arthrosis

Osteoarthritis – what is it in simple words?

Osteoarthritis is a chronic pathology in which there is a gradual destruction of the cartilage plate. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) form. The joint capsule reacts to the events that occur and reactive vasculitis develops.

About the disease and possible complications

The frequency of pathology depends on age. The first signs of arthrosis usually appear no earlier than the age of 30-35, and by the age of 70, about 90% of the population suffers from this pathology. Osteoarthritis has no gender-specific differences. The only exception is degenerative damage to the joints between the carpal phalanges. This form of the disease is ten times more common in women than in men. Osteoarthritis most commonly affects the large joints of the legs and arms.

The pathological process begins with the interstitial substance of the cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by balancing the processes of anabolism and catabolism. If the process of cartilage tissue breakdown dominates its synthesis, conditions are created for the development of arthrosis. This explains in simple terms what osteoarthritis is.

Most often, the first signs of the disease develop in places of greatest mechanical stress, with limited areas of softening of the cartilage plate occurring. As the pathological process progresses, fragments and cracks appear in the cartilage, and local deposition of calcium salts may occur. Under the cartilage defects, the underlying bone is exposed, separated cartilage fragments get into the joint cavity and can lead to so-called "jamming" (symptoms of a "joint mouse").

Damage to the cartilage that lines the articular processes of the bones causes them to lose their ideal shape and repeat the contours of each other. As a result, the joint surfaces experience unphysiological stress during movement. In response, compensatory resynthesis processes in bone tissue are stimulated. The bone becomes denser (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further change the discrepancy between the articular surfaces. Developing pathological changes gradually limit the mobility of the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasms that occur in response to pain).

Osteoarthritis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is because dead cartilage and bone fragments activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, such long-term inflammation is accompanied by sclerosis of the periarticular tissue - the joint capsule thickens and the surrounding muscles atrophy.

The main symptom of osteoarthritis is pain, which over time is accompanied by limited mobility of the joint. The restriction of mobility is initially of a compensatory functional nature and then due to organic changes. Additional imaging diagnostic procedures (X-rays, ultrasound, computer tomography or magnetic resonance imaging) help make the correct diagnosis.

Depending on the stage and degree of osteoarthritis, treatment can be carried out using conservative or surgical methods. An orthopedic traumatologist will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of osteoarthritis

There are 2 types of osteoarthritis:

1. The primary variant is a consequence of a violation of the relationship between the processes of synthesis and degeneration in cartilage tissue and is accompanied by a dysfunction of chondrocytes - the main cells of cartilage.
2. The secondary variant occurs in a previously changed joint, when the normal relationship (congruence) of the articular surfaces is disturbed, there is a redistribution of the load on them and a concentration of pressure in certain areas.

Symptoms of joint osteoarthritis

The main symptom of joint osteoarthritis is pain. It has certain distinctive features that allow the initial diagnosis of the disease.

1. Mechanical pain, caused by the loss of the shock-absorbing properties of cartilage. Painful sensations occur during physical activity and subside at rest.
2. Night pain.Caused by stagnation of venous blood and increased pressure of blood flowing in the bone.
3. Initial pain.It is short-lived and occurs in the morning when a person gets out of bed (the patient says that he needs to "disperse"). This pain is caused by the deposition of detritus on the cartilage plates; when moving, these fragments are thrown intothe joint inversions pressed so that the unpleasant sensations stop.
4. Meteor dependency.The pain may increase when weather conditions change (increased atmospheric pressure, cold weather, excessive humidity).
5. Blockage pain.These are sudden painful sensations associated with the pinching of a fragment of bone or cartilage between the articular surfaces. Against the background of the "blockage", the smallest movements in the joint come to a standstill.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case the pain becomes constant. In the morning, a person is bothered by joint stiffness. Signs of the inflammatory process are objectively determined – swelling and local increase in skin temperature.

Osteoarthritis usually begins slowly with the onset of pain in an affected joint. The pain initially only bothers you during physical activity, but later it also occurs when you are resting and sleeping at night. Over time, pain also occurs in the joints on the opposite side, which is accompanied by a compensatory increase in load. An important distinguishing feature of osteoarthritis is its frequency, with short periods of exacerbation followed by periods of remission. The progression of the pathological process is indicated by a shortening of the period between relapses and the development of adverse consequences in the form of contractures and a sharp limitation of mobility in the joint.

