In the pathological structure of the osteoarticular system, osteoarthritis occupies a leading place - about 70% of cases fall into its category. The same problem is most often faced by people after 50 years, but the early signs of the disease appear even in young people. This disease has serious medical and social importance, because in many cases it is the cause of functional failure at working age.
Many people know about a pathology such as joint arthrosis, 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 development 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. This disease is considered one of the "friends of aging" because it often affects older patients. But the age factor is far from the only cause of arthrosis deformation. The origins of this disease are quite heterogeneous and are caused by both external and internal types of pathological effects on the body.
For each patient, there are certain risk factors that contribute to the occurrence of articular pathology. Therefore, the causes of arthrosis combine the following conditions:
- Hard physical work.
- Not active.
- Traumatic injury.
- Joint dysplasia.
- Inflammation (arthritis).
- Overweight.
- Estrogen deficiency in menopause.
- Thyroid gland disease.
- As a result of operations on the joints.
- Ancestry.
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 not so important, because loaders, manual workers, and athletes often suffer from arthrosis.
The causes of arthrosis are quite diverse, it is characterized by local effects on the joints and general effects on the body.
Mechanism of development
The normal function of the joint is ensured by the harmonious work of all its structures. But the main component of any joint is cartilage. It provides the function of absorbing shocks and resisting pressure on the joints. Cartilage tissue consists of cells (chondrocytes) and matrix, the main ingredients of which are proteoglycans and collagen.
If the load on the joint exceeds what is allowed, then first of all there is a structural disorder in the cartilage. The proteoglycans that hold the collagen strands are lost, which increases the tissue's sensitivity to external influences. The process of destruction began to overtake synthesis. This is facilitated by a decrease in cartilage trophism when the synovial fluid contains an insufficient amount of nutrients. The imbalance of tissue renewal is supported by inflammatory responses and hormonal disturbances.
All this leads to the 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 growth. The synovial membrane thickens, ligaments thicken and shorten, and muscle function is affected.
The pathological process in the joints develops gradually, but does not pass without a trace. Disorders of cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Arthritis, like other diseases, has certain types. This must be taken into account in the clinical classification of the disease. Pathology is primary when it develops in a healthy joint, or secondary if it appears against the background of another disease. In cases where the cause cannot be determined, they speak of idiopathic osteoarthritis. Depending on the number of joints involved, the following types are distinguished:
- Monoarthrosis.
- Oligoarthrosis - no more than 2 joints are affected.
- Polyarthrosis - involved from 3 articular groups.
If the pathological process has a general 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 the processes that occur in the joints and adequately assess their severity. Therefore, be sure to take into account the stage of arthrosis. It does not depend on the cause and is determined by pathological changes in the articular tissue:
- Stage 1 - inflammation of the synovial membrane, loss of the cartilage's ability to withstand loads.
- Stage 2 - destruction of cartilage tissue, bone growth, dystrophy of the articular bag.
- Stage 3 - bone deformity, contracture, 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 state of the joint is important, which is determined by the degree of insufficiency:
- 1 degree - temporary limitation of function.
- Degree 2 - disability.
- 3 degrees - 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 the articular pathologies, the symptoms of arthrosis have a rather significant specificity. They develop gradually, but continue to grow, leading to limitations in the patient's physical activity. Therefore, it is very important to suspect the disease in time in order to stop its development, as well as prevent complications.
When contacting the doctor, first of all, the patient's complaint is analyzed. And mostly people worry about joint pain. But with arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - occurs on the background of load and decreases during rest.
- Onset - the appearance of pain is associated with the onset of movement (walking).
- "Articular mouse" - periodic sharp pain with joint restrictions, caused by the violation of the synovial membrane between the cartilage surfaces.
At first, the patient may only experience a vague discomfort in the joints, accompanied by a feeling of fatigue. But over time, it developed into pain. And if at the initial stage it worries after the load, 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. Both are subjective and objective, including the following characteristics:
- Stiffness in the joints in the morning for no more than 30 minutes.
- Crepitus when moving.
- Deformation of the periarticular area.
- Mobility restrictions.
With arthrosis of the hand, during the examination, one can see characteristic formations in the area of the proximal and distal phalanges - Bouchard and Heberden nodules. Feeling the affected joint is often painful. If a contracture is formed, then there is a fixation of certain parts of the limb more often in a flexed position.
