Osteoarthritis is a chronic pathology that affects the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course with gradual destruction of cartilaginous tissue.Osteoarthritis is detected in most patients over the age of 65, as one of the reasons for its development is the natural aging of the body.
The occurrence of degenerative-dystrophic pathology is caused by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, a sedentary lifestyle.The main symptoms of osteoarthritis are joint pain, swelling and limited movement.
To diagnose pathology, instrumental studies are carried out - radiography, arthroscopy, MRI, computed tomography.Arthrosis of the 1st and 2nd severity is treated conservatively with a course of medications, physiotherapeutic and massage procedures, and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
With arthrosis, pronounced changes occur in the internal structures of the connective tissue.Deforming erosions form in cartilaginous tissues, which cause the destruction of collagen fibers, as well as proteoglycans consisting of proteins (5–10%) and glycosaminoglycans (90–95%).As a result, the collagen network loses stability and metalloproteinases begin to be released, destroying all types of extracellular matrix proteins.Destruction is accelerated by increased biosynthesis of collagenases and stromelysin.Normally, the normal quantitative values of enzymes are controlled by cytokines - small peptide information molecules.But as osteoarthritis progresses, the concentration of these proteins decreases, which causes the release of a large number of enzymes that damage cartilaginous tissue.
Proteoglycans with an altered structure begin to absorb water molecules that they cannot retain.Therefore, excess liquid enters the collagen fibers.They “swell” and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of synovial fluid.With osteoarthritis, the concentration of hyaluron decreases.Hyaline cartilages no longer receive sufficient nutrients and oxygen for their regeneration.Foci of softening form in the cartilaginous tissues, then cracks and specific necrotic growths appear.The heads of the bones become exposed and begin to suffer microtraumas when displaced in relation to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) arthrosis have not yet been established.It occurs in the absence of any provoking factors, which is why theories are put forward about a hereditary predisposition to premature destruction of cartilage.Secondary arthrosis develops as a consequence of other joint pathologies or previous injuries.What can cause degenerative dystrophic disease:
- injury to a joint or nearby connective tissue structures - fracture, dislocation, meniscus injury, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of the functioning of endocrine glands, disruption of metabolic processes;
- rheumatism or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by epidermal streptococci or Staphylococcus aureus;
- tuberculosis of any location, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative disease, for example, osteochondritis dissecans.
Joint hypermobility, caused by the production of special collagen, predisposes to the development of osteoarthritis.This condition is detected in 10% of the planet's inhabitants and is not considered a pathology.But hypermobility is accompanied by weakness of the tendon-ligamentous apparatus, which leads to frequent injuries, especially in the ankle joint (sprain and rupture of ligaments, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders such as hemophilia.Hemarthrosis, or hemorrhage in the joint cavity, causes deterioration of cartilage trophism and its destruction.
Predisposing factors include advanced age, frequent loads on joints that exceed their strength limits, excess weight, surgical interventions and hypothermia.
The risk group includes menopausal women, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.If there is a deficiency in the diet of foods with vitamins and microelements, prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of osteoarthritis lies in the absence of symptoms in the first stage of its development.The pathology clinically manifests itself gradually, the first signs appear against the background of significant destruction of cartilaginous tissue.Initially, the person feels a slight pain that has no clear location.Appears after physical activity - weight lifting, sports training.Sometimes the first clinical manifestation is a crunching or clicking sound when bending or extending the joint.The person begins to realize that some movements are difficult.However, in the initial stage of osteoarthritis, stiffness occurs in the morning and soon disappears.
