Osteoarthritis is a chronic pathology that affects the connective tissue structures of the musculoskeletal apparatus. For the disease characterized by progressive course with the gradual destruction of cartilage. Arthrosis is diagnosed in most patients after 65 years as one of the reasons for its development is the natural aging process.
Yes, the appearance of degenerative-dystrophic pathology of the result of previous trauma, endocrine and inflammatory diseases, excessive physical exertion or, on the contrary, a sedentary lifestyle. Leading symptoms of osteoarthritis are pain, joint swelling, restriction of movement.
To diagnose pathology conducts instrumental studies — radiography, arthroscopy, MRI, CT. Arthritis 1 and 2 severity treated conservatively course taking drugs, physical therapy and massage, exercise therapy. When irreversible destructive changes in the joints, surgical intervention — arthrodesis, arthroplasty.
Pathogenetic mechanisms
In osteoarthritis occur pronounced changes in the internal connective tissue structures. On cartilaginous tissue formed deforming erosion, which causes destruction of the collagen fibers, and proteoglycans, which consist of protein (5-10%) and glycosaminoglycans (90-95%). The result of the collagen network loses stability, begin to break free of metalloproteinases that destroy all types of extracellular matrix proteins. Degradation is accelerated by increasing the biosynthesis of collagens and stromelysin. Usually normal values of enzymes controlling cytokines — small peptide information molecules. Hello with the progression of osteoarthritis, the concentration of these proteins decreases, which causes the release of large quantities of enzymes that affect cartilage.
Proteoglycans with altered structure begins to absorb water molecules, which are unable to keep. Therefore, the excess fluid enters the collagen fibers. They "swell", you lose strength and elasticity. Qualitative and quantitative composition of synovial fluid is also experiencing negative changes. In osteoarthritis it reduces the concentration of hyaluronic acid. Yes hyaline cartilage cease to be sufficient for their regeneration the amount of nutrients and oxygen. In the cartilaginous tissues formed foci of softening, and then ate it cracks, specific necrotic growths. Bone head bare, you begin to microtraumatic at offset relative to each other.
Causes and predisposing factors
The causes of primary (idiopathic) osteoarthritis is not yet established. It occurs when the absence of any precipitating factors, therefore, put forward the theory of hereditary predisposition and premature destruction of cartilage. Secondary osteoarthritis develops as a consequence of other pathologies of joints or previous injuries. What can cause degenerative diseases:
- injury to the joint or located in close proximity to connective tissue structures — fracture, dislocation, injuries to the meniscus, a partial tear of muscles, ligaments, tendons or complete detachment of the hell bone base;
- congenital dysplastic developmental disorder of articulation;
- violation of the endocrine glands, disorder of metabolic processes;
- rheumatism, or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic, or gouty arthritis, polyarthritis;
- purulent arthritis provoked by streptococci, or Staphylococcus epidermidis staphylococci;
- tuberculosis of any localization, bracelet, chlamydia, gonorrhea, syphilis;
- degenerative disease, for example, dissecting Legg.
Yes development of osteoarthritis induces hypermobility of the joints due to the production of a particular collagen. This condition appears in 10% of the inhabitants of the planet and is not considered a pathology. Hello hypermobility accompanied by weakness of the tendon-ligamentous apparatus, which leads to frequent injuries, the particular ankle (sprains and torn ligaments, sprains).
The cause of arthrosis hours are disorders of hematopoiesis, for example, hemophilia. Hemarthrosis or bleeding into the cavity of the joint, provoking the deterioration of the trophic cartilage and their destruction.
Yes predisposing factors include old age, frequent stress on the joints that exceed the limits of their strength, weight gain, surgery, and hypothermia.
The risk group includes women in menopause, people who live in adverse environmental conditions or contact with toxic chemical compounds. Deficiency in the diet of foods with vitamins and minerals, creating conditions for the gradual degradation of the hyaline cartilage.
The clinical picture
The danger of osteoarthritis is the lack of symptoms in the first stage of its development. Pathology is clinically manifested gradually, the first signs arise against significant destruction of the cartilage tissues. First, the person feels mild pain that has no clear localization. It is a phenomena after physical activity — weight lifting, athletic training. Hours of first clinical manifestation is a crunch, clicks when bending or unbending of the joint. People began to notice that certain movements are difficult. However, at the initial stage of osteoarthritis stiffness occurs in the morning hours and soon disappears.
