Osteoarthritis is a chronic pathology that affects the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course with gradual destruction of cartilage tissue.Osteoarthritis is diagnosed in most patients after the age of 65, as one of the reasons for its development is the natural aging of the body.
The appearance of degenerative-dystrophic pathology is caused by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, a sedentary lifestyle.The main symptoms of osteoarthritis are joint pain, swelling and restricted movement.
To diagnose pathology, instrumental examinations are carried out – radiography, arthroscopy, MRI, CT.Osteoarthritis of the 1st and 2nd degree of severity is treated conservatively with medication, physiotherapeutic and massage procedures, and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
With osteoarthritis, pronounced changes in the internal connective tissue structures occur.Deforming erosions form on cartilage tissue, leading to the destruction of collagen fibers as well as proteoglycans consisting of protein (5–10%) and glycosaminoglycans (90–95%).As a result, the collagen network loses stability and metalloproteinases are released, which destroy all types of extracellular matrix proteins.The destruction is accelerated by increasing the biosynthesis of collagenases and stromelysin.Typically, the normal quantitative levels of enzymes are controlled by cytokines - small peptide information molecules.However, as osteoarthritis progresses, the concentration of these proteins decreases, leading to the release of a variety of enzymes that damage cartilage tissue.
Proteoglycans with a changed structure begin to absorb water molecules that they cannot retain.This causes excess fluid to enter the collagen fibers.They “swell” and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of the synovial fluid.With osteoarthritis, the concentration of hyaluronic acid it contains decreases.The hyaline cartilage no longer receives sufficient nutrients and oxygen for its regeneration.Foci of softening are formed in the cartilage tissue, and then cracks and specific necrotic growths appear.The bone heads become exposed and begin to suffer microtrauma as they are displaced relative to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) osteoarthritis are not yet clear.It occurs without provoking factors, therefore theories are put forward about a hereditary predisposition to premature cartilage destruction.Secondary osteoarthritis occurs as a result of other joint diseases or previous injuries.What can cause a degenerative-dystrophic disease:
- Injury to a joint or adjacent connective tissue structures – fracture, dislocation, damage to the meniscus, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- Dysfunction of the endocrine glands, disruption of metabolic processes;
- rheumatism or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococci, epidermis or Staphylococcus aureus;
- Tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative diseases, for example osteochondritis dissecans.
Hypermobility of the joints, which is caused by the production of special collagen, promotes the development of osteoarthritis.This condition is detected in 10% of the earth's population and is not considered a pathology.However, hypermobility is accompanied by weakness of the tendon-ligament system, which leads to frequent injuries, especially of the ankle joint (sprains and torn ligaments, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders such as hemophilia.Hemarthrosis or bleeding into the joint cavity leads to worsening cartilage trophism and its destruction.
Predisposing factors include old age, frequent stress on the joints beyond their strength limits, obesity, surgical procedures and hypothermia.
The risk group includes menopausal women, people who live in unfavorable environmental conditions or come into contact with toxic chemical compounds.With a lack of foods containing vitamins and microelements in the diet, the conditions are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of osteoarthritis lies in the absence of symptoms at the first stage of its development.The pathology manifests itself clinically gradually, the first signs appear against the background of significant destruction of cartilage tissue.At first, a person feels a slight pain that cannot be clearly localized.It occurs after physical activity – weight lifting, sports training.Sometimes the first clinical manifestation is a crunching or clicking sound when flexing or extending the joint.A person begins to notice that some movements are difficult.However, in the early stages of osteoarthritis, stiffness occurs in the morning, which soon disappears.
