Osteoarthritis is a chronic disease in which the structure of the connective tissues of the musculoskeletal system is damaged. The disease is characterized by a progressive course, against the background of which the cartilage tissue is gradually destroyed. This pathology is diagnosed in many people over the age of 65, as one of the factors contributing to the formation of this condition is the natural aging process in the body.
Description of the disease
A post-trauma, endocrine and inflammatory disease, excessive physical overload or vice versa, inactivity can provoke the development of a degenerative-dystrophic disease. The main signs of arthrosis: pain in the joint area with edema and limited activity in it.
To diagnose the disease, they resort to the help of instrumental techniques: X-rays, arthroscopy, CT and MRI. In the treatment of arthrosis of stages 1 and 2, conservative methods are used: taking medication, physiotherapy, massage and physiotherapy exercises. If irreversible destructive changes have occurred in the joint tissue, an operation is required - arthrodesis or endoprosthesis.
Pathogenesis
Osteoarthritis is characterized by pronounced changes in the structure of the connective tissue. The formation of deforming erosions occurs on the cartilage, as a result of which collagen fibers and proteoglycans are destroyed, which contain proteins (5-10%) and glycosaminoglycans (90-95%).
As a result, the stability of the collagen network decreases, the metalloproteinase is released and all forms of proteins in the extracellular matrix are destroyed. The acceleration of destruction occurs due to the fact that the biosynthesis of collagenases and stromelysin increases.
As a rule, when enzymes are present in the body in normal quantities, they keep the level of cytokines - small molecules of peptide information - under control. If osteoarthritis progresses, the concentration of this protein decreases, as a result of which the enzymes affecting the cartilage are released in a large volume.
As a result, proteoglycans with a distorted structure absorb water, which they cannot retain. For this reason, the excess fluid penetrates the collagen fiber, which begins to "swell", which leads to a loss of strength and elasticity.
The qualitative and quantitative composition of joint fluid also undergoes changes for the worse. Against the background of arthrosis, a decrease in the concentration of hyaluronic acid is observed. The transport of nutrients and oxygen to the hyaline cartilage tissue stops in the volume necessary for its restoration. Softened foci are formed in the cartilage, followed by the formation of cracks, specific necrotic growths. Then the bare heads begin to be exposed, microtraumas appear against the background of displacement relative to each other.
What causes the development of the disease
Why primary (idiopathic) osteoarthritis develops has not yet been established. Such a disease develops without the influence of any factors, so doctors are of the opinion that the cause of such a problem lies in the propensity at the genetic level to premature destructive processes in the cartilage. The formation of secondary arthrosis occurs as a complication of other joint diseases or against the background of an injury.
The presence of the following can provoke the formation of degenerative-dystrophic pathologies:
- damage to joint tissue or located near the connective tissue structure in the form of fracture, dislocation, trauma to the meniscus, partial rupture or complete separation from the bone of muscle and ligament tissue, tendons;
- congenital dysplastic disorder in the development of the joints;
- disorders in the functionality of the glands of the endocrine system, metabolic disorders;
- rheumatism or rheumatic fever;
- polyarthritis, rheumatoid, reactive, metabolic, gouty or psoriatic arthritis;
- purulent arthritis, the cause of which lies in the effects of streptococci, epidermal or Staphylococcus aureus;
- tuberculosis of any place, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative-dystrophic diseases, for example osteochondritis dissecans.
The increased mobility of the joint tissue, which is observed against the background of the production of special collagen fibers in the body, can contribute to the formation of arthrosis.A similar phenomenon is observed in 10% of people living on the planet, it is not considered a disease.Although, against the background of hypermobility, there is weakness in the tendon-ligament system, as a result of which a person is susceptible to injury, especially in the ankle joint, in the form of sprains and rupture of ligament tissue, dislocations.
In some cases, problems with hematopoietic function (for example, the presence of hemophilia) can lead to the formation of osteoarthritis. Against the background of hemarthrosis (hemorrhage in the cavity of the joint), the blood supply to the cartilage tissue deteriorates, as a result of which it begins to collapse.
Among the predisposing factors, to report the presence of old age, frequent loads on the joint tissue exceeding the limits of its strength, excessive body weight, surgery, hypothermia.
The risk group includes women in menopause, citizens living in adverse environmental conditions or in contact with toxic chemicals. If the diet contains insufficient vitamins and minerals, the conditions for the gradual destruction of hyaluronic cartilage tissue occur.
Symptoms
Osteoarthritis is dangerous because the first stage of formation is asymptomatic. The manifestation of the clinical picture of the disease occurs over time, the primary symptoms appear with a significant destruction of the cartilage.At first, the patient experiences a mild pain syndrome without a clear localization.Occurs after physical exertion: lifting heavy objects, sports training.
In some cases, the first sign of a person notices the appearance of crunches and clicks when flexing or extending the joints. The patient notes that it is sometimes difficult to move. Although in the initial stage of the formation of arthrosis, mobility problems appear only in the morning and quickly pass.
With the further development of the pathology, painful sensations begin to disturb at night, as a result of which the sleep function is disturbed, and chronic fatigue also appears. When the disease progresses to grade 2, the intensity of pain increases against the background of changes in weather conditions, exacerbations of chronic diseases, acute respiratory viral infections.
