What Is Osteoarthritis?

What it is

The smooth, elastic tissue covering the ends of the bones inside a joint is called cartilage. It spreads the load and keeps friction to a minimum during movement. The condition that arises when this tissue thins over time, together with the changes that accompany it across the whole joint, is called osteoarthritis.

The everyday word "wear" is misleading. What happens is not simply erosion: as the cartilage thins, new bony outgrowths (osteophytes) form at the edges of the bone. Osteoarthritis is defined today not as a problem of cartilage alone but as a joint disease that involves the bone, the joint lining, the ligaments and the surrounding muscles as well. It most often affects the knees, hips, finger joints and spine.

Why it happens

Osteoarthritis cannot be traced to a single cause; it appears when the balance between the load placed on a joint and that joint's capacity to carry it is disturbed. The strongest factor is age: the repair capacity of cartilage falls over the years. Knee and hand osteoarthritis are more common in women, particularly after the menopause.

Among the factors that can be changed, excess weight comes first. It increases the mechanical load on the knee and hip, and because fatty tissue is linked with inflammatory processes in the body, its effect is not purely mechanical. Previous joint injuries (meniscus and ligament injuries, fractures extending into the joint), repetitive occupational loads such as years of heavy lifting or kneeling, loss of muscle strength and deformities of joint alignment also raise the risk.

Inheritance plays a clear part in osteoarthritis of the finger joints; people whose relatives have similar joint changes may develop them earlier. Certain joint diseases and metabolic conditions can also lead to secondary osteoarthritis. Distinguishing the source of the complaints therefore requires medical assessment.

Symptoms

The most typical complaint is pain that increases with movement and eases with rest. At first it is felt only on stairs, after a long walk or when squatting and standing up; over time it may appear with shorter activities as well. Pain that fluctuates through the day and may increase with changes in the weather is a frequently reported observation.

The second common complaint is stiffness. Moving the joint is difficult on getting up in the morning or after sitting still for a while; this feeling usually lasts less than half an hour and eases with movement. Grating or crackling sounds on moving the joint (crepitus), a reduced range of movement, tenderness on touch and occasional swelling may also occur. Firm bony thickenings can develop at the end joints of the fingers.

One point matters for telling conditions apart: in inflammatory rheumatic diseases, morning stiffness usually lasts longer than an hour, several joints are involved in a largely symmetrical pattern, and general symptoms such as fever and fatigue may accompany it. In osteoarthritis the stiffness is short and the complaint is limited to the affected joint. Because this distinction changes the whole approach to treatment, self-diagnosis is not appropriate.

When to see a doctor

Do not delay seeking care in the following situations: a joint that is red, hot and swollen, especially with fever (joint infection is an emergency); inability to bear weight or a visible deformity after a fall or blow; joint pain that does not settle at rest during the night; sudden and marked swelling; unexplained weight loss or night sweats alongside the joint complaints; symmetrical swelling of several joints together with long-lasting morning stiffness.

Even when the situation is not urgent, medical assessment is advised for joint pain that restricts daily activities, breaks sleep or increases over a few weeks. Treating the complaint as "a natural part of getting older" and postponing it leads to loss of muscle strength and avoidance of movement, which can make the complaints more pronounced over time.

Assessment and diagnosis

Assessment begins with history and examination. Which movements increase the pain, how long the stiffness lasts, which joints are involved, previous injuries and other medicines being taken are all reviewed. The examination covers range of movement, tenderness, swelling, the strength of the surrounding muscles and the way the person walks.

An X-ray, where it is needed, may show narrowing of the joint space, outgrowths at the bone edges and increased bone density. A common misunderstanding arises here: the degree of change on the image is not always proportional to the severity of the pain. A joint with advanced changes may cause few complaints, while mild changes may accompany marked pain. Decisions are therefore based on the person's complaints and function rather than on the image.

Blood tests are not used to diagnose osteoarthritis but to rule out other causes such as inflammatory rheumatic disease. Magnetic resonance imaging is not a routine investigation; it is used when the physician considers it appropriate for a specific question. The treatment plan is set individually according to the severity of the complaints, the function of the affected joint, age and accompanying conditions; there is no single option that suits everyone.

Follow-up and daily life

For people under medical follow-up, general adjustments to daily life help in managing the complaints. Regular movement comes first: work that strengthens the muscles around the joint, and activities that place little load on it such as walking, cycling and exercise in water, suit most people. Inactivity reduces muscle strength and is linked with worsening complaints; an exercise programme is tailored to the individual by a physician or physiotherapist.

In people carrying excess weight, weight management is the strongest modifiable factor linked with the course of knee and hip complaints. Alongside it, well-cushioned footwear, walking aids such as a stick where needed, adjustments at home such as higher seating and grab rails, warm or cold applications during painful periods, and avoiding prolonged squatting, kneeling and heavy lifting all make daily life easier.

Medicines used for pain are chosen by the physician with the person's kidney, stomach and cardiovascular status in mind. Taking over-the-counter painkillers for long periods on your own initiative may carry risks, particularly for those with kidney disease, high blood pressure or a problem related to blood potassium levels; consult your pharmacist before use. Do not stop the follow-up your physician has planned on your own decision because the complaints have eased.

This page is intended as general health information; for diagnosis and treatment consult your physician, and for questions about medicines consult your pharmacist.

Frequently asked questions

Is osteoarthritis the same as rheumatism?

No. Osteoarthritis is more closely related to load, is limited to the affected joint and causes short-lasting morning stiffness. In inflammatory rheumatic diseases the stiffness usually lasts longer than an hour and several joints are involved symmetrically; the distinction is made by a physician.

Which is the best painkiller for osteoarthritis?

There is no single option that suits everyone. The appropriate approach depends on the severity of the complaints, the joint involved, age and kidney, stomach and cardiovascular status; treatment is decided by a physician, and you can consult your pharmacist about the use of medicines.

Does worn cartilage grow back?

The capacity of cartilage to renew itself in adults is limited. Pain and function, on the other hand, can change over time with muscle strength and adjustments to daily life; the follow-up plan is set by a physician.

Does exercise wear the joint out further?

Regular activity that does not strain the joint is generally recommended; inactivity reduces muscle strength and is linked with worsening complaints. Which exercises are suitable, and which movements to avoid, is decided individually.

Does losing weight affect joint complaints?

In people carrying excess weight, reducing the load on the knee and hip is one of the strongest modifiable factors linked with the course of the complaints. The target and the method should be set together with your physician.

Does a finding on X-ray mean surgery will be needed?

No. The degree of change on the image is not always proportional to the severity of the complaints; decisions are based on the person's pain and daily function rather than on the image.

Aymed İlaç Sanayi manufactures authorised medicinal products in urology and nephrology. This page does not provide diagnosis or treatment advice; it is intended as general health information.