In the structure of the pathology of the bone-joint system, osteoarthritis occupies a leading place - about 70% of cases fall on it. Such a problem is most often encountered by people after 50 years, but the first signs of the disease appear even in young people. This disease has serious medical and social importance, as in many cases it becomes the cause of functional insufficiency in working age.
Many people know about such a pathology as arthrosis of the joints, but not every patient understands why it develops, how it manifests itself and what is needed to fight the disease. And increased awareness and caution can prevent the emergence and development of harmful 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 elderly patients. But the age factor is far from the only cause of deforming arthrosis. The origin of the disease is quite heterogeneous and is due to both external and internal types of pathological effects on the body.
For each patient there are certain risk factors that contribute to the appearance of joint pathology. Therefore, the causes of arthrosis combine the following conditions:
- Hard physical work.
- Inactivity.
- Traumatic injuries.
- Joint dysplasia.
- Inflammation (arthritis).
- Overweight.
- Estrogen deficiency in menopause.
- Diseases of the thyroid gland.
- Consequences of joint operations.
- Heredity.
As you can see, the development of arthrosis is mediated by diverse factors, which in most cases are of a mechanical or metabolic nature. In this case, the patient's lifestyle and his profession are of great importance, since loaders, physical 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.
Mechanism of development
The normal function of the joint is ensured by the harmonious operation of all its structures. But the main component of any joint is cartilage. It provides a cushioning function and withstands the pressure on the joint. Cartilage tissue consists of cells (chondrocytes) and a matrix, the main substances of which are proteoglycans and collagen.
If the load on the joint exceeds the permissible, then first there are structural disorders in the cartilage. The proteoglycans that hold the collagen fibers are lost, which increases the sensitivity of the tissue to external influences. The processes of destruction begin to predominate over 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 maintained by inflammatory reactions and hormonal disturbances.
All this leads to a thinning of the cartilage, it becomes rough and loses its elasticity. Due to the growth of the underlying bone tissue, there is a narrowing of the joint gap and the formation of osteophytes - marginal growths. The synovial membrane thickens, ligaments thicken and shorten, muscle function is impaired.
Pathological processes in the joint develop gradually, but do not pass without a trace. Disorders in cartilage and other structures inevitably affect the clinical picture of arthrosis.
Classification
Arthritis, like other diseases, has certain varieties. This should 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 against the background of other diseases. If the cause cannot be identified, it is called idiopathic osteoarthritis. Depending on the number of affected joints, the following varieties are distinguished:
- Monoarthrosis.
- Oligoarthrosis - no more than 2 joints are affected.
- Polyarthrosis - affects 3 joint groups.
If the pathological process has a generalized character, then we can talk about the defeat of almost all joints of the body, including the spine, where spondylarthrosis is observed. In this case, the disease can occur in nodular or nodular form.
It is important to understand what processes are taking place in the joint and to adequately assess their severity. Therefore, do not forget 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 cartilage's ability to withstand the load.
- Stage 2 - destruction of cartilage tissue, bone growths, dystrophy of the joint bag.
- 3 stage - bone deformation, contractures, instability of the joint.
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 function.
- 2 degree - disability.
- 3 degree - the impossibility of self-service.
All these features should be reflected in the diagnosis of osteoarthritis, as they are important for subsequent therapy.
Symptoms
Among the joint pathology, the symptoms of arthrosis have a very tangible specificity. They develop gradually, but continuously progress, which leads to the limitation of physical activity of patients. That is why it is especially important to suspect the disease in time to stop its development, as well as to prevent complications.
When you contact a doctor, patients' complaints are first analyzed. And most of all, people are worried about joint pain. But in arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - arise against the background of the load and decrease at rest.
- Initial - the onset of pain is associated with the beginning of movement (walking).
- "Joint mouse" - periodic sharp pains with blockade of the joint, caused by damage to the synovial membrane between the cartilage surfaces.
At first, patients may experience only a vague discomfort in the joints, accompanied by a feeling of fatigue. But over time it develops into pain. And if in the initial stages it worries after loading, then in the future - during movement, and in advanced cases it becomes constant, remains even at rest and at night.
In addition to pain, patients have other symptoms of arthrosis. They are both subjective and objective in nature, including the following characteristics:
- Stiffness in the joints in the morning for no more than 30 minutes.
- Crepitus when moving.
- Deformation of the periarticular area.
- Limitation of mobility.
