Osteoarthritis

Some people who have osteoarthritis don't know that they have it. Others have mild symptoms, and some have very severe symptoms. The disease usually develops in people over the age of 40. The possible symptoms include:

• Pain in the joint: This typically develops gradually over many years. It can sometimes be stronger and sometimes milder, and can even go away completely for some time. The pain is worse when you put weight or pressure on the joint. In very advanced osteoarthritis, the joint may also hurt at rest or at night.
• Joint stiffness: This mainly occurs after resting for some time. One typical symptom is "start-up pain" – for example, when you get up in the morning. It goes away quite quickly once you start moving. If the morning joint stiffness lasts longer than 30 minutes, it is more likely to be rheumatoid arthritis.
• Joint swelling: In osteoarthritis, swollen joints usually feel firm and not unusually warm. This is different in diseases like rheumatoid arthritis. The joint space may be sensitive to pressure. In certain forms of osteoarthritis, particularly in the hand, clearly visible lumps may form (called Heberden's nodes).
• Reduced mobility and ability to manage in daily life.

Some people with osteoarthritis have flare-ups, too: Then the pain suddenly gets worse and tends to be a stabbing, throbbing or burning sensation. The joint may temporarily become swollen and stiffer. These symptoms usually get better again after a few days. Flare-ups often come without warning, which makes it harder.

Osteoarthritis symptoms can make everyday life more difficult – both in your free time and at work. For example, people who have arthritis in their fingers may find it hard to do things like writing, opening bottles or holding a heavy book. Sometimes it's even impossible to do them without help. Osteoarthritis can also affect your mood, disturb your sleep and make it harder to cope with daily life.

The joint damage in osteoarthritis is caused by complex metabolic processes: The tissue in our joints is constantly being broken down and replaced. Osteoarthritis occurs when more tissue is broken down than replaced – for example, when there are too many inflammatory substances and enzymes that attack the joint, and too few that help to repair it.

Osteoarthritis can lead to various changes in the joint:

• The tough cartilage layer at the ends of the bones (known as articular cartilage) can become thinner and start to tear in places. In very advanced osteoarthritis, the bone may no longer be covered by cartilage at all in some parts of the joint.
• The space between the bones (joint space) can become narrower.
• The synovial membrane, which produces the fluid in the joint space (synovial fluid), can become thicker.
• Bone bruises and bony growths known as bone spurs (or osteophytes) can develop from the bone under the joint cartilage.
• The soft tissue in the joint may change. This includes the ligaments, the joint capsule and (in the knee) the meniscus. The muscles in and around the joint may become weaker, too.

Inflammation plays an important role in both osteoarthritis and rheumatoid arthritis. The difference: Although inflammation contributes to the development of osteoarthritis, it is not the cause of the disease. But it is the cause of rheumatoid arthritis.

Various factors can increase the risk of developing osteoporosis or cause it to develop. These include:

• Joint injuries: Knee osteoarthritis is commonly caused by an injury such as a torn anterior cruciate ligament or torn meniscus, or by a bone fracture in the area of the joint. Injuries like these cause a lot of inflammation. In the long term, they can change the mechanics of the joint. When osteoarthritis is caused by an injury, it is known as post-traumatic osteoarthritis.
• Obesity: Being very overweight puts a strain on weight-bearing joints such as the knees and hips. Having too much body fat also releases chemical messengers that promote inflammation in the joint, increasing the risk of joint damage. For this reason, obese people aren't only more likely to have osteoarthritis in their weight-bearing joints, but also in their finger joints.
• Anatomical factors: For example, one-sided strain on the joint due to things like bowlegs, knock-knees, or too little space between the top of the thigh bone and the hip socket (hip impingement).
• Hard physical labor: Certain work-related activities can be too much for joints over the long term. These include activities where you need to kneel a lot or carry heavy loads, or where the joints take a lot of knocks – like when working with a jackhammer.

There is some evidence that people may be more likely to develop osteoarthritis because of their genes (if it runs in their family) or because they have weak muscles, particularly in the thigh area.

The risk of osteoarthritis is also greater if you don't exercise enough. This is because when you move, waste products are squeezed out of the cartilage and nutrients are absorbed into it.

