Osteoarthritis is a chronic disease in which the structure of the connective tissue of the musculoskeletal system is damaged. The disease is characterized by a progressive course, on the background of which the cartilaginous tissue is gradually destroyed. This pathology is diagnosed in many people over the age of 65, because one of the factors that contributes to the development of this condition is the natural aging process in the body.
Description of the disease
Posttrauma, endocrine and inflammatory disease, excessive physical overload or vice versa, inactivity can cause the development of degenerative-dystrophic disease. The main signs of arthrosis: joint pain with edema and limited activity in it.
To diagnose the disease, they resort to the help of instrumental techniques - X-ray, arthroscopy, CT and MRI. In the treatment of stage 1 and 2 osteoarthritis, conservative methods are used - medication, physiotherapy, massage and physiotherapy exercises. If irreversible destructive changes have occurred in the joint tissue, surgery is required - arthrodesis or endoprosthesis.
Pathogenesis
Osteoarthritis is characterized by pronounced changes in connective tissue structure. Deforming erosion occurs on the cartilage, due to which collagen fibers and proteoglycans containing proteins (5-10%) and glycosaminoglycans (90-95%) are destroyed.
As a result, the stability of the collagen network is reduced, metalloproteinases are released and all forms of protein in the extracellular matrix are destroyed. Acceleration of destruction is due to the fact that the biosynthesis of collagenases and stromelysins increases.
As a rule, when enzymes are present in the body in normal amounts, they control the level of cytokines - small molecules of information about peptides. If the arthrosis progresses, the concentration of this protein decreases, due to which the enzymes that affect the cartilage are released in large quantities.
As a result, proteoglycans with a distorted structure absorb water that they cannot retain. For that reason, the excess fluid penetrates the collagen fibers, which begin to "swell", which leads to a loss of strength and elasticity.
The qualitative and quantitative composition of the joint fluid is also subject to changes upwards. In the background of arthrosis, a decrease in the concentration of hyaluronic acid is noticed in it. The transport of nutrients and oxygen to the hyaline cartilage tissue is stopped in the amount necessary for its regeneration. Softened foci form in the cartilage, followed by the formation of cracks, specific necrotic growths. Then the bare heads begin to be exposed, microtrauma appears in the background of the movement relative to each other.
What provokes the development of the disease
Why primary (idiopathic) arthrosis develops has not yet been determined. Such a disease develops without the influence of any factors, so doctors believe that the cause of such a problem lies in the tendency at the genetic level of premature destructive processes in cartilage. The formation of secondary osteoarthritis occurs as a complication of other joint diseases or in the background of injury.
The presence of the following can cause degenerative-dystrophic pathology:
- damage to joint tissue or located near the connective tissue structure in the form of fracture, dislocation, meniscus trauma, partial rupture or complete separation from bone of muscle and ligament tissue, tendon;
- congenital dysplastic joint development disorder;
- disorders in the function of the glands of the endocrine system, metabolic disorders;
- rheumatism or rheumatic fever; polyarthritis, rheumatoid, reactive, metabolic, gout or psoriatic arthritis;
- purulent arthritis, the cause of which lies in the effects of streptococcus, epidermal or Staphylococcus aureus;
- tuberculosis of any location, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative-dystrophic pathologies, for example, osteochondritis dissecans.
Increased mobility of joint tissue, which is observed in the background of the formation 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, in the background of hypermobility, there is a weakness in the tendon-ligament system, due to which a person is prone to injuries, especially in the ankle, in the form of sprains and ruptures of ligament tissue, sprains.
In some cases, problems with hematopoietic function (for example, the presence of hemophilia) can lead to the formation of osteoarthritis. In the background of hemarthrosis (bleeding into the joint cavity), the supply of blood to the cartilage tissue deteriorates, causing it to begin to decay.
Among the predisposing factors it is worth noting the presence of age, frequent loads on the joint tissue that exceed the limits of its strength, overweight, undergoing surgery, hypothermia.
The risk group includes menopausal women, citizens living in poor environmental conditions or in contact with toxic chemicals. If the diet does not contain enough vitamins and minerals, conditions appear for the gradual destruction of hyaluronic cartilage tissue.
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 occur with significant destruction of cartilage.Initially, the patient experiences mild pain syndrome without clear localization.Occurs after physical exertion - lifting heavy objects, sports training.
In some cases, the first sign that a person notices the appearance of cracking and clicking during bending or extension of the joints. The patient notices that it is sometimes difficult to move. Although in the early stages of osteoarthritis, mobility problems appear only in the morning and pass quickly.
