This information does not replace a physician’s diagnosis and advice.

Arthrosis general

Arthrosis: what’s that?

Every joint  of the body is covered by a protective layer of cartilage. It functions as a kind of “shock and friction absorber” on the joint, in order to protect it against sudden and hard movement and to enable a smooth motion sequence. If this layer of cartilage disappears or is damaged, this change is described as arthrosis.

The causes of damage to cartilage are wide-ranging. In addition to damages to cartilage as a consequence of injury, mostly age-caused wear to the cartilage surface is observed. In addition to family predisposition, this wear is fostered by heavy physical work, joint malposition such as bandy legs or knock knees or competitive sports. In some cases, also a metabolic disorder such as gout or a chronic inflammation of the joints within the scope of rheumatic disease is the cause of arthrosis.

Arthrosis symptoms

The typical arthrosis symptoms are joint pain and swelling in the joint region (reactive effusion) as well as reduced mobility. At the outset of the disease, cartilage changes often cause no complaints (latent arthrosis). As a consequence of the advance of the arthrosis, a sensation of stiffness or pain after periods of rest or when starting a movement (start-up pain) can be incurred as initial symptoms, which lessen once the synovial fluid has spread sufficiently and is again able to fulfil its function.

When cartilage loss increases, sudden stronger pain is often incurred (activated arthrosis). This irritation status is often accompanied by hyperthermia and a swelling of the joint concerned. If cartilage loss advances further, you often hear and feel friction and cracking in the joint during movement. The joint silhouette changes increasingly and also movement is increasingly impaired. Often, pain is also incurred during periods of rest (pain at rest) and not only when stressed (stress-induced pain). They can also remain permanent (decompensated arthrosis). However, the symptoms of an arthrosis differ widely individually and also depend on the respective joint affected. Arthrosis is frequently accompanied by marked meteoropathy.

Arthrosis stages

All arthrosis originates from cartilage damages. It is often limited to a small area and superficial (stages 1 and 2). With increasing wear of the cartilage layer the joint gap narrows until the cartilage layer is then missing in some places and also the joint bones show changes (stages 3 and 4).

Medically, we distinguish between different arthrosis stages (arthrosis classification):

Stage 1: Joint cartilage is still smooth and relatively healthy but already thickened and shows structural change; the joint gap is not conspicuous; inner joint skin may be irritated.

Stage 2: The cartilage surface is uneven and separated into fibres.

Stage 3: The cartilage layer is already thinned-out and the joint gap narrowed. Moreover, initial changes to the neighbouring bone are apparent.

Stage 4: The cartilage layer is missing completely in some places, also the bone shows changes.

Arthrosis diagnosis

Changes to the joint cartilage or its loss can be best recognised on X-ray images under stress or when standing. Here, the image shows the joint gap under the influence of stress or the body weight. Normally, the joint gap is lined with cartilage, however if cartilage is missing the joint gap also becomes narrower.

How can arthrosis be prevented?

The foreground of arthrosis prophylaxis incorporates joint-friendly movement without overexertion of the joints, balanced high-fibre nutrition and healthy, normal weight.

When the joint is moved, the cartilage is provided with nutrients via the synovial fluid in the joint gap (cartilage circulation). Maximum stress with existing arthrosis influences the cartilage circulation and strains the joint additionally.

So, all measures which exert positive influence on cartilage circulation and thus slow down cartilage loss have the best preventive effect. These include avoiding excess weight, stabilising musculature which relieves and supports the joint as well as movements which do not overstrain. For prevention, sport types such as swimming and moderate bicycling, but also hiking and even walking are appropriate.

What therapy options are available for arthrosis?

Treatment of arthrosis is made in principle in accordance with the cause and existing mechanical or inflammatory damage to the joint. Several arthroses improve as a result of movement, remedial gymnastics and physiotherapy as well as the supporting administration of appropriate anti-inflammatory and pain therapy medication.

If an arthrosis already exists, regular movement is definitely important. Here, supports or braces can make good sense in order to protect against overstress or to support the joint. Also, the use of Nordic Walking sticks may prove helpful. Any existing excess weight should be reduced and dietary change considered.

Depending on the joint affected and the stage of arthrosis, regular movement, therapeutic exercise as well as cooling or warming poultices, supports of braces , analgesic medication or joint injections can be applied. Also, minimally invasive procedures such as an arthroscopy with cartilage smoothing up to cartilage replacement via surface prosthesis are available as therapy options.

Minor arthroses can also be treated by injecting hyaluronic acid into the joint capsule. If the patient wishes, a severe arthrosis can be treated with an operation, e.g. with a sled prosthesis.

However, if acute joint damage is predominant in case of an already existing arthrosis, as for example with a tear of the meniscus, the first important step is to cope with the irritation in connection with the swelling and pain. To this end, rest, elevation and cooling are viable options, but also medication. Special supports and braces can have a supportive effect during the healing phase.

 

Reference: Arthrose https://flexikon.doccheck.com/de/Arthrose last visited on 30.04.2021