Arthrosis

Osteoarthritis - what is it in simple words?

Arthrosis is a chronic pathology in which gradual destruction of the cartilage plate occurs. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) appear. The joint capsule reacts to the events 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 30-35 years, and by the age of 70, about 90% of the population suffers from this pathology. Osteoarthritis does not show any gender differences. The only exception is degenerative joint damage between the carpal phalanges. This form of the disease occurs 10 times more often in women than in men. Most often, arthrosis affects the large joints of the feet and hands.

The pathological process begins with the interstitial substance of 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 degradation dominates its synthesis, then conditions are created for the development of osteoarthritis. This explains in simple terms what arthrosis is.

Most often, the first signs of the disease develop in places with the greatest mechanical load, with limited areas of softening of the cartilage plate appearing. As the pathological process progresses, local deposition of calcium salts is possible in cartilaginous fragments and cracks. Beneath the cartilage defects, the underlying bone is exposed, separated fragments of cartilage enter the joint cavity and can lead to so-called "wedging" ("joint mouse" symptoms).

Damage to the cartilage lining the articular processes of the bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, during movement, the articular surfaces experience an unphysiological load. In response to this, compensatory processes of resynthesis are stimulated in the bone tissue. The bone becomes denser (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further changes the discrepancy between the joint surfaces. The developing pathological changes gradually limit the range of motion in the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead fragments of cartilage and bone activate phagocytic leukocytosis, which is accompanied by the release of proinflammatory mediators. Over time, such prolonged inflammation is accompanied by sclerosis of the periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthrosis is pain, which over time is accompanied by limited mobility in the joint. Mobility limitation is first of a compensatory functional nature, and then due to organic changes. Additional imaging diagnostic methods (x-ray, ultrasound scan, computed tomography or nuclear magnetic resonance) help to make the correct diagnosis.

Depending on the stage and degree of arthrosis, the treatment can be carried out by 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 arthrosis

There are 2 types of arthrosis:

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

Symptoms of arthrosis of the joints

The main symptom of joint arthrosis is pain. It has some distinctive features that allow the primary diagnosis of the disease.

1. Mechanical pain, caused by the loss of shock-absorbing characteristics of cartilage. Painful sensations occur during physical activity and are relieved during rest.
2. Night pain.It is caused by stagnation of venous blood and increased pressure of the blood flowing inside the bone.
3. Initial pain.It is short-lived and appears in the morning when a person gets out of bed (the patient says that it should "spread out"). These pains are caused by the deposition of detritus on the cartilage plates, during movement these fragments are pushed into the joint bends, so the unpleasant sensations stop.
4. Meteor dependence.The pain may increase when weather conditions change (increased atmospheric pressure, cold weather, excessive humidity).
5. Blockage pain.These are sudden painful sensations that are associated with the pinching of a bone or cartilage fragment between the joint surfaces. Against the background of the "blockade", even the smallest movements in the joint stop.

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

Osteoarthritis usually begins slowly with the onset of pain in one affected joint. At first, the pain bothers you only during physical activity, but later it appears even at rest and during night sleep. Over time, pain is also felt in the joints on the opposite side, which is associated with a compensatory increase in load. An important distinguishing feature of osteoarthritis is its frequency when short periods of exacerbation are followed by periods of remission. The progression of the pathological process is manifested by a shortening of the inter-relapse period and the development of adverse consequences in the form of contractures and a sharp limitation of mobility in the joint.

Course of arthrosis during pregnancy

During pregnancy, arthrosis can appear in different ways. Usually, by 12-13 weeks, an exacerbation of the pathological process may occur, associated with hormonal changes occurring in the woman's body. The second and third trimesters are usually relatively stable. Pregnancy is managed by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of arthrosis of the joints

The main mechanism that triggers the destruction of cartilage is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthrosis is preceded by a period of metabolic disorders, which takes place in secret. This metabolic imbalance is characterized by damage to proteoglycans and their constituent components (chondroitin, glucosamine, keratan), which is accompanied by the breakdown and disintegration of the cartilage matrix. Collagen fibers are torn in the cartilage plate, the supply of metabolites necessary for life is disrupted, and the water balance also changes (first the cartilage is hydrated, and then the number of water molecules decreases sharply, which further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bond well with hyaluronic acid, so they quickly leave the matrix. In arthrosis, there is also a "boom" of cytokines - the released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate the inflammation of the synovial membrane.

The main causes of arthrosis can be different:

• "excess" weight, which increases the load on the joints;
• wearing low-quality shoes;
• concomitant diseases of the musculoskeletal system;
• suffered joint injuries.

Signs and diagnosis of joint arthrosis

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. Additional imaging tests are performed to confirm this.

1. Radiography.In the early stage, X-ray signs of the disease do not have much meaning - it can be an uneven narrowing of the joint gap, a slight thickening of the underlying bone and small cysts in this area. At a later stage, radiography is more informative - marginal bone growths appear, the shape of the joint surfaces changes, joint "mice" and areas of calcification in the capsule can be determined.
2. Ultrasound of the joints.An ultrasound scan is more informative for detecting initial signs of arthrosis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate, and secondary reactions of the capsule, musculotendinous and ligamentous compartments can be visualized.
3. Computed tomography 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 region 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 pathologies of the musculoskeletal system, which occurs in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. Initially, these are short-term pains in one joint, which a person often does not pay attention to. Gradually, the severity of the pain syndrome becomes more intense, while the periodic character of the pain is transformed into a permanent one. In the absence of treatment, the disease continues to progress and is accompanied by severe degeneration of the cartilage, which is no longer amenable to conservative therapy, and to solve this problem, only arthroplasty is needed - a complex and expensive intervention to replace the destroyed joint with a full-perfect implant. However, targeted drug therapy and lifestyle changes can help significantly delay this surgery or avoid it altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Treatment of arthrosis

According to clinical guidelines, the main goal of arthrosis treatment is to slow down 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

Unloading the joint is achieved in the following ways:

• loss of body weight (if excess);
• performing physical therapy, which excludes prolonged similar positions;
• refusal to lift heavy loads or kneel for long periods of time (relevant for some occupations).

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

For pain relief, incl. against the background of secondary synovitis, non-steroidal anti-inflammatory drugs, both local and systemic, are used. Intra-articular corticosteroid injections can be used for the same purpose.

To improve the anatomical and functional condition of the cartilage plate, chondroprotectors and preparations with hyaluronic acid 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 the mobility of the joint.

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 to remove the inflammatory fluid, but also to introduce corticosteroids that interrupt the pathological chain.
• Arthroscopic operations, which involve introducing instruments into the joint cavity through small incisions and subsequent visualization under magnification. These interventions allow washing the joint and its curves, leveling the cartilage plate, removing necrotic areas, "polishing" the joint surfaces, etc.
• Endoprosthetics- it is considered a radical operation, which is performed in the case of an advanced pathological process. It is usually used for arthrosis of the knee or hip joint.

Prevention of arthrosis

The prevention of arthrosis is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding work on the knees, dosed lifting of heavy objects and compliance with a physical activity regimen.

Rehabilitation for arthrosis of the joints

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

Questions and Answers

Which doctor treats arthrosis?

Diagnosis and treatment are carried out by a traumatologist-orthopedic.

Does X-ray always allow the correct diagnosis to be made?

The severity of clinical signs of arthrosis does not always correlate with radiological changes. Often in practice, there are cases when, in case of intense pain, radiography does not reveal significant changes, and vice versa, when a "bad" radiograph is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for arthrosis?

If arthrosis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to look for causes that may lead to a violation of the functional state of the joint (for example, damage to the menisci of the knee joint and intra-articular ligaments).