Osteoarthritis

Osteoarthritis – what is it in simple words?

Osteoarthritis is a chronic pathology in which the cartilaginous plate is gradually destroyed. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) develop. The joint capsule reacts to the events that occur and reactive vasculitis develops.

About the disease and possible complications

The incidence of the pathology depends on age. The first signs of osteoarthritis usually do not appear before the age of 30-35, and by the age of 70, around 90% of the population suffers from this pathology. Osteoarthritis does not present gender differences. The only exception is degenerative damage to the joints between the carpal phalanges. This form of the disease is 10 times more common in women than in men. Osteoarthritis most often affects the large joints of the legs and arms.

The pathological process begins with the interstitial substance of cartilaginous tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by the balance of anabolism and catabolism processes. If the process of degradation of cartilaginous tissue dominates its synthesis, conditions will be created for the development of osteoarthritis. This explains in simple terms what osteoarthritis is.

Most often, the first signs of the disease develop in places of greatest mechanical load, with limited areas of softening of the cartilaginous plate appearing. As the pathological process progresses, fragments and cracks of the cartilage and local deposition of calcium salts are possible. Beneath cartilaginous defects, the underlying bone is exposed; separate fragments of cartilage enter the joint cavity and can lead to the so-called "blockage" (symptoms of a "joint rat").

Damage to the cartilage that covers the articular processes of the bones causes them to lose their ideal shape, repeating each other's contours. As a result, during movement, the articular surfaces experience a non-physiological load. In response to this, compensatory resynthesis processes are stimulated in bone tissue. The bone becomes denser (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further alters the discrepancy between the articular surfaces. The development of pathological changes gradually limits the range of motion of the joint and contributes to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead fragments of cartilage and bone activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, this prolonged inflammation is accompanied by sclerosis of the periarticular tissues - the joint capsule thickens and the surrounding muscles atrophy.

The main symptom of osteoarthritis is pain, which over time is accompanied by limited mobility in the joint. The limitation of mobility is first of compensatory functional nature and then due to organic changes. Additional imaging diagnostic methods (radiography, ultrasound, computed tomography or magnetic resonance imaging) help to establish the correct diagnosis.

Depending on the stage and degree of osteoarthritis, treatment can be carried out by conservative or surgical methods. An orthopedic traumatologist will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of osteoarthritis

There are 2 types of osteoarthritis:

1. The primary variant is a consequence of a violation of the relationship between the processes of synthesis and degeneration of cartilage tissue and is accompanied by a disturbance in the function of chondrocytes - the main cartilage cells.
2. The secondary variant occurs in a previously modified joint when the normal relationship (congruence) of the articular surfaces is disturbed, followed by redistribution of the load on them and with pressure concentration in certain areas.

Symptoms of joint arthrosis

The main symptom of joint osteoarthritis is pain. It has certain distinctive features that allow for the primary diagnosis of the disease.

1. Mechanical pain, caused by the loss of the shock-absorbing characteristics of cartilage. Painful sensations occur during physical activity and are relieved during rest.
2. Night pain.Caused by stagnation of venous blood and increased pressure of blood flowing within the bone.
3. Initial pain.It is short-lived and appears in the morning, when the person gets out of bed (the patient says they need to "disperse"). These pains are caused by the deposition of debris in the cartilaginous plates; during movement, these fragments are pushed towards the joint inversions, causing the unpleasant sensations to cease.
4. Dependence on meteors.The pain may intensify when weather conditions change (increase in atmospheric pressure, cold, excess humidity).
5. Blocking pain.These are sudden painful sensations associated with compression of a fragment of bone or cartilage between the articular surfaces. Against the background of "blocking", the slightest movements in the joint stop.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person is bothered by stiff joints. Signs of the inflammatory process are determined objectively - swelling and a local increase in skin temperature.

Osteoarthritis usually starts slowly with the onset of pain in an affected joint. At first, the pain only bothers during physical activity, but later it appears even at rest and during night sleep. Over time, pain is also felt in the joints on the opposite side, which is associated with a compensatory increase in load. An important distinguishing feature of osteoarthritis is its frequency, when short periods of exacerbation are followed by periods of remission. The progression of the pathological process is indicated by the shortening of the period between relapses and the development of adverse consequences in the form of contractures and a sharp limitation of mobility in the joint.

