Osteoarthritis takes a leading place in the structure of the pathology of the osteoarticular system - it accounts for about 70% of cases. Most people face a similar problem after 50 years, but the initial signs of the disease appear even in young people. This disease is of serious medical and social importance, because in many cases it is the cause of functional failure 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 required to fight the disease. And heightened awareness and caution can prevent harmful changes from occurring and developing.
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 older patients. However, the age factor is not the only cause of deforming arthrosis. The origin of the disease is quite heterogeneous and is related to both external and internal types of pathological effects on the body.
For each patient, there are certain risk factors that contribute to the formation of articular pathology. Therefore, the causes of arthrosis combine the following conditions:
- Heavy physical work.
- Inactivity.
- Traumatic injuries.
- Joint dysplasia.
- Inflammation (arthritis).
- Excess weight.
- Estrogen deficiency in menopause.
- Diseases of the thyroid gland.
- Results of joint operations.
- Heredity.
As you can see, the development of arthrosis is often mediated by heterogeneous factors, which are mechanical or exchange in nature. In this case, the lifestyle of the patient and his profession are of little importance, because loaders, manual 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 functioning of the joint is ensured by the harmonious work of all its structures. But the main component of any joint is cartilage. Provides shock absorption and resists pressure on the joint. Cartilage tissue consists of cells (chondrocytes) and a matrix whose main substances are proteoglycans and collagen.
If the joint load exceeds the permissible one, first there are structural disorders in the cartilage. Proteoglycans that hold collagen chains are lost, which increases the tissue's sensitivity to external influences. Destruction processes begin to prevail over synthesis. This is facilitated by a decrease in cartilage trophism when the synovial fluid does not contain enough nutrients. The imbalance of tissue renewal is supported by inflammatory reactions and hormonal disturbances.
All this leads to thinning of the cartilage, becoming rough and losing its elasticity. Due to the growth of the main bone tissue, the joint cavity narrows and osteophytes - marginal growths - are formed. The synovial membrane thickens, the ligaments thicken and shorten, the function of the muscles is disturbed.
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 osteoarthritis.
Classification
Arthritis, like other diseases, has certain types. This should be considered in the clinical classification of the disease. Pathology is primary when it develops in healthy joints, and secondary when it appears against the background of other diseases. When the cause cannot be determined, they speak of idiopathic osteoarthritis. Depending on the number of participating compounds, the following types are distinguished:
- Monoarthrosis.
- Oligoarthrosis - no more than 2 joints are affected.
- Polyarthrosis - involves 3 articular 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 may continue in nodular or nodular form.
It is important to understand what processes occur in the joint and adequately assess their severity. Therefore, be sure to consider the stage of arthrosis. It does not depend on the cause and is determined by pathological changes in 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 growth, dystrophy of the articular bag.
- Stage 3 - bone deformation, contractures, joint instability.
The presence of signs of inflammation should also be reflected in the classification. Therefore, osteoarthritis differs between synovitis and synovitis. In addition, the functional state of the joint is important, which is determined by the degree of deficiency:
- 1 degree - temporary limitation of function.
- 2nd degree - disability.
- 3 degrees - impossibility of self-service.
All these features should be reflected in the diagnosis of osteoarthritis, as they are important for subsequent therapy.
Symptoms
Among articular pathologies, the symptoms of arthrosis have a very noticeable feature. They develop gradually, but progress continuously, causing limitation in physical activity of patients. Therefore, it is especially important to suspect the time to be able to stop its development, as well as to prevent complications.
When referring to a doctor, first of all, patients' complaints are analyzed. And mostly people are worried about pain in the joints. But with arthrosis, unlike other pathologies such as arthritis, they have the following character:
- Mechanical - occurs against the background of load and decreases at rest.
- Onset - the appearance of pain is associated with the beginning of movement (walking).
- "Articular mouse" - periodic sharp pains with joint blockade caused by disruption of the synovial membrane between cartilaginous surfaces.
At first, patients may feel only vague discomfort in the joints, accompanied by a feeling of fatigue. But over time it becomes a pain. And if in the initial stages it is disturbed after a load, in the future - during movement and in advanced cases it becomes stable, 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 features:
- Stiffness in joints for no more than 30 minutes in the morning.
- Crepitus when moving.
- Deformation of the periarticular region.
- Restriction of movement.
With arthrosis of the hands, characteristic formations - Bouchard's and Heberden's nodes - can be observed in the region of the proximal and distal phalanges during the examination. Affected joints are often painful to feel. If contractures are formed, then the fixation of certain parts of the limbs is more often in flexion.
The overt nature of osteoarthritis leads to a significant decrease in the physical activity level of patients, which leads to a decrease in their quality of life.
