In the structure of the pathology of the osteoarticular system, osteoarthritis occupies a prominent place - about 70% of cases correspond to its part. People most often encounter a similar problem after the age of 50, but the initial signs of the disease appear even in young people. This disease has important medical and social significance, since in many cases it becomes the cause of functional failure in working age.
Many people know such a pathology as arthrosis of the joints, but not all patients understand why it develops, how it manifests itself and what is required to combat the disease. And increased awareness and caution can prevent the onset and progression of detrimental changes.
The reasons
Osteoarthritis is characterized by the development of degenerative-dystrophic processes in all joint tissues: cartilage, subchondral bone, ligaments, muscles and tendons. The disease is considered one of the "companions of aging" because it often affects older patients. But the age factor is far from being the only cause of deforming osteoarthritis. The origin of the disease is quite heterogeneous and is due to both external and internal pathological effects on the body.
For each patient, there are certain risk factors that contribute to the appearance of joint pathology. Thus, the causes of arthrosis combine the following conditions:
- Hard physical work.
- Inactivity.
- Traumatic injuries.
- Joint dysplasia.
- Inflammation (arthritis).
- Over weight.
- Estrogen deficiency in menopause.
- Diseases of the thyroid gland.
- Consequences of operations on the joints.
- Inheritance.
As you can see, the development of arthrosis is mediated by heterogeneous factors, which in most cases are mechanical or exchange in nature. In this case, the lifestyle of the patient and his profession are not of little importance, because loaders, manual workers and athletes often suffer from arthrosis.
The causes of arthrosis are quite diverse, they are characterized by a local effect on the joints and a general effect on the body.
development mechanism
The normal function of the joint is ensured by the harmonious work of all its structures. But the main component of any joint is cartilage. It provides a shock absorption function and resists pressure on the joint. Cartilage tissue is made up of cells (chondrocytes) and a matrix, the main substances of which are proteoglycans and collagen.
If the load on the joint exceeds what is permissible, then there are structural disorders in the cartilage first. The proteoglycans that hold the collagen strands together are lost, increasing the tissue's sensitivity to external influences. The processes of destruction begin to prevail over those of synthesis. This is facilitated by a decrease in cartilage trophism when the synovial fluid contains an insufficient amount of nutrients. The imbalance of tissue renewal is supported by inflammatory reactions and hormonal disturbances.
All this leads to thinning of the cartilage, it becomes rough and loses its elasticity. Due to the growth of underlying bone tissue, the joint space narrows and the formation of osteophytes - marginal growths. The synovial membrane thickens, the ligaments thicken and shorten, and muscle function deteriorates.
Pathological processes in the joint develop gradually, but do not pass without a trace. Alterations in cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Arthrosis, like other diseases, has certain varieties. This must be taken into account in the clinical classification of the disease. The pathology is primary when it develops in healthy joints, or secondary if it appears in the context of other diseases. In the event that the cause cannot be established, it is referred to as idiopathic osteoarthritis. Depending on the number of joints involved, the following varieties are distinguished:
- Monoarthrosis.
- Oligoarthrosis: no more than 2 joints are affected.
- Polyarthrosis - involved in 3 joint groups.
If the pathological process has a generalized character, we can talk about the defeat of almost all the joints of the body, including the spine, where spondyloarthrosis is observed. In this case, the disease can proceed in a nodular or nodular form.
It is important to understand what processes occur in the joint and properly assess their severity. Therefore, be sure to take into account the stage of arthrosis. It does not depend on the cause and is determined by pathological changes in the joint tissues:
- Stage 1 - inflammation of the synovial membrane, loss of the ability of cartilage to withstand loads.
- Stage 2 - destruction of cartilage tissue, bone growths, joint bag dystrophy.
- Stage 3: bone deformity, contractures, joint instability.
The presence of signs of inflammation should also be reflected in the classification. Therefore, osteoarthritis is distinguished with and without synovitis. In addition, the functional state of the joint is important, which is determined by the degree of insufficiency:
- 1 degree - temporary limitation of the function.
- Grade 2 - disability.
- 3 degree - the impossibility of self-service.
All of these features should be reflected in the diagnosis of osteoarthritis, as they are important for subsequent therapy.
Symptoms
Among joint pathology, the symptoms of arthrosis have quite tangible specificity. They develop gradually, but progress steadily, leading to a limitation in the physical activity of patients. Therefore, it is especially important to suspect the disease in time to be able to stop its development, as well as prevent complications.
When contacting a doctor, first of all, patient complaints are analyzed. And most people are worried about joint pain. But with arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - occurs against the background of the load and decreases at rest.
- Onset - the onset of pain is associated with the onset of movement (walking).
- "Articular mouse" - periodic sharp pains with blockage of the joint, caused by infringement of the synovial membrane between the cartilaginous surfaces.
At first, patients may experience only vague joint discomfort, accompanied by a feeling of fatigue. But over time, it turns into pain. And if at initial stages cares after loading, then in the future - during the movement, and in late cases it becomes constant, remaining even at rest and at night.
In addition to pain, patients have other symptoms of osteoarthritis. They are both subjective and objective in nature, and include the following characteristics:
- Stiffness in the joints in the morning no more than 30 minutes.
- Crackling sensation (crepitus) when moving.
- Deformation of the periarticular region.
- Mobility restriction.
With arthrosis of the hands, during examination, characteristic formations can be noted in the region of the proximal and distal phalanges - Bouchard and Heberden nodes. Feeling the affected joints is usually painful. If contractures are formed, then there is a fixation of certain parts of the limbs most often in a flexed position.
The pronounced character of osteoarthritis leads to a significant decrease in the level of physical activity of patients, which entails a decrease in their quality of life.
