often prescribes non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid or ibuprofen. Sometimes glucocorticoids are injected into the joint against the inflammation, so “cortisone”.

Some patients get hyaluronic acid in osteoarthritis. This is a so-called glycosaminoglycan and a natural component of synovial fluid. With hyaluronic acid syringes directly into the affected joint one wants to make this again more mobile. The effectiveness is not clearly proven. In addition, there is the danger in such syringes that you can unintentionally bring in germs in the joint. These can infect the joint. Arthrosis treatment using hyaluronic syringes should therefore not be carelessly performed.

Another glycosaminoglycan is the so-called chondroitin sulfate. It is also occasionally administered as a syringe in osteoarthritis treatment. However, its effectiveness is not proven. The same applies to the glucosamine also used. This is a component of hyaluronic acid and chondroitin sulfate.

Surgical osteoarthritis treatment

Surgery can correct malpositions in osteoarthritis patients and stabilize joints. This is also to alleviate pain and prevent inflammation. In some cases, the damaged cartilage can also be replaced during surgery. Overall, osteoarthritis patients should be able to move better again after the operation and be more efficient.

There are several surgical procedures for osteoarthritis. Which used in individual cases, depends on several factors. For example, a role is played by which joint is involved and how severe the joint wear is. The age, the general condition of the patient and the treatment goal are also taken into account in the selection of the surgical method.

Lavage and debridement

In osteoarthritis sometimes the diseased joint is flushed with a saline solution (lavage). This is more often done with the knee joint, for example. The rinse removes cartilage and tissue fibers as well as other particles floating in the synovial fluid. In addition, it should calm any existing inflammation in the joint.

Debridement is a kind of articulated toilet. Rough cartilage surfaces in the arthrosis joint are smoothed using suitable instruments. Also different parts are removed, which may interfere with the mobility of the joint. These can be, for example, free joint body, cartilage or bone parts. In addition, acute pain should at least temporarily subside due to the debridement.

Lavage and debridement are usually performed as part of a joint mirroring (arthroscopy). The surgical instruments are introduced into the joint by only a small incision in the tissue.

Cartilage-improving osteoarthritis treatment

Also during an arthroscopy you can drill the remaining cartilage surface. This is to stimulate the cartilage cells to form replacement tissues. However, this new cartilaginous tissue has a different structure than the original cartilage and does not quite meet the demands on the joint.

For some years, it has also been possible in certain cases to transplant corpora cells from the outside into the damaged joint.

corrective

A corrective osteotomy repositions the joint-forming bones to more evenly distribute the load over the articular surfaces: some of the stress is transferred from the OA zone to healthy cartilage and bone areas. In most cases, the articular capsule and ligaments are also operated in this form of osteoarthritis treatment to improve joint mobility.

Corrective osteotomy is not always used to treat existing arthritis. In case of misalignments, it can also be carried out preventively to prevent the development of joint wear. Malpositions can favor arthrosis.

Endoprosthetic joint replacement

If the pain can not be relieved by any other osteoarthritis treatment, an endoprosthetic joint replacement is considered. This means that the damaged joint is replaced by an artificial joint. This is mainly done with osteoarthritis in the knee or hip joint.

In fact, the worn joint bodies and articular surfaces are surgically removed and replaced by prostheses made of metal, plastic and ceramic (alloarthroplasty). There are prostheses that replace only the joint body, and those for the entire joint. They can either be anchored in the existing bone with cement or screws. In this form of osteoarthritis treatment, if necessary, the joint position can be corrected.

Each prosthesis can relax after a while. When this happens depends on various factors. These include age, gender, clinical picture, infections, type of joint and type of prosthesis. A relaxed prosthesis often needs to be replaced. Relaxation can be detected in good time by means of regular X-rays.

arthrodesis

Also with a so-called arthrodesis you can do something with osteoarthritis pain. This is understood as an operative joint stiffening: The affected joint is more stable and usable after the procedure, but also less mobile. An arthrodesis is therefore usually performed only on joints in which a lower mobility does not disturb the daily life of the patient very much. These are about finger end joints, other finger joints and small joints in the area of ​​the carpal. Arthrodesis is also sometimes performed on the metatarsophalangeal joint.

resection

In this form of osteoarthritis treatment, the damaged articular bodies are removed and surgically reshaped without a prosthesis. However, resection arthroplasty is rarely used today. It may be considered for arthrosis of the thumb (rhizarthrosis), especially if conservative osteoarthritis treatment is unsuccessful. One of the affected metacarpal bones is removed and replaced by the body’s own tendon tissue. The tendons of the long thumb muscle or the short hand flexor are often used. This form of rhizarthrosis therapy is not considered a standard method.