The significant nature of osteoarthritis leads to a significant decrease in the level of physical activity of patients, which requires a decrease in their quality of life.
Diagnostics
To understand why the clinical picture develops, it is necessary to confirm the joint pathology. This can be done by conducting the necessary diagnostic tests, which include instrumental and laboratory methods. First of all, they try to see structural changes in the affected area, to assess their severity and prevalence. It is also necessary to determine metabolic disorders in the body, which has become a good background for the occurrence of arthrosis. Therefore, the survey complex consists of the following activities:
- Radiography.
- Magnetic resonance imaging.
- Ultrasound procedure.
- Arthroscopy.
- Biochemical blood tests (hormone spectrum, inflammatory markers, calcium metabolism, rheumatism tests).
After the examination, a consultation with an orthopedic-traumatologist will be necessary, which will help to form the correct treatment tactics for each patient.
Treatment
It is necessary to treat joint arthrosis 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 time of treatment. With advanced forms of the disease, conservative measures will help a little. Clear and lasting results can be obtained with early treatment. For the treatment of osteoarthritis, the following methods are used:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- massage
- Operation.
What 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 joint is mediated by increased load, it is first necessary to reduce the mechanical effect on the cartilage tissue. To do this, you should stop wearing heavy and intense sports training. To unload the joint, any method is suitable - from walking with crutches to special fixing orthoses. But it is impossible to completely abandon movement, physical activity should be dosed. Walking for short distances, swimming is useful.
Proper nutrition plays an important role in the correction of arthrotic changes. Diet helps improve the condition of the cartilage, but is also a key component in the fight against excess weight. Patients are advised to consume lean meat and poultry, fish, grains; you need to enrich the diet with fresh vegetables and fruits, herbs. But in return, you should refrain from smoked, spicy, fatty, pickled and pickled foods. 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 for osteoarthritis begins with medication. Using various drugs, it is possible to eliminate not only the symptoms of the disease, but also to influence the mechanism of its development. This is especially important in chronic degenerative joint pathology, when it is necessary to achieve structural modification effects on cartilage tissue. The following medications are usually recommended:
- Non-steroidal anti-inflammatories.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
With severe pain in arthrosis, intra-articular injection of glucocorticosteroids can be performed. But such treatment should be short-term, because with prolonged use, hormonal drugs have the opposite effect - they stimulate the dystrophic process. Systemic therapy should be combined with topical medications.
Taking medication for osteoarthritis is carried out on the recommendation of a doctor and under his control. Free use of any drug is not allowed.
Physiotherapy
The method of physical influence helps to eliminate the acute signs of articular pathology. Together with drugs, 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 tissue. This contributes to the activation of blood circulation, increased trophic processes and weakening of muscle contractures. Many elements of spa treatment have the effect of improving general health. But at the same time, one should 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 therapy for osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue has a clear dependence on mechanical factors. But the strength must be sufficient. Only then does the process of growth overcome 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.
During class, pain should not be allowed to appear. Exercise is done at a slow pace and only after the acute symptoms have been eliminated. Avoid sudden and 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 training at home.
Therapeutic gymnastics is an important component in the correction of degenerative-dystrophic processes in the joints. Only regular classes have positive results.
massage
To improve the condition of the musculoskeletal system, a massage session is indicated. The manual effect on the joints allows you to achieve relaxation of spasmodic muscle groups, stimulate blood circulation in soft tissues and prepare them for active training (before therapeutic training). A classic sequence includes the following elements:
- caress
- Trituration.
- knead.
- pressure.
- Ironing.
It is often combined with passive movement of the affected joint. The duration of therapy is determined by the doctor and can be from 7 to 15 sessions.
Operation
If the advanced stage of osteoarthritis does not allow to get the desired effect from conservative measures, then there is a need for surgical treatment. Its essence is the replacement of a joint with an artificial one - arthroplasty. The operation is performed openly and under general anesthesia. After completion, you need to undergo rehabilitation, which begins 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 available to everyone.
Osteoarthritis is a common problem that requires timely and active solutions. In order not to start the disease and be able to expect the success of conservative measures, treatment should be started as early as possible. This will prevent aggravation, prevent the development of changes in the joints, and restore the functional abilities of the musculoskeletal system as much as possible. If not, surgical correction should be considered.