Osteoarthritis (Arthrosis deformans, popular name - salt deposition) is a chronic disease of the joints of a degenerative-dystrophic nature, in which there is destruction of the articular cartilage, joint capsule and deformation of the bone itself.
It should be noted that osteoarthritis is a whole group of joint diseases that have different origins and similar development mechanisms.The most common osteoarthritis of large joints is:
- deforming osteoarthritis of the knee joint (gonarthrosis),
- deforming osteoarthritis of the hip joint (coxarthrosis),
- and osteoarthritis of the shoulder joint.
These are the most severe types of osteoarthritis.
Osteoarthritis of small joints is less common.Deforming arthrosis of the interphalangeal joints of the hands and the metatarsophalangeal joints of the thumb are more common.Patients note pain in the interphalangeal joints, reduced mobility and the appearance of seals near the joints (Heberden and Bouchard nodes).This form of osteoarthritis occurs more frequently in old age.Osteoarthritis of the ankles is common.
Polyarthrosis or generalized osteoarthritis is characterized by simultaneous damage to several joints.
Osteoarthritis Joints of the spine - spondyloarthrosis - belongs to the group of diseases of the spine, but has a similar development mechanism to other arthroses.
The main clinical symptoms of osteoarthritis are joint pain and limited mobility.Specific symptoms are determined by the stage of osteoarthritis and depend on the extent of destructive changes in the joint.
Causes of osteoarthritis
Osteoarthritis It is customary to divide it into primary and secondary.Primary (idiopathic) arthrosis is a consequence of disruption of the recovery processes and increased degeneration of the cartilage tissue of the joint, without causing dysfunction of the entire organism.Secondary arthrosis occurs as a result of other pathological processes in the body or in a joint that has already been damaged by external influences with partial destruction of the articular surfaces.
Traumatic osteoarthritis is most often diagnosed in young patients.And in older patients it is not always possible to draw a clear line between primary and secondary arthrosis.
Although the exact cause of osteoarthritis cannot be determined, the factors that contribute to its occurrence and development are well known.
The following types of reasons can be identified that contribute to the development of primary and secondary deforming arthrosis.
The causes of primary osteoarthritis are hereditary factors
The following hereditary diseases have been identified that can lead to the development of primary osteoarthritis:
- genetic disorders in the composition of the cartilage tissue of the joint, leading to its accelerated destruction;
- congenital defects of the musculoskeletal system (hypermobility of the joints, dysplasia, flat feet and others), which lead to injuries to certain areas of the cartilage tissue of the joint and, as a result, to the appearance of arthrosis.
It is also noted that deforming arthrosis of the interphalangeal joints of the upper extremities occurs predominantly in women and is inherited through the female line.
Causes of secondary osteoarthritis
Secondary osteoarthritis is a result of joint damage.This damage can be caused by various factors.
- Mechanical damage to joints.This group of factors includes various joint injuries, intra-articular bone fractures, as a result of which the structure of the joint is disrupted.The same result is caused by constant microtrauma to the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).Obesity also leads to overuse and joint damage.
Another factor that has a negative effect on the joints (especially the hip joints) is incorrect posture.
The structure of the joint can also be disrupted by surgery. - Joint diseases.Osteoarthritis can be a consequence of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, lack of minerals in the body.Various metabolic disorders, a lack of calcium, phosphorus and other minerals, vitamins and microelements lead to changes in the composition of bone and cartilage tissue and synovial fluid, which leads to disruption of recovery processes and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in postmenopausal women lead to changes in joint tissue and their gradual destruction.
- Vascular diseases (arteriosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins) as well as physical inactivity cause circulatory disorders in the periarticular tissue, poor blood circulation in the joint tissue and, as a result, degenerative changes.
The mechanism of arthrosis development
Development Osteoarthritis begins with the destruction of the cartilage.It is believed that initially there is a circulatory disorder in the capillaries of the subcartilaginous layer of the periosteum.Since the nutrition of the cartilage occurs through the supply of nutrients from the intra-articular fluid and the adjacent bone tissue, poor blood circulation causes the cartilage to gradually lose its elasticity, become thinner, cracks appear, the smoothness of the articular surfaces is disturbed, and the amount of synovial fluid that ensures sliding in the joint decreases.As a result, it appears Pain and crunching when moving.The width of the joint space gradually decreases and bones form along the edges of the articular surfaces. Osteophyte spines.
Ultimately, the joint deforms and mobility decreases.This creates involutive osteoarthritis, which goes hand in hand with the aging of the body.This form of osteoarthritis usually develops gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic or intoxication forms, have slightly different mechanisms of development, but as a result we get similar changes in the joint.
Symptoms of joint osteoarthritis.Stages and degrees of osteoarthritis
The classification of osteoarthritis based on clinical and radiological symptoms is considered “classic”.Accordingly, three stages of disease development are distinguished.It corresponds to a classification according to the degree of preservation of the ability to work, with 3 degrees of osteoarthritis being distinguished:
- Osteoarthritis grade I - the disease does not affect work performance, but makes it more difficult,
- Osteoarthritis grade II – the disease affects work performance,
- Osteoarthritis grade III - loss of ability to work.
Let's consider in more detail the clinical symptoms and signs of arthrosis at each of the specified stages.
