Osteoarthritis (Deforming osteoarthritis, popular name: deposition of salts) It is a chronic disease of degenerative joints -Distophical, in which the destruction of the joint cartilage, the joint capsules and the deformation of the bone itself occurs.
It should be noted that osteoarthritis is a complete group of joint diseases that have different mechanisms of origin and close development.Most of the time there is large articulations osteoarthritis:
- Deforming osteoarthritis of the knee joint (gonarrosis),
- Deformant of osteoarthritis of the hip joint (coksarrosis),
- as well as osteoarthritis of the shoulder joint.
These are the most serious types of osteoarthritis.
Small joint osteoarthritis is less common.Most of the time there are deforming osteoarthritis of the interphalable joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients point to pain in interphalable joints, a decrease in their mobility, appearance near the seal joints (Geberden and Bushar nodules).This type of osteoarthritis is more common in old age.The osteoarthritis of foot joints often occurs.
Polyrresis, or generalized osteoarthritis, is characterized by damage to several joints at the same time.
Osteoarthritis The articulations of the spine - spondilartrosis - belong to the group of diseases of the spine, although it has a similar development mechanism with other osteoarthritis.
The main clinical symptom of osteoarthritis is the pain in the articulation, a decrease in its mobility.Specific symptoms are determined by 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 into primary and secondary school.Primary osteoarthritis (idiopathic) is a consequence of a violation of recovery processes and greater degeneration in the tissue of the articulation cartilage without any deviation in the work of the entire organism.Secondary osteoarthritis occurs as a result of other pathological processes in the body, or in the joint already damaged by any external effect, with partial destruction of the articular surfaces.
Very often, traumatic osteoarthritis is diagnosed in young patients.And in older patients, it is far from being possible to draw a clear edge between primary and secondary osteoarthritis.
Although the exact cause of osteoarthritis cannot be determined, the factors that contribute to the occurrence and development are well known.
The following types of causes that contribute to the development of primary and secondary deforming 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, which leads to its accelerated destruction;
- Congenital defects of the musculoskeletal system (Hypermobile of joints, dysplasia, flat feet and others), which are the cause of the trauma of certain sections of cartilage tissue of the joint and, as a result, the appearance of osteoarthritis.
It was also observed that the deforming osteoarthritis of the joints between the phalanx of the upper extremities is mainly found in women and is inherited by the female line.
The causes of secondary osteoarthritis
Secondary osteoarthritis is a consequence of joint damage.This damage 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 joint structure is altered.The same result is caused by the constant microtraumatization of the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).In addition, obesity leads to an overload and trauma.
Another factor that has a negative effect on the joints (mainly on the hip) is an incorrect posture.
The joint structure can also interrupt surgical intervention. - Joint diseases.Arthrosis can be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolism violations, endocrine system diseases, mineral deficiency in the body.Several metabolism disorders, 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 gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), Hormonal disorders, estrogen deficiency In postmenopause, women lead to changes in joint tissues and gradual destruction.
- Vascular diseases (Atherosclerosis of the lower limb vessel Hypodinamia They cause circulatory disorders in periarticular tissues, the poor blood supply to articular tissues and, as a result, distribution changes.
The mechanism of development of osteoarthritis
Development osteoarthritis It begins with the destruction of the cartilage.It is believed that at the beginning there is a violation of blood circulation in the capillaries of the periosteum corneal layer.Since cartilage nutrition occurs due to the intra -articular fluid nutrient intake and adjacent bone tissue, circulatory interruption leads to the fact that the cartilage gradually loses elasticity, becomes thinner, cracks appear, the softness of the joint surfaces are altered, the amount of the synovial fluid in the joint appears.As a result, it seems Pain and crispy during movements.The width of the joint gap gradually decreases, the bone is formed along the edges of the articular surfaces Osteophyta peaks.
Ultimately, the articulation is deformed, the amplitude of the movements in it decreases.This develops invitative osteoarthritis associated with body aging.The development of this form of osteoarthritis generally occurs gradually, over the years.
Other forms of osteoarthritis of large joints, for example, post -traumatic poisoning, post -inffective, metabolic, have several other development mechanisms, but as a result we obtain similar changes in the joint.
Articulations osteoarthritis symptoms.Stages and degree of osteoarthritis
"Classic" is the classification of osteoarthritis based on clinical and radiological characteristics.According to him, three stages of disease development are distinguished.It corresponds to the classification by the degree of maintenance of disability, which distinguishes 3 degrees of osteoarthritis:
- I Guente of osteoarthritis: The disease does not prevents work, although it complicates it,
- II Degree of osteoarthritis: The disease prevents work performance,
- III degree of osteoarthritis: loss of work capacity.
Consider in more detail the clinical symptoms and signs of osteoarthritis in each of these stages
First grade osteoarthritis (initial stage of osteoarthritis)
In the initial stage of the disease in the morning, after rest, rigidity, movement of difficulty in the joints, which gradually passes some time after the beginning of the movement.Perhaps some restriction of mobility in the joint.Periodically, "beginning" pains appear (pain at the beginning of the movement after a long stay at rest).With acute movements, the joint opens, but there is no pain during movement.The pain at this stage of osteoarthritis appears only with a significant and prolonged load, and decreases after the break.There is no pain alone and with low loads.At this stage of the disease, patients rarely see a doctor.
