Osteoarthritis

Osteoarthritis – what is it in simple terms?

Osteoarthritis is a chronic pathology characterized by progressive destruction of the cartilage plate. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) develop. The joint capsule reacts to events that occur and reactive vasculitis develops.

About the disease and possible complications

The incidence of the pathology depends on age. The first signs of osteoarthritis generally do not appear before 30 to 35 years of age, and by the age of 70, approximately 90% of the population suffers from this pathology. Osteoarthritis shows no difference between the sexes. The only exception concerns degenerative lesions of the joints between the carpal phalanges. This form of the disease is 10 times more common in women than in men. Osteoarthritis most often affects the large joints of the legs and arms.

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 breakdown of cartilage tissue dominates its synthesis, then conditions are created for the development of osteoarthritis. This explains in simple terms what osteoarthritis is.

Most often, the first signs of the disease develop in the places with the greatest mechanical stress, with the appearance of limited areas of softening of the cartilaginous plate. As the pathological process progresses, the cartilage becomes fragmented and cracked, as well as local deposition of calcium salts. Beneath the cartilaginous defects, the underlying bone is exposed; Separated cartilage fragments enter the joint cavity and can lead to so-called "jamming" (symptoms of "joint mouse").

Damage to the cartilage lining the articular processes of the bones leads to the loss of their ideal shape, repeating the contours of each other. As a result, during movement, the joint surfaces experience a non-physiological load. In response to this, compensatory resynthesis processes are stimulated in bone tissue. The bone becomes denser (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further changes the gap between the joint surfaces. The appearance of pathological changes gradually limits the range of movements of the joint and contributes to the development of complications in the form of muscle contractures (secondary muscle spasms that occur in response to pain).

Osteoarthritis 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 pro-inflammatory mediators. Over time, such long-term inflammation is accompanied by sclerosis of the periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of osteoarthritis is pain, which over time is accompanied by limited mobility of the joint. The limitation of mobility is first of a compensatory functional nature, then due to organic changes. Additional imaging diagnostic methods (radiography, ultrasound, computed tomography or magnetic resonance imaging) help to establish the correct diagnosis.

Depending on the stage and degree of osteoarthritis, 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 osteoarthritis

There are 2 types of osteoarthritis:

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

Symptoms of joint osteoarthritis

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

1. Mechanical pain, caused by the loss of shock absorption characteristics of cartilage. Painful sensations occur during physical activity and are relieved with rest.
2. Nocturnal pain.Caused by stagnation of venous blood and increased blood pressure circulating within the bone.
3. Starting pain.It is short-lived and appears in the morning when a person gets up (the patient says that he needs to "disperse"). These pains are caused by the deposition of detritus on the cartilaginous plates; during movement, these fragments are pushed into joint inversions, so unpleasant sensations stop.
4. Addiction to meteors.The pain may intensify when weather conditions change (increased atmospheric pressure, cold, excessive humidity).
5. Blockade pain.These are sudden painful sensations associated with pinching a fragment of bone or cartilage between the joint surfaces. Against a background of "blockade", the slightest movements of the joint stop.

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

Osteoarthritis usually begins slowly with the onset of pain in an affected joint. At first, the pain only bothers you 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, associated with a compensatory increase in load. An important distinctive feature of osteoarthritis is its frequency, when short periods of exacerbation are followed by periods of remission. The progression of the pathological process is indicated by a shortening of the period between relapses and the development of harmful consequences in the form of contractures and a sharp limitation of mobility of the joint.

Evolution of osteoarthritis during pregnancy

During pregnancy, osteoarthritis can occur in different ways. Usually, up to 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 generally relatively stable. Pregnancy management is provided by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint osteoarthritis

The main mechanism that triggers the destruction of cartilage is a violation of the synthesis of proteoglycan molecules by cells of cartilage tissue. The development of osteoarthritis is preceded by a period of metabolic disorders, which occur in a hidden way. This metabolic imbalance is characterized by damage to proteoglycans and their components (chondroitin, glucosamine, keratan), which is accompanied by disintegration and degradation of the cartilage matrix. Collagen fibers break in the cartilage plate, the supply of metabolites necessary for life is disrupted, and the water balance also changes (first the cartilage is hydrated, then the number of water molecules decreases sharply, thiswhich further stimulates the cracks).