Diagnostics
To understand why the clinical picture develops, it is necessary to confirm the pathology of the joints. This can be done by conducting the necessary diagnostic examination, which includes instrumental and laboratory methods. First, they try to see structural changes in the affected areas, to assess their severity and prevalence. It is also necessary to determine metabolic disorders in the body, which have become favorable background for the occurrence of arthrosis. Thus, the survey complex consists of the following activities:
- Bone scan.
- Magnetic resonance imaging.
- Ultrasound procedure.
- arthroscopy.
- Biochemical blood tests (hormonal spectrum, markers of inflammation, calcium metabolism, rheumatic tests).
After the examination, a consultation with an orthopedist-traumatologist will be required, who will help to form the correct treatment tactics for each patient.
Treatment
It is necessary to treat arthrosis of the joints comprehensively. This means that all available therapeutic agents are used to alleviate the patient's condition. But you need to understand that its effectiveness directly depends on the time of treatment. With advanced forms of the disease, conservative measures will help little. A pronounced and long-lasting result can be obtained with early treatment. For the treatment of osteoarthritis, the following methods are used:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- Massage.
- Operation.
Which funds are suitable for a particular patient, the doctor decides. The choice is made on the basis of the results of the examination and the individual characteristics of the organism.
The best effect of treatment can be obtained if the correction is started in the early stages of the disease, when the first symptoms are just beginning to appear.
General recommendations
Since the development of degenerative changes in the joints is mediated by increased load, it is first necessary to reduce the mechanical effect on cartilage tissue. To do this, you must stop carrying out heavy and intense sports training. To unload the joint, any method is suitable - from walking with a cane to special fixation orthoses. But it is impossible to completely abandon the movements, physical activity must be dosed. Walking short distances, swimming are helpful.
Proper nutrition plays an important role in correcting arthritic changes. The diet helps improve the condition of the cartilage, but it is also the main component in the fight against excess weight. Patients are advised to consume lean meat and poultry, fish, cereals; you need to enrich the diet with fresh vegetables and fruits, herbs. But in return, you should refrain from smoked, spicy, fatty foods, marinades and pickles. It is better to pay attention to foods rich in collagen, elastin and gelatin fibers: jellied meat, hash, jellied dishes, fruit jellies.
medical therapy
Traditional treatment for osteoarthritis begins with medication. Using various drugs, it is possible to eliminate not only the symptoms of the disease, but also to influence the mechanisms of its development. This is especially important in chronic degenerative joint pathology, when it is necessary to achieve a modifying effect on the structure of cartilage tissue. The following medications are generally recommended:
- Nonsteroidal anti-inflammatory.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
With severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be performed. But such treatment should be short-term, because with prolonged use, hormonal drugs have the opposite effect - they stimulate dystrophic processes. Systemic therapy should be combined with topical medications.
Taking drugs for osteoarthritis is carried out on the recommendation of a doctor and under his control. Independent use of any medication is not allowed.
Physiotherapy
Physical influence methods help to eliminate acute signs of joint pathology. Along with medications, they can reduce the severity of pain and inflammation, and also stimulate biochemical processes in the cartilage itself. In the complex treatment of arthrosis, the following procedures are used:
- Electrophoresis.
- ultrasonic treatment.
- wave therapy
- Magnet therapy.
- laser treatment.
- Mud and hydrotherapy.
Such methods affect not only the joint, but also the surrounding tissues. This contributes to the activation of blood circulation, the improvement of trophic processes and the weakening of muscle contractures. Many elements of the spa treatment have an overall health enhancing effect. But at the same time, one should not forget about contraindications to physiotherapy: infectious diseases, tumors, cardiovascular pathology, kidney failure, bleeding, serious condition of the patient.
Physiotherapy
An important aspect of nonpharmacologic therapy for osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue clearly depends on the mechanical factor. But his strength must be adequate. Only then do the processes of growth prevail over those of destruction. Therefore, gymnastics is indicated for all patients with joint diseases. But for each person, his own set of exercises is developed, taking into account the localization and severity of the injury, as well as the general condition of the body.
During classes, pain should not be allowed to appear. The exercises are performed at a slow pace and only after the acute symptoms have been eliminated. Avoid sudden and large-amplitude movements that may cause discomfort. Physical education should be carried out under the supervision of a doctor, and after acquiring the necessary skills, you can begin to do exercises at home.
Therapeutic gymnastics is an integral component of the correction of degenerative-dystrophic processes in the joint. Only regular classes have a positive result.
Massage
To improve the condition of the musculoskeletal system, massage sessions are shown. Manual impact on the joints allows you to achieve relaxation of spasmodic muscle groups, stimulate blood circulation in soft tissues and prepare them for active exercises (before therapeutic exercises). Classic massage includes the following elements:
- caressing
- Trituration.
- Kneading.
- Pressure.
- Ironing.
It is often combined with passive movements in the affected joints. The duration of therapy is determined by the doctor and can be from 7 to 15 sessions.
Operation
If the advanced stages of osteoarthritis do not allow to obtain the desired effect of conservative measures, then there is a need for surgical treatment. Its essence is the replacement of the joint with an artificial one - arthroplasty. This operation is performed openly and under general anesthesia. After its completion, you must undergo rehabilitation, which begins as soon as possible. And as a result of surgical intervention, the patient can completely get rid of arthrosis and return to an active life. True, the operation is not available to everyone.
Osteoarthritis is a common problem that requires a timely and active solution. In order not to start the disease and to be able to wait for the success of conservative measures, treatment should be started as soon as possible. This will prevent exacerbations, prevent the progression of changes in the joints, and restore the functional capabilities of the musculoskeletal system as much as possible. Otherwise, surgical correction should be considered.