Osteoarthritis of the joints (also in the literature you can find the names "arthritis deformans", "osteoarthritis" or "osteoarthritis") is a chronic degenerative process of the joint tissues, in which, due to dystrophic processes, over timetime, the cartilage covering the joint surfaces is destroyed, in addition, degenerative processes can cover the joint capsule and the bone tissue itself, causing bone deformation.
Types of osteoarthritis of the joints
In general, the term "arthrosis" is used to denote a fairly large group of diseases of different joints, the mechanism of development of such pathologies may differ to some extent. Most often you can experience osteoarthritis of large joints, this group of diseases includes:
- gonarthrosis - a deforming lesion of the knee joint;
- coxarthrosis - a pathology of the hip joint;
- arthritis of the shoulder joint;
- osteoarthritis of the elbow joint, etc.
Less often, osteoarthritis of the small joints develops: the hands (more often interphalangeal and metacarpophalangeal) and feet. In addition, spondyloarthrosis is distinguished - a dystrophic lesion of the intervertebral joints, called diseases of the spine, despite the mechanism of development similar to other types of osteoarthritis. In the event that the pathology has spread to several joints, we can speak of generalized osteoarthritis, or - polyarthrosis.
In medicine, it is customary to distinguish two main types of arthritis of the joints, depending on the mechanism of its development. Primary osteoarthritis (also called idiopathic) is a pathology that develops mainly in the tissues of the joint, without any deviation from the systemic work of the body. Primary osteoarthritis is characterized by an increase in degenerative processes in the cartilage tissue simultaneously with a violation of its restoration.
Secondary osteoarthritis is the result of injury to the joint due to trauma (traumatic osteoarthritis). In addition, some pathological processes in the body, in particular, disorders of mineral metabolism and others, can lead to the development of secondary osteoarthritis.
At a young age, as a rule, traumatic arthritis is detected. In elderly patients, in some cases it is not possible to distinguish between primary and secondary joint damage - so closely related are many pathological processes in the body.
Why does osteoarthritis develop?
Although there is still no consensus on the exact cause of the development of osteoarthritis, the factors that contribute to pathological changes in the tissues of the joint are known to scientists. The main reason for the development of idiopathic arthritis of the joints is a variety of factors of a hereditary and genetic nature. First of all, this group includes congenital features of the composition of the tissues of the joint, which contribute to a more intensive than normal destruction of cartilage and its too slow recovery. In addition, hereditary factors may include a variety of congenital malformations and deformities of the osteoarticular system (dysplasia of the joints, their excessive mobility, deformities of the spine, feet, hands, etc. ), due to a load isplaced on certain joints. , why the joint surfaces can develop incorrectly, deform, and the cartilage covering them - collapse;
The following reasons can lead to the development of secondary osteoarthritis of the joints:
- Mechanical damage to the joints is the result of certain mechanical influences leading to a violation of the anatomical integrity of the structures forming the joint. The group of mechanical injuries includes injuries, surgeries, excessive physical activity and sports;
- joint diseases - first of all, pathologies of an inflammatory nature;
- metabolic disorders resulting in changes in the composition of the cartilage covering joint surfaces, which makes it more vulnerable, breaks down faster and recovers more slowly;
- certain diseases of the endocrine glands, which can also lead to metabolic disorders;
- a number of autoimmune pathologies in which the cells of the immune system attack the body's own tissues, in this case, the tissues of the joints, causing destruction;
- vascular pathologies, the result of which is insufficient blood supply to the tissues and the development of dystrophic processes in them.
How does osteoarthritis of the joints develop?
It is believed that the first destructive process in the joint in osteoarthritis of the joints is the defeat of the cartilage. It begins with a violation of microcirculation in the capillaries of the periosteum, located under the cartilage covering the articular surface of the bone. Normally, the nutrients in cartilage tissue come from both joint fluid and adjacent bone tissue. When blood circulation is disturbed in the vessels of the periosteum, the nutrition of the cartilage is disturbed. Gradually, the cartilage tissue loses its natural elasticity, becomes thinner, its surface becomes uneven, microcracks and tubercles may appear on them, disrupting the sliding of the joint surfaces relative to each other. The composition of synovial fluid inevitably changes.