As the disease progresses, pain also occurs at night, which not only leads to sleep disorders but also to the appearance of chronic fatigue.The severity of pain syndrome in the second stage increases with weather changes, exacerbation of chronic pathologies and acute respiratory viral infections.The range of motion is noticeably reduced.The cause of stiffness lies in the thinning of the cartilage and the person's conscious restriction of movement to avoid pain.This causes increased stress on the opposite joint, leading to further damage.Osteoarthritis is also characterized by other specific symptoms:
- Pain leads to spasms of skeletal muscles and the development of muscle contractures (limitation of passive movements in the joint);
- Crunching in the joints, clicking, crackling noises when moving become constant and occur with almost any displacement of the bones relative to each other;
- painful muscle cramps often occur;
- Joints are deformed, leading to poor posture and gait;
- in the third stage of arthrosis, the deformation is so pronounced that the joints are bent and the range of motion in them is significantly limited or completely absent;
- With third-degree arthrosis of the knee, ankle and hip joints, the patient uses a cane or crutches when moving.
Without treatment, the pathology progresses and as it progresses, remissions are replaced by relapses, and the frequency of exacerbations constantly increases.The stiffness in movement in the morning does not disappear for a long time, it becomes permanent.
When examining a patient with grade 1 osteoarthritis, the doctor notes only slight swelling of the joint and complete preservation of mobility.With pathology of the 2nd degree, palpation reveals pain and slight deformity.The formation of bone thickening is observed in the area of the joint space.
Osteoarthritis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Its main symptom is the formation of a rounded seal in the joint area, where fluid movement (fluctuation) can be felt when pressure is applied.Acute synovitis can be accompanied by an increase in temperature to 37-38 ° C, headaches and digestive disorders.
diagnosis
The diagnosis is made on the basis of the results of instrumental studies, features of the clinical picture, anamnesis and the patient's complaints.A general blood and urine test is not very informative - all values remain within the normal range if the osteoarthritis is not caused by a metabolic disease.With the development of synovitis, the erythrocyte sedimentation rate increases (30 mm/hour) and the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process in the body.In secondary forms of osteoarthritis, changes in biochemical and immunological parameters occur.
The most informative method for diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral projection.
| Stages of osteoarthritis according to the Kellgren-Lawrence classification (1957) | X-ray signs of pathology |
|---|---|
| Initially | No radiological signs |
| First | Indistinct, uneven narrowing of the joint space.Slight flattening of the edges of the bone plates, the formation of initial osteophytes or their absence |
| Second | Significant narrowing of the joint space, 2-3 times higher than normal, formation of numerous osteophytes, subchondral osteosclerosis.The appearance of cystic bulges in the epiphyses |
| Third | Occurrence of pronounced subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| Fourth | Formation of coarse, massive osteophytes, almost complete fusion of the joint space, deformation and compaction of the epiphyses of the bones forming the joint |
If, after studying the X-rays, the doctor has doubts about the diagnosis, a CT scan is prescribed.And to assess the condition of the connective tissue structures near the joint, an MRI is carried out.Through the use of contrast agent, it is possible to dynamically assess the blood supply to the tissues and determine the stage of the inflammatory process during the development of synovitis.
Basic therapy methods
Osteoarthritis is still an incurable disease because there are no pharmacological drugs to regenerate cartilage tissue.The main goal of therapy is to prevent the progression of the pathology and maintain joint mobility.Treatment is long-term and complex and includes both local and systemic medications.Patients should avoid heavy strain on the joint and, if necessary, limit the range of motion using orthopedic aids - orthoses, elastic bandages.Obese patients need to adjust their diet to gradually reduce body weight and follow a diet.
After achieving stable remission, patients are shown daily physiotherapy exercises.The first training sessions are carried out under the guidance of a physiotherapist, then the patient performs a series of exercises at home.Exercise therapy can be supplemented with swimming, yoga and cycling.
To reduce the severity of pain, drugs of various clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- Injections of anesthetic solutions in combination with glucocorticosteroids into the joint;
- Muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic measures include B vitamins, sedatives and, if necessary, sedatives and antidepressants.Chondroprotectors are required for long-term use.This is the only group of drugs that can partially restore cartilage tissue.
To increase their clinical activity, physiotherapeutic procedures are carried out - laser therapy, magnetic fields, UHF therapy.
Any pain in the joints should be a signal for immediate consultation with a doctor.Therapy carried out in the early stages of osteoarthritis stops the destruction of the cartilage and avoids loss of performance and disability.