Description of the disease
A post-traumatic, endocrine and inflammatory disease, excessive physical overload or, conversely, inactivity can provoke the development of degenerative-dystrophic disease. The main signs of osteoarthritis: pain in the joint area with edema and limited activity in it.
To diagnose the disease, they resort to the help of instrumental techniques - X-rays, arthroscopy, CT and MRI. In the treatment of stage 1 and 2 osteoarthritis, conservative methods are used - taking medication, physiotherapy, massages and physiotherapy exercises. If irreversible destructive changes have occurred in the articular tissue, an operation is required - arthrodesis or endoprosthesis.
Pathogenesis
Osteoarthritis is characterized by marked changes in the structure of connective tissue. The formation of deforming erosions occurs in cartilage, due to which collagen fibers and proteoglycans are destroyed, which contain proteins (5-10%) and glycosaminoglycans (90-95%).As a result, the stability of the collagen network decreases, metalloproteinase is released, and all forms of proteins in the extracellular matrix are destroyed. Acceleration of destruction occurs due to the fact that the biosynthesis of collagenases and stromelysin increases.
As a rule, when enzymes are present in the body in normal amounts, they control the level of cytokines - small molecules of peptide information. If osteoarthritis progresses, the concentration of this protein decreases, due to which the enzymes that affect cartilage are released in a large volume.
As a result, proteoglycans with a deformed structure absorb water, which they can not hold. For this reason, excess fluid penetrates the collagen fiber, which begins to "swell", which leads to loss of strength and elasticity.
The qualitative and quantitative composition of the common fluid also changes for the worse. Against the background of osteoarthritis, a decrease in the concentration of hyaluronic acid is observed. The transport of nutrients and oxygen to the hyaline cartilage tissue stops at the volume needed for its restoration. In cartilage, softened foci are formed, followed by the formation of cracks, specific necrotic growths. Then the bare heads begin to be exposed, microtrauma appears against the background of displacement in relation to each other.
What provokes the development of the disease
Why primary (idiopathic) osteoarthritis develops has not yet been established. Such a disease develops without the influence of any factor, so doctors are of the opinion that the cause of such a problem lies in the tendency at the genetic level to premature destructive processes in cartilage. The formation of secondary osteoarthritis occurs as a complication of other joint diseases or on the background of an injury.
The following presence may provoke the formation of degenerative-dystrophic pathology:
- damage to articular tissue or located close to connective tissue structure in the form of a fracture, dislocation, meniscus trauma, partial rupture, or complete separation from muscle and ligament tissue, tendons;
- congenital dysplastic disorder in joint development;
- disorders in the function of the glands of the endocrine system, metabolic disorders;
- rheumatism or rheumatic fever;
- polyarthritis, rheumatoid arthritis, reactive, metabolic, gout or psoriatic;
- purulent arthritis, the cause of which lies in the effects of streptococci, epidermis or Staphylococcus aureus;
- tuberculosis of any country, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative-dystrophic pathologies, for example, dissecting osteochondritis.
Increased mobility of joint tissue, which is observed against the background of the production of specific collagen fibers in the body, can contribute to the formation of osteoarthritis.A similar phenomenon is observed in 10% of people living on the planet, it is not considered a disease.Although, in the background of hypermobility, there are weaknesses in the tendon-ligament system, due to which a person is susceptible to injury, especially in the ankle joint, in the form of sprains and rupture of ligament tissue, journeys.
In some cases, problems with hematopoietic function (for example, the presence of hemophilia) can lead to the formation of osteoarthritis. Against the background of hemarthrosis (hemorrhage in the joint cavity), the blood supply to the cartilage tissue deteriorates, due to which it begins to collapse.
Among the predisposing factors, it is worth mentioning the presence of old age, frequent loads on the articular tissue that exceed the limits of its strength, excess body weight, performing operations, hypothermia.
The risk group includes women during menopause, citizens living in unfavorable environmental conditions or in contact with toxic chemicals. If the diet contains insufficient vitamins and minerals, the conditions for the gradual destruction of hyaluronic cartilage tissue appear.
Symptoms
Osteoarthritis is dangerous because the first stage of formation is asymptomatic. The manifestation of the clinical picture of the disease occurs over time, the main symptoms appear with considerable destruction of cartilage.At first, the patient feels a slight pain syndrome without a clear localization.Occurs after physical exertion - lifting heavy objects, sports training.
In some cases, the first sign that a person notices the appearance of pressure and clicks while bending or lengthening the joints. The patient notices that sometimes it is difficult to move. Although in the early stage of osteoarthritis formation, movement problems appear only in the morning and pass quickly.
With the further development of the pathology, painful sensations begin to bother at night, due to which sleep function is disturbed, and also chronic fatigue appears. When the disease progresses to grade 2, the intensity of pain increases against the background of changes in weather conditions, exacerbations of chronic diseases, acute respiratory viral infections.