The disease progresses pain is felt at night, causing not only a sleep disorder, but the phenomenon the appearance of chronic fatigue. The severity of pain at different stage increases with the change of weather I, exacerbation of chronic diseases, infection. Markedly reduced range of motion. The reason for the stiffness becomes thinning of cartilage and deliberate restriction of a person's movements in an attempt to avoid the phenomenon of the onset of pain. This also leads to increased load on the opposite joint, which causes further damage. For osteoarthritis characteristic and other specific symptoms:
- pain provokes spasms of skeletal muscles and development of muscle contractures (limitation of passive motion in the joint);
- the crunch in joints, clicks, crackle on the move become permanent, arise Amal in skin displacement of the bones relative to each other;
- often, there are painful muscle cramps;
- the joints are deformed, which leads to violations of posture and walking;
- in the third stage of arthrosis deformation expressed so bright that joint is bent, and the volume of movements in them significantly reduced or completely absent;
- in the third degree osteoarthritis of the knee, ankle, hip joint when moving the patient uses a cane or crutches.
If untreated, the pathology progresses, and in its course of remission alternate with recurrences, and the frequency of outbreaks is increasing. Stiffness in the morning, now does not disappear for a long time, it becomes permanent.
Examining a patient with osteoarthritis of 1 degree, the doctor noted only a slight swelling of the joint and complete safety AB pit movements. In the pathology of 2 degrees palpation reveals tenderness and mild pronounced deformation. In the region of the joint space observed the formation of bone nodules.
For osteoarthritis characterized by the development of synovitis — inflammation in the synovial membranes of the hip, knee, ankle, shoulder joints. Their leading symptom becomes rounded education seal in the field joint, when pressed on which one feels the displacement of fluid (fluctuation). For acute synovitis may be accompanied by a temperature rise yeah 37-38°C, headaches, digestive disorders.
Diagnosis
The diagnosis put on the basis of results of instrumental investigations, clinical features, anamnesis, complaints of patients. General analysis of blood and urine uninformative — all values remain within normal limits if the arthritis is not triggered by metabolic disorders. With the development of synovitis increases the erythrocyte sedimentation rate (30 mm/hour) in the blood increases the level of leukocytes, and fibrinogen. This indicates that occur in the body acute or chronic inflammatory process. Changes in biochemical and immunological parameters occur in secondary forms of osteoarthritis.
The most informative method of diagnostics of degenerative-dystrophic pathology — radiography in frontal and lateral projections.
| Stage of osteoarthritis in accordance with the classification of Kellgren-Lawrence (1957) | Radiographic signs of pathology |
| Initial | The absence of radiological signs |
| First | Indistinct, irregular narrowing of the joint space. A small dwelling of the edges of the bone plates, the initial formation of osteophytes or lack thereof |
| Another | Marked narrowing of the joint space, which exceeds the value of the norm in 2-3 times, the formation of a large number of osteophytes, subchondral osteosclerosis. The phenomenon of the emergence of kistevidnyj enlightenment in the epiphyses |
| Third | Phenomenon of emergence expressed subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| Fourth | The formation of coarse massive osteophytes, the almost complete fusion of the joint space, the deformation and compaction of the epiphyses of the bones that form the joint |
If after studying x-ray images to the doctor to have doubts in setting the diagnosis, prescribe a CT scan. And to assess the state located around the joint connective tissue structures MRI. When using contrast in dynamics to evaluate blood flow to the tissue, set the stage of the inflammatory process in the development of synovitis.
The main methods of therapy
Arthrosis of the phenomenon is still an incurable disease, as there are no pharmaceutical drugs for the regeneration of cartilage. The main task of treatment becomes the prevention of progression of diseases, preservation of joint mobility. Treatment is long and complex, using both local and systemic medications. Patients should avoid serious esneh loads on the joint, if necessary, to limit the range of motion orthopedic devices such as braces, elastic bandages. Patients with excess weight, you need to make adjustments to the diet for gradual weight reduction and a diet.
After achieving a sustained remission patients shown daily physical therapy sessions. The first training is conducted under the guidance of a physical therapist, then the patient performs exercises at home. Physical therapy can be supplemented with swimming, yoga, Cycling.
To reduce the severity of pain prescribers various clinical and pharmacological groups:
- nonsteroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration the active ingredients;
- injections into the joint solutions of anesthetics in combination with corticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
In the therapeutic scheme includes the B vitamins, sedatives, if necessary, tranquilizers and antidepressants. Is also appointed chondroprotectors for long course receiving. This is the only group of drugs that possess the ability to partially restore cartilage.
To enhance their clinical activity carried physiotherapy — laser therapy, magnetic field, UHF-therapy.
Any joint pain should be a signal for immediate treatment and the doctor. Therapy conducted at the initial stage of osteoarthritis, it will help stop the destruction of cartilage, avoid disability, and disability.