arthrosis

Osteoarthritis (osteoarthrosis, osteoarthritis deformans) is a process of slow degeneration and destruction of cartilage in the joint. The articular ends of the bones deform and grow, and the periarticular tissue becomes inflamed. The general diagnosis of "osteoarthritis" refers to a group of diseases that are similar in their symptoms but differ in their origins. The joint - the affected area - consists of articular surfaces covered with cartilage tissue, a cavity with synovial fluid, a synovial membrane anda joint capsule. When the disease progresses, it loses its mobility and the patient experiences pain due to inflammatory processes.

causes

Osteoarthritis of the joints occurs due to the discrepancy between the load and the body's capabilities. Nutrient deficiency, obesity, heavy physical work and even exercise can lead to this.

Factors affecting the development of the disease:

• genetics, hereditary predisposition;
• age over 40 years;
• obesity, overweight;
• sedentary work, passive lifestyle;
• hard work, work requiring constant physical activity;
• inflammatory diseases;
• congenital joint diseases (dysplasia);
• injuries, wounds;
• Malfunction of the body (poor blood circulation, imbalance of hormones, microelements).

The disease can be primary or secondary. The causes of primary osteoarthritis are not yet fully understood. Doctors believe that it develops in the presence of genetic factors (predisposition) and external unfavorable conditions.

Secondary arthrosis occurs against the background of inflammatory diseases, dysplasia and as a result of injuries, including professional ones.

Representatives of working professions and athletes have an increased risk of developing the disease. Representatives of the arts are also at risk: dancers (especially ballerinas), pianists. Osteoarthritis of the wrists and fingers most often affects people whose work requires fine motor skills: mechanics, mechanics and pianists. The "professional" osteoarthritis caused by stress is localized in the knees, collarbones and elbows. Drivers, painters and miners suffer from elbow and shoulder joints. The weak point of ballerinas is the ankle. Depending on the type of sporting activity, it is also more common in athletesInjuries to the ankle and other joints of the arms and legs. For example, a tennis player is at high risk of diseases of the shoulder and elbow joints.

Pathogenesis

Structural changes in cartilage occur due to an imbalance between tissue breakdown and repair. Collagen and proteoglycans are gradually "washed out" of the body and new nutrients are not supplied. Cartilage tissue loses its elasticity, becomes soft and can no longer withstand stress.

Regardless of the location and cause, the disease progresses in the same way. Gradually, the cartilage is completely destroyed, the ends of the bones "grind" against each other. The patient feels pain, the intensity of which increases depending on the stage. The mobility of the joint gradually decreases and the patient's movements are restricted.

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classification

Orthopedists use the classification formulated by the professor in 1961:

• Stage I. The bone becomes denser, the joint space is slightly narrowed. Discomfort during physical activity that disappears after rest;
• Stage II. The joint space is noticeably narrowed, the edges of the bones grow and the connective tissue becomes denser. The pain becomes constant, the muscles are hypertrophied, the joint is much less mobile, specific symptoms appear at the site;
• Stage III. Joint space is virtually nonexistent, bone growth is large, and destruction of the bone beneath the cartilage is likely. The joint is completely deformed and immobile. Depending on the type and location of the disease, acute or persistent pain is possible;

Depending on the location and form of the disease, the symptoms, the speed of development and the treatment methods vary.

to form

The disease is characterized by a chronic course, but can also occur in an acute form.

If the disease spreads to multiple joints (e. g. fingers), it is called a generalized disease.

Anatomical shapes:

• Deformity (osteoarthrosis). Leads to bone growth;
• uncovertebral. Destroys intervertebral discs and intervertebral tissue in the neck area;
• post-traumatic. Develops as a result of trauma, injury;
• rheumatoid. Autoimmune disease, connective tissue inflammation. May be a result of previous arthritis;
• Psoriasis. Develops against the background of psoriatic arthritis.

Localizations

Osteoarthritis is a disease that affects joints throughout the body.

Spine. The causes can be autoimmune diseases, back diseases, increased stress, injuries, lack of microelements, hormonal imbalance.

Localizations:

• Coccyx;
• lumbar region;
• thoracic spine;
• Neck region

Legs. Knees and ankles are more susceptible to osteoarthritis. The reasons are injuries, excess weight, incorrect, excessive loads. Types of localization:

• gonarthrosis - knee;
• patellofemoral – femur and patella;
• Ankle;
• talonavicular joint;
• Feet and toes.

