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Osteoarthritis

Arthritis of the ankle joint

Osteoarthritis is a whole group of dystrophic diseases of the joint apparatus with various etiologies, but a similar clinical image of pathological changes.The hyalin cartilage of the joint, then the drunk bone tissue, the joint capsule and the ligament apparatus, are exposed to destruction and deformation.The disease is gradual chronic and without appropriate treatment can considerably limit the motor activity of the patient.

The diagnosis and treatment of pathology are engaged in an arthrologist, a rheumatologist, a surgeon, an orthopedist.



general information

Arthritis is diagnosed in approximately 1/5 of the population of the planet, but the disease is more characteristic of the elderly.This proves the statistics of its spread between the different ages:

  • Young people up to 40 years old, either 6 to 7%;
  • Mature faces after 45 years at 20-25%;
  • After 70 years - up to 80%.

The disease affects the tissues which are under a constant load: small joints of the hands and more legs, joints of the hip and knee, areas of the cervical and thoracic parts of the spine, a little less often of the ankle and the shoulder joint.

Note! The defeat of the interfering joints in women in women occurs 10 times more often than in men.

In many Western countries, the term "osteoarthritis" is not used, replacing it with the concept of "arthritis".Such a substitution is fairly justified, as inflammatory processes in most cases precede osteoarthritis or accompany it.In domestic medicine, the terms "osteoarthritis" and "arthritis" essentially mean the same disease, but with a different etiology of the process.In addition, the concepts of osteoarthritis, osteoarthrosis, distorting osteoarthrosis are used to designate pathology.

Note! The difference between arthritis and osteoarthritis lies in the cause of the disease.In the first case, these are inflammatory processes (the suffix -it means inflammation), in the disturbances of the second -metabolic (protein, mineral). 

The development mechanism and the causes of osteoarthritis

The main cause of osteoarthritis is a violation of balance in the processes of anabolism and catabolism of cartilage and bone tissue.If the synthesis processes normally prevail, then during osteoarthritis changes, destruction processes go more quickly.Consequently, rapid aging and degeneration of tissue structures are observed.They start to collapse first at the cellular level, then in the tone of the organ.The first destructive changes appear:

  • obscure cartilage;
  • Superficial storageness;
  • microcofrantes and tears;
  • Focal and general lighting of the cartilage layer.

Cartilage loses natural elasticity and density and is no longer able to serve as a shock absorber during movements.The mutual correspondence of the shape of the articular surfaces is disturbed, which leads to the deformation of the connection.This exacerbates the development of pathological changes and triggers a number of irreversible processes.In exchange for lost cartilage, bone tissue is starting to grow with the formation of tips and growths, which grenons movements and can subsequently lead to a serious handicap of the patient.

Reasons for this scenario:

  • Mineral metabolism violations are capable of leading to gouty changes in joints, osteoporosis, etc.
  • The disadvantage of tissue nutrition is venous stagnation and poor microcirculation slows blood supply and lymphatic drainage.The mineral composition of the bone is exhausted, it becomes osteoporous and loses the ability to self-collapse.The phenomenon is characteristic of a lack of movement, with vascular pathologies, hormonal failures.
  • Inflammatory process - consequence of acute infectious diseases, body hypothermia, altered hormonal background.
  • Autoimmune reactions are chronic foci of inflammation, nervous stress, endocrine pathologies and other causes can cause the body's immune system against its own cells, including joint tissues.The most common autoimmune lesions with rheumatoid arthritis, scleroderma and red lupus.
  • Increase in joint wear - a discrepancy between the functionality and the load posed slows the synthesis processes and accelerates destruction.The phenomenon is characteristic of athletes, dancers, overweight people, as well as all those who are engaged in heavy physical work or who is associated with long static loads (standing work).
  • Wounds - bruises, dislocations, fractures, penetrating wounds, tears - violate the structure of the tissues and give momentum at the start of the deformation.
  • Genetically determined pathologies - Dysplasia of the connective tissue, a violation of the synthesis of collagen initially form an unstable and weak joint.

