In the structure of the pathology of the osteoarticular system, arthrosis occupies a prominent place - about 70% of cases fall under its share. A similar problem is most often encountered by people after 50 years, but the first signs of the disease appear even in young people. This disease has serious medical and social significance, since in many cases it becomes the cause of functional failure at working age.
Many people are familiar with such a pathology as arthrosis of the joints, but not all patients understand why it develops, how it manifests itself and what is needed to combat the disease. And increased awareness and caution can prevent the onset and progression of detrimental changes.
The reasons
Arthrosis is characterized by the development of degenerative-dystrophic processes in all articular 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 being the only cause of deforming osteoarthritis. The origin of the disease is quite heterogeneous and is due to external and internal types of pathological effects on the body.
For each patient there are certain risk factors that contribute to the occurrence of joint pathology. Therefore, the causes of arthrosis combine the following conditions:
- Heavy physical work.
- Inactivity.
- Traumatic injuries.
- Joint dysplasia.
- Inflammation (arthritis).
- Overweight.
- Estrogen deficiency in menopause.
- Diseases of the thyroid gland.
- Consequences of operations on the joints.
- Heredity.
As you can see, the development of osteoarthritis is mediated by heterogeneous factors, which in most cases are mechanical or exchange in nature. In this case, the lifestyle of the patient and his profession are not unimportant, since loaders, manual workers and athletes often suffer from arthrosis.
The causes of arthrosis are quite diverse, they are characterized by a local effect on the joints and a general effect on the organism.
Mechanism of development
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. It provides shock absorption function and resists pressure on the joint. Cartilage tissue is made up of cells (chondrocytes) and a matrix, the main substances of which are proteoglycans and collagen.
If the load on the joint exceeds the permissible limit, first of all there are structural disorders in the cartilage. The proteoglycans that hold the collagen strands together are lost, which increases the tissue's sensitivity to external influences. Destruction processes begin to prevail over synthesis. This is facilitated by a decrease in cartilaginous trophism when the synovial fluid contains an insufficient amount of nutrients. The imbalance of tissue renewal is favored by inflammatory reactions and hormonal imbalances.
All this leads to thinning of the cartilage, it 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, ligaments thicken and shorten, and muscle function is impaired.
Pathological processes in the joint develop gradually, but do not pass without a trace. Disturbances of cartilage and other structures inevitably affect the clinical picture of osteoarthritis.
Classification
Arthrosis, like other diseases, has certain varieties. This must be taken into account in the clinical classification of the disease. The 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 called idiopathic osteoarthritis. Depending on the number of affected joints, 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 the joints of the body, including the spine, where spondylarthrosis is observed. In this case, the disease can progress in a nodular or nodular form.
It is important to understand what processes occur in the joint and correctly assess their severity. Therefore, be sure to consider the stage of osteoarthritis. It does not depend on the cause and is determined by pathological changes in joint tissues:
- Stage 1 - inflammation of the synovial membrane, loss of the ability of cartilage to withstand the load.
- Stage 2 - destruction of cartilage tissue, bone growth, joint bag dystrophy.
- Stage 3 - bone deformity, contractures, joint instability.
The presence of signs of inflammation should also be reflected in the classification. Therefore, arthrosis 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.
- Degree 2 - disability.
- 3 degree - the impossibility of self-service.
All of these features should be taken into account in the diagnosis of osteoarthritis, as they are important for further treatment.
Symptoms
Among joint pathology, the symptoms of osteoarthritis have a very tangible specificity. They develop gradually, but progress steadily, resulting in limitation of 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, first of all, patient complaints are analyzed. And most people worry about joint pain. But with osteoarthritis, 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).
- "Articular mouse" - periodic sharp pains with blockage of the joint, caused by a violation of the synovial membrane between the cartilaginous surfaces.
At first, patients may feel only vague discomfort in the joints, accompanied by a feeling of fatigue. But over time, it turns into pain. And if at the initial stages it worries after a load, then in the future - during movement, and in advanced cases it becomes constant, remaining even at rest and at night.
In addition to pain, patients experience 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.
- Cracking (crackling) sensation when moving.
- Deformity of the periarticular region.
- Mobility restrictions.
