What can be done to treat this remarkably common disease? What are its causes?
More than one hundred factors have been identified as contributing to the development of osteoarthritis, which is the most common form of arthritis.
Before the age of 45, osteoarthritis occurs more frequently men. After the age of 55, it occurs more frequently in women. Osteoarthritis most commonly affects the large weight-bearing joints, such as the hips and knees.
Most forms of treatment for osteoarthritis aim to alleviate the pain, reduce any associated inflammation, maintain patient mobility, minimize disabilities and otherwise improve the patient's quality of life.
The approach to treating osteoarthritis can be represented in the form of an inverted pyramid:
At the top of the inverted pyramid, we find measures that are used for nearly all patients:
the provision of information about the disease, general practical counseling, dietary advice (i.e. in the interest of weight reduction) and the intrdution of exercises geared to maintaining muscle strength and the mobility of the affected joint.
Treatment for more serious or advanced cases of osteoarthritis then includes measures, aids and devices to protect the affected joint, a regimen including simple painkillers and conventional antirheumatics and, more recently, modern antirheumatics that are gentler on the stomach.
Treatment for osteoarthritis aims primarily to alleviate the pain, reduce any associated inflammation, maintain patient mobility, minimize disabilities and to improve the patient's quality of life.
What is osteoarthritis?
Osteoarthritis is caused by an increasing breakdown and eventual loss of cartilage in one or more joints.
Cartilage is a substance with a high concentration of protein that acts as a cushion and bearing surface between the bones of the joints. Cartilage cells, present from birth, show no capacity divide once the body's growth phase is complete so long long as they remain embedded in the layer of proteoglykanes that surrounds them. This layer can only be dissolved enzymatically in laboratory conditions, whereupon the cartilage cells resume a process of propagation in the form of cell division. This is the reason why cartilage transplantation can only be carried out with the help of cartilage cells grown in the laboratory.
Given that its layers contain no sensate nerve endings, cartilage damage is typically not perceived until the defects in question have extended to the layer of bone under the cartilage. This layer of so-called bone skin (periosteum) is very sensitive, as we all know from having experienced a sharp blow to the elbow or shin.
What causes osteoarthritis?
Osteoarthritis is primarily associated with the aging process. As we age the water content in our cartilage tissue decreases and the tissue begins to wear. While the causes are manifold, they are almost always related to the stress that the joint is exposed to. Mechanical stress to the joint leads to irritation and inflammation in the joint. The surface of the cartilage begins to tear and become thinner. Holes appear. The exact pattern of wear varies from individual to individual. In advanced case, the cartilage disappears altogether. The cushioning function of the cartilage in the joint is lost. The loss leads to an increase in the mechanical stress to the joint. Friction in the joint increases significantly. The load on the adjacent bone increases rapidly. And inflammation in the joint intensifies.
Inflammation arises in primary osteoarthritis as a result of wear (wear particles) in the joint and is accompanied by inflammation in the synovial membrane lining the joint (synovitis).
A vicious circle manifests itself, with greater wear leading to a greater degree of inflammation and a greater degree of inflammation leading to a greater degree of wear and cartilage degradation.
Ultimately, the inflammation and the exposure to mechanical stress lead to a reaction on the part of the adjoining bone. Bone spurs (osteophytes) develop in the degenerating joint. The bone under the remaining layer of cartilage may thicken (subchondral sclerosis) or even begin to erode in areas exposed to high load and stress.
How does your doctor arrive at a diagnosis?
Your description of the symptoms you are experiencing and a brief clinical investigation often provide sufficient basis for a preliminary diagnosis. Additional clinical examinations such as impingement testing and range-of-motion testing may provide further evidence.
While x-rays are often used to confirm a diagnosis, they do not always reveal signs of cartilage damage or the onset of osteoarthritis.
A narrowing of the joint cavity and bone spurs are some of the most conspicuous signs of osteoarthritis and its extent that can be detected via standard x-rays.
When is joint replacement advisable?
If the pain and disability increase and conservative forms of treatment remain ineffective, then cartilage transplantation or the replacement of the joint with an artificial joint emerge as the only alternatives. In Germany alone today, around 200,000 people receive an artificial hip and around 150,000 an artificial knee every year. The medical advances made in recent years offer the promise of an optimized treatment of this disease. The implantation of an artificial joint (total hip arthroplasty - hip resurfacing - total knee arthroplasty - partial knee arthroplasty - ankle arthroplasty - big toe joint replacement) is to reproduce the normal form of the natural joint (with head and cup) restore its function.
Other links on the subject of osteoarthritis on our website (quick links):
hip osteoarthritis, knee osteoarthritis, ankle osteoarthritis, osteoarthritis of the big toe joint, facet joint osteoarthritis, shoulder osteoarthritis
