arthrosis

Synonyms

Polyarthrosis, ideopathic arthrosis, joint wear, cartilage abrasion, cartilage wear, cartilage wear, chondromalacia (cartilaginous softening), osteoarthritis

English : Osteoarthrosis
Medical : Arthrosis deformans

introduction

Osteoarthritis is a degenerative change of the joints and their appendages. In this context, corresponding pain and movement restrictions often occur.
Osteoarthritis usually manifests itself without inflammatory accompanying components.

definition

The term arthrosis initially means nothing more than joint disease.

In medicine, however, osteoarthritis is defined as an increasing, age-related cartilaginous abrasion of the joints of the body.

This cartilage abrasion can occur creeping (latent arthrosis) or pass into a painful disease (activated arthritis).

In advanced cases, changes occur in the region of the joint near the joint, the joint mucosa, the joint capsule and the joint-spanning musculature. Therefore, osteoarthritis as a clinical picture is not limited to cartilage abrasion alone.

In the end, osteoarthritis can also lead to the destruction of the joint. The joint then loses its shape. In this case, the term Arthrosis deformans is also a common disease description.

If osteoarthritis occurs on many joints at the same time, it is called a polyarthrosis.

Occurrence

Everyone can suffer from osteoarthritis sooner or later. The entire human consists of biological tissue, which is subject to natural wear over the years. In orthopedics, wear-related (degenerative) changes of the joints are in the foreground of the clinical pictures to be treated.

Both men and women are affected. However, there are differences in the frequency of the individual clinical pictures.

Suffering begins slowly, usually after the age of 50 and runs in spurts. In the beginning, osteoarthritis is usually asymptomatic, later it manifests itself in part through severe states of pain.
From an appropriate age, changes in the sense of an arthrotic change (joint wear) can be recognized practically at all joints.

Interestingly, the strength of cartilage abrasion is not directly related to a patient's discomfort. This means that a patient with relatively low cartilage abrasion may experience significantly greater pain than a patient with significantly more advanced osteoarthritis.

The reason for this is that the cartilage abrasion as such does not cause any pain. In the meantime, the mucosal inflammation (synovitis / synovitis) of the joint caused by the cartilage particles is responsible for this. It also triggers overheating of the joint and intra-articular (intra-articular) water formation (joint effusion).

Osteoarthritis can affect any joint.
The most common changes, however, are found in the large, supporting joints:

  • Hip osteoarthritis (med.
  • Osteoarthritis in the knee (medial gonarthrosis),
  • Spinal arthrosis (spondylarthrosis);

Cartilage wear on these joints has the greatest clinical relevance in orthopedics.

frequency

The incidence of osteoarthritis is increasing with age.
Generally, the risk for each joint varies individually.
Most frequently one finds in descending order:

  • facet arthrosis
  • Knee osteoarthritis (gonarthrosis)
  • Hip osteoarthritis (coxarthrosis)
  • ankle arthritis
  • Metatarsophalangeal joint arthrosis
  • Carpometacarpal joint osteoarthritis
  • finger osteoarthritis
  • other joints.

causes

Basically, the actual causes that lead to the development of osteoarthritis are unknown to this day. Nevertheless, some of the previously adopted theories have now been successfully refuted.
Contrary to popular assumptions, osteoarthritis is not a typical age-related disease. Age is therefore no longer the actual cause, but a decisive risk factor for the development of osteoarthritis. The reason for this is the fact that both the elasticity and the resilience of the articular cartilage decrease significantly in the course of aging. However, pathological joint changes in the form of osteoarthritis are becoming increasingly common in younger people.

The development of osteoarthritis due to a possible cause is almost impossible. Rather, it is now believed that this form of degenerative joint disease can be attributed to an interaction of different factors (causes). The most common causes of osteoarthritis include injuries and accidents. About one third of the known cases of arthritis are caused by traumatic causes.
In this context, even the smallest cracks and bumps in the tendons and ligaments are enough to negatively influence the cartilaginous structure.

