Osteoarthritis is a chronic pathology that affects the connective tissue structures of the muscle-skeletal apparatus. The disease is characterized by a progressive course, with progressive destruction of the cartilage. Arthrosis is diagnosed in the majority of patients under 65 years as one of the reasons for the development of the natural ageing process.
The appearance of degenerative-dystrophic pathology due to previous trauma, endocrine, and inflammatory diseases, excessive physical exertion or, on the contrary, a sedentary life-style. The leading symptoms of osteoarthritis are pain, swelling, limitation of motion.
To diagnose the pathology of the lead instrument of the study — radiography, arthroscopy, MRI, CT scan. Arthritis 1 and 2-the severity of the treated conservatively, of course, taking drugs, physical therapy, physical therapy and massage, exercise therapy. When the irreversible adverse changes in the joints, surgery — arthrodesis, arthroplasty.
Pathogenetic mechanisms
When osteoarthritis occurs, the significant changes in the internal connective tissue structures. The cartilaginous tissue forms the deforming of the erosion, which causes destruction of the collagen fibers, and proteoglycans, which are composed of protein (5 to 10%), and glycosaminoglycans (90-95%). The result of the collagen of the eye loses its stability, begins to be released by metalloproteinases, is that you get rid of all kinds of extracellular matrix proteins. The degradation is increased by increasing the biosynthesis of collagens, and stromelysin. Usually, the normal value of the enzyme control of the cytokines — a small peptide information molecules. But with the progression of osteoarthritis, the concentration of this protein decreases, which leads to the release of a large number of enzymes, damage to the cartilage.
Proteoglycans, the modified structure begins to absorb the water molecules which are unable to keep them. Therefore, the excess fluid enters into the collagen fibers. They "swell up", lose their strength and elasticity. The qualitative and quantitative composition of the synovial fluid, is also experiencing negative changes. In osteoarthritis, reduces the concentration of hyaluronic acid. The hyaline cartilage ceases to be enough for them to regenerate the amount of nutrients and oxygen. The cartilaginous tissue formed foci of softening, and then cracks, especially the necrotic growths. The bones of the head bare, you will begin to microtraumatic at a distance relative to each other.
The cause and predisposing factors
The cause of primary (idiopathic) osteoarthritis is not yet established. This is what happens when there were no precipitating factors, and, therefore, is to present the theory of hereditary predisposition to premature breakdown of cartilage. Secondary osteoarthritis develops as a result of other diseases of the joints, or previous injuries. What could be the cause of the degenerative disease:
- injury to the joint or in the vicinity of the connective tissue structures, fracture, dislocation, or damage to the meniscus, a partial tear of the muscles, ligaments, tendons, or their complete separation from the bones of the base;
- congenital dysplastic developmental disorders of articulation;
- violation of the endocrine glands, disturbances of the digestion process;
- rheumatism, or rheumatic fever;
- of rheumatoid, reactive, metabolic, psoriatic, or gouty arthritis, polyarthritis;
- purulent arthritis provoked by streptococci or Staphylococcus epidermidis infections;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative diseases, such as, dissecting Legg.
For the development of osteoarthritis predisposes hypermobility of the joints due to the production of a particular collagen. However, this condition is diagnosed in 10% of the population of the planet, and it is not considered to be a pathology. However, the hypermobility accompanied by a weakness of the tendinous-ligamentous apparatus, which leads to the frequent injuries, especially the ankle (sprains and torn ligaments, sprains).
Cause arthritis sometimes to have a disorder of hematopoiesis, for example, hemophilia. Hemarthrosis, or bleeding into the cavity of the joint, which led to the deterioration of the trophic cartilage and destroying it.
The predisposing factors are old age, and often to the stress on the joints, which goes beyond the limits of their strength, weight gain, surgery, and hypothermia.
The risk group also includes women in menopause, people who are living in adverse environmental conditions, or contact with poisonous chemical compounds. Deficiencies in the diet of foods with vitamins and minerals, creating conditions for the progressive degradation of the hyaline cartilage.
The clinical picture
The danger of osteoarthritis, there is a lack of symptoms in the first stages of its development. The pathology is clinically manifested gradually, the first signs of it occur prior to significant destruction of the cartilage tissue. First, the person feels mild pain, without clear localization. It seems to be according to the physical activities — weight lifting, sports, training. Sometimes the first clinical manifestation of the crunch, click, when, bending or unbending of the joint. People are starting to notice that some of the movements that are to difficult for you. However, it is in the early stages of osteoarthritis, the stiffness that occurs in the early morning hours, and soon it disappears.