Course of arthrosis during pregnancy

During pregnancy, osteoarthritis can occur in different ways. Normally, up to 12-13 weeks, an exacerbation of the pathological process may occur, associated with hormonal changes occurring in the woman's body. The second and third trimesters are generally relatively stable. Pregnancy management is carried out by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint arthrosis

The main mechanism that triggers the destruction of cartilage is the violation of the synthesis of proteoglycan molecules by cells of cartilage tissue. The development of arthrosis is preceded by a period of metabolic disorders, which occurs in a latent form. This metabolic imbalance is characterized by damage to proteoglycans and their constituent components (chondroitin, glucosamine, keratan), which is accompanied by the disintegration and degradation of the cartilage matrix. Collagen fibers break in the cartilaginous plate, the supply of metabolites necessary for life is interrupted and the water balance also changes (first the cartilage is hydrated and then the number of water molecules decreases drastically, which further stimulates cracking) .

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. With arthrosis, a "boom" of cytokines is also observed - the released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of osteoarthritis can be varied:

• "excess" weight, which increases the load on the joints;
• wear poor quality shoes;
• concomitant diseases of the musculoskeletal system;
• suffered joint injuries.

Signs and diagnosis of joint arthrosis

Based on clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are performed.

1. Radiography.At an early stage, radiographic signs of the disease are of little importance - they may be irregular narrowness of the joint space, slight compaction of the underlying bone and small cysts in this area. At a later stage, radiography is more informative - marginal bone growths appear, the shape of the articular surfaces changes, articular "rats" and areas of calcification in the capsule can be determined.
2. Ultrasound of the joints.Ultrasound is more informative for detecting early signs of osteoarthritis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilaginous plate and secondary reactions of the capsule, musculotendinous and ligament compartments can be seen.
3. Computed or nuclear magnetic tomography.This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the state of the cartilaginous plate, the subchondral region of the bone, and determine the volume of synovial fluid, incl. in joint inversions.

Opinion of an 'expert

Deforming osteoarthritis of the joints is one of the most common pathologies of the musculoskeletal system, occurring in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. At first, these are short-term pains in a joint, which the person often does not pay attention to. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain turns into constant. In the absence of treatment, the disease continues to progress and is accompanied by severe degeneration of the cartilage, which no longer responds to conservative therapy and to solve this problem only arthroplasty is required - a complex and expensive intervention to replace the destroyed joint with a complete. -full-fledged implant. However, targeted drug therapy and lifestyle modification can help significantly delay this operation or avoid it altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Osteoarthritis treatment

According to clinical guidelines, the main objective of osteoarthritis treatment is to delay the progression of degenerative lesions of the cartilaginous plate. To achieve this, measures are taken that reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to prevent the development of secondary synovitis.

Conservative treatment

Joint unloading is carried out in the following ways:

• loss of body weight (if excessive);
• carry out physiotherapy that excludes prolonged similar postures;
• refusal to lift large loads or remain on your knees for long periods (relevant for some professions).

In the early stages of the disease, in addition to physiotherapy, swimming and cycling are helpful. In the later stages, to unload the joint during an exacerbation, it is recommended to walk with an orthopedic cane or use crutches.

To relieve pain, incl. against the background of secondary synovitis, non-steroidal anti-inflammatory drugs are used, both local and systemic. Intra-articular corticosteroid injections can be used for the same purpose.

To improve the anatomical and functional state of the cartilaginous plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help improve the metabolism of cartilage tissue, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progression of the pathological process and improve mobility in the joint.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

• Joint puncture– indicated for severe reactive synovitis. It allows not only to remove the inflammatory fluid, but also to introduce corticosteroids that interrupt the pathological chain.
• Arthroscopic operations, which involves the introduction of instruments into the joint cavity through small punctures and subsequent visualization under magnification. These interventions allow washing the joint and its inversions, leveling the cartilaginous plate, removing necrotic areas, "polishing" the joint surfaces, etc.
• Endoprostheses– is considered a radical operation, which is performed in case of an advanced pathological process. Typically used for osteoarthritis of the knee or hip joint.

Osteoarthritis prevention

Osteoarthritis prevention aims to maintain a normal weight, wear orthopedic shoes, avoid working your knees, lifting heavy objects in doses and adhering to a physical activity regime.

Rehabilitation for joint arthrosis

Rehabilitation of joint arthrosis involves a set of procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and recreational gymnastics are used.

Questions and answers

Which doctor treats osteoarthritis?

Diagnosis and treatment are carried out by a traumatologist-orthopedist.

Does radiography always allow the correct diagnosis to be made?

The severity of clinical signs of osteoarthritis does not always correlate with radiological changes. Often in practice there are cases when, with severe pain, the x-ray does not reveal significant changes, and vice versa, when a "bad" x-ray image is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for osteoarthritis?

If arthrosis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to look for causes that could lead to disruption of the functional state of the joint (for example, damage to the menisci of the knee joint and intra-articular ligaments).