In the structure of the pathology of the osteoarticular system, osteoarthritis occupies a leading place - about 70% of cases fall to its share. A similar problem is most often encountered by people after 50 years, but the initial signs of the disease appear even in young people. This disease has a serious medical and social significance, because in many cases it becomes the cause of functional failure at 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 required to fight the disease. And heightened awareness and caution can prevent the occurrence and progression of detrimental 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 arthrosis. The origin of the disease is quite heterogeneous and is due to 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.
- Inactivity.
- Traumatic injuries.
- Joint dysplasia.
- Inflammation (arthritis).
- Overweight.
- Estrogen deficiency in menopause.
- Diseases of the thyroid gland.
- Consequences of operations on the joints.
- Heredity.
As you can see, the development of arthrosis is mediated by heterogeneous factors, which in most cases are of a mechanical or exchange nature. In this case, the lifestyle of the patient and his profession are of no small 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 work of all its structures. But the main component of any joint is cartilage. It provides shock-absorbing function and resists pressure on the joint. Cartilage tissue consists of cells (chondrocytes) and a matrix, the main substances of which are proteoglycans and collagen.
If the load on the joint exceeds the allowable, then first there are structural disorders in the cartilage. The proteoglycans that hold the collagen strands are lost, which increases the sensitivity of the tissue to external influences. Destruction processes 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 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 underlying bone tissue, the joint space narrows and the formation of osteophytes - marginal growths. The synovial membrane thickens, the ligaments thicken and shorten, and the function of the muscles 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
Arthrosis, 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 against the background of other diseases. In the case when 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 from 3 articular 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 occur in the joint 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 tissues:
- Stage 1 - inflammation of the synovial membrane, the loss of the ability of the cartilage to withstand the load.
- Stage 2 - destruction of cartilage tissue, bone growths, dystrophy of the articular 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 state of the joint is important, which is determined by the degree of insufficiency:
- 1 degree - temporary limitation of function.
- Grade 2 - disability.
- 3 degree - the impossibility of self-service.
All of these features should be reflected in the diagnosis of osteoarthritis, as they are important for subsequent therapy.
Symptoms
Among the articular pathology, the symptoms of arthrosis have quite tangible specificity. They develop gradually, but steadily progress, leading to a limitation in the 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, complaints of patients are analyzed. And mostly people are worried about pain in the joints. But with arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - occur against the background of the load and decrease at rest.
- Starting - the appearance of pain is associated with the beginning of movement (walking).
- "Articular mouse" - periodic sharp pains with blockade of the joint, caused by infringement of the synovial membrane between the cartilaginous surfaces.
At first, patients may experience only vague discomfort in the joints, accompanied by a feeling of fatigue. But over time, it develops into pain. And if at the initial stages it worries after a 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. They are both subjective and objective in nature, including the following features:
- Stiffness in the joints in the morning no more than 30 minutes.
- Sensation of crunching (crepitus) when moving.
- Deformation of the periarticular region.
- Restriction of mobility.
With arthrosis of the hands, during the examination, one can notice characteristic formations in the region of the proximal and distal phalanges - Bouchard and Heberden's nodules. Feeling the affected joints is often painful. If contractures are formed, then there is a fixation of certain parts of the limbs more often in a flexion 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
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 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 survey complex consists of the following activities:
- Radiography.
- Magnetic resonance imaging.
- 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, which will help to 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 their effectiveness directly depends on the time of treatment. With advanced forms of the disease, conservative measures will help little. 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.
What funds are suitable for a particular patient, the doctor decides. The choice is made on the basis of the results of the examination and the individual characteristics of the organism.
The best effect of treatment can be obtained if 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 an increased load, it is first necessary to reduce the mechanical effect on the cartilage tissue. To do this, you should stop wearing heavy, intense sports training. To unload the joint, any method is suitable - from walking with a cane to special fixing orthoses. But it is impossible to completely abandon movements, physical activity should be dosed. Walking for short distances, swimming are useful.
Proper nutrition plays an important role in the correction of arthrotic changes. Diet helps to improve the condition of cartilage, but 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 fibers, elastin and gelatin: jellied meat, hash, aspic dishes, fruit jellies.
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 mechanisms of its development. This is especially important in chronic degenerative joint pathology, when it is necessary to achieve a structure-modifying effect on cartilage 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 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 topical drugs.
Taking medications for osteoarthritis is carried out on the recommendation of a doctor and under his control. Independent use of any medicines is not allowed.
Physiotherapy
Methods of physical influence help to eliminate acute signs of articular 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 a general health-improving effect. But at the same time, one should not forget about contraindications to physiotherapy: infectious diseases, tumors, cardiovascular pathology, renal failure, bleeding, the patient's serious condition.
Physiotherapy
An important aspect of non-drug therapy of osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue has a clear dependence on the mechanical factor. But his strength must be adequate. 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.
During classes, pain should not be allowed to appear. Exercises are performed at a slow pace and only after the acute symptoms have been eliminated. Avoid sudden and high-amplitude movements that can provoke 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 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. Manual impact on the joints allows you to achieve relaxation of spasmodic muscle groups, stimulate blood circulation in soft tissues and prepare them for active exercises (before therapeutic exercises). Classical 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 to obtain the desired effect from conservative measures, then there is a need for surgical treatment. Its essence is the replacement of the joint with an artificial one - arthroplasty. This operation is performed in an open way and under general anesthesia. After its 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 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 early 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.