In addition to traumatic joint damage, persistent over- or under-loading is one of the typical causes of osteoarthritis. People who tend to perform certain movements day after day and over a longer period of time, in many cases suffer a significant overload of the joints in question. In this context, osteoarthritis frequently occurs in certain occupational groups.

In addition, too high body weight can lead to chronic overloading of the joints. For this reason, overweight (obesity) is one of the typical causes of osteoarthritis.

Furthermore, studies have shown that arthrotic changes in the joint structure among family members are more common. Accordingly, a genetic component (heredity) can not be excluded in the development of osteoarthritis. In this context, the structure and structure of the articular cartilage and the tendency for premature wear of the joints play a decisive role.

Other typical causes of osteoarthritis are various congenital misalignments of the normal body axis. A pronounced misalignment can also lead to a misalignment or overloading of individual joints. This is due to the one-sided body burden associated with most congenital deformities.
Since the affected patients usually have to carry significantly more weight on one side of the body, the degradation of the articular cartilage can be accelerated.

osteoarthritis species

  • Gonarthrosis | knee osteoarthritis
  • Coxarthrosis | hip osteoarthritis
  • Osteoarthrosis | Shoulder osteoarthritis
  • Spondyloarthrosis | Osteoarthritis of the spine
  • Osteoarthritis | English term of osteoarthritis
  • Herbeden - Osteoarthritis | Osteoarthritis of the Fingerendgelenke
  • Bouchard - Osteoarthritis | Osteoarthritis of the finger middle joints
  • Rhizarthrosis | Daumensattelgelemksarthrose
  • Radiocarpal Osteoarthritis | Osteoarthritis of the wrist
  • Hallux rigidus | Osteoarthritis of the great toe joint
  • Hallux valgus | Deformity of the first toe, which is often combined with arthrosis in the big toe joint
  • Cubital osteoarthritis | Osteoarthritis of the elbow joint
  • Facet arthrosis | Osteoarthritis of the small vertebral joints
  • Talocrural Osteoarthritis | ankle arthritis

A detailed explanation of the special arthrosis form can be found on the respective topic.

Different forms of osteoarthritis

First, one distinguishes a primary form from a secondary form of osteoarthritis.

In the case of primary osteoarthritis, also called idiopathic osteoarthritis, no clear cause is recognized. The most common cause of misloading over the years is the uneven wear of the joints and pain on movement.
Age is another factor that promotes the occurrence of osteoarthritis.
Genetic factors can also contribute to the emergence of osteoarthritis.

Elderly patients sometimes also suffer from finger joints (finger arthrosis). This particular condition is called Heberden Osteoarthritis. Cause are characteristic nodules on the finger joints.

The secondary arthritis form is characterized by the fact that the cause is known. Often, trauma or accidents as well as congenital misalignments are the reason that the joints are worn unevenly and thus lead to the fact that bone eventually rubs on bones.
Furthermore, excessive joint loads lead to faster wear and to the occurrence of osteoarthritis. As an example, construction workers are often listed who work eg with a jackhammer. The constant vibrations mainly on the joints of the upper extremity (shoulder, fingers, elbows) lead to increased stress and faster wear.

In the recreational area, bodybuilders and weightlifters are more at risk for arthritic changes in the body. People with obesity are also at an increased risk of getting osteoarthritis faster than thin people. The reason for this is usually a general malposition, especially of the legs and knees, which are due to increased body weight.

Patients suffering from rheumatoid arthritis (rheumatism) also secondary to arthritis. The reason for this is the malalignment of the joints caused by severe rheumatism.

Staging of osteoarthritis

After the physical examination, an X-ray of the joint is usually taken, which shows one or more of the typical arthrotic changes in advanced osteoarthritis.
These would be joint space narrowing due to depleted cartilage and articular surfaces, rubble cysts, osteophytes and sclerosis.
These are compensation mechanisms with which the body tries to balance the degenerative processes. Due to the osteophytes (bony attachments on the joint) new bone should replace the degenerate. The sclerotherapy is a sign of replacement material, which should protect the joint instead of the bone and ensure the movements. Sclerotherapy is a compression of the bone, which arises because the bone is too heavily mechanically stressed. If one or more of these signs is found in the radiograph, the diagnosis of osteoarthritis can be made.

