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Arthrosis

Arthrosis of the ankle joint

Arthrosis is a whole group of dystrophic depth diseases of the joint apparatus with different etiology, but a similar clinical picture of pathological changes.The hyaline cartilage of the joint, then the drunk bone tissue, the joint capsule and the band apparatus are exposed to destruction and deformation.The disease is chronically progressive and can significantly restrict the patient's motor activity without proper treatment.

The diagnosis and treatment of pathology is in an arthrologist, rheumatologist, surgeon, orthopedic surgeon.



General information

Arthrosis is diagnosed in about 1/5 of the planet's population, but the disease is more characteristic for older people.This proves the statistics of their spread between different age groups:

  • Youth up to 40 years ---- more than 6-7 %;
  • Mature faces after 45 years up to 20-25%;
  • After 70 years - up to 80%.

The disease affects the tissues that are under constant stress: small handpugs and plus the legs, hip and knee joints, areas in the neck and breast parts of the spine, a little less often ankle and shoulder joint.

Note! The defeat of the interfalizing joints of the hands in women is ten times more often than in men.

In many western countries, the term “osteoarthritis” is not used, which replaces it with the concept of “arthritis”.Such a substitution is fairly justified, since inflammatory processes precede or accompany osteoarthritis in most cases.In domestic medicine, the terms "arthrosis" and "arthritis" essentially mean the same disease, but with different etiology of the process.In addition, the concepts of osteoarthritis, arthrosis and deforming arthrosis are used to designate the pathology.

Note! The difference between arthritis and arthrosis is the cause of the disease.In the first case, these are inflammatory processes (suffix -means inflammation) in the second metabolic disorders (protein, mineral). 

The development mechanism and the causes of osteoarthritis

The main cause of osteoarthritis is a violation of the balance in the processes of anabolism and catabolism of cartilage and bone tissue.If the synthesis processes are normal, the destruction processes become faster during the change of osteoarthritis.As a result, a quick aging and degeneration of tissue structures is observed.They first start collapse at the cellular level and then on the organ tone.The first destructive changes appear:

  • Clouds of the cartilage;
  • superficial storage;
  • Microricish and tears;
  • The focal and general thinning of the cartilage layer.

The cartilage loses natural elasticity and density and can no longer serve as a shock absorber during the movements.The mutual correspondence of the shape of the articular surfaces is disturbed, which leads to the deformation of the connection.This exacerbates the development of pathological changes and triggers a number of irreversible processes.In exchange for the lost cartilage, the bone tissue grows with the formation of spikes and outgrowth, which can lead to the movements and then to a severe patient.

Reasons for this scenario:

  • Violations of mineral metabolism can lead to gout changes in the joints, osteoporosis, etc.
  • The disadvantage of tissue nutrition is venous stagnation and poor microcirculation slows down blood supply and lymphatic drainage.The mineral composition of the bone is exhausted, becomes osteoporious and loses the ability to manage yourself.The phenomenon is characteristic of a lack of movement, with vascular pathologies and hormonal mistakes.
  • Inflammatory processes - a result of acute infectious diseases, hypothermia of the body, impaired hormonal background.
  • Autoimmune reactions are chronic forms of inflammation, nerve stress, endocrine pathologies and other causes can cause aggression of the body of the body against its own cells, including the joint tissue.The most common autoimmunlesions with rheumatoid arthritis, scleroderma and red lupus.
  • Increased joint wear - a mismatch between functionality and the load slows down the synthesis processes and accelerates the destruction.The phenomenon is characteristic of athletes, dancers, overweight people and for everyone who deals with severe physical work or are associated with long static stress (standing work).
  • Injuries - bruises, transfers, fractures, penetrating wounds, tears - violate the structure of tissues and give impulses to the beginning of the deformation.
  • Genetically determined pathologies - connective tissue plaque, a violation of collagen synthesis initially forms an unstable, low functional joint.