As the disease progresses, pain is also felt at night, causing not only sleep disturbances but also the onset of chronic fatigue.The severity of pain syndrome in the second stage increases with climate change, exacerbation of chronic pathologies and acute respiratory viral infections.The range of movements is visibly reduced.The cause of stiffness is the thinning of the cartilage, as well as the conscious restriction of the person's movements in an attempt to avoid pain.This leads to increased load on the opposite joint, which causes greater damage.Osteoarthritis is also characterized by other specific symptoms:
- pain causes spasms of skeletal muscles and the development of muscle contractures (limitation of passive movements of the joint);
- clicking in the joints, clicks, crunches during movement become constant, occurring with almost all displacements of the bones relative to each other;
- painful muscle cramps often occur;
- joints become deformed, which leads to disturbances in posture and gait;
- in the third stage of arthrosis, the deformation is so pronounced that the joints are flexed and the range of movements in them is significantly reduced or completely absent;
- with third-degree arthrosis of the knee, ankle, hip joint, the patient uses a cane or crutches to move.
In the absence of treatment, the pathology progresses, and during its course remissions are replaced by relapses, and the frequency of exacerbations increases more and more.Stiffness in movements in the morning now does not disappear for a long time, it becomes permanent.
When examining a patient with grade 1 arthrosis, the doctor notes only slight swelling of the joint and complete preservation of range of motion.In grade 2 pathology, palpation reveals pain and slight deformity.In the region of the joint space, the formation of bone thickenings is observed.
Arthrosis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Its main symptom is the formation of a rounded seal in the area of the joint, when pressure is applied on which fluid movement (flotation) is felt.Acute synovitis may be accompanied by an increase in temperature to 37-38 °C, headaches and digestive disorders.
Diagnosis
The diagnosis is made based on the results of instrumental studies, features of the clinical picture, anamnesis and patient complaints.A general blood and urine test is not very informative - all values remain within normal limits if arthrosis is not caused by metabolic pathology.With the development of synovitis, the erythrocyte sedimentation rate increases (30 mm/hour) and the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.Changes in biochemical and immunological parameters occur in secondary forms of osteoarthritis.
The most informative method for diagnosing degenerative dystrophic pathology is radiography in frontal and lateral projection.
| Stages of osteoarthritis according to the Kellgren-Lawrence classification (1957) | Radiographic signs of pathology |
|---|---|
| Home | No radiological signs |
| First | Indistinct and uneven narrowing of the joint space.Slight flattening of the edges of bone plates, formation of initial osteophytes or their absence |
| Second | Marked narrowing of the joint space, 2-3 times greater than normal, formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic clearings in the epiphyses |
| Third | The appearance of pronounced subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| Room | Formation of coarse massive osteophytes, almost complete fusion of the joint space, deformation and compaction of the epiphyses of the bones that form the joint |
If, after studying the radiographic images, the doctor has doubts about the diagnosis, a computed tomography is prescribed.And to assess the condition of the connective tissue structures located near the joint, an MRI is performed.When using contrast, it is possible to dynamically assess the blood supply to tissues and establish the stage of the inflammatory process during the development of synovitis.
Basic therapy methods
Osteoarthritis is still an incurable disease, as there are no pharmacological medications for the regeneration of cartilage tissue.The main objective of therapy is to prevent the progression of the pathology and maintain joint mobility.Treatment is long-term, complex, using local and systemic medications.Patients should avoid severe stress on the joint and, if necessary, limit the range of motion with orthopedic devices - orthoses, elastic bandages.Overweight patients need to make adjustments to their diet to gradually reduce body weight and follow a diet.
After achieving stable remission, patients do daily physical therapy exercises.The first workouts are carried out under the guidance of a physiotherapist, then the patient performs a series of exercises at home.Exercise therapy can be supplemented with swimming, yoga and cycling.
To reduce the intensity of pain, medications from several clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- joint injections of anesthetic solutions in combination with glucocorticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic regimens include B vitamins, sedatives and, if necessary, tranquilizers and antidepressants.Chondroprotectors are necessary for long-term use.This is the only group of drugs that has the ability to partially restore cartilage tissue.
To increase its clinical activity, physiotherapeutic procedures are carried out - laser therapy, magnetic fields, UHF therapy.
Any joint pain should be a signal for immediate consultation with a doctor.Therapy carried out in the initial phase of osteoarthritis will stop the destruction of cartilage and prevent loss of performance and disability.