Resection arthroplasty is sometimes also performed in arthrosis of the great toe joint (hallux rigidus) or arthrosis between the collarbone and shoulder roof.

Alternative osteoarthritis treatment

What helps with osteoarthritis apart from orthodox medical procedures? This question interests many patients. They want to support the traditional medical arthrosis treatment with the help of alternative healing methods. Although the efficacy of many alternative methods is not scientifically proven, for some patients they are a good aid in osteoarthritis. Homeopathy, plant substances, magnetic therapy and acupuncture to relieve the arthritis symptoms. Often also Schüßler salts are used in osteoarthritis.

Osteoarthritis treatment: Schüßler salts and homeopathy

Osteoarthritis patients rely in many ways on these two alternative methods: Schuessler salts should be able to relieve osteoarthritis symptoms in the same way as homeopathic globules. In addition, Schuessler salts should also prevent osteoarthritis. Advocates say that both treatments have no side effects and are therefore suitable for the self-treatment of osteoarthritis.

Suitable Schüßler salts for osteoarthritis are:

• No. 1 Calcium fluoratum
• No. 2 Calcium phosphoricum
• No. 8 sodium chloratum
• No. 9 Sodium phosphoricum
• No. 11 Silicea
• No. 16 Lithium chloratum

Experts recommend using these minerals combined as ointment or cream gel.

If osteoarthritis treatment with homeopathy is to be supported, various preparations are available. If, for example, exercise helps relieve osteoarthritis pain, Rhus Toxicodendron D12 is recommended. Dulcamara D12 is used when joint pain worsens due to cold weather. Other remedies for osteoarthritis homeopathy should be discussed with an experienced therapist.

Osteoarthritis treatment: plant substances

For centuries, the osteoarthritis treatment has been based on medicinal plants. These include African devil’s claw, nettle, comfrey, willow, dandelion, cayenne pepper and rosehip. However, arthrosis symptoms only improve if you apply the medicinal plants over a long period of time. Your doctor or pharmacist will advise you on the exact application and dosage.

Osteoarthritis treatment: Magnetic field therapy

The arthritis treatment with magnetic therapy is intended to alleviate the pain, make the joints swell and increase the well-being of the patient. The magnetic field is generated either by a natural magnetic stone or by an electric coil.

Medical studies have shown that magnetic therapy can be particularly helpful in osteoarthritis of the knee. But also patients with chronic complaints in several joints (polyarthritis) should benefit from it. Side effects were not observed in this alternative osteoarthritis treatment.

Osteoarthritis treatment: X-ray pain

Arthrosis treatment with X-rays is designed to inhibit inflammatory processes and improve blood circulation. The irradiation must be repeated at certain intervals in order to work. Only very small radiation doses are used.

X-ray pain irradiation is used, for example, in rhizarthrosis therapy and Heberden osteoarthritis therapy. Both are forms of joint wear in finger joints.

Osteoarthritis Treatment: Acupuncture

The stimulation of certain points on the skin with acupuncture needles to normalize abnormal processes in the body again. This usually requires several sessions.

The use of acupuncture in osteoarthritis is not universally recognized. However, some patients report that acupuncture was actually able to relieve their arthritis pain. Especially with joint wear in the knee, acupuncture can reduce chronic pain.

Osteoarthritis and nutrition

A link between arthritis and diet is often discussed: Can an unfavorable diet promote osteoarthritis? Is therefore worthwhile a diet change in osteoarthritis?

In general, it can not be said that some foods cause osteoarthritis. Overall, however, the type of diet can actually influence osteoarthritis: what matters is how much we eat and how our meals are made up.

Less calories

When you gain weight, the joints must carry a greater weight. As a result, they wear out faster. Obese people therefore have a higher risk of osteoarthritis. If you already have osteoarthritis, obesity promotes joint wear, especially in the knee (“osteoarthritis knee”).

