Osteoarthritis (Distorting osteoarthritis, folk name-Salt deposit) is a chronic disease of degenerative-dystrophic joints, in which the destruction of the articular cartilage, joint capsules and the deformation of the bone itself occurs.
It should be noted that osteoarthritis is a whole group of joint diseases which have different mechanisms and different narrow development.Most often, there is osteoarthritis of large joints:
- distorting osteoarthritis of the knee joint (gonarthrosis),
- distorting osteoarthritis of the hip joint (coksartrose),
- as well as osteoarthritis of the shoulder joint.
These are the most serious types of osteoarthritis.
The osteoarthritis of the small joints is less common.Most often, there is a distorting osteoarthritis of the interfalancing joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients note pain in the interfanals joints, a decrease in their mobility, the appearance near the seal joints (Geberden and Bushar nodules).This type of osteoarthritis is more common in old age.Often occurs osteoarthritis of the foot joints.
Polyrrose, or generalized osteoarthritis, is characterized by damage to several joints at the same time.
Osteoarthritis The joints of the spine - spondylarthrosis - belong to the group of vertebral column disease, although it has a similar development mechanism with other osteoarthritis.
The main clinical symptom of osteoarthritis is pain in the joint, a decrease in mobility.Specific symptoms are determined at the stage of osteoarthritis and depend on the degree of destructive changes in the joint.
The causes of osteoarthritis
Osteoarthritis It is customary to divide in primary and secondary.Primary (idiopathic) osteoarthritis is a consequence of a violation of recovery processes and increased degeneration in the tissue of the cartilage of the joint without any gap in the work of the whole organism.Secondary osteoarthritis occurs following other pathological processes in the body, or in the already damaged joint by any external effect, with a partial destruction of the joint surfaces.
Most often, traumatic osteoarthritis is diagnosed in young patients.And in older patients, it is far from always possible to draw a clear border between primary and secondary osteoarthritis.
Although the exact cause of osteoarthritis cannot be determined, the factors contributing to the occurrence and development are well known.
The following types of causes which contribute to the development of primary and secondary deformation osteoarthritis can be distinguished.
The causes of primary osteoarthritis are hereditary factors
The following hereditary disorders have been identified, which can cause the development of primary osteoarthritis:
- Genetic disorders in the composition of the cartilage tissue of the joint, leading to its accelerated destruction;
- Congenital defects in the musculoskeletal system (hypermobile joints, dysplasia, flat feet and others), which are the cause of the trauma of certain sections of tissue of the joint and, therefore, of the appearance of osteoarthritis.
It has also been noted that the distorting osteoarthritis of the inter-phalanx joints of the upper limbs is mainly found in women and is inherited by the female line.
The causes of secondary osteoarthritis
Secondary osteoarthritis is a consequence of joint lesions.These damage can be caused by various factors.
- Mechanical damage to joints.This group of factors includes various joint wounds, intra-articular bone fractures, following which the joint structure is disturbed.The same result is caused by constant microtraumation of the joints due to excessive constant charges, both static and dynamic (for example, in athletes).In addition, obesity leads to overload and trauma.
Another factor that has a negative effect on the joints (mainly on the hip) is an incorrect posture.
The structure of the joint can also disrupt surgery. - Joint diseases.Osteoarthritis can be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolism violations, diseases of the endocrine system, mineral deficiency in the body.Various disorders of metabolism, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage, synovial fluid, which leads to a violation of recovery processes and the progressive destruction of composition.
- Autoimmune diseases(drop, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency In postmenopause, women lead to changes in joint tissues and their progressive destruction.
- Vascular diseases . Hypodynamics They cause circulatory disturbances in periarticular tissues, a poor blood supply to the joint tissues and, therefore, dystrophic changes.
The arthritis development mechanism
Development osteoarthritis It begins with the destruction of cartilage.It is believed that at the beginning, there is a violation of the blood circulation in the capillaries of the corneal layer of the periosteum.Since the nutrition of cartilage occurs due to the supply of nutrients of intra-articular liquid and adjacent bone tissue, circulatory disturbance leads to the fact that cartilage gradually loses elasticity, becomes thinner, the cracks appear, the softness of the joint surfaces is disturbed, the amount of synovial liquid in the joint is reduced.Consequently, it appears Pain and crunch during movements.The width of the joint space gradually decreases, the bones form along the edges of the joint surfaces Osteophyte peaks.
In the end, the joint is distorted, the amplitude of the movements in it decreases.Thus develops involutionary osteoarthritis associated with the aging of the body.The development of this form of osteoarthritis is generally occurring gradually, over the years.
Other forms of osteoarthritis of large articulations, for example, post-traumatic, post-infectious, metabolic, poisoning has several other development mechanisms, but consequently, we obtain similar changes in the joint.
Symptoms of arthritis of the joints.Stages and degree of osteoarthritis
"Classical" is the classification of osteoarthritis based on clinical and radiological characteristics.In accordance with this one, three stages of the development of the disease are distinguished.It corresponds to the classification by the degree of maintaining disability, which distinguishes 3 degrees of osteoarthritis:
- I degree of osteoarthritis - The disease does not prevent work, although it complicates it,
- II degree of osteoarthritis - The disease prevents labor performance,
- III degree of osteoarthritis - Loss of work capacity.