The disease progresses pain is felt on the night that causes not only sleep disturbances, but the onset of the chronic fatigue. The intensity of the pain syndrome in the second phase, to be increased by a change in the weather, exacerbation of chronic diseases, infections. A pronounced decrease of range of motion. The reason for the stiffness becomes, the thinning of the cartilage, and the deliberate restriction of the individual's movement in an attempt to avoid the pain. This leads to an increased load on the joint, causing further damage. Of osteoarthritis characteristic of, and specific symptoms:
- the pain of the induced contractions of skeletal muscles and development of muscle contractures (limitation of passive movement of the joint);
- the crunch of the joints, clicks, crackle, on the way to become permanent, which can occur at almost any movement of the bones relative to each other;
- they are often painful muscular spasms;
- the joints are deformed, which leads to problems with posture and walking;
- in the third stage of the arthrosis deformation is expressed in terms of the so vivid that the joint is bent, and the range of motion on them is significantly reduced, or completely absent;
- in the third stage of osteoarthritis of the knee, ankle, hip joint, when moving the patient uses a cane or a crutch.
If it is left untreated, the pathology progresses, and in its course of remission alternate with recurrences and the frequency of exacerbations increases all the time. Stiffness in the morning, now don't disappear for a long period of time, it becomes permanent.
The treatment of patients with osteoarthritis 1. the level is, the doctor noted only a slight swelling of the joint, and the ultimate safety of the range of motion. The pathology of 2 degrees, palpation reveals pain, and poor expressed by the deformation. In the region of the joint space observed the formation of bone nodules.
The osteoarthritis is characterized by the development of synovitis — an inflammation of the synovial membranes of the hip, knee, ankle, shoulder joints. Their leader can be a symptom of becomes a comprehensive education to the seal area of the joint, pressing on which there is a displacement of the liquid (oscillation). For an acute synovitis may be accompanied by a rise in temperature of 37-38°C, headache, indigestion.
The diagnosis of
The diagnosis put on the basis of the results of the instrumental investigation of clinical features, anamnesis, complaints of patients. The general analysis of blood and urine uninformative — all the values remain within the normal limits, if the arthritis is not triggered by a metabolic disorder. With the development of a synovitis increases the erythrocyte sedimentation rate (30 mm/hr) in the blood and increases the level of leukocytes, and fibrinogen. It tends to occur in the body, an acute or chronic inflammatory process. Changes in the biochemical and immunological parameters, which occur in secondary forms of osteoarthritis.
The most informative method of diagnostics of degenerative-dystrophic pathology — radiography in frontal and lateral projections.
| The stage of osteoarthritis, according to the classification of Kellgren-Lawrence (1957) | Radiographic signs of pathology |
| The initial | The absence of radiological signs of |
| The first | Indistinct, irregular narrowing of the joint space. A small flattening of the edges of the bone plate, the initial formation of osteophytes, or the lack thereof |
| The other | The marked narrowing of the joint space, which is larger than the norm by 2-3 times, the emergence of a large number of osteophytes, subchondral osteosclerosis. The appearance of the kistevidnyj the enlightenment of the epiphyses |
| The third | The appearance of the expressed subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| The fourth | The formation of coarse a massive osteophytes, the nearly complete fusion of the joint area, the deformation and compaction in the epiphyses of the bones forming the joint |
If it is by the study of x-ray images to the doctor to have concerns of the diagnosis, the prescription of a CT scan. Assess the situation, which are located around the joint connective tissue structures of the MRI. With the use of contrast in dynamics to assess the flow of blood to the tissues, to set the stage of the inflammatory process in the development of synovitis.
The main method of treatment
Osteoarthritis is still incurable disease, as they are no pharmaceutical drugs for the regeneration of the cartilage. The main goal of treatment becomes the prevention of the progression of the disease, the preservation of joint mobility. The treatment is long and complicated, with local and systemic medications. Patients should avoid severe stress on the joint, if it is necessary, in order to limit the extent of movement of the orthopedic devices such as braces, elastic bandages. Patients with a the excess weight, you need to adjust your diet for a gradual weight loss and dieting.
According to a permanent remission of the patients recorded daily physical therapy sessions. The first training was conducted under the guidance of a physical therapist, and the patient performs the exercises at home. Physical therapy can be supplemented with swimming, yoga or Cycling.
To reduce the severity of the pain to the prescribers of the various clinical and pharmacological group:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration the active ingredient;
- injections into a joint solution to the operation in combination with a corticosteroid;
- muscle relaxants, to eliminate the muscular spasms and restrictions contractures.
In the therapeutic scheme includes vitamins a, B, a sedative, if necessary, tranquilizers, and antidepressants. Also referred to as chondroprotectors for a long time between the receipt of the notification. This is the only group of drugs that have the possibility of a partial restoration of cartilage.
To enhance its clinical activities of the physiotherapy — laser therapy, magnetic-field, UHF-therapy.
All of the pain should be the signal for an immediate treatment to a doctor. The treatment carried out at a very early stage of osteoarthritis, it will help to stop the destruction of the cartilage, in order to avoid the loss of health and disability.