Physical activity decreases significantly. Mobility is hampered by thinning cartilage tissue and deliberately restricting the patient's movement in an effort to prevent pain. This increases the load on the tissue of the opposite joint, which contributes to its further destruction.
Osteoarthritis is characterized by other specific characteristics:
- pain that causes the appearance of spasms in the skeletal muscles and the formation of muscle contractures (limited passive motor function of the joint);
- crunching in the joint tissue, clicking, crepitus during movement of a constant nature, which occurs practically during each movement of the bones relative to each other;
- frequent painful muscle cramps;
- deformation of the joints, leading to altered posture and gait;
- pronounced deformity up to the curvature of the joints with a significant decrease or complete absence of motor activity in them against the background of grade 3 arthrosis.
If osteoarthritis of the knee, ankle, or hip has developed to stage 3, a person must use a cane or crutches when moving.
If you do not start treatment in a timely manner, the disease begins to progress, relapses begin to bother you regularly, in addition, exacerbations appear more and more often over time. Stiffness in the morning hours does not go away for a long time, it gradually becomes permanent.
During the examination of a person with stage 1 of osteoarthritis, the doctor notes only a slight edema of the joint tissue with complete preservation of motor function. Stage 2 of the disease is manifested by pain and mild deformity on palpation. Bone thickenings form near the synovial cavity.
Osteoarthritis is characterized by the formation of synovitis - inflammation of the synovium in the hip, ankle, knee or shoulder joint. The main symptom of this disease is the development of a rounded seal near the joint, when you press it, you can feel how the contents of the liquid move. With acute synovitis, the temperature can rise to 37-38 degrees, headaches and digestive problems can occur.
Diagnostic measures
The disease is diagnosed on the basis of the results of the study by instrumental methods, clinical features, anamnestic data, patient complaints. In this case, a clinical study of blood and urine is not very informative - all indicators remain within the normal range, if the cause of arthrosis does not lie in metabolic problems.
If synovitis develops, there is an increase in the sedimentation rate of erythrocytes (up to 30 mm / h), leukocytes and an increase in fibrinogen in the blood.Indicates the presence of acute or chronic inflammation in the body.Biochemical and immunological parameters change with osteoarthritis of the secondary form.
The most informative way to detect degenerative-dystrophic diseases is radiography in 2 views (lateral and straight).
On the X-ray image, osteoarthritis is displayed as follows:
- In the initial stage, there are no radiological signs.
- In the first stage, the pathology appears as an indistinct and irregular narrowing of the joint cavity. The edges of the bone plates are slightly flattened, initial osteophytes are formed (sometimes they are absent).
- In the second stage, you can see a picture in the picture in the form of a pronounced narrowing of the cavity in the joint, which exceeds the norm by 2-3 times. Osteophytes are formed in large numbers, the formation of subchondral osteosclerosis is noted. Cyst-like illuminations appear in the appendages.
- In the third stage, the image shows pronounced subchondral osteosclerosis and large marginal osteophytes. The joint space is significantly reduced.
- At the fourth stage, massive rough osteophytes are formed, the joint space is almost completely fused, the bony appendages that form the joint are deformed and compacted.
If the doctor has doubts about the diagnosis after reviewing the X-ray images, the patient is prescribed a computed tomography scan. To assess the condition of the connective tissue located near the joint, MRI is performed. The use of a contrast agent allows you to dynamically monitor how tissues are supplied with blood, to determine the degree of inflammation in synovitis.
Treatment for osteoarthritis
At the moment, it is impossible to completely cure osteoarthritis, since there are no pharmacological agents that restore cartilage tissue.The main goal of treatment is to prevent further development of the disease, to keep the joints mobile.Therapy for osteoarthritis is long-term, complex, involves the use of local and systemic drugs.
Patients should not overload the joints, it will be necessary to limit motor activity with the help of orthopedic devices: orthosis, elastic bandage. Overweight people will need to adjust their diet to lose weight over time and start the diet.
When stable remission is achieved, the patient should perform therapeutic gymnastics exercises every day. At first, you will have to do this under the supervision of a specialist, and in the future, you will have to do gymnastics at home on your own. In addition to physiotherapy, you can sign up for the pool, do yoga, or ride a bike.
To reduce the intensity of pain, the use of drugs belonging to different pharmacological groups is prescribed:
- Non-steroidal anti-inflammatory drugs in tablets, ointments, solutions for intravenous injections.
- Intra-articular injections of anesthetics with added glucocorticosteroids.
- Muscle relaxants to relieve muscle spasms and contractures.
In addition, the treatment regimen for osteoarthritis involves the use of vitamins of group B, sedatives, if necessary - antidepressants and tranquilizers. It is mandatory to appoint chondroprotectors in the form of a long course.Means of this group contribute to the partial restoration of cartilage.
To increase the clinical activity of the joint tissue, it is necessary to perform physiotherapeutic procedures: laser therapy, magnetotherapy, UHF.
Any painful manifestation in the joint area should be the basis for an immediate visit to the doctor. The treatment carried out in the early stages of the development of osteoarthritis allows to stop the destructive processes in the cartilage, to prevent disability and disability.