Let's see clinical symptoms in in more detail and signs of osteoarthritis at each of these steps
1st degree osteoarthritis (initial stage of osteoarthritis)
At the initial stage of the disease in the morning, after rest, stiffness, movement of difficulty in the joints, which gradually spends some time after the start of the movement.Perhaps a restriction of mobility in the joint.Periodically, "starting" pains appear (pain at the start of the movement after a long stay at rest).With sharp movements, the joint cracks, but there is no pain during movement.Pain at this stage of osteoarthritis only appears with a significant and prolonged load, and calm down after rest.There is no pain alone and with low loads.At this stage of the disease, patients rarely see a doctor.
In the image of X -rays with osteoarthritis of the 1st degree of special changes in the joint is not visible, sometimes small osteophytes along the edges of the joint can be visible, the joint space is slightly narrowed.
2 -degree osteoarthritis (second stage of osteoarthritis)
With the subsequent development of osteoarthritis, pain becomes more important, acquires a sharp character.A distinct crisis in the articulation appears with any movement, there is a notable restriction of mobility in the articulation (contracture), the functional shortening of the limb, the altered biomechanics of movements, but joint mobility is always preserved.This step is characterized by a notable strengthening of the start -up pain, they become acute and longer.Under the influence of diurnal physical activity, constant fatigue appears, a feeling of pressure in the affected joints, the "mechanical pain" if called occurs caused by a decrease in the absorption capacities of the tissue of the cartilaginous tissues of the joint.
The destruction in the joint is already quite large, the joints are already partially deformed.
On radiographs, notable osteophytes are visible, the narrowing of the joint gap is 2 to 3 times compared to the standard, the sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal area are observed.
2nd degree osteoarthritis is characterized by a decrease in working capacity, the inability to carry out certain types of work.
3 degree osteoarthritis (third stage of osteoarthritis)
Osteoarthritis 3 degrees are a severe and neglected stage of the disease.At this point, there is:
- significant deformation of the joint (due to the growth of bones and the accumulation of liquid in the joint cavity);
- a strong restriction of movements, until the preservation of swinging movements only;
- Net pain not only during displacement, but also in a complete state of rest - constant pain associated with reflex cramps nearby muscles, as well as the development of a reactive synovitis;
- joint inflammation,
- Sensitivity of joints to the change of time.
- The muscles around the knee are nasty and atrophied;
The axis of the limbs is distorted, substantially varus or valgus curved legs (that is to say in the form of the letter "o" or "x").
On radiographs with 3rd degree osteoarthritis, the almost complete disappearance of the joint gap, a severe deformation of joint surfaces, vast multiple regional osteophytes are observed.Joint mice and calcification of paraarticular tissue can be determined.
In 3 degrees, the disease went very far, often it is already the cause of a persistent handicap.It manifests itself as follows:
- The pain becomes constant and painful: walking, and especially the descent and mounting the stairs - a difficult test for the patient;
- Strong crunch in all movements, finally - the others;
- The deformation of the joints is strongly expressed, the movements are only limited by a small amplitude or even impossible;
The images show the destruction of intra-articular structures (ligaments and meniscus), as well as the complete abrasion of cartilage and signs of sclerosis (replacement of functional organs and structures of connective tissue).
4th degree osteoarthritis
The complete state of destruction of the joint osteoarthritis, when the joint stops completely, is often distinguished in a degree of separate osteoarthritis - 4. There is a "joint block" if called - an acute pain syndrome, in which even a limited movement in a sick joint is impossible.The fourth degree of osteoarthritis is accompanied by unbearable joint pain, which is not eliminated even by powerful drugs and intensive physiotherapy.Complete ankylosis (joint fusion) or neoartrosis (the formation of a false articulation between the displaced ends of the bones) is possible.The independent movement in both cases is almost impossible.
On the images, brutal sclerosis of SatTime surfaces with the pronounced cystic illumination, the fusion of connection bones into the joint space is visible.The development of disease at this stage almost always means disability, which can only be avoided by the implantation of the artificial joint prosthesis.
Osteoarthritis
Treatment of osteoarthritis at the initial stage of the disease
It is best to start treating osteoarthritis as soon as possible, with the appearance of the first signs - crunching in the joints, difficulty of movement.At this stage, the drugs are useful -chondroprotector which improve the structure of the cartilage, as well as the complexes of vitamins.
Medical physical education, appropriate nutrition, as well as preventive measures are important.It should be noted that prevention of osteoarthritis is also of great importance to prevent exacerbation of the disease.
2 -degree osteoarthritis treatment
Although it is already impossible to completely cure osteoarthritis of 2-3 degrees, the process of its development can be significantly inhibited.The treatment of osteoarthritis at this stage implies the following steps:
- Elimination or reduce pain syndrome
- Remove inflammation in the joint.
- Improve the restoration of cartilage and slow down degenerative processes.
In the acute period, the treatment of osteoarthritis begins with the elimination of pain.For this, non-hormonal (NSAID) anti-inflammatory pain relievers are used.Intra-articular corticosteroid injections are possible.It is necessary to reduce the load on the joint, you cannot walk or hold for a long time, lift heavy objects.
After eliminating acute pain syndrome, the main task is to ensure, as far as possible, the activation of recovery processes in joint and periarticular tissues: improvement in blood circulation, increased metabolism, elimination of inflammatory processes.Chondroprotectors, vasodilating drugs, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of osteoarthritis at 4 degrees
At this stage of the disease, the joint is almost completely destroyed.In this case, an exit remains - the operation and replacement of the sick joint with endoprosthesis.Endoprosthesis considerably improves the mobility of the joint, allows the patient to resume active life, at least, to get rid of pain.