Course of osteoarthritis during pregnancy

Osteoarthritis can occur in different ways during pregnancy. Normally, it can take up to 12-13 weeks for the pathological process to worsen, which is associated with hormonal changes in the woman's body. The second and third trimesters are usually relatively stable. Pregnancy management is carried out by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint osteoarthritis

The main mechanism that triggers cartilage destruction is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of osteoarthritis is preceded by a phase of metabolic disorders that occurs in secret. This metabolic imbalance is characterized by damage to proteoglycans and their components (chondroitin, glucosamine, keratan), which is accompanied by disintegration and degradation of the cartilage matrix. Collagen fibers tear in the cartilage plate, the supply of vital metabolites is disrupted and the water balance also changes (first the cartilage is hydrated, then the number of water molecules decreases sharply, which further stimulates the formation of cracks).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative properties of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to the hyaluronic acid and therefore quickly leave the matrix. A cytokine "boom" can also be observed in osteoarthritis - released cytokines disrupt the synthesis of collagen and proteoglycans and also stimulate inflammation of the synovial membrane.

The main causes of osteoarthritis can be varied:

• "Excess weight", which increases the load on the joints;
• wearing inferior shoes;
• Concomitant diseases of the musculoskeletal system;
• suffered joint injuries.

Signs and diagnosis of joint osteoarthritis

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging studies will be performed.

1. Radiography.In the early stages, radiological signs of the disease are hardly informative - they can include uneven narrowing of the joint space, slight compaction of the underlying bone and small cysts in this area. At a later stage, the X-ray is more informative: marginal bone growths appear, the shape of the articular surfaces changes, joint mice and areas of calcification in the capsule can be identified.
2. Ultrasound of joints.Ultrasound examination is more informative in detecting the first signs of osteoarthritis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate, and secondary reactions of the capsule, muscle-tendon, and ligament compartments can be visualized.
3. Computer or magnetic resonance imaging.This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilage plate, the subchondral area of the bone and determine the volume of synovial fluid, incl. in joint inversions.

Expert opinion

Deforming arthrosis of the joints is one of the most common diseases of the musculoskeletal system, occurring in 10-15% of the world's population. The insidious thing about the disease is that it develops slowly and gradually. This is initially a short-term pain in a joint that is often not paid attention to. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain turns into a constant one. Without treatment, the disease progresses and is accompanied by severe degeneration of the cartilage, which no longer responds to conservative therapy. To solve this problem, only arthroplasty is required - a complex and expensive procedure to replace the destroyed joint with a full-grown implant. However, targeted drug therapy and lifestyle changes can help significantly delay or avoid this procedure altogether. It is therefore important to see a doctor as soon as possible if you experience joint pain.

Treatment of osteoarthritis

According to clinical guidelines, the main goal of osteoarthritis treatment is to slow the progression of degenerative lesions of the cartilage plate. To achieve this, measures are taken that reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

The connection is relieved in the following way:

• loss of body weight (if it is excessive);
• Conducting physical therapy that excludes longer similar poses;
• Refusal to lift large loads or remain on your knees for long periods of time (relevant for some professions).

In the early stages of the disease, in addition to physiotherapy, swimming and cycling are also useful. In later stages, to relieve stress on the joint during an exacerbation, walking with an orthopedic cane or using crutches is recommended.

To relieve pain, including against the background of secondary synovitis, non-steroidal anti-inflammatory drugs are used both locally and systemically. Intra-articular injections of corticosteroids can be used for the same purpose.

To improve the anatomical and functional condition of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help to improve the metabolism of cartilage tissue, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progression of the pathological process and improve joint mobility.

surgery

The options for surgical treatment depend on the stage and activity of the pathological process.

• Joint puncture– indicated in severe reactive synovitis. It allows not only the removal of the inflammatory fluid, but also the introduction of corticosteroids that break the chain of the disease.
• Arthroscopic operationsInstruments are inserted into the joint cavity through small punctures and then made visible under magnification. These procedures make it possible to wash the joint and its inversions, align the cartilage plate, remove necrotic areas, "polish" the articular surfaces, etc.
• Endoprosthetics– is considered a radical operation that is carried out in the event of an advanced pathological process. Typically used for osteoarthritis of the knee or hip joint.

Prevention of osteoarthritis

Prevention of arthrosis is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding work on the knee, lifting heavy objects in a measured manner and maintaining a physical activity regime.

Rehabilitation for arthrosis of the joints

Rehabilitation for arthrosis of the joints includes a number of procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and health-promoting gymnastics are used.

questions and answers

Which doctor treats osteoarthritis?

Diagnosis and treatment is carried out by a traumatologist-orthopedist.

Does x-ray always provide the correct diagnosis?

The severity of clinical signs of osteoarthritis does not always correlate with radiological changes. In practice, it often happens that when the pain is severe, no significant changes are detected on the x-ray and vice versa when a "bad" x-ray is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for osteoarthritis?

If osteoarthritis is suspected, arthroscopy is usually not carried out to make a diagnosis, but rather to search for causes that can lead to disruptions in the functional state of the joint (e. g. damage to the menisci of the knee joint and the intra-articular ligaments). .