Osteoarthritis (deforming arthrosis, popular name - salt deposition) is a chronic disease of the joints, degenerative-dystrophic in nature, in which there is destruction of the articular cartilage, the joint capsule and deformation of the bone itself.
It should be noted that arthrosis 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),
- as well as arthrosis of the shoulder joint.
These are the most serious types of osteoarthritis.
Osteoarthritis of small joints is less common.More common are deforming arthrosis of the interphalangeal joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients note pain in the interphalangeal joints, decreased mobility and the appearance of seals near the joints (Heberden and Bouchard's nodes).This type of osteoarthritis is more common in old age.Osteoarthritis of the foot joints is common.
Polyarthrosis, or generalized osteoarthritis, is characterized by damage to several joints at the same time.
Osteoarthritis spinal joints - spondyloarthrosis - belongs to the group of spinal diseases, although it has a similar development mechanism to other arthrosis.
The main clinical symptom of osteoarthritis is joint pain and decreased mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree 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 the interruption of restoration processes and increased degeneration of the cartilaginous tissue of the joint, without any deviations in the functioning of the entire organism.Secondary arthrosis occurs as a result of other pathological processes in the body, or in a joint already damaged by some external influence, with partial destruction of the articular surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in elderly 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 contributing to the development of primary and secondary deforming arthrosis can be identified.
Causes of primary osteoarthritis – hereditary factors
The following hereditary disorders have been identified that can cause the development of primary osteoarthritis:
- genetic disorders in the composition of the cartilaginous tissue of the joint, leading to its accelerated destruction;
- congenital defects of the musculoskeletal system (joint hypermobility, dysplasia, flat feet and others), which cause trauma to certain areas of the cartilage tissue of the joint and, consequently, the appearance of osteoarthritis.
It is also observed that deforming osteoarthritis of the interphalangeal joints of the upper extremities occurs predominantly in women and is inherited through the female line.
Causes of secondary osteoarthritis
Secondary arthrosis is a consequence of damage to the joint.This damage can be caused by several factors.
- Mechanical damage to joints.This group of factors includes various joint injuries, intra-articular bone fractures, as a result of which the joint structure is disrupted.The same result is caused by constant microtraumas in the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).Obesity also leads to overload and joint damage.
Another factor that has a negative impact on joints (especially hip joints) is incorrect posture.
The structure of the joint can also be disturbed by surgery. - Joint diseases.Arthrosis 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, mineral deficiency in the body.Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone and cartilage tissue, 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 they lead to changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins), as well as physical inactivity cause circulatory disorders in the periarticular tissues, insufficient blood supply to the articular tissues and, as a result, degenerative changes.
The mechanism of development of arthrosis
Development arthrosis It begins with the destruction of cartilage.It is believed that at the beginning there is a circulatory disorder in the capillaries of the subcartilaginous layer of the periosteum.Since cartilage nutrition occurs due to the supply of nutrients from intra-articular fluid and adjacent bone tissue, poor 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 seems pain and crushing 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 becomes deformed and range of motion decreases.This is how involutive arthrosis develops, associated with the aging of the body.The development of this form of osteoarthritis usually occurs gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication, have slightly different mechanisms of development, but as a result we get similar changes in the joint.
Symptoms of joint arthrosis.Stages and degrees of arthrosis
The classification of osteoarthritis based on clinical and radiological signs is considered “classic”.According to him, three stages of development of the disease can be distinguished.It corresponds to a classification according to the degree of preservation of work capacity, distinguishing 3 degrees of arthrosis:
- I degree of osteoarthritis - the disease does not hinder the performance of work, although it makes it difficult,
- II degree of osteoarthritis - the disease interferes with work performance,
- III degree of arthrosis - loss of working capacity.
Let us consider in more detail the clinical symptoms and signs of arthrosis in each of the indicated stages.
1st degree osteoarthritis (initial stage of osteoarthritis)
In the initial stage of the disease, in the morning, after rest, there is stiffness and difficulty in moving the joints, which gradually disappears some time after the start of movement.There may be some limitation of mobility in the joint.“Initial” pain (pain when starting to move after a long period of rest) appears periodically.With sudden movements, the joint contracts, but there is no pain when moving.Pain at this stage of arthrosis appears only with significant and prolonged stress and disappears after rest.At rest and with small efforts there is no pain.At this stage of the disease, patients rarely see a doctor.
