Osteoarthrosis: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 5, 2023

Osteoarthrosis is a degenerative and chronic disease that affects the slow process of erosion and thinning of the articular cartilage, causing anatomical alterations also to the surrounding tissues and muscles, with negative effects on the patient’s normal joint movement

According to scientific literature, those most affected by osteoarthritis are over 70 years old, due to the physiological ageing process affecting muscles and bones.

It is becoming less and less rare, however, that the diagnosis is also made in patients in the 40 to 50 age bracket

The sex most affected seems to be women, for reasons related to the menopause and the resulting hormonal changes.

Among young people, the disease mainly affects boys, as they are more prone to work and/or sports-related strain and trauma.

Articular cartilage is a very important tissue for our organism

Hard, but extremely elastic, it covers the bones and has the task of acting as a protective cushion for them.

A sort of ‘shock absorber’ against the friction, impacts and rubbing to which the bones are constantly subjected during movement.

The normal cartilaginous resistance can in fact be put at risk by continuous strain, incorrect posture and a whole series of conditions that lead it towards a slow erosion: this is the origin of osteoarthritis.

The joints most affected by osteoarthrosis are those that bear the brunt of body weight, i.e. mainly the hips, knees, cervical and lumbar vertebrae, but also the small joints of the hands and feet.

Osteoarthrosis, what is it?

Cartilage plays a very important role, due to its ability to cushion the micro-traumas and stresses to which joints are repeatedly subjected.

However, with advancing age, the cartilage progressively thins and does not regenerate, leaving the joint surfaces lacking the ability to slide and move that they have in a younger individual.

Therefore, we can define cartilage as a fundamental tissue, as it protects bones over time.

When a bone is subjected to trauma or strain, the body, in an attempt to repair damaged cartilage tissue, stimulates the production of chondrocytes (cartilage cells).

This regeneration process, however, can also occur abnormally in the bone tissue located underneath the cartilage, known as the subchondral bone, generating beaks of bone tissue called osteophytes, which, when they touch each other or compress adjacent nerve structures, can be responsible for the appearance of pain and tingling.

Osteoarthrosis can also frequently affect the spinal column: in this case, the most typical symptom is lumbago.

In the individual diagnosed with osteoarthrosis, all the components of the joints (bone, joint capsule and synovial tissue, tendons, ligaments and cartilage) tend to fail, altering normal stability and, in the case of lower limb joints, walking.

It is important not to underestimate the painful symptoms that are a sign of osteoarthritis and to visit your doctor immediately even when the symptoms are mild.

If detected in time, the progression of osteoarthrosis can be slowed down, avoiding its complications and the need for surgery as much as possible.

Osteoarthrosis: the causes

The main causes recognised to date are undoubtedly old age and having done heavy work or intense sports activities for a prolonged period of time.

Additional risk factors have been described that may lead some individuals to be more prone to osteoarthritis.

Let’s see which ones:

High body weight: an overweight or obese person subjects his or her bones and cartilage to greater strain and friction, which can lead to the development of arthrosis even at a young age. As a result, the joints most affected are those of the hips, knees and feet, due to the body load they are subjected to even for everyday movements.
Heredity and genetics: Individuals with parents suffering from osteoarthritis are more likely to develop it.
Fractures, deep joint injuries, and previous surgery are all risk factors as they can alter the normal anatomy of the joint.
Alterations of the knee muscles or ligamentous hyperlaxity are conditions that favour progressive joint deformity.
Osteoarthrosis caused by the continuous maintenance of forced positions and incorrect posture.
Gender: as already mentioned, osteoarthrosis mainly affects women, which is why a hormonal factor is thought to be involved. However, men are more affected at a younger age due to the high physical exertion caused by work or sporting activity.

Osteoarthrosis classification

Primary osteoarthrosis or idiopathic osteoarthrosis (the one discussed so far, the causes of which are not exactly known, but only risk factors for its development) is characterised by generally small, single and often repeated injuries or trauma due to abnormal and abrupt movements that the subject involuntarily makes.

It may affect one or more joints

Osteoarthrosis, on the other hand, is called secondary when it develops as a consequence, generally late, of another joint pathology: in most cases osteoarthrosis is secondary to a bone infection (osteomyelitis) or joint infection (septic arthritis) or to a congenital or acquired bone/joint abnormality (developmental defects, osteomalacia, rickets, inflammatory arthritis).
A pathological state of ligamentous hyperlaxity can also be a cause of osteoarthrosis, as it generates an anatomical condition in which the joints do not move as they should in their natural location.

Symptoms of Osteoarthrosis

Although osteoarthrosis is quite painful and disabling in its more advanced stages, it is almost totally asymptomatic at the beginning, making early diagnosis difficult, with patients realising the condition when it is well advanced.

Although the onset of the disease is therefore not associated with specific symptoms, it is good to list some complaints that, if felt, can act as alarm bells and convince the patient to visit his or her doctor or rheumatologist for a clinical test.

Let us look at them below:

Pain and swelling of the joints, especially at the end of intense exertion due, for example, to prolonged sports practice.
Joint stiffness after resting (in the morning as soon as you wake up or after sitting/lying for a long time). A fairly subtle symptom that tends to disappear completely as soon as the affected joint is moved.
Creaking and jerking of joints when performing certain movements.
Joints that give way without apparent cause when performing certain movements.
When osteoarthritis affects the cervical spine, one may experience accompanying symptoms such as dizziness, headache, pain and tingling in the neck, shoulders and arms. Lumbar arthrosis, on the other hand, may be associated with pain and problems in the sciatic nerve.
Loss of sensation and joint function, with marked functional limitation (extension or flexion deficit)
In the early stages of the disease, joint pain may be frequent at some times and disappear completely at others.

