Arthrosis 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.Arthrosis is detected in most patients after the age of 65, since one of the reasons for its development is the natural aging of the body.
The appearance of degenerative-dystrophic pathology is due to previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, a sedentary lifestyle.The main symptoms of arthrosis are joint pain, swelling and limitation of movement.
To diagnose the pathology, instrumental tests are performed - radiography, arthroscopy, MRI, CT.Arthrosis of the 1st and 2nd degree of severity is treated conservatively with a course of drugs, physiotherapy and massage procedures and exercises.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
In arthrosis, pronounced changes occur in the internal structures of the connective tissue.Deforming erosions are formed on cartilage tissues, which leads 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 begin to be released, destroying all types of extracellular matrix proteins.Destruction is accelerated by increasing the biosynthesis of collagenases and stromelysin.Normally, the normal quantitative values of enzymes are controlled by cytokines - small peptide messenger molecules.But as arthrosis progresses, the concentration of these proteins decreases, which provokes the release of a large number of enzymes that damage cartilage tissue.
Proteoglycans with a changed structure begin to absorb water molecules that they cannot retain.Because of this, excess fluid enters the collagen fibers.They "swell" and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of the synovial fluid.In arthrosis, the concentration of hyaluronan in it decreases.Hyaline cartilages no longer receive enough nutrients and oxygen for their regeneration.Foci of softening are formed in the cartilaginous tissues, after which cracks and specific necrotic growths appear.The bony heads become exposed and begin to undergo microtrauma as they move relative to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) arthrosis have not yet been established.This happens in the absence of provoking factors, which is why theories are put forward about a hereditary predisposition to premature destruction of cartilage.Secondary arthrosis develops as a result of other joint pathologies or previous injuries.What can cause degenerative-dystrophic disease:
- injury to a joint or nearby connective tissue structures - fracture, sprain, damage to the meniscus, partial tearing of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of the functioning of endocrine glands, disruption of metabolic processes;
- rheumatism or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococci, epidermal or Staphylococcus aureus;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative disease, eg osteochondritis dissecans.
The hypermobility of the joints caused by the production of special collagen predisposes to the development of arthrosis.This condition is found in 10% of the inhabitants of the planet and is not considered a pathology.But hypermobility is accompanied by weakness of the tendon-ligament apparatus, which leads to frequent injuries, especially of the ankle joint (sprains and ruptures of ligaments, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders, such as hemophilia.Hemarthrosis or hemorrhage in the joint cavity provokes deterioration of cartilage trophicity and its destruction.
Predisposing factors include advanced age, frequent joint loads exceeding the limits of their strength, overweight, surgical interventions and hypothermia.
The risk group includes women during menopause, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.In the case of a deficiency in the diet of foods with vitamins and microelements, prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of arthrosis lies in the lack of symptoms at the first stage of its development.Clinically, the pathology manifests itself gradually, the first signs appear against the background of significant destruction of cartilage tissue.Initially, a person feels a slight pain that does not have a clear localization.Appears after physical exertion - lifting weights, sports training.Sometimes the first clinical manifestation is a crunching or clicking sound when the joint is flexed or extended.One begins to notice that some movements are difficult.However, in the initial stage of arthrosis, stiffness appears in the morning and soon disappears.
As the disease progresses, the pain is also felt at night, causing not only sleep disturbance, but also the appearance of chronic fatigue.The severity of the pain syndrome in the second stage increases with changes in weather, exacerbation of chronic pathologies and acute respiratory viral infections.Range of motion is greatly reduced.The reason for the stiffness is the thinning of the cartilage, as well as the conscious limitation of the person's movements in an attempt to avoid pain.This leads to an increased load on the opposite joint, which provokes additional damage.Arthrosis is also characterized by other specific symptoms:
- pain provokes spasms of skeletal muscles and the development of muscle contractures (restriction of passive movements in the joint);
- crunching in the joints, clicking, popping sounds when moving become constant, occurring at almost every displacement of the bones relative to each other;
- painful muscle cramps often occur;
- the joints are deformed, which leads to disorders in posture and gait;
- at the third stage of arthrosis, the deformation is so pronounced that the joints are bent and the range of motion in them is significantly reduced or completely absent;
- with arthrosis of the third degree of the knee, ankle, hip joint, the patient uses a cane or crutches when moving.
In the absence of treatment, the pathology progresses, and during its course, remissions are replaced by relapses, and the frequency of exacerbations constantly increases.Stiffness of movements in the morning now does not disappear for a long time, it becomes constant.
When examining a patient with arthrosis of the 1st degree, the doctor notes only slight swelling of the joint and complete preservation of the range of motion.In grade 2 pathology, palpation reveals pain and slight deformity.Formation of bony thickenings is observed in the area of the joint space.
Arthrosis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Their leading symptom is the formation of a rounded seal in the area of the joint, upon pressure on which fluid movement (fluctuation) is felt.Acute synovitis can be accompanied by an increase in temperature to 37-38 ° C, headache and digestive disorders.
Diagnosis
The diagnosis is made on the basis of the results of the instrumental studies, the characteristics of the clinical picture, the anamnesis and the patient's complaints.The general blood and urine test is not very informative - all values remain within normal limits if arthrosis is not caused by metabolic pathology.With the development of synovitis, the rate of sedimentation of erythrocytes increases (30 mm / hour), the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.Changes in biochemical and immunological parameters occur in secondary forms of arthrosis.
The most informative method for diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral projection.
| Stages of arthrosis according to the Kellgren-Lawrence classification (1957) | X-ray signs of pathology |
|---|---|
| Initially | No radiological signs |
| First | Unclear, uneven narrowing of the joint space.Slight flattening of the edges of the bone plates, formation of initial osteophytes or their absence |
| Second | Pronounced narrowing of the joint space, 2-3 times larger than normal, formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic spaces in the pineal glands |
| third | The appearance 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-ray images, the doctor has doubts about the diagnosis, a CT scan is prescribed.And to assess the condition of the connective tissue structures located near the joint, an MRI is performed.When using contrast, it is possible to dynamically evaluate the blood supply to the tissues and establish the stage of the inflammatory process during the development of synovitis.
Basic methods of therapy
Osteoarthritis is still an incurable disease, as there are no pharmacological drugs for cartilage tissue regeneration.The main goal of therapy is to prevent the progression of the pathology and maintain the mobility of the joints.The treatment is long-term, complex, with local and systemic drugs.Patients should avoid strong stress on the joint and, if necessary, limit the range of motion with orthopedic devices - orthoses, elastic bandages.Overweight patients should adjust their diet to gradually reduce body weight and maintain a diet.
After achieving a stable remission, patients are shown daily physical therapy exercises.The first training sessions are conducted under the guidance of a physiotherapist, after which the patient performs a set of exercises at home.Exercise therapy can be supplemented with swimming, yoga and cycling.
To reduce the severity of pain, drugs from different clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- injection into the joint of anesthetic solutions in combination with glucocorticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic regimens include B vitamins, sedatives, and, if necessary, tranquilizers and antidepressants.Chondroprotectors are necessary for long-term use.This is the only group of drugs that have the ability to 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 initial stage of arthrosis will stop the destruction of cartilage and avoid loss of working capacity and damage.