Arthrosis is a chronic pathology that affects the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course with gradual destruction of cartilage tissue.Arthrosis is detected in most patients after the age of 65, as one of the reasons for its development is the natural aging of the body.
The appearance of degenerative-dystrophic pathology is caused by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, a sedentary lifestyle.The main symptoms of arthrosis are joint pain, swelling and limitation of movement.
To diagnose the pathology, instrumental studies are carried out - X-ray, arthroscopy, MRI, CT.Osteoarthritis of the first and second severity is treated conservatively with a course of medications, physiotherapeutic procedures and massage and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
With arthrosis, significant changes occur in the internal structures of the connective tissue.Deformative erosions are formed in cartilage tissue, which cause the destruction of collagen fibers, as well as proteoglycans composed of protein (5-10%) and glycosaminoglycans (90-95%).As a result, the collagen network loses stability and metalloproteinases begin to be released, destroying all types of extracellular matrix proteins.Destruction is accelerated by increasing the biosynthesis of collagenase and stromelin.Typically, normal quantitative values of enzymes are controlled by cytokines - small peptide information molecules.But as arthrosis progresses, the concentration of these proteins decreases, which provokes the release of a large number of enzymes that damage cartilage tissue.
Proteoglycans with a changed structure begin to absorb water molecules that they are unable to hold.Therefore, excess fluid enters the collagen fibers.They "swell" and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of the synovial fluid.With arthrosis, the concentration of hyaluron in it decreases.Hyaline cartilage no longer receives enough nutrients and oxygen for its regeneration.Softening foci are formed in the cartilaginous tissue, and then cracks and specific necrotic growths appear.The heads of the bones are exposed and begin to suffer microtrauma when they move relative to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) arthrosis have not yet been determined.It occurs in the absence of any provoking factor, which is why theories are put forward about a hereditary predisposition to the premature destruction of cartilage.Secondary arthrosis develops as a result of other joint pathologies or previous injuries.What can cause degenerative-dystrophic disease:
- damage to a joint or nearby connective tissue structures - fracture, displacement, damage to the meniscus, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of the functioning of endocrine glands, disorder of metabolic processes;
- rheumatism, or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococci, epidermis or Staphylococcus aureus;
- tuberculosis of any location, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative diseases, for example, osteochondritis dissecans.
Hypermobility of the joints, caused by the production of special collagen, predisposes to the development of arthrosis.This condition is detected in 10% of the planet's inhabitants and is not considered a pathology.But hypermobility is associated with weakness of the tendon-ligament apparatus, which leads to frequent injuries, especially of the ankle (ligament sprains and ruptures, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders, such as hemophilia.Hemarthrosis, or bleeding in the joint cavity, provokes deterioration of cartilage trophism and its destruction.
Predisposing factors include old age, frequent loads on the joints that exceed their strength limits, excess weight, surgical interventions and hypothermia.
The risk group includes women during menopause, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.If there is a lack of foods with vitamins and trace elements in the diet, the prerequisites for the gradual destruction of hyaline cartilage are created.
Clinical picture
The risk of arthrosis lies in the absence of symptoms in the first stage of its development.Clinical pathology manifests itself gradually, the first signs appear against the background of significant destruction of cartilage tissue.Initially, a person feels a slight pain that does not have a clear localization.Appears after physical activity - weight lifting, sports training.Sometimes the first clinical manifestation is a popping or clicking sound when the joint is flexed or extended.A person begins to notice that some movements are difficult.However, in the initial stage of arthrosis, stiffness appears in the morning and quickly disappears.
