Osteoarthritis is a chronic disease of the joints associated with degenerative-dystrophic changes in their structures with predominant damage to the cartilaginous tissue.The disease progresses slowly and is asymptomatic at first.The cartilage and bone tissue of the joint, its capsule and periarticular bursa are gradually destroyed, and later the surrounding muscles, ligaments and subcutaneous tissues are involved in the pathological process.
According to the WHO, one in ten people suffer from this disease and the risk of developing it increases significantly in people over 50 years old.The knee and hip joints are most often affected.The cause of osteoarthritis is the inability of the joint to cope with the load placed on it.In response to traumatic effects, inflammation develops, which leads to pathological processes in the tissues of the joint.
Patients suffering from osteoarthritis of the joints require complex treatment, without which the disease leads to a reduction in working capacity and quality of life, limitation of sports and professional activities and, ultimately, disability.
Classification of osteoarthritis
Depending on the cause of occurrence, the disease is divided into:
- primary osteoarthritis - is due to the fact that the cells of the cartilage tissue of the joint are destroyed faster than new ones are formed.Most often, this is associated with age-related changes and is not the consequence of any specific pathological processes in the body;
- secondary osteoarthritis - appears against the background of a specific disease or as a result of joint damage.
Depending on the location, osteoarthritis is divided into localized (affecting less than 3 joints) and generalized (affecting more than 3 joints).The latter is also called polyarthrosis.
Causes of osteoarthritis
This disease ranks first worldwide among the causes of pain and activity impairment.Although age-related changes are considered the main cause, they are often diagnosed in younger patients.Women are more prone to osteoarthritis than men, although around the age of 70, this difference becomes almost imperceptible.
Osteoarthritis of the hip, knee, ankle and shoulder joints has the greatest negative impact on the quality of life and work capacity of patients.Osteoarthritis of the elbow and temporomandibular joints, as well as the hands, feet and spine, is less common.
Predisposing factors include:
- old age;
- genetic predisposition;
- intense physical activity associated with sporting or professional activities, or, conversely, a sedentary lifestyle, which disrupts the normal nutrition of tissues, particularly in large joints;
- joint injuries (fractures, cracks, dislocations);
- wearing inappropriate shoes;
- systemic diseases (metabolic disorders, endocrine diseases, neuropathies, gastrointestinal diseases, coagulation disorders);
- poor diet;
- overweight.
Women are more likely to suffer from this condition because they are more susceptible to hormonal imbalances.
Symptoms and degrees of osteoarthritis
The main clinical sign of osteoarthritis is pain.In the early stages, it may be absent, mild or intermittent.As the disease progresses, the pain becomes more noticeable, it may occur during exercise, and in advanced stages it may be bothersome even at rest.
Secondary manifestations of the disease depend on the localization of the process.Most often, these are limited mobility in the affected area (especially after prolonged sleep or rest), deformation, swelling and redness of the joint area, creaking and crackling sounds when moving, sleep disturbances due to pain and inability to find a comfortable body position, changes in gait and coordination, muscle spasms.
It should be noted that the pathological process in one joint can move to neighboring joints due to poor load distribution or restrictions in movement.
Depending on the severity of the lesion, we distinguish:
- 1st degree osteoarthritis - is asymptomatic or the signs are not expressed, the patient remains able to work and the diagnosis is difficult;
- 2nd degree osteoarthritis – accompanied by severe symptoms, the patient's quality of life decreases, the diagnosis reveals obvious disorders;
- osteoarthritis of the 3rd degree - characterized by an increase in clinical signs, deformation of the joints is noted from the outside, and diagnostic methods reveal serious intra-articular disorders;
- osteoarthritis of the 4th degree - leads to partial or total disability;Disorders are found in all structures of the joint, surrounding muscles and ligaments.
Diagnosis of osteoarthritis
An orthopedic traumatologist makes a primary diagnosis based on the patient's data about his lifestyle and professional activities, the nature and duration of complaints, the dynamics of symptoms, the presence of osteoarthritis in relatives, and also conducts an examination and prescribes tests or consultations with relevant specialists (endocrinologist, hematologist, nutritionist, gastroenterologist).
Laboratory tests include a general blood test with a white blood cell count, hemoglobin level and ESR.These indicators indicate inflammation in the body, necessarily present in osteoarthritis.Biochemical parameters measure the level of rheumatoid factor and C-reactive protein.If certain pathologies are suspected, other laboratory blood parameters are checked.The analysis of synovial fluid also has diagnostic value, which reveals pathological cells and inclusions, allows you to confirm the diagnosis or differentiate from another disease.
Instrumental and visual methods of diagnosing osteoarthritis help not only to detect pathology, but also to determine the stage of the disease and the degree of involvement of surrounding tissues.The most effective of them are:
- x-ray - performed mainly in two projections, it is used to detect narrowing of the joint space and the formation of bone growths (osteophytes) at the site of damaged cartilage;
- magnetic resonance and computed tomography - prescribed in the early stages, when minor changes are not yet noticeable on x-rays;
- Ultrasound - used as an addition to these methods and allows you to identify the accumulation of excess fluid in the joint cavity (for example, Baker's cyst in gonarthrosis), assess the condition of the surrounding tissues and measure the thickness of the articular cartilage;
- scintography – involves the intravenous administration of a radioactive drug that accumulates in tissues with inflammatory processes, and these areas of accumulation are displayed on the images, thanks to which it is possible to identify osteoarthritis at an early stage and carry out differential diagnosis;
- arthroscopy - allows you to examine the joint from the inside by introducing a microcamera into the joint cavity through a small incision.So you can collect detailed data on pathological processes and ongoing injuries, as well as perform a biopsy of the affected area;
- histological examination of the synovial membrane - reveals an altered ratio of healthy cells and the presence of pathological inclusions in the joint, allowing differential diagnosis.
Differential diagnosis allows you to distinguish arthritis from other diseases with a similar clinical picture, including:
- various arthritis (ankylosing, reactive, rheumatoid, psoriatic, infectious);
- gout and pseudogout;
- muscle and ligament diseases (fibromyalgia, polymyalgia rheumatica);
- arthropathy (diabetic, paraneoplastic);
- congenital diseases (hypoplasia of the femoral head).
Treatment of osteoarthritis
Despite the widespread prevalence of the disease and well-studied methods, there is no treatment for osteoarthritis.Therapeutic approaches aim to eliminate pain, relieve inflammation, restore joint function and prevent complications.
The choice of treatment depends on the cause, location and degree of osteoarthritis:
- drug therapy in the form of taking tablets for osteoarthritis (non-steroidal analgesics and anti-inflammatory drugs, corticosteroids, chondroprotectors), intra-articular or periarticular injections of these groups of drugs, additionally using ointments and gels;
- physiotherapy in remission (medicinal electrophoresis, galvanization, acupuncture, electrical stimulation, shock wave therapy, massage, magnetic and laser therapy, cryotherapy);
- therapeutic exercises for osteoarthritis are prescribed individually, sessions are carried out under the supervision of a specialist;
- in advanced cases, surgical intervention is performed (partial or complete arthroplasty, suturing or removal of a torn meniscus, removal of bone growths and Baker's cysts).
Osteoarthritis prevention
It is recommended to control the load on the joints, maintain a healthy lifestyle, practice therapeutic exercises, monitor weight and adhere to proper nutrition.
An orthopedic traumatologist will help select knee braces, orthosis or bandage for patients suffering from osteoarthritis in order to repair the affected joint, reduce the load on it and prevent injuries.
Preventive examinations and timely consultation with a doctor in case of discomfort in the joints allow you to identify the problem at an early stage and avoid serious complications and disability.