In the X -ray image with osteoarthritis of the first degree of special changes in the joint is not visible, sometimes small osteophys can be visible along the edges of the joint, the articular gap narrows slightly.
2 -degree osteoarthritis (second stage of osteoarthritis)
With the additional development of osteoarthritis, pain becomes more significant, acquires an acute character.A different crunch in the joint appears with any movement, there is a remarkable restriction of articulation mobility (contracture), functional shortening of the limb, deteriorated biomechanics of the movements, but joint mobility is still preserved.This stage is characterized by a notable strengthening of initial pain, they become acute and longer.Under the influence of diurnal physical activity, a constant fatigue appears, a sensation of pressure on the affected joints, the "mechanical pain" called are arise caused by a decrease in the shock absorption capabilities of the cartilage tissues of the joint.
The destruction in the joint is already quite significant, the joints are already partially deformed.
In the radiographs, notable osteophytes is visible, the narrowing of the articular gap is 2-3 times compared to the norm, the sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal zone are observed.
Second degree osteoarthritis is characterized by a decrease in work capacity, the inability to perform certain types of work.
3 degree osteoarthritis (third stage of osteoarthritis)
Osteoarthritis 3 degrees are a serious and careless stage of the disease.At this stage, there are:
- significant deformation of the joint (due to the growth of the bones and the accumulation of fluid in the joint cavity);
- a strong restriction of movements, until the preservation of only balancing movements;
- Acute pain not only when it moves, but also in a complete state of rest: constant pain associated with cramps reflexes of nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- Sensitivity of the articulations to the change in the climate.
- The muscles around the knee are unpleasant and atrophied;
The axis of the extremities is notably deformed, the curvature varus or valgus of the legs (that is, in the form of the letter "or" or "x").
In radiographs with osteoarthritis of the third grade, the almost complete disappearance of the articular gap, the severe deformation of the articular surfaces, large multiple regional osteophytes are observed.Joint mice and calcification of paraarticular tissues can be determined.
In 3 degrees, the disease has gone very far, it is often the cause of persistent disability.It manifests as follows:
- The pain becomes constant and painful: walking, and especially the descent and climbing the stairs, a difficult test for the patient;
- Strong crunch in any movement, well, with others;
- The deformation of the joints is expressed strongly, the movements are limited only 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 the cartilage and the signs of sclerosis (replacement of organs and structures in operation of connective tissue).
Fourth grade osteoarthritis
The state of complete destruction of the joint osteoarthritis, when the joint stops working completely often it is distinguished in a separate one: 4 degrees of osteoarthritis.There is a "articulation block" named, an acute pain syndrome, in which even the limited movement in a sick joint is impossible.The fourth degree of osteoarthritis is accompanied by unbearable joint pain, which are not eliminated even by powerful drugs and intensive physiotherapy.Complete ankylosis (joint fusion) or neo -arthrosis (the formation of a false joint between the displaced ends of the bones) is possible.The independent movement in both cases is almost impossible.
In the images, the approximate sclerosis of the SATTIIME surfaces with the cordered cystic lighting, the merger of the connection bones is seen in the joint gap.The development of the disease to this stage almost always means disability, which can only be prevented by implementing artificial articular prostheses.
Treatment of osteoarthritis
Treatment of osteoarthritis in the initial stage of the disease
It is better to start treating osteoarthritis as soon as possible, with the appearance of the first signs: creak in the joints, difficulty in movement.At this stage, medications are useful -condroprotectors that improve the structure of the cartilage, as well as vitamin mineral complexes.
Medical physical education, adequate nutrition and preventive measures are important.It should be noted that the prevention of osteoarthritis is also of great importance to prevent the exacerbation of the disease.
Treatment of osteoarthritis 2 - 3 degrees
Although it is already impossible to completely cure the osteoarthritis of the 2-3 degrees, however, the process of its development can be significantly inhibited.The treatment of osteoarthritis at this stage implies the following stages:
- elimination or reduction of pain syndrome
- Remove inflammation in the joint.
- Improve cartilage restoration and slow down the degenerative processes in it.
In the acute period, the treatment of osteoarthritis begins with pain elimination.For this, non -hormonal anti -inflammatory medications (NSAIDs) are used, analgesics are used.Intraarticular corticosteroid injections are possible.It is necessary to reduce the load in the joint, cannot walk or support for a long time, lift heavy objects.
After eliminating acute pain syndrome, the main task is to guarantee, as far as possible, the activation of recovery processes in joint and periarticular tissues: improvement of blood circulation, increased metabolism, elimination of inflammatory processes.Condroprotectors, vasodilatory medications, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of osteoarthritis 4 degrees
At this stage of the disease, the joint is almost completely destroyed.In this case, there is an output: the operation and replacement of the sick joint with an endoprosthesis.Endoprosthesis significantly improves the mobility of the joint, allows the patient to resume active life, at least, get rid of pain.