[Osteoarthritis: epidemiology, pathophysiology, and conservative treatment options]

Osteoarthritis is the most common degenerative joint disease worldwide and one of the leading causes of morbidity and reduced quality of life in older adults. In Germany, approximately 17.9% of adults are affected, including 21.8% of women and 13.9% of men. In individuals over 65 years of age, up to 48% of women and 31% of men are affected, with direct annual costs exceeding 12 billion euros in 2020. The pathophysiology is multifactorial and is driven by the interplay of cellular senescence, inflammatory cascade reactions, biomechanical factors, and metabolic dysregulation. Modifiable risk factors such as overweight, previous joint injuries, and physical inactivity account for roughly half of all incident cases of knee osteoarthritis. Evidence-based management prioritizes intensive (active) exercise therapy, weight management, and targeted analgesic strategies, with topical NSAIDs as the first-line option. Emerging biological approaches, including mesenchymal stem cell therapy, platelet-rich plasma (PRP), and disease-modifying osteoarthritis drugs (DMOADs), show promising potential but still require further clinical validation.