Arthrosis can be classified into different stages based on these features. Thus, stage 1 is a clinically irrelevant osteoarthritis, which only stands out in the X-ray image as such and is more of a chance finding.
Stage 2 usually leads to a doctor's visit to the patient, as he feels pain especially when he is moving. The joints are not overheated, it is not an inflammatory form.
In stage 3, the articular surfaces and cartilage are already degenerated so much that persistent pain occurs, which can also occur when no movement is performed.

osteoarthritis pain

The arthritis pain is typical.
So will

  • a pain in the morning
  • a movement pain in the corresponding joints
  • and a stressful pain in repetitive movements

described.

risk factors

One of the most important risk factors for the development of osteoarthritis is obesity.

The main risk factors for arthrosis include:

  • genetic factors (increased occurrence of osteoarthritis in the family)
  • the body weight
    Patients with obesity have a much higher risk of osteoarthritis especially at the knees or hip joints than light people. Reason is on the one hand, the higher weight that weighs on the joints, on the other hand, the incorrect load that results from it.

    nutrition

    A theory for the development of arthritis states that years of poor nutrition and unhealthy lifestyle have an effect on osteoarthritis.

    Thus, the consumption of animal protein, unhealthy fats, cereal products (such as baked and pasta) and ready meals with synthetic food additives to promote the development of arthritis by acidification of the organism.
    It also discusses whether a lack of minerals, abuse of stimulants (eg, caffeine, alcohol, sugar), high levels of stress and lack of exercise, or improper exercise can also trigger osteoarthritis.

    A consistent dietary change towards a balanced and well-balanced diet is recommended to alleviate the discomfort caused by osteoarthritis. However, even a comprehensive dietary change can not cure osteoarthritis because damaged cartilage tissue can not be restored. Nevertheless, diet seems to play an important role.
    A healthy diet has a positive effect on the course of osteoarthritis and can even prevent further development. Especially recommended are foods such as fruits, salads, vegetables, potatoes, brown rice, spelled, millet, skimmed milk products and fish.
    One hypothesis states that animal fats, as well as sweets, sugar, citrus fruits, coffee, alcohol and black tea should be avoided. Nevertheless, the study situation for the individual foods in osteoarthritis is still very poor and controversial.
    A cartilage-preserving effect also showed a high proportion of leek vegetables, onions and garlic in the diet.
    As with any dietary change, it is also important with regard to osteoarthritis that little ready meals are consumed and instead much is cooked with fresh produce.
    In addition, care should be taken to ensure adequate fluid intake, as much fluid leads to increased acid secretion through the kidneys. Neutral drinks such as water should be preferred and soft drinks, sodas, carbonated or caffeinated and alcoholic beverages should be avoided.

    The intake of dietary supplements (such as chondroitin sulfate, certain vitamins or glucosamine) is the subject of controversial debate, but the study on the influence of dietary supplements on osteoarthritis is not yet conclusive.

    It is important that an experienced orthopedist is consulted prior to a planned treatment attempt for osteoarthritis due to a change in diet or weight loss. The clarification of possible underlying diseases and the exact causes of osteoarthritis are in the foreground.

    therapeutic measures

    The treatment measures range from physical therapy to medication and surgery.

    The first thing to do is to adjust the movements that have led to the corresponding strain on the joint.

    Movements that promote osteoarthritis are:

    • To ski
    • tennis
    • Climb
    • Football etc.

    However, the general avoidance of exercise promotes the development of osteoarthritis in any case.
    Proper exercise and exercise and proper exercise are therefore very important and are recommended to prevent osteoarthritis or relieve symptoms.
    In this case, the individually correct form of movement must be found for each patient.

