Osteoarthritis

Osteoarthritis is a joint condition characterized by the deterioration of cartilage in both quality and thickness. The term "wear and tear" is often incorrectly used, as it implies that movement is harmful to the joint, which is not the case.

What is osteoarthritis?

The parts of the bones that together form a joint are covered with cartilage. Together with joint fluid, called synovial fluid, cartilage ensures that the bone pieces slide smoothly over each other. In osteoarthritis, this layer of cartilage deteriorates in quality and thickness. This means the joint no longer functions properly. Examples include osteoarthritis of the knee, hip, shoulder, and hand.

In addition to the deterioration of cartilage, other changes occur around the joint. The bone at the joint edges becomes deformed, forming 'bony outgrowths' called osteophytes, which cause the joint to broaden and movement to become more difficult.

The bone tissue under the cartilage also changes in structure, becoming denser and harder. This is called sclerosis. Osteoarthritis generally continues to deteriorate over time.

Cause

The exact cause of osteoarthritis is not yet known. However, several factors increase the risk of developing osteoarthritis. While it can occur in anyone, women and older people are at greater risk. Being overweight, long-term overuse or underuse of a joint, and previous joint injuries also increase the risk. Osteoarthritis is more common in certain families, suggesting a hereditary component.

Symptoms

About 10% of people over the age of 55 experience symptoms due to osteoarthritis, and this percentage increases with age.

As cartilage quality declines and disappears, symptoms may eventually arise. The most common complaints are pain and stiffness, especially noticeable in the morning or after extended periods of inactivity. This is known as 'morning and start-up stiffness,' which usually disappears or significantly reduces within half an hour. Generally, stiffness and pain decrease with movement.

There may also be crepitus, crackling sounds during joint movement. Additionally, an inflammatory reaction can cause the joint to swell and feel warmer.

Diagnosis

An X-ray is often used to assess the joint. This may reveal a narrowing of the joint space, which occurs when the cartilage layer between the bones becomes thinner or disappears completely. X-rays can also show the formation of osteophytes and joint deformities caused by osteoarthritis.

Osteoarthritis does not always cause pain or limitations. Sometimes significant osteoarthritis is visible on an X-ray, yet there are few or no symptoms. The opposite can also occur.

The degree of osteoarthritis visible on an X-ray is classified using the Kellgren-Lawrence scale, which does not indicate the severity of symptoms someone experiences:

• 0 (No osteoarthritis) = No cartilage abnormalities.
• 1 (Possible osteoarthritis) = Doubtful joint space narrowing and possible early osteophyte formation.
• 2 (Minimal osteoarthritis) = Osteophyte formation and possible joint space narrowing.
• 3 (Moderate osteoarthritis) = Multiple osteophytes, joint space narrowing, bony sclerosis, and possible bone deformity.
• 4 (Severe osteoarthritis) = Multiple large osteophytes, marked joint space narrowing, severe bony sclerosis, and bone deformity.

Treatment

There are many ways to address problems caused by osteoarthritis. The primary goals are to slow down deterioration, reduce pain, and improve joint function.

It is important to stay active, as movement helps lubricate and nourish the cartilage. Lack of movement causes joint stiffness and decreases muscle strength and fitness, leading to more complaints. Exercise therapy guided by a physiotherapist can help.

Using a crutch or cane and/or pain relief can reduce pain, making movement easier. Weight loss, if overweight, is also beneficial. Contact a physiotherapist to treat the symptoms.

If osteoarthritis causes significant symptoms and therapy is insufficient, surgery may be considered. Options include cleaning the joint, replacing a loose cartilage fragment, or stimulating the joint to repair damaged cartilage. Adjusting joint alignment to better distribute cartilage load is also possible. (Partial) joint replacement, such as a knee prosthesis, is another option.

A more drastic option is to completely fuse the joint, eliminating movement but significantly reducing pain. This is relatively common in joints of the spine or foot.