With movements in the joint, pain, crunches, the clicks begin to bother. Over time, the pathology progresses, the range of motion in the joint decreases, the joint space narrows, the cartilage on the protruding parts of the joint surfaces can become thinner until it completely disappears, and osteophytes are formed. on the edges of the articular surfaces.
The described mechanism is characteristic mainly of senile osteoarthritis, which develops gradually over time. The mechanism of development of other forms of osteoarthritis - for example, post-traumatic, postoperative, post-infectious, associated with metabolic disorders - may be slightly different, but in general, changes in the joint with such pathologieswill be identical to senile osteoarthritis.
The degree of osteoarthritis and its manifestations
The specific manifestations of the pathological process, their severity largely depends on the intensity of the destructive process in the joint, on the amount of tissue involved. Nevertheless, there are two main clinical symptoms characteristic of osteoarthritis at any stage. First of all, it is joint pain. In addition, the decrease in joint mobility is of concern.
In our country, it is customary to distinguish the degrees of osteoarthritis according to the clinical and radiological classification adopted in 1961.
Osteoarthritis of the joints 1 degree- the initial stage of development of the pathological process.Its main symptom is stiff joint movements in the morning after rest. Once the patient begins to move, the stiffness subsides. In the joints, there may be some impairment of mobility, minor pain may disturb after being at rest, during the first movements. Cracks in the joints are often noted. However, there is no pronounced pain after performing normal movements, the pain can appear only with a clearly excessive load on the joint, and after resting it goes away on its own.
X-ray examination of the affected joint does not show pronounced changes in anatomical structures; in some cases, there may be a slight narrowing of the joint space or the presence of single, small bone growths along the edges of the joint surface.
Due to the absence of obvious pain and movement disturbances in the joint, patients rarely seek medical help at this stage in the development of the disease.
2 degree of osteoarthritis - the progression of the disease.It is manifested by the appearance of severe, sharp pain, as well as a distinct tightening, clicking in the joint during movements of it. The range of motion of the joint is significantly limited, therefore, if we are talking about the defeat of a large joint, the development of a functional shortening of the limb is possible. The pains are annoying in the morning, immediately after waking up, as in the first stage of osteoarthritis, but unlike this, they are more intense, longer, often they gradually turn into daytime pain. The latter are formed during the day, when mechanical work in the joint gradually decreases the cushioning capacity of the cartilage. At this stage, there is a fairly significant destruction of the joint, deformations of the bones that form it. Meteorosensitivity of the joint can be bothersome: the appearance or significant intensification of pain in it as the weather changes, which is associated with a decrease in the compensatory properties of joint tissues and its ability to regulateintra-articular pressure during fluctuations in atmospheric pressure. pressure.
X-ray examination shows significant narrowing of the cleft joint, a large number of bone growths. Bone tissue in the pericartilaginous zone is sclerotic due to pronounced dystrophic processes; cystic cavities can form there.
At this stage of the disease, the patient's working capacity decreases; he cannot perform a number of jobs at all due to severe pain when moving the affected joint or its contracture.
Osteoarthritis of the joints of the 3rd degree corresponds to the advanced stage of the pathological process.Pain is constantly disturbing - both during movements and in a state of complete rest, which is associated with a number of factors: inflammation of joint tissues, deformation of joint surfaces, muscle spasms around it. The range of motion is severely limited, in some cases they are usually not possible. Movement in the affected joint is accompanied by a loud cracking, audible not only to the patient, but also to those around him. The joint at this stage is significantly deformed, fluid accumulates in the joint capsule due to the intense inflammatory process. Severe meteorosensitivity develops: intensification of pain due to climate change Muscles in the area of large joints are spasmodic, due to lack of mobility their atrophy may develop. With 3rd degree osteoarthritis of the knee joints, a curvature of the legs can be noted - varus (in the form of the letter "O") or valgus (in the form of the letter "X").