Certain reasons echo each other with each other and form a complex pathological complex.

Attention! Hormonal deviations play a particularly important role in violations of bone tissue metabolism.A failure in the thyroid gland, menopause, by taking contraceptives, corticosteroids - all this is a direct path to osteoporous and arthrus changes in the skeleton.

Classification of changes

In the systematics of osteoarthritis, several defining criteria are used: causes and etiology, location, area of coverage.

By etiology:

  • Primary osteoarthritis - Develop independently, with damage to completely healthy joints, without the participation of previous pathologies;
  • Secondary - are formed in the context of a disease (drop, psoriasis, rheumatism), as well as in the presence of existing deformations or joint injuries.

By the degree of coverage:

  • Local forms with damage to a limited number of joints: monoarthrosis-1 articulation, oligoarthritis-2-3;
  • Generalized forms are different types of polyarthrosis, when 3 large structures and others are involved in the pathological process.

Depending on the location of the process, the names of osteoarthritis of each joint are given separately:

  • Coksartrose - deactivates hip connection;
  • spondylarosis - affects intervertebral discs, mainly cervical, thoracic and lumbar;
  • Gonarthrosis - with an alteration of the work of the knee joint;one of the most common species;
  • Cruzartrose - with the involvement in the pathological process of the ankle.

Osteoarthritis can be quickly or slowly progressive, offset or decompensated.

The main symptoms and signs

Osteoarthritis is a complex disease.Conventionally, it can be divided into several united pathologies:

  • Chondrite and chondosis - inflammatory and degenerative lesion of the cartilage fabric;
  • Osteoporosis is also osteoporosis - a pathological process in bone structures;
  • Synovitis - The involvement of the lining shell of the joint capsule;
  • Stock Exchange - General inflammation of the spouse's bag;
  • Reactive damage to soft tissue in the adjacent area - affect muscles, ligaments, fibers.
Stock and pain in the arthritis of the hand joints

Depending on the scene, the degree and the form, they are observed simultaneously or selectively.In this spirit, a complex of symptomatic changes is formed.Among them:

  • Pokhrutzhazing is a symptom of a violation of mineral metabolism and the first sign of the disease.This can happen at any age.
  • Stock - Demonstrating intensively in the morning.It is in the short term and can be expressed by the effect of the scrambling of the joint.
  • Limit mobility - Reduce the amplitude of movements in the Commission for active or passive actions.
  • Pain is a different manifestation, from unpleasant and painful, which, after intense loads, acquires a substantive character and ending with acute movements.The “start -up pains” are particularly characteristic, which manifest itself after a long period of rest and last until the joint is completely developed.
  • MOUTH - With inflammation of soft tissues, synovitis, bursitis.
  • Deformation - is observed with complete degeneration of the cartilage and the absence of a factor absorbing shocks.

Note! The nodules of Bushara and Geberden are a characteristic sign of the distorting osteoarthritis of the hands.These are bone growths with osteophyte processes.

Stages and degree of osteoarthritis

In terms of intensity of osteoarthritis changes, 4 stages of the disease are distinguished:

  • 1st step - with a slight flood of cartilage (violation of the structure and functionality in collagen fibers).In the X -ray, the image is practically not visible.
  • STEP 2 - The tingling of the cartilage fabric in the light of the joint are up to 50%.It is covered with cracks, slight pain appears in the damaged compound area.Osteophytic complexes appear on Ray X;The joint space slightly reduces its size.
  • Step 3 - The lesion of cartilage reaches almost the bone base, the joint space is sharply reduced.
  • 4 steps - Cartilage is completely damaged, which leads to a partial or complete degeneration of the synovial fluid, to the abrasion of the bone tissue on each other and to the deformation of the compound.In some regions, sclerosis changes are developing.The extreme manifestation of osteoarthritis is the fusion of joint tissues with the ossification of structures and a complete loss of mobility.