Nutrition in osteoarthritis should therefore be calorie-reduced, if one tends to overweight or already brings excess kilos on the scales. A healthy body weight relieves the joints, can relieve the discomfort of the disease and slow their progression.

Less animal food

The right diet for osteoarthritis is low in meat and other animal foods. The reason: Osteoarthritis damaged joints can easily inflame. Certain metabolic products in the body mediate these inflammatory reactions. Some are made from the omega-6 fatty acid arachidonic acid. This is mainly in animal foods.

The diet for osteoarthritis should therefore provide little arachidonic acid. This means: you should reduce the consumption of meat and meat products. Instead, you should increasingly resort to products that contain many omega-3 fatty acids. Because these inhibit inflammatory reactions. Omega-3 fatty acids are found, for example, in canola and linseed oil, as well as in high-fat fish such as herring, mackerel and salmon.

In summary, the following tips apply to a suitable arthritis diet:

• Reduce the consumption of meat and eggs.
• Eat fish twice a week (like salmon, mackerel, herring).
• Use vegetable oils such as rapeseed oil, linseed oil, sunflower oil or olive oil.
• Eat a lot of fruits and vegetables.
• Prefer whole grains and legumes.
• Drink at least 1.5 liters of water or unsweetened tea daily.
• Calcium from low-fat dairy products strengthens your bones.
• Avoid caffeine, alcohol and nicotine.

Such an arthrosis diet can not replace other therapeutic measures, but make sense. This means that while it can not cure osteoarthritis, it has a positive effect on the condition. For an OA diet to be successful, it must be permanent. By the way, it helps with all kinds of arthrosis – from knee arthrosis to finger arthrosis (Heberden).

Osteoarthritis: symptoms

Initially, joint wear often causes no discomfort. Over time, however, pain sets in when the affected joint is moved or loaded. In late arthrosis stages, the joint pain can also occur at rest or permanently. Many patients also report noticeable or audible grating and pops in the joint.

Osteoarthritis joints also often feel “stiff” and are limited in their mobility, such as the fingers in osteoarthritis in the finger joint. In addition, over time, the joint position may change pathologically.

Sometimes inflammation is added to the continuous joint wear. This can happen, for example, in acute overload. Then one speaks of activated osteoarthritis: The affected joint swells and is overheated. The pain intensifies and an articular effusion may form.

Read more about the signs of joint wear and tear in the different arthrosis stages in the article Osteoarthritis Symptoms.

Osteoarthritis: causes and risk factors

Osteoarthritis is associated with increasing wear and tear of articular cartilage. There can be different reasons. In all cases, however, the affected joint is burdened for a longer time beyond its capacity. This causes cartilage damage. Since the cartilage can not repair itself, it wears out.

With age, it comes with every person to the joint wear. Other possible causes include:

• Overload: for example, overweight or exceptionally high joint load (for example, in competitive sports or when working with the jackhammer)
• Improper load: for example, by joint deformities such as O-legs or X-legs
• Metabolic diseases such as gout (deposition of uric acid crystals in joints favors cartilage damage)
• Injuries: for example, cartilage trauma (post-traumatic arthritis) or broken bones, which heal in deformity

In such clearly demonstrable causes doctors speak of secondary arthrosis. In other cases, however, no cause for the joint wear can be detected. Then there is a primary arthrosis.

From cartilage damage to osteoarthritis

A destroyed cartilage usually affects normal joint function. Normally, the individual components of the cartilage are constantly renewed. But defective cartilage cells can not do this anymore. In addition, the cartilage substance is decomposed by attracted enzymes. The cartilage loses its strength and elasticity. The cartilage layer becomes thinner and may easily tear or fissure under stress.

If the joint continues to be stressed too much, other structures in the joint area change over time: the synovial membrane (synovial membrane), the bones and the ligaments. Only then is it called osteoarthritis.

In the strongest stress zones, the cartilage coating finally disappears completely. The joint space narrows, and the joint bones are exposed. Doctors speak here of “bone bald”. In order to withstand the unfamiliar load, the bone tissue is compressed. This is called subchondral sclerotherapy.

In addition, bony outgrowths (osteophytes) form on the edge of the joint. This changes the entire anatomy of the joint (Arthrosis deformans).