Some reasons are closely with each other and form a complex pathological complex.

Attention! Hormonal deviations play a particularly important role in violations of the metabolism of the bone tissue.A failure in the thyroid gland, menopause, taking contraceptives, corticosteroids - all of this is a direct way to osteoporous and osteoarthritis changes in the skeleton.

Classification of changes

Several defining criteria are used in the systematics of arthrosis: causes and etiology, localization, coverage area.

Through etiology:

  • Primary arthrosis - develop independently of one another, damaged with fully healthy joints without the participation of earlier pathologies;
  • Against the background of an illness (gout, psoriasis, rheumatism) as well as in the presence of existing articular deformations or injuries are secondary.

Due to the degree of cover:

  • Local shape damage on a limited number of joints: monoarthrosis-1 joint, oligoarthritis-2-3;
  • Generalized forms are different types of polyarthrosis when 3 large structures and more are involved in the pathological process.

After localization of the process, the names of arthrosis of each joint are specified:

  • Coksartrose - deactivates the hip connection;
  • Spondylarthrosis - influences the intervertebral discs, mainly cervix, chest and lumbar vertebrae;
  • Gonarthrosis - with impaired work of the knee joint;one of the most common species;
  • Cruzartrose - with the participation in the ankle pathological process.

Osteoarthritis can be quickly or slowly progressively, compensated for or decompensated.

The main symptoms and signs

Osteoarthritis is a complex disease.In general, it can be divided into several pathologies that are united among themselves:

  • Chondritis and chondrosis - inflammatory and degenerative lesion of cartilage tissue;
  • Osteoporosis is also osteoporosis - a pathological process in bone structures;
  • Synovitis - the participation of the feed cover of the joint capsule;
  • Bursit - general inflammation of the common bag;
  • Reactive damage to the soft tissue in the adjacent area - affects the muscles, ligaments, fiber.
Storage stock and pain in the osteoarthritis of the hands

Depending on the stage, degree and shape, they are observed at the same time or selectively.Against this background, a complex symptomatic changes are formed.Below:

  • Pokrutz hazing is a symptom for a violation of the mineral metabolism and the first sign of the disease.It can occur at any age.
  • Storage - intensively manifested in the morning.It is at short notice and can be expressed by the effect of the jamming of the joint.
  • Limitation of mobility - reduction in the amplitude of movements in the Commission of active or passive actions.
  • Pain-a different manifestation, starting of uncomfortable and painful, which gains a background character after intensive loads and ends with acute sharp movements.The so -called "starting pain" are particularly characteristic, which manifests itself after a long rest and the load until the joint is fully developed.
  • Swimness - with inflammation of the soft tissue, synovitis, bursitis.
  • Deformation - is observed with complete degeneration of cartilage and a lack of shock absorption factor.

Note! The nodules of BUSHARA and encounters are a characteristic sign of deformation of the hand arthrosis.They are bone growth with osteophyte processes.

Stages and degrees of arthrosis

With regard to the intensity of osteoarthritis changes, 4 stages of the disease are differentiated:

  • 1. Level - with minor cartilage (violation of structure and functionality in collagen fibers).The picture is practically not visible in the X -Ray.
  • Level 2 - The stinging of the cartilage in the lumen of the joint is up to 50%.It is covered with cracks, a small pain occurs in the area of the damaged connection.Osteophytic complexes appear on the X -Ray;The joint gap slightly reduces its size.
  • Level 3 - The lesion of the cartilage almost reaches the bone base, the joint column is greatly reduced.
  • 4 levels - The cartilage is completely damaged, which leads to a partial or complete degeneration of the synovial fluid, the abrasion of bone tissue and the deformation of the connection.Sclerosis changes develop in some areas.The extreme manifestation of osteoarthritis is the fusion of joint tissue with the ossification of structures and a complete loss of mobility.

In some sources, level 1 and 2 is combined into one.