As the disease progresses, the pain is felt even at night, causing not only sleep disturbance, but also the appearance of chronic fatigue.The severity of the pain syndrome in the second stage increases with weather changes, worsening of chronic pathologies and acute viral respiratory infections.The range of motion is significantly reduced.The cause of the stiffness is the thinning of the cartilage, as well as the conscious limitation of the person's movements in an effort to avoid pain.This leads to increased load on the opposite joint, which provokes further damage.Arthrosis is also characterized by other specific symptoms:
- pain provokes spasms of skeletal muscles and the development of muscle contractures (restriction of passive movements in joints);
- crackling in the joints, clicks, crackling noises during movement become constant, occurring with almost every displacement of the bones in relation to each other;
- painful muscle cramps often occur;
- the joints are deformed, which leads to discomfort in standing and walking;
- in the third stage of arthrosis, the deformation is so pronounced that the joints are bent, and the range of motion in them is significantly reduced or completely absent;
- with arthrosis of the third degree of the knee, ankle, hip joint, the patient uses a cane or crutches when moving.
In the absence of treatment, the pathology progresses, and during its course remissions are replaced by relapses, and the frequency of exacerbations is increasing all the time.Stiffness in movements in the morning now does not disappear for a long time, it becomes permanent.
When examining a patient with stage 1 arthrosis, the doctor notices only slight swelling of the joint and full preservation of the range of motion.In grade 2 pathology, palpation reveals pain and slight deformity.In the area of the joint space, the formation of bone thickening is observed.
Arthrosis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Their main symptom is the formation of a rounded seal in the joint area, when pressure is applied, on which the movement of the liquid (oscillation) is felt.Acute synovitis can be accompanied by an increase in temperature to 37-38 °C, headache and digestive disorders.
Diagnosing
The diagnosis is established on the basis of the results of instrumental studies, features of the clinical picture, anamnesis and complaints of patients.A general blood and urine test is not very informative - all values remain within normal limits if arthrosis is not caused by metabolic pathology.With the development of synovitis, the sedimentation rate of erythrocytes increases (30 mm/hour) and the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.Changes in biochemical and immunological parameters occur in secondary forms of arthrosis.
The most informative method for diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral projection.
| Stages of arthrosis according to the Kellgren-Lawrence classification (1957) | X-ray signs of pathology |
|---|---|
| Novices | There are no radiological signs |
| First | Unclear, uneven narrowing of joint space.Slight flattening of the edges of the bone plates, the formation of initial osteophytes or their absence |
| Secondly | Marked narrowing of the articular space, 2-3 times higher than normal, the formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic clearings in the pineal gland |
| Thirdly | The appearance of pronounced subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space. |
| Fourthly | The formation of massive thick osteophytes, almost complete fusion of the joint space, deformation and compression of the epiphyses of the bones that form the joint. |
If, after studying the X-ray images, the doctor has doubts about establishing a diagnosis, a CT scan is prescribed.And to assess the condition of the connective tissue structures located near the joint, an MRI is performed.When using contrast, it is possible to dynamically evaluate the blood supply to the tissues and determine the stage of the inflammatory process during the development of synovitis.
Basic methods of therapy
Arthritis is still an incurable disease, as there are no pharmacological drugs for the regeneration of cartilage tissue.The main goal of therapy is to prevent the progression of the pathology and maintain joint mobility.Treatment is long-term, complex, using local and systemic medications.Patients should avoid heavy stress on the joints and, if necessary, limit the range of motion with orthopedic devices - orthoses, elastic bandages.Overweight patients should make adjustments to their diet to gradually reduce body weight and follow a diet.
After achieving stable remission, patients are shown daily physical therapy exercises.The first training sessions are carried out under the guidance of the physical therapy doctor, then the patient performs a set of exercises at home.Exercise therapy can be supplemented with swimming, yoga and cycling.
To reduce the severity of pain, drugs of various clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- joint injections of anesthetic solutions in combination with glucocorticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic regimens include B vitamins, tranquilizers and, if necessary, tranquilizers and antidepressants.Chondroprotectors are necessary for long-term use.This is the only group of drugs that have the ability to partially restore cartilage tissue.
To increase their clinical activity, physiotherapeutic procedures are performed - laser therapy, magnetic fields, UHF therapy.
Any pain in the joints should be a signal for immediate consultation with a doctor.Therapy carried out in the initial stage of arthrosis will stop the destruction of cartilage and avoid loss of performance and disability.