osteoarthritis (deforming osteoarthritis, popular name - salt deposition) is a chronic disease of the joints of a degenerative-dystrophic nature, in which the destruction of the articular cartilage, the joint capsule and deformation of the bone itself occurs.
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),
- as well as osteoarthritis of the shoulder joint.
These are the most serious types of osteoarthritis.
Osteoarthritis of small joints is less common.More common are deforming osteoarthritis of the interphalangeal joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients notice pain in the interphalangeal joints, decreased mobility and the appearance of seals near the joints (Heberden and Bouchard nodules).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 once.
osteoarthritis The joints of the spine (spondyloarthrosis) belong to the group of spinal diseases, although it has a development mechanism similar to that of other osteoarthritis.
The main clinical symptom of osteoarthritis is joint pain and decreased mobility.Specific symptoms are determined by the stage of osteoarthritis 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) osteoarthritis is a consequence of disruption of restoration processes and further degeneration of the cartilaginous tissue of the joint without any deviations in the functioning of the entire organism.Secondary osteoarthritis arises 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 osteoarthritis is diagnosed in young patients.And in older patients it is not always possible to draw a clear line between primary and secondary osteoarthritis.
Although the exact cause of osteoarthritis cannot be determined, the factors that contribute to its appearance and development are well known.
The following types of reasons can be identified that contribute to the development of primary and secondary deforming osteoarthritis.
Causes of primary osteoarthritis: hereditary factors.
The following hereditary disorders have been identified that can lead to 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 cartilaginous tissue of the joint and, as a consequence, 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 osteoarthritis is a consequence of damage to the joint.These damages can be caused by several factors.
- Mechanical damage to the joints.This group of factors includes various joint injuries, intra-articular bone fractures, as a result of which the structure of the joint is disturbed.The same result is caused by constant microtrauma of the joints as a result of constant excessive loads, both static and dynamic (for example, in athletes).Obesity also causes overload and injuries to the joints.
Another factor that has a negative impact on the joints (mainly the hip joints) is incorrect posture.
The structure of the joint can also be altered through 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, mineral deficiency in the body.Various metabolic disorders, a lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone and cartilaginous tissue and synovial fluid, which leads to a disruption of recovery processes and a gradual destruction of the composition.
- autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in postmenopausal women they cause changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, endarteritis obliterans, varicose veins), as well as physical inactivity they cause circulatory disorders in the periarticular tissues, poor blood supply to the joint tissues and, as a result, degenerative changes.
The mechanism of development of osteoarthritis.
Development osteoarthritis It begins with the destruction of cartilage.It is believed that at first 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 the intra-articular fluid and adjacent bone tissue, poor circulation leads to the fact that the cartilage gradually loses its elasticity, becomes 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 crunching when moving.The width of the joint space gradually decreases, and bones form along the edges of the joint surfaces. osteophyte spines.
Ultimately, the joint becomes deformed and the range of motion decreases.This is how involutional osteoarthritis develops, associated with the aging of the body.The development of this form of osteoarthritis usually occurs gradually over many years.
Other forms of osteoarthritis 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 osteoarthritis.Stages and degrees of osteoarthritis.
The classification of osteoarthritis based on clinical and radiological signs is considered “classical”.In accordance with this, three stages of development of the disease are distinguished.It corresponds to a classification according to the degree of conservation of work capacity, distinguishing 3 degrees of osteoarthritis:
- I degree of osteoarthritis: the disease does not interfere with work performance, although it makes it difficult,
- II degree of osteoarthritis: the disease interferes with work performance,
- III degree of osteoarthritis: loss of ability to work.
Let us consider in more detail the symptoms and clinical signs of osteoarthritis at each of the indicated stages.
1st degree osteoarthritis (initial stage of osteoarthritis)
At the initial stage of the disease, in the morning, after rest, stiffness and difficulty in moving in the joints are observed, 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 creaks, but there is no pain when moving.Pain at this stage of osteoarthritis appears only with significant and prolonged stress and disappears after rest.At rest and with light efforts there is no pain.At this stage of the disease, patients rarely go to the doctor.
On an x-ray with first degree osteoarthritis, no special changes in the joint are seen;Sometimes small osteophytes can be seen at the edges of the joint, the joint space narrows slightly.
Osteoarthritis 2 degrees (second stage of osteoarthritis)
With further development of osteoarthritis, the pain becomes more significant and acute.With any movement, a distinctive crunch appears in the joint, there is a noticeable 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 the initial pains, they become sharp and last longer.Under the influence of daily physical activity, constant fatigue appears, a feeling of pressure in the affected joints and the so-called "mechanical pain", caused by a decrease in the shock-absorbing ability of the cartilage tissues of the joint.
The destruction in the joint is already quite significant, the joints are already beginning to partially deform.
X-rays show noticeable osteophytes, a narrowing of the joint space is observed by 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal zone.
Second degree osteoarthritis is characterized by a decrease in the ability to work and the inability to perform certain types of work.
Osteoarthritis 3 degrees (third stage of osteoarthritis)
osteoarthritis Stage 3 is an advanced and severe 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);
- strong restriction of movements, until maintaining only rocking movements;
- acute pain not only when moving, but also in a state of complete rest: constant pain associated with reflex spasms of nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- Joint sensitivity to climate changes.
- the muscles around the knee are spasmed and atrophied;
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 osteoarthritis, an almost complete disappearance of the joint space, pronounced deformation of the articular surfaces, and multiple extensive marginal osteophytes are observed.Joint mice and calcification of paraarticular tissues can be detected.
In grade 3, the disease has progressed greatly and is often already causing permanent disability.It appears as follows:
- the pain becomes constant and painful: walking, and especially going up and down stairs, is a difficult test for the patient;
- a loud crunch during any movement, clearly audible to others;
- joint deformation is severe, movements are limited to a small amplitude or even impossible;
The photographs show the destruction of intra-articular structures (ligaments and menisci), as well as complete abrasion of cartilage and signs of sclerosis (replacement of organs and functional structures with connective tissue).
Osteoarthritis 4 degrees
The state of complete destruction of the joint with osteoarthritisWhen the joint stops functioning completely, it is often classified as a fourth degree of independent osteoarthritis.There is the so-called "joint block" - an acute pain syndrome in which even limited movement of the affected joint is impossible.The fourth degree of osteoarthritis is accompanied by unbearable pain in the joints, which cannot be relieved even with strong pain relievers and intensive physiotherapy.Complete ankylosis (fusion of the joint) or neoarthrosis (formation of a false joint between the displaced ends of the bones) is possible.Independent movement in both cases is almost impossible.
Photos show rough sclerosis of the articular surfaces with pronounced cystic gaps, fusion of 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 implantation of an artificial joint prosthesis.
Osteoarthritis treatment
Treatment of osteoarthritis in the initial stage of the disease.
It is better to start treating osteoarthritis as early as possible, when the first signs appear: creaking 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.
Physical therapy, proper nutrition, and preventive measures are important.It should be noted that the prevention of osteoarthritis is of great importance in preventing exacerbation of the disease.
Treatment of osteoarthritis 2 - 3 degrees.
Although it is no longer possible to completely cure osteoarthritis of grade 2-3, 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 cartilage tissue and slow down degenerative processes in it.
In the acute period, osteoarthritis treatment begins with pain relief.For this, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular injections of corticosteroids 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 ensure, as far as possible, the activation of restoration processes in the joint itself and in the periarticular tissues: improving blood circulation, increasing metabolism and eliminating inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy, are prescribed.
Treatment of fourth 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 return to an active life, at least without pain.