In the structure of the pathology of the osteoarticular system, osteoarthritis occupies a leading place - it accounts for about 70% of cases. A similar problem is most often encountered by people after the age of 50, but the initial signs of the disease also appear in young people. This disease has a serious medical and social significance, because in a large number of cases it becomes the cause of functional failure in the 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 vigilance can prevent the occurrence and progression of harmful changes.
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 arthrosis. The origin of the disease is quite heterogeneous and is caused by external and internal types of pathological effects on the body.
For each patient there are certain risk factors that contribute to the development of joint pathology. Therefore, the causes of arthrosis combine the following conditions:
- Hard physical work.
- Inactivity.
- Traumatic injuries.
- Dysplasia of joints.
- Inflammation (arthritis).
- Excessive weight.
- 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 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.
Development mechanism
The normal function of the joint is ensured by the harmonious operation of all its structures. But the main component of every joint is cartilage. It provides a shock absorption function and resists pressure on the joint. Cartilage tissue consists of cells (chondrocytes) and matrix, the main substances of which are proteoglycans and collagen.
If the load on the joint exceeds the permissible, then structural disturbances in the cartilage occur first. The proteoglycans that hold the collagen strands are lost, which increases the tissue's sensitivity to external influences. Destruction processes begin to prevail over synthesis. This is facilitated by the reduction of cartilage trophism when the synovial fluid contains an insufficient amount of nutrients. The imbalance of tissue renewal is supported by inflammatory reactions and hormonal disorders.
All this leads to thinning of the cartilage, it becomes rough and loses its elasticity. Due to the growth of the basic bone tissue, there is a narrowing of the joint space 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. Disorders in cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Arthrosis, like other diseases, has certain variants. 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 against the background of other diseases. In the case when the cause cannot be determined, they speak of idiopathic osteoarthritis. Depending on the number of joints involved, the following variants are distinguished:
- Monoarthrosis.
- Oligoarthrosis - no more than 2 joints are affected.
- Polyarthrosis - affected from 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 proceed in a nodular or nodular form.
It is important to understand what processes are happening in the joint and adequately assess their severity. Therefore, definitely take into account 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 cartilage's ability to withstand load.
- Phase 2 - destruction of cartilage tissue, bone growths, dystrophy of the joint bag.
- 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 condition of the joint is important, which is determined by the degree of insufficiency:
- 1 degree - temporary limitation of function.
- Level 2 - disability.
- 3rd degree - impossibility of self-service.
All these characteristics should be reflected in the diagnosis of osteoarthritis, as they are important for subsequent therapy.
Symptoms
Among joint pathology, the symptoms of arthrosis have a rather tangible specificity. They develop gradually, but constantly progress, which leads to the limitation of physical activity of patients. Therefore, it is especially important to suspect the disease in time in order to be able to stop its development, as well as prevent complications.
When contacting a doctor, first of all, patients' complaints are analyzed. And mostly people are worried about joint pain. But in arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - occur in the background of the load and decrease at rest.
- The onset - the onset of pain is associated with the onset of movement (walking).
- "Articular mouse" - periodic sharp pains with joint blockage, caused by damage to the synovial membrane between the cartilaginous surfaces.
At first, patients may feel 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, remaining 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 region.
- Limitation of mobility.
In arthrosis of the hands, during the examination, characteristic formations in the area of the proximal and distal phalanges can be observed - Bouchard's and Heberden's nodules. The sensation of the affected joints is often painful. If contractures are formed, then certain parts of the limbs are fixed 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 entails a decrease in their quality of life.
Diagnostics
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 examination, which includes instrumental and laboratory methods. First of all, they try to see structural changes in the affected areas, to assess their severity and distribution. It is also necessary to determine metabolic disorders in the body, which have become a favorable background for the development of arthrosis. Therefore, the survey complex consists of the following activities:
- Radiography.
- M. R. I.
- Ultrasound procedure.
- Arthroscopy.
- Biochemical blood tests (hormone spectrum, markers of inflammation, calcium metabolism, rheumatic tests).
After the examination, a consultation with an orthopedist-traumatologist will be required, who will help in forming the correct treatment tactics for each patient.
Treatment
It is necessary to comprehensively treat arthrosis of the joints. This means that all available therapeutic agents are used to alleviate the patient's condition. But you must 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 marked and lasting result can be achieved. The following methods are used to treat osteoarthritis:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- Massage.
- Operation.
Which means are suitable for a particular patient is decided by the doctor. The choice is made based on the results of the examination and the individual characteristics of the organism.
The best treatment effect can be achieved if the correction is started at an early stage 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 increased load, it is necessary to first reduce the mechanical effect on the cartilage tissue. To do this, you should stop wearing heavy, intense sports training. Any method is suitable for joint relief - from walking with a cane to special orthoses for attachment. But it is impossible to completely abandon movements, physical activity should be dosed. Walking short distances, swimming are beneficial.
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 must enrich your 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 fibers, elastin and gelatin: meat jelly, hashish, aspic, fruit jellies.
Medical therapy
Traditional treatment of osteoarthritis begins with medication. Using different 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 generally recommended:
- Non-steroidal anti-inflammatory.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
Intra-articular injections of glucocorticosteroids can be done for severe pain in arthrosis. But such treatment should be short-term, because with prolonged use, hormonal drugs have the opposite effect - they stimulate dystrophic processes. Systemic therapy should be combined with local drugs.
Taking medicines for osteoarthritis is carried out according to the doctor's recommendation and under his control. Independent use of any medication is not allowed.
Physiotherapy
Methods of physical influence help to eliminate acute signs of joint pathology. Along with drugs, they can reduce the intensity of pain and inflammation, but also stimulate biochemical processes in the cartilage itself. In the complex treatment of arthrosis, the following procedures are used:
- Electrophoresis.
- Ultrasound 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, improvement of trophic processes and weakening of muscle contractures. Many elements of the spa treatment have a general health effect. But at the same time, we should not forget about contraindications for physiotherapy: infectious diseases, tumors, cardiovascular pathologies, 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 its strength must be appropriate. Only then do growth processes 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 to appear during classes. Exercises are performed at a slow pace and only after acute symptoms have been eliminated. Avoid sudden, high-amplitude movements that can cause discomfort. Physical education should be done 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
Massage sessions are shown to improve the condition of the musculoskeletal system. By manual action on the joints, you can 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:
- Stroking.
- Trituration.
- 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 achieving the desired effect with conservative measures, then there is a need for surgical treatment. Its essence is to replace 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. 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 hope for the success of conservative measures, treatment should be started as soon as possible. This will avoid exacerbations, prevent the progression of changes in the joints and restore the functional abilities of the musculoskeletal system as much as possible. Otherwise, surgical correction will have to be considered.