In the structure of the pathology of the osteoarticular system, osteoarthritis takes a leading place - it accounts for about 70% of cases. People most often encounter a similar problem after the age of 50, but the initial signs of the disease appear even in young people. This disease has serious medical and social significance, because in many cases it becomes the cause of functional failures of working age.
Many people are familiar with such a pathology as joint arthrosis, but not all patients understand why it develops, how it manifests itself, and what is needed to overcome the disease. Increased awareness and caution can prevent harmful changes from occurring and progressing.
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 a "companion 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 due to external and internal pathological effects on the body.
Each patient has certain risk factors that contribute to the occurrence of joint pathology. Therefore, the causes of arthrosis combine the following conditions:
- Hard physical work.
- Inaction.
- Traumatic injuries.
- Joint dysplasia.
- Inflammation (arthritis).
- Overweight.
- Estrogen deficiency in menopause.
- Diseases of the thyroid gland.
- Consequences of operations on the joints.
- Heredity.
As can be seen, the formation of arthrosis is mediated by heterogeneous factors, which in most cases are mechanical or exchange in nature. In this case, the patient's lifestyle and profession are of considerable importance, because loaders, manual workers, and athletes often suffer from arthrosis.
The causes of arthrosis are quite varied, characterized by a local effect on the joints and a general effect on the body.
Development mechanism
The normal functioning of the joint is ensured by the harmonious work of all its structures. But the main component of every joint is cartilage. It provides a shock-absorbing 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 there are first structural abnormalities in the cartilage. The proteoglycans that hold the collagen fibers 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 portrophism, 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, it becomes rough and loses its elasticity. Due to the growth of the underlying bone tissue, the joint space narrows and osteophytes - marginal growths - are formed. The joint membrane thickens, the ligaments thicken and shorten, the function of the muscles is impaired.
Pathological processes in the joint develop gradually, but they do not disappear without a trace. Disorders of cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Arthrosis, like other diseases, has certain types. This should be taken into account in the clinical classification of the disease. The pathology is primary if it develops in healthy joints, or secondary if it appears against the background of other diseases. If the cause cannot be determined, it is called idiopathic osteoarthritis. Depending on the number of affected joints, the following types are distinguished:
- Monoarthrosis.
- Oligoarthrosis - up to 2 joints are affected.
- Polyarthrosis - 3 joint groups are affected.
If the pathological process is of a general nature, 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 to properly 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 load-bearing capacity of the cartilage.
- Stage 2 - destruction of cartilage tissue, bone growth, dystrophy of the joint bag.
- Stage 3 - bone deformity, contractures, joint instability.
It should also reflect the presence of signs of inflammation in the classification. Therefore, osteoarthritis with and without synovitis is distinguished. In addition, the functional state of the joint is important, which is determined by the degree of insufficiency:
- 1 degree - temporary restriction of function.
- 2nd degree - 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 joint pathologies, the symptoms of arthrosis have a rather tangible feature. They develop gradually, but continuously, which leads to the limitation of physical activity of patients. Therefore, it is especially important to suspect the disease in time, so that we can stop its development and prevent complications.
When visiting a doctor, patients' complaints are first of all analyzed. And mostly people worry about joint pain. But in the case of arthrosis, unlike other pathologies, such as arthritis, they have the following properties:
- Mechanical - occurs against the background of load and decreases at rest.
- Onset - the appearance of pain is associated with the beginning of movement (walking).
- "Joint mouse" - periodic sharp pains with blockade of the joint, caused by a violation of the synovial membrane between the cartilaginous surfaces.
At first, patients may experience only a vague discomfort in the joints, accompanied by a feeling of fatigue. But over time it develops into pain. And if at the initial stage you are worried after a load, then in the future - during movement, and in advanced cases it becomes constant, even at rest and at night.
In addition to pain, patients also have other symptoms of arthrosis. They are subjective and objective in nature, including the following characteristics:
- Stiffness of the joints in the morning for a maximum of 30 minutes.
- Crepitus sensation during movement.
- Deformation of the periarticular region.
- Restriction of mobility.
With arthrosis of the hand, during the examination, characteristic formations can be observed in the proximal and distal phalanx region - Bouchard and Heberden nodules. Palpation of the affected joints is often painful. If contractures develop, certain parts of the limbs are more often fixed in a flexed position.
The pronounced nature of osteoarthritis leads to a significant decrease in the physical activity of patients, which is associated with 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 carrying out the necessary diagnostic examination, which includes instrumental and laboratory methods. Primarily, they try to see structural changes in the affected areas, assess their severity and prevalence. It is also necessary to determine the metabolic disorders occurring in the body, which have become a favorable background for the development of arthrosis. Therefore, the survey complex consists of the following activities:
- Radiography.
- Magnetic resonance imaging.
- Ultrasonic procedure.
- Arthroscopy.
- Biochemical blood tests (hormonal spectrum, inflammatory markers, calcium metabolism, rheumatism test).
After the examination, a consultation with an orthopaedist-traumatologist will be necessary, which will help to develop appropriate treatment tactics for each patient.
Treatment
Arthrosis of the joints must be treated comprehensively. This means that all available therapeutic agents are used to alleviate the patient's condition. But you need to understand that their effectiveness directly depends on the time of treatment. In advanced forms of the disease, conservative measures are of little help. Pronounced and lasting results can be achieved with early treatment. The following methods are used to treat osteoarthritis:
- Medical therapy.
- Physiotherapy.
- Physiotherapy.
- Massage.
- Operation.
The doctor decides which funds are suitable for a particular patient. The choice is made based on the results of the examination and the unique characteristics of the organization.
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 have just begun to appear.
General recommendations
Since the development of degenerative changes in the joints is mediated by the increased load, the mechanical impact on the cartilage tissue must first be reduced. To do this, you need to stop wearing heavy, intense sports training. Any method is suitable for relieving the joint - from walking with a cane to special fixing orthoses. But it is impossible to completely abandon movements, physical activity must be dosed. Short-distance walking and swimming are useful.
Proper nutrition plays an important role in the correction of joint changes. The 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 eat lean meat and poultry, fish, cereals; the diet should be enriched with fresh vegetables and fruits and herbs. But in return, you must refrain from 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 for osteoarthritis begins with medication. With the help of various medicines, it is possible not only to eliminate the symptoms of the disease, but also to influence the mechanisms of its development. This is particularly important in chronic degenerative joint pathology, when a structure-modifying effect on the cartilage tissue must be achieved. In general, the following drugs are recommended:
- It is a non-steroidal anti-inflammatory.
- Chondroprotectors.
- It's worth it.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
In case of severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be given. But 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 the treatment of osteoarthritis are taken on the basis of a doctor's recommendation and under the supervision of a doctor. The independent use of any medication is prohibited.
Physiotherapy
Methods of physical influence help eliminate acute signs of joint pathology. Together with drugs, they can reduce the severity of pain and inflammation, as well as stimulate biochemical processes in the cartilage itself. 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. This contributes to the activation of blood circulation, the improvement of trophic processes and the weakening of muscle contractures. Many elements of the spa treatment have a general health-improving effect. At the same time, one should not forget about the contraindications of physiotherapy: infectious diseases, tumors, cardiovascular pathology, kidney failure, bleeding, serious condition of the patient.
Physiotherapy
An important aspect of the non-pharmacological therapy of osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue clearly depends on the mechanical factor. But its power must be adequate. Only then do growth processes win over destruction. Therefore, gymnastics is recommended 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 injury, as well as the general condition of the body.
Pain should not occur during classes. The exercises are performed at a slow pace and only after the 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 doing exercises at home.
Therapeutic gymnastics is an integral part of the correction of joint degenerative-dystrophic processes. Only regular classes have positive results.
Massage
In order to improve the condition of the musculoskeletal system, massage treatments are presented. The manual effect on the joints allows spasmodic muscle groups to relax, stimulates blood circulation in the soft tissues and prepares them for active exercises (before therapeutic exercises). A classic massage consists of the following elements:
- To caress.
- Trituration.
- Kneading.
- pressure.
- Ironing.
It is often combined with passive movement of the affected joints. The duration of the therapy is determined by the doctor and can be 7-15 sessions.
Operation
If the advanced stages of osteoarthritis do not allow the desired effect to be achieved with conservative measures, then surgical treatment is required. Its essence is the replacement of the joint with an artificial one - arthroplasty. This operation is performed in an open manner and under general anesthesia. After its completion, you will undergo rehabilitation, which will begin as soon as possible. And as a result of the surgical intervention, the patient can completely get rid of arthrosis and return to 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 hope for the success of conservative measures, treatment should be started as early as possible. This avoids exacerbations, prevents the progression of joint changes, and restores the functional capabilities of the musculoskeletal system as much as possible. Otherwise, surgical correction should be considered.