The damaged cartilage does not provide a dense delimitation between the joint space and the bone tissue (cancellous bone) anymore. As a result, synovial fluid can enter the bone structure and form a cavity in the bone (rubble cyst). Cellular debris and metabolic products accumulate in the joint. As a result, the artificial skin inflamed very easily. Often there is also an articular effusion. A hitherto perhaps even asymptomatic joint wear turns into an inflammatory (activated) osteoarthritis in this way.

Osteoarthritis stadiums

Physicians differentiate depending on the extent of wear various arthrosis stages:

• Stage 1: The articular cartilage still looks smooth and is relatively healthy, but is thickened and structurally altered. The synovial membrane may be irritated.
• Stage 2: The cartilage surface is uneven and frayed.
• Stage 3: The cartilage layer is thinned, the joint space narrows. First changes of the neighboring bone are recognizable.
• Stage 4: The cartilage layer is missing in places completely. The bone has densifications (subchondral sclerosis) and dislocations (osteophytes).

Osteoarthritis in the knee

In principle, any joint in the body can be affected by osteoarthritis: ankle, elbow or thumb, for example. Even arthritis in the temporomandibular joint and “arthritis toes” are possible. Most commonly, however, joint wear occurs on the lower extremities and spine. Here, the joints have to carry a lot of body weight and therefore wear out more easily.

Joint wear in the knee is the most common form of osteoarthritis. Such gonarthrosis in some cases has no concrete cause (primary gonarthrosis). In contrast, a secondary knee osteoarthritis, for example, caused by an axial misalignment, so for example by X or O legs. Other possible causes include inflammation or pre-injury due to accidents (such as meniscal injuries).

Read more about the causes, consequences and treatment of arthritis in the knee in the article Gonarthrosis.

Osteoarthritis in the hip joint

Hip replacement is called coxarthrosis and is another common form of osteoarthritis. In most cases, the cause is known: Often, deformities or malformations of the hip joint, the reason why it comes to premature wear. Also, rheumatic diseases, bacterial inflammation of the hip joint and bone fractures in the joint area are among the possible triggers of secondary hip arthrosis.

For more information on the causes, diagnosis and treatment of hip osteoarthritis, see the article Coxarthrosis.

Osteoarthritis of the small vertebral joints

Joint wear of the small vertebral joints in the spine is called spondylarthrosis. It occurs in almost every person in old age. In addition, there are some diseases that favor the wear of the vertebral joints. These include overweight and herniated disc. Certain sports and occupations also promote the wear of the vertebral joints.

If you want to know more about causes, symptoms and treatment of this type of osteoarthritis, please read the article Spondylarthrosis.

Finger osteoarthritis

The hand consists of many small bones, each connected by a joint: the eight carpal bones, the five metacarpal bones, the two finger bones of the thumb and the three finger bones of the remaining fingers.

Arthrosis in the hand can affect several of these joints, including the various finger joints. The more common types of finger arthrosis have their own name: Arthrosis in the thumb saddle joint is called rhizarthrosis. If osteoarthritis affects finger joints, a distinction is made between Heberden arthrosis in the end joints and Bouchard osteoarthritis in the middle joints.

Also a joint wear in the area of ​​the small carpal bones occurs. It occurs mainly between the scaphoid (skaphoid) and polygon (trapezium). In this case one speaks therefore of Skaphotrapezial- or STT arthrosis.

Rhizarthrosis is a very common form of finger osteoarthritis. Read more about their development and treatment in the article Rhizarthrosis.

Osteoarthritis in the shoulder joint

Joint wear in the shoulder joint is called osteoarthrosis. It usually arises as a result of old injuries or illnesses (such as rheumatism). A primary shoulder joint arthrosis without known cause, however, is rare.

You will learn more about the causes, symptoms and treatment of osteoarthritis in the shoulder joint in the article Omarthrosis.