Diagnostics
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 examination, which includes instrumental and laboratory methods. First of all, they try to see the structural changes in the affected areas, to assess their severity and distribution. It is also necessary to identify metabolic disorders in the body, which become a favorable background for the occurrence of arthrosis. Thus, the survey complex consists of the following activities:
- Radiography.
- Magnetic resonance imaging.
- 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 required, which will help to formulate the correct treatment tactics for each patient.
Treatment
Arthrosis of the joints should be treated thoroughly. This means that all available therapeutic agents are used to alleviate the patient's condition. However, you should understand that their effectiveness directly depends on the duration of treatment. With advanced forms of the disease, conservative measures will help little. With early treatment, a clear and lasting result can be achieved. The following methods are used to treat arthrosis:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- Massage.
- Operation.
The doctor decides which means is suitable for a particular patient. The choice is made based on the results of the examination and the individual characteristics of the body.
The best effect of the treatment can be achieved if the correction is started in the early stages of the disease, when the first symptoms start to appear.
General recommendations
Since the development of degenerative changes in the joints is mediated by increased load, it is necessary to reduce the mechanical effect on the cartilage tissue first. For this, you need to give up heavy, intense sports training. Any method to loosen the joint is suitable - from walking with a cane to special fixation orthoses. However, it is impossible to completely abandon the movements, physical activity must be dosed. Walking and swimming are useful for short distances.
Proper nutrition plays an important role in the correction of arthrosis changes. Diet helps to improve the condition of the cartilage, and is also a key component in the fight against excess weight. Patients are recommended to eat lean meat and poultry, fish, cereals; you should enrich the diet with fresh vegetables and fruits, greens. But in return, you should give up smoked, spicy, fatty foods, marinades and pickles. It is better to pay attention to foods rich in collagen fibers, elastin and gelatin: jellied meat, hash, aspic dishes, fruit jelly.
Medical therapy
Traditional treatment of arthrosis begins with drug treatment. Using various drugs, it is possible not only to eliminate the symptoms of the disease, but also to affect the mechanisms of its development. This is especially important in chronic degenerative joint pathology, when it is necessary to achieve a structurally modifying effect on the cartilage tissue. The following medications are generally recommended:
- Non-steroidal anti-inflammatory.
- Chondroprotectors.
- Vein.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
With severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be done. However, 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 under the doctor's advice and supervision. Independent use of any medicine is not allowed.
Physiotherapy
Methods of physical influence help to eliminate acute symptoms of articular pathology. In addition to drugs, they can reduce the severity of pain and inflammation, and also stimulate biochemical processes in the cartilage. The following procedures are used in the complex treatment of arthrosis:
- Electrophoresis.
- Ultrasonic treatment.
- wave therapy.
- Magnetotherapy.
- laser treatment.
- Mud and hydrotherapy.
Such methods affect not only the joint, but also the surrounding tissues. It helps to activate blood circulation, improve trophic processes and weaken muscle contracture. Many elements of a spa treatment have a general healing effect. But at the same time, we must not forget the contraindications to physiotherapy: infectious diseases, tumors, cardiovascular pathology, kidney failure, bleeding, serious condition of the patient.
Physiotherapy
An important aspect of non-drug treatment of osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue has a clear dependence on the mechanical factor. But its power should be adequate. Only then are processes of growth superior to destruction. Therefore, gymnastics is indicated for all patients with joint diseases. But for each person, his own set of exercises is prepared - taking into account the localization and severity of the lesion, as well as the general condition of the body.
Pain should not be allowed to appear during classes. Exercises are performed at a slow pace and only after acute symptoms have been eliminated. Avoid sudden and high-amplitude movements that may cause discomfort. Physical education should be done under the supervision of a doctor, and after acquiring the necessary skills, you can start training at home.
Therapeutic gymnastics is a component of correction of degenerative-dystrophic processes in the joint. Only regular classes give positive results.
Massage
Massage sessions are indicated to improve the condition of the musculoskeletal system. Manual impact on joints allows 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:
- Squeeze.
- Trituration.
- Do not knead.
- 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 between 7 and 15 sessions.
Operation
If the advanced stages of arthrosis do not allow to achieve the desired effect from conservative measures, then surgical treatment is needed. Its essence is to replace the joint with an artificial one - arthroplasty. This operation is performed openly and under general anesthesia. After completion, you should undergo rehabilitation starting as early as possible. And as a result of surgical intervention, the patient can completely get rid of arthrosis and return to an active life. True, the operation is not possible for everyone.
Osteoarthritis is a common problem that requires a timely and active solution. In order not to start the disease and hope for the success of conservative measures, treatment should be started as early as possible. This will prevent exacerbations, prevent the development of changes in the joints and restore the functional abilities of the musculoskeletal system as much as possible. Otherwise, surgical correction should be considered.