On an x-ray with 1st degree arthrosis, no special changes in the joint are visible;Sometimes small osteophytes can be visible at the edges of the joint, the joint space is slightly narrowed.
Osteoarthritis 2 degrees (second stage of arthrosis)
As osteoarthritis develops, the pain becomes more significant and acute.A distinct crisis in the joint appears with any movement, there is a notable limitation of mobility in the joint (contracture), functional shortening of the limb, disturbances in the biomechanics of movements, but the mobility of the joint is still preserved.At this stage, there is a noticeable increase in initial pain, which becomes acute and longer lasting.Under the influence of daily physical activity, constant fatigue appears, a feeling of pressure in the affected joints and the so-called “mechanical pain” occurs, caused by a decrease in the shock-absorbing capacity of the cartilaginous tissues of the joint.
The destruction in the joint is already quite significant, the joints are already starting to partially deform.
Radiographs show noticeable osteophytes, narrowing of the joint space 2 to 3 times normal, sclerosis of the subchondral bone and formation of cystic cavities in the epiphyseal zone are observed.
2nd degree arthrosis is characterized by a decrease in working capacity and the inability to perform certain types of work.
Arthrosis 3 degrees (third stage of arthrosis)
Osteoarthritis Stage 3 is a severe and advanced stage of the disease.At this stage, the following are observed:
- significant deformation of the joint (due to bone growth and accumulation of fluid in the joint cavity);
- severe restriction of movements, until only rocking movements are maintained;
- sharp pain not only when moving, but also in a state of complete rest - constant pain associated with reflex spasm of nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- joint sensitivity to climate change.
- the muscles around the knee spasm and atrophy;
The axis of the limb is deformed, varus or valgus curvature of the legs is noticeable (that is, in the shape of the letter “O” or “X”).
On radiographs with grade 3 arthrosis, almost complete disappearance of the joint space, pronounced deformation of the articular surfaces and extensive multiple marginal osteophytes are observed.Articular mice and calcification of paraarticular tissues can be detected.
At grade 3, the disease has progressed a lot and is often the cause of permanent disability.It appears as follows:
- the pain becomes constant and painful: walking, and especially going up and down stairs, is a difficult ordeal for the patient;
- a loud, squeaky sound during any movement, clearly audible to other people;
- the joint deformation is severe, movements are limited to only a small amplitude or even impossible;
The photographs show destruction of intra-articular structures (ligaments and menisci), as well as complete abrasion of the cartilage and signs of sclerosis (replacement of organs and functional structures by connective tissue).
4 degree osteoarthritis
The state of complete destruction of the joint with arthrosisWhen the joint completely ceases to function, it is often classified as a separate 4th degree of osteoarthritis.There is the so-called “joint block” - an acute pain syndrome in which even limited movement in the affected joint is impossible.The fourth degree of arthrosis is accompanied by unbearable pain in the joints, which 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 dislocated ends of the bones) is possible.Independent movement in both cases is almost impossible.
The photographs show rough sclerosis of the articular surfaces with pronounced cystic clearings, fusion of the connective bones in the area of the joint space.The development of the disease to this stage almost always means disability, which can only be avoided with the implantation of an artificial joint prosthesis.
Osteoarthritis treatment
Treatment of osteoarthritis in the initial phase of the disease
It is best to start treating osteoarthritis as early as possible, when the first signs appear - clicking in the joints, difficulty moving.At this stage, medications 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 the prevention of osteoarthritis is of great importance to prevent the exacerbation of the disease.
Treatment of arthrosis 2 - 3 degrees
Although it is no longer possible to completely cure grade 2-3 arthrosis, the process of its development can be significantly slowed down.Treatment of osteoarthritis at this stage involves the following steps:
- relieve or reduce pain
- relieve inflammation in the joint.
- improve the restoration of cartilaginous tissue and slow down degenerative processes in it.
In the acute period, osteoarthritis treatment begins with pain relief.For this purpose, non-steroidal 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 a long time, nor lift heavy objects.
After relieving acute pain syndrome, the main task becomes to ensure, as far as possible, the activation of restorative processes in the joint itself and in periarticular tissues: improving blood circulation, increasing metabolism, eliminating inflammatory processes.Chondroprotectors, vasodilators are prescribed, as well as therapeutic exercises and physiotherapy.
Treatment of 4th degree osteoarthritis
At this stage of the disease, the joint is almost completely destroyed.In this case, there is only one way out - surgery and replacement of 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.