In case of arthrosis of the hands, characteristic formations in the area of the proximal and distal phalanges - Bouchard's and Heberden's nodes - are noticed during the examination. Palpation of the affected joints is often painful. If contractures are formed, then there is fixation of certain parts of the limbs more often in a position of flexion.
The pronounced nature of osteoarthritis leads to a significant decrease in the level of physical activity of patients, which leads to a decrease in their quality of life.
Diagnosis
In order 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 research, which includes instrumental and laboratory methods. First of all, they try to see structural changes in the affected areas, to assess their severity and spread. It is also necessary to determine the metabolic disorders in the body, which have become a favorable background for the appearance of arthrosis. Therefore, the complex of studies consists of the following activities:
- Radiography.
- Magnetic resonance.
- Ultrasound procedure.
- Arthroscopy.
- Biochemical blood tests (hormonal spectrum, inflammatory markers, calcium metabolism, rheumatic tests).
After the examination, a consultation with an orthopedic traumatologist will be necessary, which will help to form the correct treatment tactics for each patient.
Treatment
The treatment of arthrosis of the joints is necessary in a complex manner. This means that all available therapeutic agents are used to alleviate the patient's condition. But you should understand that their effectiveness directly depends on the time of treatment. In advanced forms of the disease, conservative measures will help little. With early treatment, a pronounced and lasting result can be obtained. The following methods are used to treat osteoarthritis:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- Massage.
- Operation.
The doctor decides what means are suitable for a particular patient. The choice is made based on the results of the study and the individual characteristics of the organism.
The best effect of the treatment can be achieved if the correction begins in the early stages of the disease, when the first symptoms have just begun to appear.
General recommendations
Since the development of degenerative changes in the joints is mediated by increased loading, it is first necessary to reduce the mechanical effect on the cartilage tissue. To do this, you need to stop wearing heavy, intense sports training. Any method is suitable for unloading the joint - from walking with a cane to special fixing orthoses. But it is impossible to completely abandon the movements, physical activity must be dosed. Walking short distances, swimming are useful.
Proper nutrition plays an important role in the correction of arthritic changes. Diet helps to 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 should enrich the diet with fresh vegetables and fruits, herbs. But in return, you should refrain from smoked, spicy, fatty foods, pickles and pickles. It is better to pay attention to foods rich in collagen fibers, elastin and gelatin: jellied meat, hashish, dishes with aspic, fruit jellies.
Medical therapy
Traditional treatment for osteoarthritis begins with medication. With the help of 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 structural-modifying effect on cartilage tissue. The following drugs are usually recommended:
- Nonsteroidal anti-inflammatory.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
For severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be made. But such treatment should be short-term, because with long-term use, hormonal drugs have the opposite effect - they stimulate dystrophic processes. Systemic therapy should be combined with local drugs.
Medicines for arthrosis are taken on the recommendation of a doctor and under his control. Independent use of any medication is prohibited.
Physiotherapy
Methods of physical impact help to eliminate the acute signs of joint pathology. Together with drugs, they can reduce the intensity of pain and inflammation, and also stimulate biochemical processes in the cartilage itself. The following procedures are used in the complex treatment of arthrosis:
- Electrophoresis.
- Ultrasonic processing.
- wave therapy.
- Magnetotherapy.
- laser treatment.
- Mud therapy and water therapy.
Such methods affect not only the joint, but also the surrounding tissues. This contributes to the activation of blood circulation, improvement of trophic processes and weakening of muscle contractures. Many of the elements of balneotherapy have a general health effect. But at the same time, we must not forget the contraindications for physiotherapy: infectious diseases, tumors, cardiovascular pathology, kidney failure, bleeding, serious condition of the patient.
Physiotherapy
An important aspect of non-drug therapy for osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue has a clear dependence on the mechanical factor. But his strength should be enough. Only then do processes of growth prevail over destruction. Therefore, gymnastics is indicated for all patients with joint diseases. But for each person, their own set of exercises is developed - taking into account the localization and severity of the lesion, as well as the general condition of the body.
Pain should not be allowed during classes. Exercises are performed slowly and only after the acute symptoms are removed. Avoid sudden and amplitude movements that can cause discomfort. Physical education should be carried out under the supervision of a doctor, and after acquiring the necessary skills, you can start home exercises.
Therapeutic gymnastics is an integral part 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 indicated. 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.
- Crushing.
- 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 achieve 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 in an open manner 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. It is true that 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 hope for the success of conservative measures, treatment should be started as early as possible. This will avoid exacerbations, prevent the progression of changes in the joints and maximally restore the functional abilities of the musculoskeletal system. Otherwise, surgical correction will need to be considered.