With arthrosis of the hands, upon examination, one can notice characteristic formations in the region of the proximal and distal phalanges - Bouchard and Heberden nodules. The sensation of the affected joints is often painful. If contractures are formed, there is a fixation of certain parts of the limbs more often in the position of flexion.
The pronounced nature of arthrosis leads to a significant decrease in the level of physical activity of patients, which leads to a decrease in their quality of life.
Diagnostic
To understand why the clinical picture develops, it is necessary to confirm the pathology of the joints. This can be done by performing the necessary diagnostic examination, which includes instrumental and laboratory methods. First of all, they try to see the structural changes in the affected areas, to assess their severity and prevalence. It is also necessary to determine metabolic disorders in the body, which have become a favorable background for the occurrence of arthrosis. Therefore, the investigation complex includes the following activities:
- X-ray.
- Magnetic resonance imaging.
- Ultrasound procedure.
- Arthroscopy.
- Biochemical blood tests (hormone spectrum, markers of inflammation, calcium metabolism, rheumatic tests).
After the examination, a consultation with an orthopedist-traumatologist will be required, which will help to define the right treatment tactics for each patient.
Treatment
It is necessary to treat osteoarthritis 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.
Which 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 are just beginning to appear.
General recommendations
Since the development of degenerative changes in the joints is mediated by an increased load, it is first necessary to reduce the mechanical effect on the cartilage tissue. To do this, you need to stop wearing heavy and intense sports workouts. To unload the joint, any method is suitable - from walking with a cane to special fixing braces. But it is impossible to completely abandon the movements, physical activity must be dosed. Walking short distances, swimming are helpful.
Proper nutrition plays an important role in correcting osteoarthritic changes. Diet helps to improve the condition of cartilage, but is also the main component in the fight against excess weight. Patients are advised to consume lean meats and poultry, fish, cereals; you need to enrich the diet with fresh vegetables and fruits, herbs. But in return, you should refrain from smoked, spicy, fatty foods, pickles and pickles. It is better to pay attention to foods rich in collagen fibers, elastin and gelatin: meat in jelly, minced meat, aspic, 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 especially important in chronic degenerative joint pathology, when it is necessary to achieve a structure-modifying effect on the cartilage tissue. The following medications are generally recommended:
- Non-steroidal anti-inflammatory drug.
- Chondroprotectors.
- Vascular.
- Vitamins and antioxidants.
- Metabolic (estrogens, thyroid hormones).
In severe pain in osteoarthritis, intra-articular injections of glucocorticoids 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 treatment should be combined with topical medications.
Taking drugs for arthrosis is carried out on the recommendation of a doctor and under his control. Independent use of any medication is not allowed.
Physiotherapy
Methods of physical influence help to eliminate acute signs of joint pathology. Together with drugs, 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 a general health-enhancing effect. But at the same time, one should not forget about contraindications to physiotherapy: infectious diseases, tumors, cardiovascular pathology, renal failure, bleeding, serious condition of the patient.
Physiotherapy
An important aspect of non-drug therapy for osteoarthritis is exercise therapy. It is known that the metabolism of cartilage tissue clearly depends on the mechanical factor. But its strength must be sufficient. Only then do the processes of growth prevail over destruction. Therefore, gymnastics is indicated for all patients with joint diseases. But for each person, his own set of exercises is developed - taking into account the location 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 the elimination of acute symptoms. Avoid sudden, high-amplitude movements that can cause discomfort. Physical education should be carried out under the supervision of a doctor, and after acquiring the necessary skills, you can start exercises at home.
Therapeutic gymnastics is an integral part 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 spastic 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.
- Trituration.
- Kneading.
- pressure.
- Ironing.
It is often associated with passive movements in the affected joints. The duration of treatment is determined by the doctor and can be from 7 to 15 sessions.
Operation
If the advanced stages of arthrosis do not allow to achieve the desired effect from conservative measures, then surgical treatment is necessary. Its essence is the replacement of the joint with an artificial joint - arthroplasty. This operation is performed in the open and under general anesthesia. After its completion, you need to undergo rehabilitation, which begins as soon as possible. And as a result of surgery, the patient can completely get rid of arthrosis and return to an active life. Admittedly, the operation is not accessible to everyone.
Osteoarthritis is a common problem that requires a quick and active solution. In order not to trigger 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. Otherwise, surgical correction should be considered.