With the further development of the pathology, painful feelings begin to torment at night, due to which the sleep function is disturbed, and chronic fatigue also appears. When the disease progresses to degree 2, the intensity of pain increases in the background of changes in weather conditions, worsening of chronic diseases, acute respiratory viral infections.
Physical activity is significantly reduced. Mobility makes it difficult for the cartilage to thin and deliberately restricts the patient's movement in an attempt 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 features:
- pain that provokes the appearance of spasms in the bone muscles and the formation of muscle contracture (limited passive motor function of the joint);
- crunch in the joint tissue, clicking, cracking during constant movement, occur during virtually every movement of the bone relative to each other;
- frequent painful muscle cramps;
- joint deformity, leading to impaired posture and gait;
- pronounced deformity to the curvature of the joints with a significant reduction or complete absence of motor activity in them in the background of arthrosis of the 3rd degree.
If osteoarthritis of the knee, ankle or hip joint has developed to stage 3, the person must use a cane or crutches when moving.
If you do not start treatment on time, the disease begins to progress, relapses begin to torment you regularly, in addition, exacerbations appear more often over time. The stiffness in the morning does not last long, it gradually becomes permanent.
When examining a person with stage 1 arthrosis, the doctor notices only mild edema of the joint tissue with complete preservation of motor function. Stage 2 of the disease is manifested by pain and mild deformities 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. The main symptom of this disease is the development of a rounded seal near the joint, when you press it you can feel the liquid content moving. With acute synovitis, the temperature can rise to 37-38 degrees, headaches and digestive problems can occur.
Diagnostic measures
The disease is diagnosed based on the results of the study by instrumental methods, clinical characteristics, anamnestic data, patient complaints. In this case, the clinical study of blood and urine is not very informative - all indicators remain within normal limits, if the cause of arthrosis is not in metabolic problems.
If synovitis develops, there is an increase in the erythrocyte sedimentation rate (up to 30 mm / h), an increase in leukocytes and fibrinogen in the bloodstream.This indicates the presence of acute or chronic inflammation in the body.Biochemical and immunological parameters are altered by secondary arthrosis.
The most informative way to detect degenerative-dystrophic diseases is X-ray in 2 projections (lateral and flat).
The X-ray image shows osteoarthritis as follows:
- There are no radiological signs in the initial stage.
- In the first stage, the pathology is visualized as a vague, uneven narrowing of the joint cavity. The edges on the bone plates are slightly flattened, initial osteophytes are formed (sometimes they are absent).
- In the second stage, the image shows the image 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 has been reported. Cyst-like enlightenments appear in the appendages.
- In the third stage, the image shows pronounced subchondral osteosclerosis and large marginal osteophytes. The joint space is significantly narrowed.
- In the fourth stage, coarse massive osteophytes are formed, the joint space is almost completely fused, the bony appendages that form the joint are deformed and compacted.
If the doctor doubts the diagnosis after examining the X-rays, the patient is prescribed a computed tomography. 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 the tissues are supplied with blood, in order to determine the degree of inflammation in synovitis.
Treatment of osteoarthritis
It is currently impossible to completely cure osteoarthritis because there are no pharmacological agents that regenerate cartilage tissue.The main goal of treatment is to prevent further development of the disease, to keep the joints mobile.Osteoarthritis therapy is long-term, complex, and involves the use of local and systemic medications.
Patients should not overload their joints; it will be necessary to limit motor activity with the help of orthopedic aids - orthoses, elastic bandage. Overweight people will need to adjust their diet to lose weight over time and start a diet.
When stable remission is achieved, the patient should perform therapeutic gymnastic exercises daily. In the beginning, you will have to do it under the supervision of an expert, and in the future, you will have to do gymnastics at home on your own. In addition to physical therapy, you can sign up for the pool, do yoga or ride a bike.
In order to reduce the intensity of pain, the use of drugs belonging to different pharmacological groups is prescribed:
- Nonsteroidal anti-inflammatory drugs in tablets, ointments, solutions for intravenous injection.
- Intra-articular injections of anesthetics with the addition of glucocorticosteroids.
- Muscle relaxants to relieve cramps and muscle contractures.
Also, the arthrosis treatment regimen includes the use of B vitamins, sedatives, if necessary - antidepressants and sedatives. It is mandatory to appoint chondroprotectors in the form of a long course.The means of this group contribute to the partial restoration of cartilage.
In order to increase the clinical activity of the joint tissue, it is necessary to perform physiotherapeutic procedures - laser therapy, magnetotherapy, UHF.
Any painful manifestations in the area of the joints should be the basis for an immediate visit to the doctor. Treatment carried out in the early stages of the development of osteoarthritis allows stopping the destructive processes in the cartilage, in order to prevent disability and disability.