In some sources, floors 1 and 2 are combined in one.

With the progression of symptoms, the motor activity of a person suffers.Given the violations of the functional performance of the articulation, 4 degrees of possible development of the pathology are distinguished:

  1. 0 degree - Mobility and performance are fully preserved;
  2. 1 degree - The patient retains the capacity of self -service and to demonstrate social activity, but is unable to engage in the activity of work;
  3. 2 degrees - The difficulties of manifestation of social activity are added to a violation of the work activity;
  4. 3 degrees - All types of activities are limited or completely impossible: work, social and self -service;The patient needs constant care.

What are the possible complications

By tightening with treatment, you can cause a number of unpleasant consequences:

  • constant pain syndrome;
  • lameness;
  • vertebrates (with spondylarthrosis);
  • pronounced joint deformation;
  • Removability complete with the ossification of structures.

What is the investigation procedure

For the diagnosis of osteoarthritis, a medical examination with the collection of an anamnesis is sufficient.To determine the degree of damage, an instrumental examination is carried out.The main ways to get a clear image of the disease:

  • radiography;
  • CT, MRI;
  • ultrasound;
  • scintigraphy;
  • Diagnostic arthroscopy with biopsy of the cartilage tissue and synovial fluid.

In an acute inflammatory process, the doctor prescribes additional analyzes: general blood test, rums, biochemistry (glucose level, protein compounds, electrolytes).

Treatment

It is impossible to completely eliminate the disease.The appropriate treatment of osteoarthritis allows you to maintain the functionality of the joint, a normal motor activity and to prevent pain.To exclude complications, it should start at the first stage.

Pharmacotherapy Understand:

  • Anti-inflammatory drugs, mainly NSAIDs;
  • Blocs of intra-articular pain of pain and inflammation (with pronounced synovitis, bursitis);
  • Proteolysis inhibitors - slow down and suspend the process of destruction of bone and cartilage;
  • Antispasmodics - prevent muscle cramps;
  • Angioprotectors and drugs to improve blood microcirculation in affected tissues;
  • chondroprotectors;
  • synthetic substitutes for synovial fluid;
  • Compositions of vitamins and minerals.
Exercise therapy for the treatment of arthritis of the joints

A physiotherapy complex prescribed in parallel to improve the effect of drugs.Main physiotherapy: 

  • magnetotherapy;
  • electrophoresis;
  • UHF;
  • mud;
  • Thermal baths;
  • massage;
  • Exercise therapy and kinesiotherapy using special simulators.



Surgery - The only way to treat in the last stages, when the cartilage fabric is completely destroyed.The following solutions to the problem are possible:

  • Endoscopy - with a partial or complete replacement of the joint with an artificial analog;
  • Arthroscopy - A mini -invasive operation to eliminate osteophytes or partial replacement of the cartilage;
  • Arthrodesis - The closure of the joint and fix it in the most practical position;Immobile connected joint surfaces develop over time.

Forecast 

Arthrosis does not threaten the patient's life, but lack of treatment can considerably limit freedom of movement and worsen quality of life.A timely and competent therapy in the early stages can restore the articulation to a healthy state.In other cases, only a slowdown in the degeneration process is possible using conservative treatment and compensation for the functions lost to prostheses.

Disease prevention

A complete recovery is almost impossible, therefore, prevention must be paid to particular attention.The main requirement is a healthy lifestyle and a complete treatment of inflammatory processes:

  • Do not leave hypothermia and do not treat infectious diseases in a timely manner;
  • Avoid physical overload and long static loads;
  • Maintain normal body weight;
  • Adhering to the right diet - The balanced composition of vitamins and minerals is very important for the health of the musculoskeletal system;
  • Fully (if possible, until complete recovery), treat any damage to the joints;
  • Practice systematic physical exercises to stimulate blood circulation (bike, hiking, light jogging, Scandinavian walking).

If you are at risk (elderly age, poor inheritance, physical overload), be sure to undergo a regular radiographic examination.