Physical activity is significantly reduced. Mobility is impeded by thinning of cartilage tissue and intentional restriction of the patient's movement in an attempt to prevent pain. This increases the load on the tissue of the opposite node, which contributes to its further destruction.
Osteoarthritis is characterized by other specific features:
- pain that provokes the appearance of spasm in skeletal muscle and the formation of muscle contraction (limited passive motor function of the wrist);
- crumbling in the articular tissue, clicks, cracks during movement of constant nature, arising from virtually every displacement of the bones relative to each other;
- frequent painful muscle cramps;
- joint deformity, which leads to impaired posture and gait;
- pronounced deformity up to the bending of the joints with a significant decrease or complete lack of motor activity in them against the background of grade 3 osteoarthritis
If osteoarthritis of the knee, ankle, or hip joint has developed by stage 3, a person should use a cane or crutch when moving.
If you do not start treatment on time, the disease starts to progress, relapses start to bother you regularly, in addition, exacerbations appear more and more often over time. Stiffness in the morning hours does not disappear for a long time, it gradually becomes permanent.
When examining a person with stage 1 osteoarthritis, the doctor notices only a slight edema of the articular tissue with complete preservation of motor function. Stage 2 of the disease is manifested by bitterness and slight deformity on touch. Bone thickening forms near the synovial cavity.
Osteoarthritis is characterized by the formation of synovitis - inflammation of the synovium at the hip, ankle, knee or shoulder joint. The main symptom of this disease is the development of a rounded seal near the joint, when you press it, you can feel how the liquid contents move. With acute synovitis, the temperature may rise to 37-38 degrees, headaches and indigestion may occur.
Diagnostic measures
The disease is diagnosed based on the results of the study with instrumental methods, clinical features, anamnestic data, patient complaints. In this case, a clinical study of blood and urine is not very informative - all indicators remain within normal limits, if the cause of osteoarthritis does not lie in metabolic problems.
If synovitis develops, there is an increase in erythrocyte sedimentation rate (up to 30 mm / h), leukocytes and fibrinogen increase in the bloodstream.This indicates the presence of acute or chronic inflammation in the body.Biochemical and immunological parameters differ with secondary osteoarthritis.
The most informative way to detect degenerative-dystrophic diseases is X-ray in 2 projections (lateral and right).
In the X-ray image, the arthrosis is visualized as follows:
- In the initial stage, there are no radiological signs.
- In the first stage, the pathology is visualized as a vague, uneven narrowing of the article cavity. The edges on the bone plates are slightly flattened, initial osteophytes are formed (sometimes they are missing).
- In the second stage, the image shows an image in the form of a pronounced narrowing of the cavity in the joint, which exceeds the norm by 2-3 times. Osteophytes are formed in large numbers, the formation of subchondral osteosclerosis is noted. Cyst-like lights appear in the appendages.
- In the third stage, the image shows pronounced subchondral osteosclerosis and large marginal osteophytes. The joint space is significantly narrowed.
- In the fourth stage, thick massive osteophytes are formed, the joint space is almost completely fused, the bony appendages that form the joint are deformed and compacted.
If the doctor has any doubts about the diagnosis after examining the X-ray images, the patient is prescribed a computed tomography. To assess the condition of connective tissue located near the node, MRI is performed. Using a contrast agent allows you to track in dynamics how tissues are supplied with blood, to determine the degree of inflammation in the synovium.
Treatment for osteoarthritis
At present, it is impossible to completely cure osteoarthritis, as the pharmacological agents that restore cartilage tissue do not exist.The main purpose of treatment is to prevent further development of the disease, keeping the joints moving.Therapy for osteoarthritis is long-term, complex, involves the use of local and systemic medications.
Patients should not overload the joints; it will be necessary to limit motor activity with the help of orthopedic devices - orthoses, elastic bandage. Overweight people will need to adjust their diet in order to lose weight over time and start dieting.
When a lasting remission is achieved, the patient needs to perform therapeutic gymnastic exercises every day. In the beginning, you will have to do it under the supervision of a specialist, and in the future, you will have to do gymnastics at home yourself. In addition to physical therapy, you can sign up for the pool, do yoga or ride a bike.
To reduce the intensity of pain, the use of drugs belonging to different pharmacological groups is prescribed:
- Non-steroidal anti-inflammatory drugs in tablets, oils, solutions for intravenous injections.
- Intra-articular injections of anesthetics with the addition of glucocorticosteroids.
- Muscle relaxants to relieve muscle spasms and contractures.
Also, the treatment regimen for osteoarthritis includes the use of B vitamins, sedatives, if necessary - antidepressants and sedatives. It is mandatory to appoint chondroprotectors in the form of a long course.The tools of this group contribute to the partial restoration of cartilage.
To increase the clinical activity of articular tissue, it is necessary to perform physiotherapeutic procedures - laser therapy, magnetotherapy, UHF.
Any painful manifestation in the joint area should be the basis for an immediate visit to the doctor. Treatment carried out in the early stages of osteoarthritis development makes it possible to stop the destructive processes in cartilage, to prevent disability and disability.