X-ray images reveal an almost complete absence of joint space, the joint surfaces are significantly deformed, and large bony growths are localized on their edges. Intra-articular structures (menisci, ligaments) are destroyed, bone tissue is sclerotic. Tissues around the joint are calcified, joint mice may appear in the joint cavity - fragments of bone tissue.
With osteoarthritis of the joints of the third degree, there is a persistent decrease in the patient's working capacity, his disability.
4 degree of osteoarthritis - the stage of complete destruction of the affected joint.Its "blockade" develops - the impossibility of the slightest movements due to severe pain. Pain cannot be relieved even by strong non-narcotic pain relievers, they are not relieved by physiotherapy procedures. With the defeat of the knee joints, the patient loses the ability to move independently. Intense inflammation of the joint tissues can cause joint fusion (ankylosis) or the formation of false joints (neoarthrosis).
On the roentgenogram, we can see the strongest sclerosis of the bones forming the joint, their fusion, a large number of osteophytes and intense calcification of the joint tissues.
How is osteoarthritis treated?
The scope of therapeutic measures for the treatment of osteoarthritis of the joints depends on the stage of the disease and the prevalence of the pathological process. There is a simple scheme: the earlier treatment for osteoarthritis is started, the more effective it is. Therefore, it is very important to consult a doctor in a timely manner, at the first signs of discomfort in the joint area, at the slightest morning stiffness or the appearance of tightening during movements. At the early stages of the pathological process, it is effective to take vitamin-mineral complexes and chondroprotectors - drugs that improve metabolism in cartilage tissue and its structure. For example, a drug whose active ingredient is crystalline glucosamine sulfate - a natural component of healthy cartilage. It stimulates the production of proteoglycans and at the same time inhibits the processes of destruction of cartilage tissue.
A good addition to the measures listed for treating osteoarthritis will be physiotherapy exercises, physiotherapy techniques, it is important to have a good diet with a sufficient amount of protein and fat in the diet. Timely therapeutic and prophylactic measures not only eliminate pain and discomfort, but also prevent the progression of the disease, the transition of pathology to more severe stages.
Osteoarthritis of the second degree and more severe degrees cannot be completely cured. At these stages, treatment for osteoarthritis is reduced to eliminating or reducing pain, as well as removing inflammation in the tissues of the joint. To relieve pain, nonsteroidal anti-inflammatory drugs and non-narcotic analgesics are used, in the form of local agents (ointments, gels with anesthetic and anti-inflammatory effect), as well as systemic drugs. An important role is played in relieving the load on the diseased joint, which helps to reduce mechanical damage to the joint surfaces.
After the acute pain is eliminated, an important task is to normalize metabolic processes in cartilage tissue, slow down destructive processes, for which it is also recommended to take chondroprotective drugs. In addition, drugs that stimulate tissue microcirculation have been proven to work. In the remission stage of osteoarthritis (in the absence of severe pain), physiotherapy and physiotherapy exercises are helpful, which will reduce the likelihood of another exacerbation and reduce the need for pain relievers and NSAIDs. .
The list of physiotherapeutic measures in the treatment of osteoarthritis of the joints includes electrophoresis, exposure to ultrasound, radiation therapy and magnetotherapy. The most important condition for the effectiveness of such measures is the carrying out of physiotherapeutic treatment of osteoarthritis only during the period outside the exacerbation of the disease, otherwise there is a high probability of activating the processinflammatory and increase pain.
How to treat osteoarthritis in the fourth stage of the disease? Joint tissue at this stage is practically destroyed, the only effective solution is surgery, during which the damaged joint is replaced with a special stent. Not always, such an operation allows you to completely restore the range of motion of the joint, however, after the end of the recovery period, the patient can resume an active life, work, get rid of pain.
Osteoarthritis, the symptoms and treatment of which are described in this article, is a serious pathology that can lead to disability, significantly reducing the quality of one's life. Timely started treatment can significantly slow the progression of the disease, prevent the development of serious complications, and maintain the patient's activity and working capacity.