Osteoarthritis: Symptoms, Affected Joints and What Really Helps

What is osteoarthritis?

Osteoarthritis is the most common joint disease in the world. The joint cartilage, which covers the ends of the bones and acts as a shock absorber, gradually wears down. As the cartilage thins, the bones rub against each other more. The result is pain, stiffness and, over time, reduced mobility.

Unlike pure inflammation (arthritis), osteoarthritis is mainly about wear. The two can overlap, though: an irritated joint with signs of inflammation is called activated osteoarthritis. Worth knowing: many people show signs of wear on an X-ray without feeling any symptoms. Conversely, the extent on the image does not always say much about the level of pain.

Causes and risk factors

Osteoarthritis usually develops from a combination of several factors. The main ones are:

• age and the general wear over the years.
• excess weight, which puts a lot of strain on the knees and hips in particular.
• previous injuries such as a torn cruciate ligament, meniscus damage or a fracture.
• malalignment such as knock knees or bow legs.
• heavy one-sided strain through work or sport.
• a family tendency, especially with hand osteoarthritis.

Symptoms of osteoarthritis

Osteoarthritis has a typical pain pattern that sets it apart from other joint complaints:

• Start-up pain: the first steps after getting up or after sitting for a while hurt, then it eases.
• Pain on loading: pain when walking, climbing stairs or carrying.
• brief morning stiffness that usually eases within a few minutes (generally under 30 minutes).
• grinding or crunching in the joint.
• reduced mobility of the joint.

In advanced stages the pain can also occur at rest or at night. You can read more on the page Joint pain.

Self-check: Do I have osteoarthritis?

This short self-check is not a diagnosis, but it helps you gauge whether your symptoms fit osteoarthritis. The more points apply, the more likely it is.

• The first steps after getting up or after sitting for a long time hurt, then it gets better.
• My joint hurts on loading, such as climbing stairs, walking or carrying.
• In the morning the joint is briefly stiff but loosens up within a few minutes.
• I feel or hear grinding or crunching in the joint.
• The joint no longer moves as far as it used to.
• I am over 50 or had a previous joint injury or heavy strain.

Which joints are affected?

Osteoarthritis can affect almost any joint, but some particularly often. The affected joint also shapes which symptoms stand out and which treatment helps most.

The spine is also frequently affected when the small facet joints wear down. This can lead to back and neck pain.

Diagnosis: How is it determined?

The doctor usually makes the diagnosis from the typical symptoms, a physical examination and an X-ray. The X-ray shows signs such as a narrowed joint space, bony outgrowths (osteophytes) and denser bone beneath the cartilage.

An important point: the extent on the X-ray and the level of symptoms do not always match. Blood tests are not part of the osteoarthritis diagnosis itself, but they help rule out other causes such as rheumatoid arthritis or gout.

Treatment overview

Osteoarthritis cannot be cured, but it can be treated well. The goals are to relieve pain, keep mobility and slow the progression. Treatment follows a stepwise approach and always begins with the basics:

• exercise and targeted training.
• weight loss if there is excess weight.
• painkillers as needed, from gel to tablet.
• aids such as insoles, braces or walking sticks.
• only when this is not enough, surgery.

Which elements come first depends on the affected joint, the stage and your personal risks.

Medication: the steps of pain therapy

For medication, the rule is: as targeted and as low a dose as possible. Rather than reaching for a tablet straight away, it is best to go step by step.

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What does little

Some well-known remedies are often used even though their benefit in osteoarthritis is small or unproven:

• Paracetamol on its own: barely effective in osteoarthritis, at most a short-term add-on.
• Glucosamine and chondroitin: no convincing proof of effect, not recommended by guidelines.
• Opioids: only in rare exceptions and with clear risks.
• Hyaluronic acid injections: the benefit is disputed, and they are usually not recommended.

Exercise and physiotherapy

With osteoarthritis, exercise is not only allowed but one of the most effective measures of all. What matters is that it is the right kind of exercise. Blanket advice like just walk more falls short. What counts:

• strength training of the surrounding muscles stabilises the joint. With knee osteoarthritis, the thigh muscles (quadriceps) are especially important.
• gentle endurance activities such as cycling, swimming or water aerobics keep the joint moving without jarring it.
• physiotherapy helps you learn the right exercises and correct faulty loading.

The combination of exercise and weight loss is particularly effective. Just 5 to 10 percent less body weight can clearly reduce knee pain, because with every step a multiple of your body weight presses on the joint.

When nothing else helps: a joint replacement

When the conservative measures are exhausted and the pain severely limits quality of life, an artificial joint (joint replacement) can make sense, especially for the knee and hip. The operation replaces the worn joint surfaces, often clearly relieves pain and improves mobility.

A joint arthroscopy with cartilage smoothing, on the other hand, is not recommended for pure knee osteoarthritis, because it has no proven benefit.

When to see a doctor

A doctor's visit makes sense when the symptoms limit you. You do not have to wait until nothing works anymore. You should seek medical advice in the following situations:

• The pain affects your everyday life or your sleep.
• The joint gets worse despite treatment.
• You want to take painkillers for longer and need advice on this.

Stay on top of your osteoarthritis treatment with brite

Whether pain gel, tablets or injection appointments: brite helps you keep track of your medication and symptoms.

• Intake reminders: never miss your gel or tablet, every day at the right time.
• Symptom diary: track pain and mobility and see what works.
• Interaction check: see at a glance whether your medications work well together.
• Medication plan: always up to date and ready for your next appointment.

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