    • Running or light jogging
    • as well as crawl swimming
    • Crosstrainer / Ergomerter
    • Cycle

    are counted among the joint-saving sports and recommended. Overall, you should move about 30 minutes per day.
    If necessary, physiotherapists can be called in, which show in a patient training, which movements are gentle on the joints and how the patient can relieve the corresponding joints.

    Especially patients who sit a lot, a regular exercise is advisable. On the one hand, this makes sense, because the condition is promoted, on the other hand, because a reasonable movement of the articular cartilage is sufficiently supplied with nutrients and thus less rapidly degenerate.
    Sliding, low-load movements are good for the joints and are recommended, while fast, sudden stopping movements - such as those found in ball sports - should be avoided.
    Furthermore, cooling measures (cryotherapy) can be taken.

    Medicinal drugs are mostly used in the group of nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen or diclofenac). These have an anti-inflammatory effect.
    However, it should be noted that the prolonged use of the drugs results in decreased mucus production of the stomach, thus increasing the risk of gastric bleeding. Therefore, the administration of a gastric protection is recommended.

    If medical and physical therapy does not benefit or if osteoarthritis is too advanced, only the surgical treatment is used as a therapeutic approach.
    The smaller measures include arthroscopy, the mirroring of the joint. Keyhole surgery can be used to repair changes to the cartilage.

    If the damage can not be repaired with arthroscopy, artificial joints can help.
    As a rule, parts of the joint or the entire joint are removed and replaced by an artificial joint. Meanwhile, this intervention in Germany has become routine intervention.
    After the operation, weeks or even months of physical rehabilitation measures have to be connected, so that the patient can learn movements again and appropriate muscle building can take place.

    There are newer approaches that focus mainly on the destroyed articular cartilage. So there are ways to remove parts of the undamaged cartilage of the joint and insert it in the place that is already destroyed. This is done at the open joint.
    Thereafter, the cartilage must grow and take over the tasks of the destroyed cartilage. There are also attempts to remove healthy cartilage and multiply it outside the body. Then this is also used again to the destroyed cartilage site.
    The prerequisite of these two methods, however, is that only the cartilage of the joint is destroyed and the joint surface is still preserved.

    Other modern approaches to osteoarthritis treatment involve daily food intake. It is believed that over-acidification of the body is responsible for arthrosis and supports the progression of joint degeneration.

    Another way of treating osteoarthritis is the use of homeopathic remedies.

    Summary

    A joint commonly affected by osteoarthritis is the shoulder joint.

    Osteoarthritis is the most common joint disease in Germany.
    The cause of osteoarthritis in most cases is a malaise caused by lack of exercise or extreme sports. This is followed by the degenerative change of the corresponding joint.
    First, the articular cartilage becomes thinner, resulting in small holes that become progressively larger. Finally, the two articular surfaces rub against each other unhindered, which leads to the known movement-dependent pain.
    As the process progresses, the bone of the articular surfaces wears off. As soon as pain occurs, usually a doctor is consulted. The doctor first tries to find out from the medical history what would be the cause of the pain in question.
    Based on the joints often affected by osteoarthritis, the suspected diagnosis can be made early.
    In most cases, arthrosis occurs in particularly stressed joints. These include the knee joint, the hip joint, the shoulder joint and the finger joints. The physical examination shows if it is an inflammation (overheated swollen aching joints).

    Certainly, one can only see during a surgery on the open joint, how strongly a joint is degenerated.

    The diet alone can not prevent or cure osteoarthritis. However, the importance of regular hyperacidity through nutrition has recently become increasingly important.

    Arthrosis is much more prevalent in western countries than in developing countries, although it can be assumed that working population there will put much more strain on joints than in western countries.
    It is therefore believed that the combination of physical inactivity and sudden overworking (extreme sports) are among the main factors for arthrosis. Furthermore, incorrect work (too frequent and incorrect sitting and moving) are the main causes of osteoarthritis.

    Osteoarthritis - causes, symptoms, diagnosis, treatment & pathology (December 2019).


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