1st degree osteoarthritis (initial stage of osteoarthritis)
In the initial stages of the disease, there is stiffness and difficulty moving in the joints in the morning after rest, which gradually disappear some time after the start of movement.The joint's mobility may be restricted.“Initial pain” (pain when starting to move after a long period of rest) occurs at regular intervals.The joint crunches during sudden movements, but there is no pain during movement.Pain in this stage of osteoarthritis only occurs with significant and prolonged exertion and subsides after rest.There is no pain at rest or with light exertion.At this stage of the disease, patients rarely see a doctor.
No special changes to the joint can be seen in the x-ray of grade 1 osteoarthritis;Sometimes small osteophytes are visible on the edges of the joint and the joint space is slightly narrowed.
Osteoarthritis 2 degrees (second stage of osteoarthritis)
As the osteoarthritis develops further, the pain increases and becomes acute.With every movement, a noticeable crunch occurs in the joint, there is a noticeable limitation of mobility in the joint (contracture), functional shortening of the limb, disturbances in the biomechanics of the movements, but the mobility of the joint remains.At this stage, the initial pain increases significantly, becomes acute and lasts longer.Under the influence of daily physical activity, constant fatigue, a feeling of pressure in the affected joints and so-called “mechanical pain” appear, which are caused by a decrease in the shock-absorbing ability of the cartilage tissue of the joint.
The destruction in the joint is already significant and the joints are already beginning to partially deform.
X-rays reveal noticeable osteophytes, narrowing of the joint space by 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal zone.
Grade 2 osteoarthritis is characterized by reduced ability to work and the inability to perform certain jobs.
Osteoarthritis 3 degrees (third stage of osteoarthritis)
Osteoarthritis Stage 3 is a severe, advanced stage of the disease.At this stage the following is observed:
- significant deformation of the joint (due to bone growth and fluid accumulation in the joint cavity);
- severe restriction of movement up to only maintaining rocking movements;
- stabbing pains not only when moving, but also in a state of complete rest – constant pain associated with reflex spasms of neighboring muscles, as well as the development of reactive synovitis;
- inflammation of the joints,
- Joint sensitivity to weather changes.
- the muscles around the knee are cramped and atrophied;
The axis of the limb is deformed, a varus or valgus curvature of the legs is noticeable (i.e. in the form of the letter “O” or “X”).
On X-ray images, in grade 3 osteoarthritis, an almost complete disappearance of the joint space, pronounced deformations of the articular surfaces and extensive multiple marginal osteophytes can be observed.Joint mice and calcifications of paraarticular tissue can be detected.
In the 3rd degree, the disease is very advanced and is often the cause of permanent disability.It appears like this:
- the pain becomes constant and painful: walking, and especially going up and down stairs, is a heavy burden for the patient;
- a loud crunching sound with every movement, clearly audible to others;
- The joint deformity is severe, movements are limited to a small amplitude or even impossible.
The photos show the destruction of intra-articular structures (ligaments and menisci), as well as complete cartilage abrasion and signs of sclerosis (replacement of functioning organs and structures with connective tissue).
Osteoarthritis 4 degrees
The condition of complete destruction of the joint with OsteoarthritisIf the joint stops functioning completely, it is often referred to as 4th degree osteoarthritis.There is a so-called “joint blockage” - an acute pain syndrome in which even limited movements in the affected joint are impossible.The fourth degree of osteoarthritis is accompanied by unbearable joint pain that cannot be relieved even with strong painkillers and intensive physiotherapy.Complete ankylosis (fusion of the joint) or neoarthrosis (formation of a false joint between the displaced bone ends) are possible.Independent movement is almost impossible in both cases.
The photographs show gross sclerosis of the articular surfaces with pronounced cystic bulges, fusion of the connecting bones in the area of the joint space.The development of the disease to this stage almost always means disability, which can only be prevented by implanting an artificial joint prosthesis.
Treatment of osteoarthritis
Treatment of osteoarthritis in the initial stages of the disease
It is better to start treating arthrosis as early as possible, when the first signs appear - crunching in the joints, difficulty in movement.At this stage, drugs are useful – chondroprotectors that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physiotherapy, proper nutrition and preventative measures are important.It should be noted that prevention of osteoarthritis is of great importance in order to prevent the disease from worsening.
Treatment of arthrosis 2 - 3 degrees
Although it is no longer possible to completely cure grade 2 to 3 osteoarthritis, the development process can be significantly slowed down.Treatment of osteoarthritis at this stage includes the following steps:
- Relieve or relieve pain
- relieves inflammation in the joint.
- improve the restoration of cartilage tissue and slow down degenerative processes in it.
In the acute phase, treatment of osteoarthritis begins with pain relief.For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular corticosteroid injections are possible.It is necessary to reduce the load on the joint;You should not walk or stand for long periods of time or lift heavy objects.
After relieving acute pain syndrome, the main task is to activate as much as possible the recovery processes in the joint itself and in the periarticular tissue: improving blood circulation, increasing metabolism, eliminating inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of grade 4 osteoarthritis
At this stage of the disease the joint is almost completely destroyed.In this case, there is only one way out - surgery and replacing the diseased joint with an endoprosthesis.The endoprosthesis significantly improves joint mobility and allows the patient to resume an active life, at least without pain.