Osteoarthritis is one of the most common joint diseases. A large German study found that 2% of adults had been treated for hip osteoarthritis, 4% for knee osteoarthritis and 2% for finger osteoarthritis in the last 12 months.

Osteoarthritis usually occurs in people over the age of 40. The likelihood of developing osteoarthritis then increases steadily until the end of life. This is because the metabolism in the joint changes as we grow older and the cartilage becomes thinner, which makes the joint more vulnerable. Risk factors such as joint injuries and being overweight are also more common in older age.

It is not possible to predict how osteoarthritis will develop over time. This depends on things like what caused the disease, the risk factors you have, and also the age at which it began.

Sometimes people with osteoarthritis do not have any symptoms for a long time. The disease often progresses slowly over time, with phases of worse and better symptoms. Many people cope well with that for years. But in some people the symptoms get worse quickly. And in others the symptoms stay the same after a certain point or even get better.

Osteoarthritis can usually be diagnosed based on the typical symptoms and an examination of the joint. The doctor will ask you about your symptoms and examine the joint with their hands.

If there is any doubt, an x-ray can be done. If typical changes can be seen on the x-ray image – such as a very narrow joint space – it is very likely that you have osteoarthritis.

But x-rays and other kinds of imaging scans aren't enough to make a diagnosis: In some people, the joint has changed a lot but they have hardly any symptoms – in others, the joint looks healthy but they have severe symptoms. So the treatment should be based on your symptoms and individual situation, and not what can be seen in scans.

Sometimes the symptoms are less typical or doctors need to rule out other diseases such as rheumatoid arthritis or gout. Then they may do blood tests, an MRI ( magnetic resonance imaging) scan or an ultrasound scan. Images of the joint are also needed when planning an operation.

There is currently no cure for osteoarthritis, but the symptoms can be relieved. The most suitable choice of treatment will also depend on which joint is affected. The possible treatment options include:

• Exercise: Staying active and doing exercises for the affected joint are among the most important things people with osteoarthritis can do. Movement is necessary to ensure that the joint cartilage gets enough nutrients. Movement and targeted exercises can also strengthen the ligaments and muscles that stabilize the joint.
• Weight loss: People who are very overweight are advised to lose weight, particularly if they have osteoarthritis of the knee or hip. This reduces the load on the joints and prevents inflammation caused by too much body fat. To make a real difference, you have to lose at least 5% (more like 10%) of your body weight. A change in diet is usually recommended, together with regular exercise.
• Anti-inflammatory painkillers: Medication such as ibuprofen can relieve osteoarthritis pain effectively. To reduce the risk of side effects, it is best to use them only as needed and in the lowest effective dose. Sometimes you can use a pain relief gel instead. These gels are applied directly to the joint and have fewer side effects.
• Occupational therapy: If you have osteoarthritis of the finger or wrist joints, occupational therapy can help you learn how to avoid troublesome movements or how to do them in a way that is gentle on the joints.
• Medical aids: These can reduce the load on joints and make everyday life easier. Examples include walking sticks (if your knees or hips are affected) or special products that help you to grip drinking glasses or open bottles (if your fingers are affected). If you have knee or hip osteoarthritis, you can also try out well-fitting shoes with a thicker and firm sole that supports the arch of the foot.
• Steroid injections: These injections can relieve the symptoms for a few weeks. But repeated injections can weaken the joint cartilage.
• Joint replacement surgery: Especially in advanced knee or hip osteoarthritis, the affected parts of the joints can be fully or partially replaced with an artificial joint (endoprosthesis). This can usually relieve the symptoms very effectively. But surgery is also associated with risks.

Many treatments have not been proven to help in osteoarthritis. These include arthroscopy (keyhole surgery), herbal products, dietary supplements, hyaluronic acid injections, therapeutic ultrasound and transcutaneous electrical nerve stimulation (TENS). There is also not enough research on the effect of certain diets in osteoarthritis.

Because the pain can be very distressing, osteoarthritis has become a lucrative market for suppliers of dubious products such as dietary supplements. Advertising is not always recognizable as such and often makes pseudo-scientific claims without using good scientific studies. You will find independent information on certain products and individualized healthcare services (IGeL services) in Germany on the websites of consumer organizations, medizin-transparent.at and IGeL-Monitor, among others.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.