Hands. Injuries to the hands and fingers are more common and in most cases are associated with professional activities, injuries, age-related and hormonal changes. In addition, the disease is localized in the shoulder, wrist and elbow joints.

Torso. Localization in the trunk is less common compared to arthrosis of the extremities. The lesions are associated with professional activity and a sedentary lifestyle (stagnation).

Types of localization:

• collarbone. When moving, "clicks" and pain are felt. At risk are athletes who engage in weight lifting and military personnel due to possible injuries;
• Hip joints (coxarthrosis). The disease is manifested by pain in the groin area.

Head>. Sometimes dental problems, autonomic disorders and even hearing loss are due to damage to the temporomandibular joint. Swelling disrupts the symmetry of the face, can affect the ear and cause headaches.

Symptoms

The symptoms of the disease depend on its location. Common manifestations of all types are:

• Pain in the affected area. In the early stages – during movement, at work, in the later stages – at rest;
• Inflammation, swelling. The periarticular tissue swells, the skin turns red;
• "Clicks", crunching noises. When moving, characteristic noises can be heard;
• Difficulty moving. As the disease progresses, mobility of the affected area becomes impaired;
• reaction to cold. Many types of osteoarthritis are characterized by aggravation in rainy and cold weather.

Exacerbations of the disease are accompanied by a general weakening of health. Due to viral diseases and increased stress, it takes an acute form and develops many times faster. During an exacerbation, symptoms, especially pain, increase. It is difficult for the patient to move, up to complete loss of mobility, and to carry out normal work.

Possible complications

The main danger is the loss of mobility of the joint and its deformation, which makes recovery impossible. The axis shift disrupts the posture and the figure loses symmetry. Possible increased pressure on internal organs, their displacement, compression. Concomitant diseases and failures of body systems occur. For example, with arthrosis of the coccyx in women, gynecological complications are possible, and arthrosis of the temporomandibular joint or cervical spine leads to disorders of the autonomic system: dizziness, sleep disorders. A patient with osteoarthritis may become disabled.

diagnosis

A comprehensive examination is carried out to make the diagnosis:

• take anamnesis;
• Radiography in multiple projections;
• MRI and CT to rule out tumors and create a three-dimensional image;
• Blood and urine tests to rule out comorbidities and assess general health.

Depending on the cause of the disease, the patient is referred to a rheumatologist, traumatologist, surgeon or orthopedist.

Treatment

Stage I of the disease is best treated. Stage II patients can expect long-term relief from bone destruction. Stage III most often requires surgical intervention.

Conservative (non-surgical) treatment:

• Physiotherapy, use of orthoses, sticks, crutches for relief. Elimination of accompanying and complicating factors (e. g. weight loss, stress, change in activity);
• Taking non-steroidal anti-inflammatory drugs. Selective COX-2 inhibitors are the most effective. Chondroprotectors and atypical antidepressants are prescribed as aids;
• intra-articular injections of glucocorticoid hormones to relieve severe pain and inflammation.

Surgical methods:

• Arthroscopy – internal examination of the joint and removal of cartilage fragments;
• Arthroplasty – implantation of artificial cartilage;
• Osteotomy – removal or dissection of bone tissue;
• Chondroplasty – restoration of cartilage;
• Arthrodesis – artificial immobilization of a joint (usually the ankle);
• Endoprosthetics – removal and replacement of damaged joints with artificial ones.

Cardinal treatment allows you to stop the disease even at a late stage. In individual cases, it is possible to restore mobility (after replacing it with an artificial one). However, this method is effective in controlling pain. After the operation, recovery using physiotherapy and medication methods is required.

Prognosis and prevention

After starting treatment for osteoarthritis in stages I and II, there is lasting improvement: pain and inflammation disappear. In this case, complete relief of the disease or its long-term preservation is possible.

When treating stage III osteoarthritis, improvements do not occur immediately. In some cases, pain can only disappear after surgery. Often the joint remains stationary or deformed. Patients with severe forms of arthrosis of the hip and knee joints receive disability group I or II.

It has been proven that there is no effective prevention against osteoarthritis. Weight control, a balanced diet and moderate exercise help reduce the risk of developing the disease. An examination at the first signs of arthrosis (especially after injuries and infectious diseases) and careful attention to health allow you to detect the disease at an early stage.