Arthrosis (osteoarthritis) is a non-inflammatory joint disease that causes cartilage degeneration and joint surface defects. This is the most common connective tissue disease. Its incidence among joint diseases accounts for 70%. It is believed that 20% of the world's population is diagnosed with arthrosis of varying severity.
The prevalence of the disease among people over the age of 50 reaches 50%. In people after the age of 70, the occurrence of arthrosis exceeds 80%.
Causes of arthrosis
There are two causes of the development of arthrosis. The first is an excessive functional load on the joint, while the second one is a reduction of resistance to a normal load on the joint, as a result of which it becomes conditionally excessive. Consequently, a degeneration of articular cartilage develops.
Risk factors for arthrosis:
- Age of over 50 years old
- Strenuous physical labour
- Accompanying joint pathologies
Depending on the cause of the disease, arthrosis can be primary (idiopathic) or secondary.
- Primary arthrosis occurs in the most clinical cases of this pathology. It is characterised by the lack of a causal link between the degeneration of the articular cartilage and external or internal factors that have caused the pathological process.
- Secondary arthrosis is diagnosed in case of such an obvious link. It can be a systemic disease of the connective tissue, trauma, the outcome of an acute inflammatory process, endocrine diseases.
Symptoms of arthrosis
Arthrosis usually begins with the lesion of a single joint. The main clinical symptom is pain. Arthrosis is characterised by several types of pain syndrome. Most patients experience mechanical pain. It occurs upon the carrying of loads and disappears or subsides at rest. Pain also often intensifies during the day and subsides after rest.
- Swelling of the joint
- Joint stiffness
- Development of muscle contractures
- Cracking in the joint while walking
- Occurrence of subluxations
- Crawling and burning sensations
- Deformation of joints
- Atrophy of the adjacent muscles
The disease has the following clinical signs, which depend on the location of the pathological process:
- Hip osteoarthritis (coxarthrosis). The condition accounts for 25% of all its cases. The most severe form of arthrosis often develops against arthritis. Menopause can be a trigger factor in females. The pain is initially mild but eventually progresses. Movement disorders develop quite quickly. As a result, a person develops a waddling gait.
- Knee osteoarthritis (gonarthrosis). It has a more favourable clinical course than coxarthrosis. The main symptom is pain, which is usually felt on the inside of the joint. Over time, the patient develops reduced mobility. Initially only bending is limited and later knee straightening becomes restricted as well. In 40% of patients the joint is deformed and increased in volume. An atrophy of the muscles of the thigh and lower leg can develop.
- Osteoarthritis of distal interphalangeal joints. It accounts for about 20% of cases of arthrosis. This condition has another name - Heberden's nodes. It usually develops in postmenopausal women. In the course of this form of disease, deformity of the joints often occurs earlier, before the pain manifests itself. The passive movements show lateral hypermobility of the distal interphalangeal joints.
- Osteoarthritis of proximal interphalangeal joints. Another name of the condition is Bouchard's nodes. In 50% of the cases it is combined with Heberden's nodes. The pain syndrome is usually absent or mild. The fingers become spindle-shaped, which is associated with the formation of nodules on the lateral surfaces of the proximal interphalangeal joints.
- Elbow osteoarthritis. The condition is rare. The joint mobility is severely limited due to the bone growth around the joint surface of the ulna.
- Shoulder osteoarthritis. It is a rare disease. It develops after a fracture of the head of the humerus or as a result of chondrocalcinosis. The main symptom is painful shoulder abduction. There is no deformity of the shoulder joint. The condition is characterised by the muscle atrophy of the shoulder girdle in the pathological process. As the disease progresses, the shoulder abduction becomes limited.
- Ankle Arthritis. The condition develops due to the trauma. The primary form of arthrosis of this location practically does not occur. The disease progresses rapidly, causing a sudden disorder of joint mobility and disability of the patient.
- Osteoarthritis of intervertebral joints. The condition is also called facet syndrome. It is manifested by pain and a slowly progressing limitation of the mobility of the spine. While performing either active or passive movements, one can hear crunching in the affected joints. In the mornings a person can feel stiffness but during the day it subsides.
Diagnosis of arthrosis
The diagnosis is based on x-ray. Criteria for osteoarthritis diagnosis:
- Osteophytes (marginal bone growths)
- Narrowing of the joint space
- Increased bone density (subchondral sclerosis)
The subsidiary criteria of diagnosis include subluxations, erosion and cysts in the areas of the greatest mechanical loads.
Based on radiographic findings, arthrosis can have the following stages:
- Stage 1 - doubtful signs
- Stage 2 – very few osteophytes, minimal narrowing of the joint space
- Stage 3 - multiple osteophytes, a pronounced narrowing of the joint space
- Stage 4 - multiple coarse osteophytes and there is almost no joint space
Such diagnostic methods as MRI, CT, bone scan and arthroscopy are more accurate but not always available in poorly equipped hospitals. German medical institutions carry out all these diagnostic measures, if necessary, and therefore it is possible to accurately determine the stage of arthrosis and to choose an effective treatment.
Treatment of arthrosis abroad
A patient with osteoarthritis needs comprehensive and continuous treatment. It includes not only therapeutic measures carried out within the medical institution, but also a drastic improvement in lifestyle.
The main goals of the treatment:
- Delayed development of arthrosis
- Elimination or reduction of symptoms
- Restoration or maintenance of working ability
- Restoration of the joint surface using surgical techniques
- Physical therapy
- Unloading joints
- Compliance with orthopaedic treatment
- Physiotherapeutic procedures (the best analgesic effect is achieved through the ultrasound action on the joint)
- Spa treatment
The following drugs are used to relieve symptoms and improve a functional state of the joint:
- Hyaluronic acid for intra-articular administration
European hospitals widely use various procedures and medical manipulations that makes its possible to achieve a long-term improvement in the patient's condition and delayed progression of the disease.
- Laser therapy
- Intraosseous blockades
- Decompression of the epiphyseal cartilage
- Multichannel electrostimulation
The further development of arthrosis may require surgery. Most patients undergo joint replacement. The surgery involves the replacement of patient’s own joint with an artificial prosthesis.
Arthrosis - Prognosis
A natural course of the disease has an unfavourable prognosis. Despite the progressive radiographic signs of arthrosis, some patients have a stable joint for many years. Nevertheless, the condition eventually causes a complete destruction of the articular cartilage, which is accompanied with the development of ankylosis (complete immobility of the joint) or neoarthrosis (unnatural mobility).
German hospitals offer highly effective and timeous treatment of osteoarthritis, which can significantly improve the outcome of the disease. The use of conservative and surgical treatments can restore a patient’s working ability at any stage of the pathological process.
The treatment of arthrosis is provided in the following hospitals:
- St. Louise Hospital. There is a department staffed by physicians, who focus solely on the restoration of the bones, cartilages, joints of the patients with arthrosis or sports injury.
- Hospital Neuwerk “Maria von den Aposteln”. The Department of Orthopaedics uses conservative and surgical techniques to treat joint diseases. The use of minimally invasive surgery (arthroscopy) is very common here.
- Waldbrol District Hospital of the Klinikum Oberberg. The latest innovative techniques for articular cartilage restoration are implemented here.
Germany has many reputable hospitals specialising in the treatment of arthrosis. To choose the most suitable one, feel free to use our online platform Booking Health. If you cannot find a suitable medical institution on your own, send us a request for a hospital search. Our service manager will gladly select the hospital within a few hours and get back to you.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova