Osteoarthritis (osteoarthritis, deforming arthrosis) is a process of slow degeneration and destruction of the cartilage of the joint. The articular ends of the bones deform and grow, while the periarticular tissues become inflamed. The general diagnosis of "arthrosis" indicates a group of diseases similar in symptoms, but different in origin. The joint - the affected area - consists of joint surfaces covered with cartilaginous tissue, a cavity with synovial fluid, a synovial membrane and a joint capsule. With advanced disease, he loses mobility, and the patient experiences pain due to inflammatory processes.
Causes
Osteoarthritis of the joints develops due to the discrepancy between the amount of stress and the body's capabilities. This can be caused by lack of nutrients, excess body weight, heavy physical work and even sports.
Factors influencing the development of the disease:
- genetics, hereditary predisposition;
- age over 40 years;
- obesity, overweight;
- sedentary work, passive lifestyle;
- hard work, work that involves constant physical activity;
- inflammatory diseases;
- congenital joint pathologies (dysplasia);
- injuries, wounds;
- malfunction of the body (poor blood circulation, imbalance of hormones, microelements).
The disease can be primary or secondary. The causes of primary osteoarthritis are not yet well understood. Doctors believe that it develops in the presence of genetic factors (predisposition) and unfavorable external conditions.
Secondary arthrosis occurs against the background of inflammatory diseases, dysplasia and following injuries, including professional ones.
Representatives of working professions and athletes are more likely to develop the disease. Representatives of the arts are also at risk: dancers (especially ballerinas), pianists. Osteoarthritis of the wrist and finger joints most often affects people whose work involves fine motor skills: mechanics, mechanics and pianists. "Professional" arthrosis of loaders is localized in the knees, clavicles and elbows. Drivers, painters and miners suffer from elbow and shoulder joints. The weak point of ballerinas is the ankle. Athletes are also more likely to have injuries to the ankle and other joints in the arms and legs, depending on the type of sporting activity. For example, a tennis player will be at high risk for diseases of the shoulder and elbow joints.
Pathogenesis
Structural changes in cartilage occur due to an imbalance between tissue breakdown and repair. Collagen and proteoglycans are gradually "washed out" from the body, new nutrients are not supplied. Cartilage tissue loses elasticity, becomes soft and cannot withstand stress.
Regardless of the location and root cause, the disease develops in the same way. Gradually, the cartilage is completely destroyed, the bone ends "grind" against each other. The patient feels pain, the intensity of which increases depending on the stage. The mobility of the joint gradually decreases, the patient is limited in movement.
p>Classification
Orthopedists use the classification formulated by the professor in 1961:
- Phase I. The bone becomes denser, the joint space is slightly narrowed. Discomfort during physical activity, which disappears after rest;
- Phase II. The joint space noticeably narrows, the bone edges grow and the connective tissue becomes denser. The pain becomes constant, the muscles are hypertrophied, the joint is much less mobile, specific symptoms appear at the site;
- Phase III. The joint space is practically absent, the bony growths are extensive and destruction of the bone under the cartilage is likely. The joint is completely deformed and immobile. Sharp or constant pain is possible depending on the type and localization of the disease;
Depending on the location and form of the disease, the symptoms, speed of development and treatment methods will vary.
Shapes
The disease is characterized by a chronic form, but can also occur in an acute form.
When the disease spreads to multiple joints (for example to the fingers), it is called generalization.
Anatomical shapes:
- deforming (osteoarthritis). Leads to bony growths;
- noncovertebral. Destroys discs and intervertebral tissue in the cervical region;
- post traumatic. It develops following trauma, injury;
- rheumatoid. Autoimmune disease, inflammation of the connective tissue. It may be a consequence of previous arthritis;
- psoriatic. It develops against the background of psoriatic arthritis.
Localizations
Osteoarthritis is a disease that affects joints throughout the body.
Vertebral column. The causes may be autoimmune diseases, back diseases, increased stress, injuries, lack of microelements, hormonal imbalance.
Localizations:
- coccyx;
- lumbar region;
- thoracic spine;
- cervical region
Legs. Knees and ankles are more susceptible to osteoarthritis. The reasons are injuries, overweight, incorrect and excessive loads. Types of localization:
- gonarthrosis: knees;
- patellofemoral: femur and patella;
- ankle;
- talonavicular joint;
- feet and toes.
Hands. Injuries of the hands and fingers are more common and in most cases are associated with professional activities, injuries, age-related and hormonal changes. In addition, the disease is localized in the shoulder, wrist and elbow joints.
Torso. Localization in the trunk is less common than osteoarthritis of the extremities. Injuries are associated with professional activity, sedentary lifestyle (stagnation).
Types of localization:
- clavicle. "Clicking" and pain are felt during movement. At risk are athletes involved in weightlifting and military personnel due to possible injuries;
- hip joints (coxarthrosis). The disease manifests itself as pain in the groin area.
Testa>. Sometimes dental problems, autonomic disorders, and even hearing loss are caused by damage to the temporomandibular joint. The swelling disrupts the symmetry of the face, can affect the ear and cause headaches.
Symptoms
The symptoms of the disease depend on its location. Common manifestations for all types are:
- pain in the affected area. In the early stages - during movement, work, in the later stages - at rest;
- inflammation, swelling. The periarticular tissues swell, the skin turns red;
- "clicks", creaks. When you move you hear characteristic sounds;
- difficulty moving. As the disease progresses, the mobility of the affected area is compromised;
- reaction to cold. Many types of arthrosis are characterized by exacerbations in rain and cold.
Exacerbations of the disease are associated with a general weakening of health. Due to viral diseases and increased stress, it takes an acute form and develops many times faster. During a flare-up, symptoms, especially pain, become more pronounced. It is difficult for the patient to move, up to complete loss of mobility, and carry out usual work.
Possible complications
The main danger is the loss of joint mobility, its deformation beyond the possibility of recovery. Due to the shift of the axis, the posture is disturbed and the figure loses symmetry. Possible increase in pressure on internal organs, their displacement, compression. Concomitant diseases and failures of body systems appear. For example, with arthrosis of the coccyx in women, gynecological complications are possible, and arthrosis of the temporomandibular joint or cervical spine causes disorders in the autonomic system: dizziness, sleep disturbances. A patient with osteoarthritis can become disabled.
Diagnostics
To make a diagnosis, a comprehensive examination is carried out:
- take medical history;
- x-ray in different projections;
- MRI and CT to exclude tumors and obtain a three-dimensional image;
- blood and urine tests to exclude concomitant diseases and evaluate general health.
Depending on the cause of the disease, the patient is referred to a rheumatologist, traumatologist, surgeon or orthopedist.
Treatment
Stage I of the disease is the best treatment. Patients with stage II can expect long-term relief from bone destruction. Stage III most often requires surgery.
Conservative (non-surgical) treatment:
- physiotherapy, use of orthoses, sticks, crutches to reduce the load. Elimination of accompanying and aggravating factors (e. g. weight loss, stress, change in activity);
- take non-steroidal anti-inflammatory drugs. Selective COX-2 inhibitors are the most effective. Chondroprotectors and atypical antidepressants are prescribed as auxiliary agents;
- intra-articular injections of glucocorticoid hormones to reduce severe pain and inflammation.
Surgical methods:
- arthroscopy: internal examination of the joint and removal of cartilage fragments;
- arthroplasty - artificial cartilage implantation;
- osteotomy: removal or dissection of bone tissue;
- chondroplasty: cartilage restoration;
- arthrodesis: artificial immobilization of a joint (usually the ankle);
- endoprosthesis: removal and replacement of damaged joints with artificial ones.
Cardinal treatment allows you to stop the disease even at an advanced stage. It is possible to restore mobility in isolated cases (after replacing it with an artificial one). However, this method is effective in combating pain. After surgery, recovery is necessary using physiotherapeutic and pharmacological methods.
Prognosis and prevention
After the start of treatment of stage I and II arthrosis, a lasting improvement occurs: pain and inflammation disappear. In this case, complete relief from the disease or its long-term preservation is possible.
In the treatment of stage III osteoarthritis, improvements do not occur immediately. In some cases the disappearance of pain is possible only after surgery. Often the joint remains immobilized or deformed. Patients with severe forms of arthrosis of the hip and knee joints receive disability group I or II.
It has been proven that there is no effective prevention against osteoarthritis. Weight control, a balanced diet and moderate physical activity will help reduce the risk of developing the disease. An examination at the first signs of arthrosis (especially after injuries and infectious diseases) and careful attention to health will allow you to identify the disease at an early stage.