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 bind poorly to hyaluronic acid and therefore quickly leave the matrix. With osteoarthritis, a cytokine "boom" is also observed - the released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of osteoarthritis can be varied:

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

Signs and diagnosis of joint osteoarthritis

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are carried out.

1. X-ray.At an early stage, radiological signs of the disease are not significant: they may be uneven narrowness of the joint space, slight compaction of the underlying bone and small cysts in this area. At a later stage, the x-ray is more informative: marginal bony growths appear, the shape of the articular surfaces changes, joint "mice" and areas of calcification in the capsule can be determined.
2. Ultrasound of joints.Ultrasound is more informative for detecting the first signs of osteoarthritis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilaginous plate and secondary reactions of the capsule, musculotendinous and ligamentous compartments can be visualized.
3. Computed or nuclear magnetic tomography.This diagnosis of joint osteoarthritis is carried out in complex clinical cases, when it is necessary to assess in detail the state of the cartilaginous plate, the subchondral region of the bone, and to determine the volume of synovial fluid, incl. in joint inversions.

Expert opinion

Deforming osteoarthritis of the joints is one of the most common pathologies of the musculoskeletal system, which affects 10-15% of the world's population. The insidious nature of the disease is that it develops slowly and gradually. At first, these are short-term pains in a joint, to which a person often does not pay attention. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain turns into constant. In the absence of treatment, the disease continues to progress and is accompanied by severe degeneration of the cartilage, which no longer responds to conservative treatment and to solve this problem, only arthroplasty is necessary - a complex and expensive intervention to replacethe joint destroyed by a complete arthroplasty. -full-fledged implant. However, targeted drug treatment and lifestyle changes can help to significantly delay this operation, or even avoid it altogether. Therefore, if joint pain occurs, it is important to consult a doctor as soon as possible.

Treatment of osteoarthritis

According to clinical guidelines, the main goal of treating osteoarthritis is to slow the progression of degenerative damage to the cartilage plate. To achieve this, measures are taken to reduce the load on the damaged joint and promote its recovery, and treatment is prescribed to stop the development of secondary synovitis.

Conservative treatment

Unloading of the joint is carried out in the following ways:

• loss of body weight (if excess);
• perform physical therapy that excludes prolonged similar poses;
• refusal to lift heavy loads or kneel for long periods (relevant for certain professions).

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

To relieve pain, incl. against the background of secondary synovitis, nonsteroidal anti-inflammatory drugs are used, both local and systemic. Intra-articular injections of corticosteroids can be used for the same purpose.

To improve the anatomical and functional state of the cartilaginous plate, chondroprotectors and hyaluronic acid preparations 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

Surgical treatment options depend on the stage and activity of the pathological process.

• Joint puncture– indicated in cases of severe reactive synovitis. It not only eliminates the inflammatory fluid, but also introduces corticosteroids which interrupt the pathological chain.
• Arthroscopic operations, which involve the introduction of instruments into the joint cavity through small perforations and subsequent visualization under magnification. These interventions make it possible to wash the joint and its inversions, level the cartilaginous plate, eliminate necrotic areas, "polish" the joint surfaces, etc.
• Endoprostheses– is considered a radical operation, carried out in case of an advanced pathological process. Typically used for osteoarthritis of the knee or hip.

Osteoarthritis prevention

Prevention of osteoarthritis is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding working on your knees, lifting heavy objects in a dosed manner, and adhering to a physical activity regime.

Rehabilitation for osteoarthritis of the joints

Rehabilitation of osteoarthritis of the joints involves a set of procedures to improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massages and health-improving gymnastics are used.

Questions and answers

Which doctor treats osteoarthritis?

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

Does radiography always allow us to make the correct diagnosis?

The severity of clinical signs of osteoarthritis is not always correlated with radiological changes. Often in practice there are cases when in case of severe pain the x-ray does not reveal significant changes, and vice versa, when a "bad" x-ray picture is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for osteoarthritis?

If osteoarthritis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to search for causes that can lead to a disruption in the functional state of the joint (for example, damage to the menisci of the joint of theknee and intra-articular ligaments). .