In the structure of the pathology of the osteoarticular system, osteoarthritis occupies a leading place: about 70% of cases fall into its part. A similar problem is most often encountered by people after 50 years, but the initial signs of the disease also appear in young people. This disease has serious medical and social significance, because in many cases it becomes the cause of functional insufficiency in working age.
Many people know a pathology such as osteoarthritis of the joints, but not all patients understand why it develops, how it manifests itself and what is needed to fight the disease. And increased awareness and caution can prevent harmful changes from occurring and progressing.
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 the deformation of osteoarthritis. The origin of the disease is quite heterogeneous and is due to both external and internal pathological effects on the body.
For each patient, there are certain risk factors that contribute to the onset of joint disease. Therefore, the causes of osteoarthritis 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 joint interventions.
- Inheritance.
As can be seen, the development of arthrosis is mediated by heterogeneous factors, which in most cases are of a mechanical or exchange nature. In this case, the patient's lifestyle and his profession are of no small importance, because loaders, manual workers and athletes often suffer from osteoarthritis.
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. Provides a 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 permissible, then first there are structural disorders in the cartilage. Proteoglycans holding collagen strands are lost, which increases the sensitivity of the tissue to external influences. The processes of destruction begin to prevail over the 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 disturbances.
All this leads to thinning of the cartilage, 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. Disorders of cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Arthrosis, like other diseases, has some 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. If the cause cannot be established, it is referred to as 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 in 3 joint groups.
If the pathological process has a generalized character, then we can talk about the defeat of almost all joints in 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 properly assess their severity. Therefore, be sure to take into account the stage of osteoarthritis. It does not depend on the cause and is determined by pathological changes in the joint tissues:
- Stage 1: inflammation of the synovial membrane, loss of the cartilage's ability to withstand the load.
- Stage 2: destruction of cartilage tissue, bone growths, joint bag dystrophy.
- 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.
- 3rd degree - the impossibility of self-service.
All these features should be reflected in the diagnosis of osteoarthritis, as they are important for subsequent therapy.
Symptoms
Among the joint pathologies, the symptoms of osteoarthritis have a fairly tangible specificity. They develop gradually, but steadily progress, leading to a limitation of 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 and prevent complications.
When contacting a doctor, patient complaints are first analyzed. And most people are worried about joint pain. But with arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - occurs against the background of the load and decreases at rest.
- Onset: the onset of pain is associated with the onset of movement (walking).
- "Joint mouse" - periodic acute pains with blockage of the joint, caused by the violation 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 turns into pain. And if in the initial stages it worries after a load, in the future - during movement and in advanced cases it becomes constant, also remaining at rest and at night.
In addition to pain, patients have other symptoms of osteoarthritis. They are both subjective and objective in nature, including the following characteristics:
- Stiffness in the joints in the morning no more than 30 minutes.
- Sensation of creaking (crepitus) during movement.
- Deformation of the periarticular region.
- Mobility limitation.
With arthrosis of the hands, during the examination, characteristic formations in the region of the proximal and distal phalanges can be noted - the Bouchard and Heberden nodules. Feeling the affected joints is often painful. If contractures are formed, there is a fixation of some parts of the limbs most often in a flexion position.
The pronounced nature of arthrosis 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, they try to see structural changes in 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 investigation complex consists of the following activities:
- X-ray.
- Magnetic resonance.
- Ultrasound procedure.
- Arthroscopy.
- Biochemical blood tests (hormone spectrum, inflammation markers, calcium metabolism, rheumatic tests).
After the examination, a consultation with an orthopedic-traumatologist will be required, who will help 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 achieved with early treatment. For the treatment of arthrosis, 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 achieved if the 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 of all necessary to reduce the mechanical effect on the cartilage tissue. To do this, you should stop wearing heavy and intense sports training. Any method from walking with a cane to special fastening orthoses is suitable for relieving the joint. But it is impossible to completely abandon the movements, physical activity should be dosed. Walking short distances, swimming are useful.
Proper nutrition plays an important role in correcting arthritic changes. Diet helps improve the condition of cartilage, but it is also the main component of the fight against excess weight. Patients are advised to consume lean meats and poultry, fish, cereals; it is necessary to enrich the diet with fresh fruits and vegetables, herbs. But in return, you should refrain from smoked, spicy, fatty, marinated and pickled foods. It is best to pay attention to foods rich in collagen, elastin and jelly fibers: jellied meat, hashish, 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 particularly important in chronic degenerative joint disease when a structure-modifying effect on cartilage tissue is required. The following medications are generally recommended:
- Non-steroidal anti-inflammatory.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogen, thyroid hormones).
With severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be performed. But such treatment should be short-term, because with prolonged use, hormonal drugs have the opposite effect - they stimulate dystrophic processes. Systemic therapy must be combined with topical medications.
Taking medications for osteoarthritis is carried out on the recommendation of a doctor and under her supervision. Independent use of any medicine is not allowed.
Physiotherapy
Methods of physical influence help to eliminate acute signs of joint pathology. Together 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.
- Ultrasound 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 an overall health-enhancing effect. But at the same time, one should not forget about the contraindications to physiotherapy: infectious diseases, tumors, cardiovascular pathology, renal failure, bleeding, severe patient condition.
Physiotherapy
An important aspect of non-drug therapy for osteoarthritis is physical therapy. It is known that the metabolism of cartilage tissue has a clear dependence on the mechanical factor. But its strength must be adequate. Only then do the processes of growth 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 injury, as well as the general condition of the body.
During classes, pain should not appear. Exercises are performed at a slow pace and only after acute symptoms are eliminated. Avoid sudden, large-scale movements that can cause discomfort. Physical education should be carried out under the supervision of a doctor, and having acquired the necessary skills, you can start exercises at home.
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). The classic massage includes the following elements:
- Caress.
- Shredding.
- Knead.
- pressure.
- Press.
It is often combined with passive movements in the affected joints. The duration of therapy is determined by the doctor and can vary from 7 to 15 sessions.
Operation
If the advanced stages of osteoarthritis do not allow to achieve the desired effect from conservative measures, surgical treatment is required. Its essence is the replacement of the joint with an artificial one: arthroplasty. This operation is performed openly and under general anesthesia. After its completion, it is necessary to undergo rehabilitation, which begins as soon 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 initiate the disease and to be able to hope for the success of conservative measures, treatment should be started as soon 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. If not, surgical correction will have to be considered.