In the framework of the pathology of the osteoarticular system, osteoarthritis occupies a leading place - about 70% of cases fall into its share. A similar problem is most often encountered by people over the age of 50, but the early signs of the disease appear even in young people. This disease has serious medical and social significance, as in many cases it becomes the cause of functional failure in working age.
Many people know about a pathology such as osteoarthritis of the joints, but not all patients understand why it develops, how it manifests itself and what is needed to fight the disease. And heightened awareness and caution can prevent the occurrence and progression 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 older patients. But the age factor is far from the only cause of deforming osteoarthritis. The origin of the disease is quite heterogeneous and is due to external and internal types of pathological effects on the body.
For each patient, there are certain risk factors that contribute to the occurrence of joint pathology. Therefore, the causes of arthrosis combine the following conditions:
- Heavy 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 heterogeneous factors, which in most cases are mechanical or exchange rate. In this case, the patient's lifestyle and profession are not of little importance, as porters, manual workers and athletes often suffer from osteoarthritis.
The causes of osteoarthritis are quite diverse, characterized by a local effect on the joints and a general effect on the body.
development mechanism
The normal function of the joint is ensured by the harmonious working of all its structures. But the main component of any joint is cartilage. It provides shock absorption function and resists pressure on the joint. Cartilaginous tissue consists of cells (chondrocytes) and a matrix, whose main substances are proteoglycans and collagen.
If the load on the joint exceeds what is allowed, then there will first be structural disturbances in the cartilage. Proteoglycans that retain collagen strands are lost, which increases tissue sensitivity to external influences. The processes of destruction begin to prevail over synthesis. This is facilitated by a decrease in cartilage trophism when the synovial fluid contains an insufficient amount of nutrients. The tissue turnover imbalance is supported by inflammatory reactions and hormonal disturbances.
All this leads to thinning of the cartilage, it becomes rough and loses its elasticity. Due to the growth of the underlying bone tissue, the joint space narrows and the formation of osteophytes - marginal growths. The synovial membrane thickens, ligaments thicken and shorten, and muscle function is impaired.
Pathological processes in the joint develop gradually, but do not pass without a trace. Disturbances in cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Osteoarthritis, like other diseases, has certain varieties. This must be taken into account in the clinical classification of the disease. Pathology is primary when it develops in healthy joints, or secondary if it appears in the context of other diseases. In the event that the cause cannot be established, they speak of idiopathic osteoarthritis. Depending on the number of joints involved, the following varieties are distinguished:
- Monoarthrosis.
- Oligoarthrosis - no more than 2 joints are affected.
- Polyarthrosis - involved in 3 joint groups.
If the pathological process has a generalized character, then we can talk about the defeat of almost all the joints in the body, including the spine, where spondylarthrosis is observed. In this case, the disease may proceed in a nodular or nodular fashion.
It is important to understand what processes occur in the joint and properly assess their severity. So be sure to take into account the stage of osteoarthritis. It does not depend on the cause and is determined by pathological changes in the joint tissues:
- Stage 1 - inflammation of the synovial membrane, the loss of the cartilage's ability to bear load.
- Stage 2 - destruction of cartilage tissue, bone growth, joint bursa dystrophy.
- Stage 3 - bone deformity, contractures, joint instability.
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 status of the joint is important, determined by the degree of insufficiency:
- 1 degree - temporary limitation of function.
- Grade 2 - disability.
- 3rd 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 joint pathology, the symptoms of arthrosis have quite tangible specificity. They develop gradually but progress steadily, leading to a limitation in patients' physical activity. Therefore, it is especially important to suspect the disease in time to be able to stop its development, as well as prevent complications.
When contacting a doctor, patients' complaints are analyzed first. And mostly people are worried about joint pain. But with arthrosis, unlike other pathologies such as arthritis, they have the following character:
- Mechanical - occur against the background of load and decrease at rest.
- Starting - the onset of pain is associated with the start of movement (walking).
- "Joint Rat" - periodic sharp pains with blockage of the joint, caused by the violation of the synovial membrane between the cartilaginous surfaces.
At first, patients may experience only vague joint discomfort, accompanied by a feeling of fatigue. But over time, it evolves into pain. And if in the early stages it worries after a load, in the future - during movement, and in advanced cases it becomes constant, remaining even at rest and at night.
In addition to pain, patients have other symptoms of osteoarthritis. They are both subjective and objective in nature, including the following features:
- Stiffness in joints in the morning no more than 30 minutes.
- Crunching sensation (crepitus) when moving.
- Deformation of the periarticular region.
- Mobility restriction.
With arthrosis of the hands, during the examination, characteristic formations can be noted in the region of the proximal and distal phalanges - Bouchard's and Heberden's nodes. Feeling the affected joints is often painful. If contractures are formed, there is a fixation of certain parts of the limbs more often in a flexed position.
The pronounced nature of osteoarthritis leads to a significant decrease in the level of physical activity of patients, which leads to a decrease in quality of life.