With the progress of the symptoms, a person's motor activity suffers.In view of the violations of the functional performance of the joint, a distinction is made between 4 degrees of the possible development of the pathology:

  1. 0 degrees - mobility and performance are fully preserved;
  2. 1 degree - the patient retains the ability to serve himself and manifest social activities, but cannot take part in work activities in work.
  3. 2 degrees - difficulties in manifestation of social activities are added to a violation of work activity.
  4. 3 degrees - all kinds of activities are limited or completely impossible: work, social and self -service;The patient needs constant care.

What are possible complications

By tightening the treatment, you can provoke a number of unpleasant consequences:

  • Constant pain syndrome;
  • Lameness;
  • Vertebrates (with spondylarthrosis);
  • pronounced common deformation;
  • Complete immobility with the ossification of structures.

What does the survey procedure include?

A medical examination with the collection of an anamnesis is sufficient for the diagnosis of osteoarthritis.In order to determine the degree of damage, an instrumental investigation is carried out.The main methods to get a clear picture of the disease:

  • Radiography;
  • CT, MRI;
  • Ultrasonic;
  • Scintigraphy;
  • Diagnostic arthroscopy with biopsy of cartilage tissue and synovial fluid.

In an acute inflammatory process, the doctor prescribes additional analyzes: a general blood test, rheumen, biochemistry (level of glucose, protein compounds, electrolytes).

Treatment

It is impossible to completely eliminate the disease.The timely treatment of osteoarthritis enables you to maintain the functionality of the joint, to maintain normal motor activity and avoid pain.To rule out complications, it should start in the first stage.

Pharmaceutical therapy Contains:

  • anti -inflammatory medication, mainly NSAIDS;
  • Intra -karticular steroid blocks of pain and inflammation (with pronounced synovitis, bursitis);
  • Proteolysis inhibitors - slow down and suspend the process of destroying bones and cartilage;
  • Anti -spas modos - prevent muscle cramps;
  • Ango -protectors and medicines to improve blood microcirculation in those affected;
  • Chondroprotectors;
  • Synthetic substitutes for synovial fluid;
  • Vitamin and mineral compositions.
Training therapy for the treatment of osteoarthritis of the joint

A complex of physiotherapy Prescribed in parallel to improve the effect of medicinal products.The main physiotherapy: 

  • Magnetotherapy;
  • Electrophoresis;
  • UHF;
  • Dirt;
  • Bathroom;
  • Massage;
  • Exercise therapy and kinesiotherapy using special simulators.



operation - The only way to treat in the later stages when the cartilage tissue is completely destroyed.The following solutions for the problem are possible:

  • Endoscopy - with a partial or complete exchange of the joint with artificial analogue;
  • Arthroscopy - a minimal invasive process for removing osteophytes or partial exchange of cartilage;
  • Arthrodesis - the closure of the joint and fixing in the most convenient position;The motionless joint surfaces grow over time.

forecast 

Osteoarthritis does not threaten the patient's life, but the lack of treatment can significantly restrict freedom of movement and deteriorate the quality of life.A timely and competent therapy in the early stages can restore the joint in a healthy state.In other cases, only slowing down the degeneration process with the help of conservative treatment and compensation for lost functions based on prostheses is possible.

Prevention of the disease

Complete recovery is almost impossible, so prevention should be paid special attention.The main requirement is a healthy lifestyle and a complete treatment of inflammatory processes:

  • Do not allow hypothermia and treat infectious diseases in good time.
  • Avoid physical overload and long static loads;
  • maintain the normal body weight;
  • Stick to the correct nutrition of vitamins and minerals is very important for the health of the musculoskeletal system.
  • Completely (if possible, until full recovery) to damage damage to the joints;
  • Practice systematic physical exercises to stimulate blood circulation (bike, hiking, light jogging, scandinavian walking).

If you are at risk (older age, poor inheritance, physical overload), you should undergo a regular radiological examination.