However, if the patient has reached an advanced stage of osteoarthritis, the cartilage will have almost completely disappeared and the symptoms tend to be more intense and constant.

Joint deformity and stiffness are felt, with frequent episodes of even intense pain and swelling.

The clinical course of the pathology can be very variable

As a rule, osteoarthrosis is a disease that can remain stable for years, but can also progress rapidly and suddenly.

For this reason, when faced with the first signs, it is always a good idea to seek immediate consultation.

Diagnosis of osteoarthritis: how does it happen?

The diagnostic process for osteoarthrosis initially involves a careful anamnestic collection and an objective test during a medical examination, in which the patient’s medical history, symptoms and the most obvious manifestations that can be traced back to the disease are carefully investigated.

The doctor who deals with it is usually a rheumatologist, since arthrosis is one of the bone and rheumatic diseases.

Afterwards, the specialist may decide to subject the patient to some haematochemical tests (mainly aimed at assessing the presence of systemic inflammation) or may require further investigations with imaging techniques such as radiography, MRI, bone scintigraphy and arthroscopy.

The latter, although more invasive, provides the best information on the size of the cartilage erosion, but is rarely used in clinical practice, as it can be fraught with complications.

Obviously, a diagnosis cannot be made based solely on the pain felt, firstly because the pain threshold varies greatly depending on the patient being tested (it is subjective), and secondly because there may be small lesions that are very painful and, conversely, large tissue degeneration that is not particularly bothersome.

This is why imaging techniques are a valuable ally in defining the damage and the extent of the pathology.

Among the techniques that can be used, magnetic resonance imaging remains the favourite among rheumatologists because, unlike X-rays, it is able to show even the early stages of the disorder.

Performing diagnostic investigations is very important because it makes it possible to rule out other types of joint disease other than arthrosis.

Remember that, to avoid complications, it is a good idea to visit your doctor for an objective test as soon as you notice reddened, painful, swollen joints or friction creaks.

Osteoarthrosis: Treatment and Prevention

Unfortunately, to date, osteoarthrosis remains a chronic condition.

However, although there is still no cure-all therapy, some treatments with proven effectiveness can act directly on pain and the maintenance of joint mobility and flexibility, thus making life easier for the patient being tested.

So-called ‘pain therapy’ comprises a series of treatments that, combined with the administration of certain drugs, act on reducing pain.

This is the first step towards delaying surgery for the implantation of artificial prostheses to replace the joint affected by arthrosis as much as possible.

Here is a short list of the most commonly used treatments and medications

Administration of analgesics (paracetamol) and NSAIDs (ibuprofen). These drugs have a good pain-relieving function, allowing the patient to recover the functions that intense pain takes away. They can be taken orally, but the use of ointments and creams to be applied near the affected joint (topical application) is becoming increasingly popular.
Local infiltrative treatments with hyaluronic acid or cortisone. These are widely used when joints suddenly become inflamed, causing pain and swelling.
Excess joint fluid is removed from the joint using an aspiration needle (a procedure known as arthrocentesis) and the drug that provides temporary relief is injected. These injections can reduce pain, but do not stop the progression of the disease (it is therefore only symptomatic therapy).
Tissue engineering treatments. These are recent mini-invasive treatments involving the harvesting of cartilage cells (chondrocytes) from other areas of the body. We are talking about therapies still in the experimental phase and reserved for certain types of patients (young, with few joint lesions, and with cartilage and surrounding bones in good condition).
Thermotherapy. Hot or cold compresses that act on the joints, temporarily relieving pain.
Electrostimulation and acupuncture techniques. These are natural painkillers, because they stimulate an appropriate area of the brain that acts against pain. The same goes for massage and ultrasound.

If these non-invasive treatments do not bring the desired results – and the pain, swelling and lack of mobility persist – the orthopaedist may decide to perform an arthroplasty with an artificial implant (usually made of titanium) of the damaged joint.

This implant may be total, if the entire joint is replaced, or partial if only certain areas of the joint are modified.

Surgery improves the quality of movement and stops the pain, but must be seen as a last resort when the pain becomes unmanageable and walking suffers.

It is important to be aware that even the artificial joint does not last indefinitely (about 20 years); for this reason, there is a tendency to delay surgery in young people, because otherwise there is a risk of having to replace the prosthesis several times during the patient’s life span.

Preventing the worsening of osteoarthritis, in young people as well as in adulthood, is possible by adopting a healthy lifestyle

It is important not to lead too sedentary a life. Joints need to be kept moving.

If you suffer from osteoarthritis, however, it is recommended that you avoid all sports with a high impact and load on the joints, such as weight training, but also running, jumping and athletic activities.

Prefer low-impact, but all-round sports such as swimming and cycling, which also help strengthen the muscles and ligaments around the different joint areas.

Keeping muscles healthy means not forgetting a fair amount of daily stretching, which of course should only be done after an adequate aerobic warm-up.

If you are overweight or obese, it is important to change your eating habits.

Together with constant exercise, a correct diet allows you to lose weight and thus reduce the weight on your joints.

For everyone, it is essential to use the joints properly.

No to the maintenance of forced and incorrect postures.

In all cases, the treating physician may decide to recommend courses in postural gymnastics, physiotherapy or osteopathy to the patient to improve bone misalignment and posture.

Wearing orthotics also helps to maintain a correct posture while walking.

Where osteoarthritis is advanced, the use of crutches and other supplements is recommended to reduce stress on the knees and hips.

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