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Johann Wolfgang von Goethe

    Joint pain – something CAN be done Osteoarthritis can strike anyone Causes of osteoarthritis The amazing knee joint

    Joint pain – something CAN be done

    In every day life, being independent and active as we grow older is an ideal that most of us strive for. Joint pain and back pain interfere with our ability to go about our daily activities and to participate in sports and other recreational and professional activities. Many sports, such as jogging, golf or skiing, put a great deal of stress on the joints. It is therefore extremely important that our joints continue to function smoothly and without pain into advanced age. Mobility is a major determinant of our quality of life. Joint problems are frequently caused by the degeneration of cartilage. As the cartilage breaks down, pain and restricted mobility ensue. Osteoarthritis, one of the most widespread causes of pain and disability in the Western world, has set in. As common as degenerative joint disease is, little is known about the underlying causes. Conventional treatment, in a nutshell, has been limited to reducing the pain for as long as possible. Finally, when pain control is no longer effective, the damaged joint is surgically replaced with an artificial one. Is it possible to influence the disease mechanisms that cause osteoarthritis? What can be done to slow or even stop the degenerative processes altogether? These are the problems Molecular Orthopedics is concerned with. The goal of this discipline is to decode the language of the cells, to better understand diseases of the musculoskeletal system and to develop new treatment approaches based on knowledge of the biological causes underlying them.

    Osteoarthritis can strike anyone

    Osteoarthritis is part of the natural aging process that affects us all, as it is normal for the cartilage in the joints to break down over time. Osteoarthritis often develops very slowly over many years, and only ­becomes painfully debilitating when damage to the joint has already occurred. Osteoarthritis can affect any of the body’s joints, ­particularly the knee, hip and hand joints, as well as the joints of the spine. Up to 10% of the population in the developed countries suffer from osteoarthritis, with the knee being the most frequently affected joint. In recent studies, ten percent of people over the age of 55 reported pain and stiffness in their knees, and had x-rays which showed signs of degeneration of the knee joint. Osteoarthritis of the knee and hip joints are among the top ten complaints diagnosed by orthopedists. They are among the 30 most frequent disorders for which hospitalization is required. In 2004, more than seven billion euros were spent in Germany alone for the treatment of osteoarthritis. ­Degenerative joint and spine disease also accounts for a considerable portion of all cases of disability, early retirement and rehabilitation, and as such is one of the greatest contributors to lost productivity out of all chronic diseases.

    Causes of osteoarthritis

    Osteoarthritis can be triggered by a variety of factors such as excessive stress on joints due to over-use, poor posture, muscu​loskeletal misalignment or sports injuries. It affects mainly older people or people whose work involves hard physical labor or repetitive actions, as well as athletes and people who are overweight. In the case of athletes, wear and tear on the joints is caused by pushing the body to its limits repeatedly; in the case of obese people, it is caused carrying by excess weight. ­Deformations such as bowlegs and knock-knees can also lead to chronic strain, which in turn leads to joint degeneration. Furthermore, as we age, the layer of cartilage that cushions the joint generally loses water and elasticity. Along with these mechanical processes, inflammation also plays a role. Pieces of cartilage may break off and float around in the joint, irritating the synovial membrane that forms the inner lining of the joint capsule. This causes the joint to become inflamed and swell up. This is sometimes referred to as “inflammatory arthritis.” The inflammatory changes to the synovial ­membrane prevent nutrients from entering the cartilage, thereby further ­accelerating the disease process. Thus, there are risk factors that may ­contribute to osteoarthritis. In the early ­stages at least, osteoarthritis is in many cases a natural result of the body’s aging process. But since not everyone ages in the same way, onset and severity of the condition vary widely from one person to another.

    At a glance

    • Osteoarthritis is a chronic illness of the joints

    • It can affect any joint in the body

    • The knee is particularly susceptible to osteoarthritis

    • Damage tends to begin within the articular cartilage

    • Cartilage: a tissue without blood vessels

    The amazing knee joint

    Although we are not consciously aware of it, our knee joints move thousands of times a day, absorbing abrupt shocks and sudden turns, carrying our body weight and ­keeping us stable. Given the multi‑ directional stresses and strains to which they are subjected, it is hardly surprising that the knees are more likely to be injured or wear out than any other joint in the body. So it makes sense to take a closer look at this hardworking joint.

    The largest joint in the body:

    The knee joint works like a hinge: it can bend (flex) and straighten (extend), and it also rotates slightly to allow the lower leg to turn in or out. The joint is formed by the ends of the femur (thigh bone) and the tibia (shin bone). The bone ends are covered by a layer of elastic cartilage (articular ­cartilage) that acts both as a bearing, allowing the bones to slide freely on one another, and as a shock absorber. The ends of the bones and the cartilage are enclosed by an articular capsule. The inner layer of the capsule, the synovial ­membrane, contains many nerves and blood vessels. It produces a fluid (synovial fluid) that lubricates the joint and nourishes the cartilage. Four ligaments connect the bones of the knee and provide stability to the joint:

    Collateral ligaments

    The medial and lateral collateral ligaments, located on the inner and outer sides of the joint, provide lateral stability when the knee is extended.

    Cruciate ligaments

    The anterior and posterior cruciate ligaments cross in the center of the knee and limit the joint’s rotational or twisting motions.

    Medial and lateral meniscus

    The meniscus, or meniscal cartilage, consists of two crescent-shaped cartilage discs, the medial (inner) and lateral (outer) menisci, that provide improved contact and cushioning between the ends of the femur and tibia bones. Most importantly, they distribute the weight of the body over a larger surface area and thus reduce the pressure on the articular cartilage. In a healthy knee, as much as 50 percent of the load on the joint is transferred to the menisci, thus reducing the pressure on the articular cartilage by half.

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