Other arthrosis forms

Other more common arthrosis include:

• Ankle osteoarthritis: Osteoarthritis in the ankle can affect the lower (USG) or upper ankle (OSG) osteoarthritis.
• Osteoarthritis in the toe: The joint wear is often seen in the metatarsophalangeal joint (hallux rigidus).
• Temporomandibular Joint Osteoarthritis: The temporomandibular joint is the most commonly used joint in the body and can therefore be more easily overloaded.
• Iliosacral joint osteoarthritis (ISG osteoarthritis): wear in the joint between the iliac scoop and sacrum
• Radiocarpal arthrosis: arthritis in the wrist
• Cubital arthrosis: Osteoarthritis elbow
• Polyarthrosis: wear in multiple joints at the same time

Osteoarthritis: examinations and diagnosis

A specialist in orthopedics is in most cases the right contact person for osteoarthritis. On the other hand, a dentist or orthodontist can judge TMJ complaints well.

To collect the medical history (anamnesis), the doctor will first talk in detail with the patient. For example, he can ask the following questions:

• Is your joint pre-loaded with an injury or illness?
• Does your pain start at the beginning of a movement or only after a longer period of exercise?
• Do the pain improve with exercise or at rest?
• Does the pain accumulate in certain situations?

Physical examination

The medical history is followed by a physical examination. The doctor assesses the position and function of the affected joint. He tells the patient how to move his joint. For example, with discomfort in the legs or spine, he asks the patient to take a few steps. So he can best judge the movement.

In addition, the doctor will usually move the affected joint itself and examine the range of motion. He also tests certain pressure points over the joint space, muscles and at the approach of tendons and ligaments. With pronounced joint wear, he can often feel with the hand a fine rubbing or even coarse crunching in the joint (crepitation).

imaging

Already in early arthrosis stages one can recognize in the X-ray that the joint space of the affected joint narrows. A condensed bone structure under the articular cartilage (subchondral sclerosis) appears whiter in the radiograph. Bony attachments (osteophytes) usually present themselves as bright as the bones themselves. Rubble cysts, on the other hand, leave a dark cavity in the light bone in the X-ray image. In addition, malpositions and changes in the bone structure can be shown in the X-ray image.

Caution: Visible changes in the X-ray image do not allow any conclusion as to whether and how much someone suffers from discomfort. Sometimes you can see significant changes on the radiograph, but the patient can not feel any discomfort.

On the other hand, early stages can be overlooked in the radiograph. In unclear cases, computer tomography (CT) or magnetic resonance imaging (MRI) is sometimes performed. These are imaging procedures that are much more accurate than an X-ray examination.

Exclusion of other causes

Joint pain can have other causes than osteoarthritis. For example, arthritis is another common cause. This inflammatory disease affects the whole body. It manifests itself mainly as a painful joint inflammation.

If osteoarthritis is suspected, the doctor must therefore clarify whether the joint pain is actually due to wear or have another cause (such as arthritis).

Osteoarthritis: Disease course and prognosis

The most common question from sufferers is: “Is osteoarthritis curable?”. The answer: Since the articular cartilage can regenerate at most in children, no arthritis disappears. So the disease is not curable. However, effective OA treatment can relieve discomfort and slow the progression of the disease.

Prevent osteoarthritis

Regular physical exercise can prevent joint wear. Particularly suitable are sports in which the joints are evenly loaded. This is the case with cycling and swimming, for example. These sports are also recommended in the treatment of existing joint wear.

In addition, osteoarthritis can be prevented by orthopedically correcting joint misalignments and avoiding over or underloads. An important overload arises, for example, by being overweight. Who brings too much weight on the scales should, therefore, among other things, his joints lose weight.

An important preventative measure is also the avoidance of unilateral joint loads. These promote namely a joint wear. Therefore, for example, you should regularly alternate between sitting and standing activities.

Footwear also has an influence on joint wear and tear arthrosis Zehengrundgelenk oder andere Fußgelenke, weil sie sehr oft ungeeignetes Schuhwerk tragen. Dazu gehören vor allem Schuhe mit hohen Absätzen.

Additional information

Book recommendations:

• Arthrose selbst heilen: Das ganzheitliche Anti-Schmerz-Programm, Martin Marianowicz, Willibald Walter, 2017, GRÄFE UND UNZER Verlag GmbH; Auflage: 3
• In Bewegung bleiben trotz Arthrose: Wieder ohne Schmerzen leben, Peter Krapf, Frank Giarra, 2017, Kneipp Verlag in Verlagsgruppe Styria GmbH & Co. KG; Auflage: 1