Diagnosis
To understand why the clinical picture develops, it is necessary to confirm the pathology of the joints. This can be done by performing the necessary diagnostic examination, which includes instrumental and laboratory methods. First, they try to see structural changes in the affected areas, to assess their severity and prevalence. It is also necessary to determine the metabolic disorders in the body, which have become a favorable background for the occurrence of arthrosis. Therefore, the research complex consists of the following activities:
- X-ray.
- MRI image.
- Ultrasound procedure.
- arthroscopy.
- Biochemical blood tests (hormonal spectrum, inflammation markers, calcium metabolism, rheumatic tests).
After the examination, a consultation with an orthopedist-traumatologist will be required, who will help form the correct treatment tactics for each patient.
Treatment
It is necessary to treat arthrosis of the joints comprehensively. This means that all available therapeutic agents are used to alleviate the patient's condition. But you need to understand that its effectiveness directly depends on the treatment time. With advanced forms of the disease, conservative measures will do little to help. A pronounced and lasting result can be obtained with early treatment. For the treatment of osteoarthritis, the following methods are used:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- Massage.
- Operation.
Which funds are suitable for a particular patient, the doctor decides. The choice is made based on the results of the examination and the individual characteristics of the organism.
The best treatment effect can be obtained if the correction is started in the early stages of the disease, when the first symptoms have just started to appear.
general recommendations
Since the development of degenerative changes in the joints is mediated by an increase in load, it is first necessary to reduce the mechanical effect on the cartilage tissue. To do this, you must stop using heavy, intense sports training. For unloading the joint, any method is suitable - from walking with a cane to special fixation orthoses. But it is impossible to completely abandon the movements, physical activity must be dosed. Walking short distances, swimming are helpful.
Adequate nutrition plays an important role in correcting arthrotic changes. Diet helps to improve the condition of cartilage, but it is also the main component of the fight against excess weight. Patients are advised to consume lean meats and poultry, fish, cereals; you need to enrich the diet with fresh vegetables and fruits, herbs. But in return, you should refrain from smoked, spicy, fatty foods, marinades and pickles. It is better to pay attention to foods rich in collagen, elastin and gelatin fiber: gelatinous meat, hashish, aspic dishes, fruit jellies.
medical therapy
Traditional treatment for osteoarthritis starts with medication. Using various drugs, it is possible to eliminate not only the symptoms of the disease, but also influence the mechanisms of its development. This is especially important in chronic degenerative joint pathology, when it is necessary to obtain a structure-modifying effect on cartilaginous tissue. The following medications are generally recommended:
- Non-steroidal anti-inflammatory.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
With severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be done. But this treatment should be short-term, because with prolonged use, hormonal drugs have the opposite effect - they stimulate dystrophic processes. Systemic therapy must be combined with topical drugs.
Taking medications for osteoarthritis is carried out on the recommendation of a doctor and under his control. Independent use of any medication is not allowed.
Physiotherapy
Physical influence methods help to eliminate acute signs of joint pathology. Along with medications, they can reduce the severity of pain and inflammation and also stimulate biochemical processes in the cartilage itself. In the complex treatment of arthrosis, the following procedures are used:
- Electrophoresis.
- Ultrasonic treatment.
- wave therapy.
- Magnetotherapy.
- laser treatment.
- Mud and hydrotherapy.
Such methods affect not only the joint, but also the surrounding tissues. This contributes to the activation of blood circulation, the improvement of trophic processes and the weakening of muscle contractures. Many elements of spa treatment have an overall health-enhancing effect. But at the same time, one should not forget about contraindications to physiotherapy: infectious diseases, tumors, cardiovascular pathology, renal 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 your strength must be adequate. Only then do the processes of growth prevail over destruction. Therefore, gymnastics is indicated for all patients with joint diseases. But for each person, his own set of exercises is developed - taking into account the location and severity of the injury, as well as the general condition of the body.
During classes, pain should not appear. The exercises are performed at a slow pace and only after the acute symptoms have been eliminated. Avoid sudden, large-amplitude movements that could cause discomfort. Physical education should be done under the supervision of a doctor, and once you have acquired the necessary skills, you can start exercising at home.
Therapeutic gymnastics is an integral component 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 shown. The manual impact on the joints allows to obtain the relaxation of the spasmodic muscle groups, stimulate the blood circulation in the soft tissues and prepare them for active exercises (before therapeutic exercises). Classic massage includes the following elements:
- caressing.
- Crushing.
- Crumple.
- pressure.
- Iron clothes.
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 the desired effect of conservative measures to be obtained, surgical treatment is necessary. Its essence is the replacement of the joint with an artificial one - arthroplasty. This operation is performed openly and under general anesthesia. Upon its completion, you need to undergo rehabilitation, which starts as early as possible. And as a result of the surgical intervention, the patient can completely get rid of arthrosis and return to an active life. True, 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 wait for the success of conservative measures, treatment should be started as early as possible. This will prevent exacerbations, prevent the progression of joint changes, and maximally restore the functional abilities of the musculoskeletal system. Otherwise, surgical correction will have to be considered.