Osteoarthritis 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.Osteoarthritis is detected in most patients after 65 years, one of the reasons for its development is natural aging of the body.
The occurrence of degenerative-dystrophic pathology is provoked by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, conversely, a sedentary lifestyle.The main symptoms of osteoarthritis are joint pain, swelling and limitation of movement.
To diagnose pathology, instrumental studies are carried out - x-ray, arthroscopy, MRI, CT scan.Osteoarthritis of 1st and 2nd severity is treated conservatively with a course of medications, physiotherapy and massage procedures, and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprostheses.
Pathogenic mechanisms
With osteoarthritis, pronounced changes occur in the internal structures of the connective tissue.Deforming erosions form on cartilaginous tissues, which cause the destruction of collagen fibers, as well as proteoglycans consisting of proteins (5-10%) and glycosaminoglycans (90-95%).As a result, the collagen network loses its 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.As a rule, the normal quantitative values of enzymes are controlled by cytokines - small peptide information molecules.But as osteoarthritis progresses, the concentration of these proteins decreases, causing the release of a large number of enzymes that damage cartilage tissue.
Proteoglycans whose structure is altered begin to absorb water molecules that they are unable to retain.As a result, excess fluid penetrates the collagen fibers.They “swell” and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of the synovial fluid.With osteoarthritis, the concentration of hyaluron decreases.Hyaline cartilages no longer receive sufficient nutrients and oxygen for their regeneration.Foci of softening are formed in the cartilaginous tissues, then specific cracks and necrotic growths appear.The bony heads become exposed and begin to experience microtrauma when moved relative to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) osteoarthritis have not yet been established.This occurs in the absence of any provoking factors, which is why theories are put forward about a hereditary predisposition to premature cartilage destruction.Secondary osteoarthritis 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, dislocation, damage to the meniscus, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of the functioning of the endocrine glands, disorder 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, for example osteochondritis dissecans.
Hypermobility of the joints, caused by the production of special collagen, predisposes to the development of osteoarthritis.This condition is detected in 10% of the planet's inhabitants and is not considered a pathology.But hypermobility is accompanied by a weakness of the tendon-ligamentous system, which leads to frequent injuries, particularly at the ankle joint (sprains and ruptures of ligaments, dislocations).
Osteoarthritis is sometimes caused by blood-forming disorders, such as hemophilia.Hemarthrosis, or hemorrhage in the joint cavity, causes deterioration of cartilage trophism and its destruction.
Predisposing factors include old age, frequent loads on the joints exceeding their strength limits, excess weight, surgical interventions and hypothermia.
The risk group includes postmenopausal women, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.In case of deficiency in the diet of foods containing vitamins and microelements, the prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of osteoarthritis lies in the absence of symptoms at the first stage of its development.The pathology manifests itself clinically gradually, the first signs appear against the background of significant destruction of cartilage tissue.Initially, a person feels slight pain that does not have a clear localization.It appears after physical activity - bodybuilding, sports training.Sometimes the first clinical manifestation is a cracking or clicking sound when flexion or extension of the joint.A person begins to notice that certain movements are difficult.However, in the initial stage of osteoarthritis, stiffness appears in the morning and quickly disappears.
As the disease progresses, pain is also felt at night, causing not only sleep problems, but also the appearance of chronic fatigue.The severity of pain syndrome in the second stage increases with climate changes, exacerbation of chronic pathologies and acute respiratory viral infections.The range of movements is noticeably reduced.The cause of stiffness is thinning of the cartilage, as well as the person's conscious restriction of movement in an attempt to avoid pain.This results in increased load on the opposite joint, causing further damage.Osteoarthritis is also characterized by other specific symptoms:
- pain causes spasms of skeletal muscles and the development of muscle contractures (limitation of passive movements of the joint);
- creaks in the joints, clicks, crackles when moving become constant, occurring with almost every movement of the bones relative to each other;
- painful muscle cramps often occur;
- joints are deformed, leading to posture and gait disorders;
- in the third stage of osteoarthritis, the deformation is so pronounced that the joints are bent and the range of movements is significantly reduced or completely absent;
- In case of third degree osteoarthritis of the knee, ankle or hip, the patient uses a cane or crutches to get around.
In the absence of treatment, the pathology progresses, and during its course remissions are replaced by relapses, and the frequency of exacerbations continues to increase.Stiffness of movements in the morning does not disappear for a long time, it becomes permanent.
When examining a patient with grade 1 osteoarthritis, the doctor notes only slight swelling of the joint and complete preservation of range of motion.In grade 2 pathology, palpation reveals pain and slight deformation.In the joint space, we observe the formation of bone thickening.
Osteoarthritis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Their main symptom is the formation of a rounded seal at the joint, when pressure is applied on which fluid movement (fluctuation) is felt.Acute synovitis can be accompanied by a rise in temperature up to 37-38 ° C, headaches and digestive disorders.
Diagnosis
The diagnosis is made based on the results of instrumental studies, features of the clinical picture, anamnesis and patient complaints.A general blood and urine test is not very informative - all values remain within normal limits if osteoarthritis is not caused by metabolic pathology.With the development of synovitis, the erythrocyte sedimentation rate increases (30 mm/hour) and 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 osteoarthritis.
The most informative method for diagnosing degenerative-dystrophic pathology is x-ray in frontal and lateral projection.
| Stages of osteoarthritis according to the Kellgren-Lawrence classification (1957) | Radiological signs of pathology |
|---|---|
| Initial | No radiological signs |
| First of all | Indistinct and irregular narrowing of the joint space.Slight flattening of the edges of the bone plates, formation of initial osteophytes or absence of them |
| Second | Marked narrowing of the joint space, 2-3 times higher than normal, formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic clearings at the level of the epiphyses |
| 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 assess the blood supply to the tissues and establish the stage of the inflammatory process during the development of synovitis.
Basic therapy methods
Osteoarthritis is still an incurable disease, since there are no pharmacological drugs for the regeneration of cartilage tissue.The main goal of therapy is to prevent the progression of the pathology and maintain joint mobility.Treatment is long-term, complex, using both local and systemic drugs.Patients should avoid severe stress on the joint and, if necessary, limit the range of movements with orthopedic devices - orthoses, elastic bandages.Overweight patients need to adjust their diet to gradually reduce weight and follow a diet.
After achieving stable remission, patients undergo daily physiotherapy exercises.The first training sessions are carried out under the guidance of a physiotherapist doctor, then the patient performs a set of exercises at home.Exercise therapy can be supplemented with swimming, yoga and cycling.
To reduce the intensity of pain, drugs of various clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration containing active ingredients;
- injections into the joint of anesthetic solutions in combination with glucocorticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
Treatment 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 capable of partially restoring 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 at the initial stage of osteoarthritis will stop the destruction of cartilage and prevent loss of performance and disability.