Arthrosis of the joints (also in the literature you can find the names "deforming arthrosis", "arthrosis" or "arthrosis") is a chronic degenerative process of the joint tissues, in which, due to dystrophic processes, over time, the cartilagejoint surface coverage is destroyed, in addition, degenerative processes can cover the joint capsule and actual bone tissue, causing bone deformation.
Types of arthrosis of the joints
In general, the term "arthrosis" is used to refer to a fairly large group of diseases of different joints, the mechanism of development of such pathologies may differ to some extent. Most often, you can meet arthrosis of large joints, this group of diseases includes:
- gonarthrosis - a deforming lesion of the knee joint;
- coxarthrosis - a pathology of the hip joint;
- arthrosis of the shoulder joint;
- arthrosis of the elbow joint, etc.
Less often arthrosis of small joints develops: hands (more often interphalangeal and metacarpophalangeal) and feet. In addition, spondyloarthrosis is distinguished, a dystrophic lesion of the intervertebral joints, which is called a disease of the spine, despite the mechanism of development similar to other types of arthrosis. In the event that the pathology has spread to several joints, we can say generalized arthrosis or - polyarthrosis.
In medicine, it is customary to distinguish two main types of arthrosis of the joints, depending on the mechanism of its development. Primary osteoarthritis (also called idiopathic) is a pathology that develops mainly in the tissues of the joint, outside of any deviations in the systemic work of the body. Primary osteoarthritis is characterized by an increase in degenerative processes in the cartilage tissue simultaneously with a violation of its restoration.
Secondary osteoarthritis is the result of a joint injury due to trauma (traumatic osteoarthritis). In addition, some pathological processes in the body, in particular, disorders of mineral metabolism and others, can lead to the development of secondary osteoarthritis.
At a young age, as a rule, traumatic osteoarthritis is detected. In elderly patients, in some cases, it is not possible to distinguish between primary and secondary joint damage - so closely related are many pathological processes in the body.
Why does osteoarthritis develop?
Despite the fact that there is still no consensus on the exact cause of the development of arthrosis, the factors that contribute to pathological changes in the tissues of the joint are known to scientists. The main reason for the development of idiopathic arthrosis of the joints is a variety of factors of a hereditary and genetic nature. First of all, this group includes congenital features of the composition of the tissues of the joint, which contribute to the more intense than normal destruction of cartilage and its too slow recovery. In addition, hereditary factors can include a variety of congenital defects and deformities of the osteoarticular system (dysplasia of the joints, their excessive mobility, deformities of the spine, feet, hands, etc. ), due to which an excessive or non-physiologicalthe load is placed on some joints. , because the joint surfaces can develop incorrectly, deform, and the cartilage covering them - collapses;
The following reasons can lead to the development of secondary arthrosis of the joints:
- mechanical damage to the joints is the result of certain mechanical influences that lead to a violation of the anatomical integrity of the structures that form the joint. The group of mechanical injuries includes injuries, surgery, excessive physical activity and sports;
- joint diseases - first of all, pathologies of an inflammatory nature;
- metabolic disorders that lead to changes in the composition of the cartilage covering the joint surfaces, as a result of which it becomes more vulnerable, breaks down faster and recovers more slowly;
- some diseases of the endocrine glands, which can also cause metabolic disorders;
- a series of autoimmune diseases in which the cells of the immune system attack the tissues of the body itself, in this case the tissues of the joints, causing their destruction;
- vascular pathologies, the result of which is an insufficient blood supply to the tissues and the development of dystrophic processes in them.
How does arthrosis of the joints develop?
It is believed that the first destructive process in the joint in arthrosis of the joints is the defeat of the cartilage. It begins with a violation of microcirculation in the capillaries of the periosteum, located under the cartilage covering the articular surface of the bone. Normally, the nutrients in cartilage tissue come from both joint fluid and adjacent bone tissue. When blood circulation is disturbed in the vessels of the periosteum, the nutrition of the cartilage is disturbed. Gradually, the cartilage tissue loses its natural elasticity, becomes thinner, its surface becomes uneven, microcracks and tubercles may appear, disrupting the sliding of the joint surfaces relative to each other. The composition of the synovial fluid inevitably changes.
With the movements of the joint, pain, creaking, clicks begin to disturb. Over time, the pathology progresses, the range of motion in the joint decreases, the joint gap narrows, the cartilage on the protruding parts of the joint surfaces can become thinner until it disappears completely, and osteophytes form on the edges of the joint surfaces.
The described mechanism is mainly characteristic of senile arthrosis, which develops gradually over time. The mechanism of development of other forms of osteoarthritis - for example, post-traumatic, postoperative, post-infectious, associated with metabolic disorders - may be slightly different, but in general, changes in the joint with such pathologies will be identical to osteoarthritissenile.
The degree of arthrosis and its manifestations
The specific manifestations of the pathological process, their severity largely depend on the intensity of the destructive process in the joint, the amount of tissue involved in it. However, there are two main clinical symptoms characteristic of osteoarthritis at any stage. First of all, it is the pain in the joints. Additionally, decreased joint mobility is a cause for concern.
In our country it is customary to distinguish the degrees of arthrosis according to the clinical and radiological classification adopted in 1961.
Arthrosis of the joints 1 degree- the initial stage of the development of the pathological process.Its main symptom is stiff joint movements in the morning, after rest. When the patient begins to move, the stiffness disappears. In the joints there may be some impairment of mobility, slight pains may disturb after being at rest, during the first movements. Cracks in the joints are often noted. However, there is no pronounced pain after performing normal movements, the pain can appear only with a clearly excessive load on the joint, and after rest it disappears on its own.
X-ray examination of the affected joint does not show pronounced changes in anatomical structures; in some cases, there may be a slight narrowing of the joint space or the presence of single small bony growths along the edges of the joint surface.
Due to the absence of noticeable pain and movement disorders in the joint, patients rarely seek medical assistance at this stage in the development of the disease.
2 degrees of arthrosis: the progression of the disease.It is manifested by the appearance of a sharp sharp pain, as well as a distinct crunch, clicking in the joint during movements in it. The range of motion in the joint is significantly limited, which is why, if we talk about the defeat of a large joint, the development of functional shortening of the limb is possible. The pains are annoying in the morning, immediately after waking up, as in the first phase of arthrosis, but on the contrary, they are more intense, longer, often gradually turning into daytime pains. The latter are formed during the day, when the mechanical work in the joint gradually decreases the amortization capacity of the cartilage. At this stage, there is a fairly significant destruction of the joint, deformations of the bones that form it. Meteosensitivity of the joint can be disturbing: the appearance or significant intensification of pain in it when the weather changes, which is associated with a decrease in the compensatory properties of the joint tissues and its ability to regulate intra-articular pressure during fluctuationsatmospheric pressure.
X-ray examination shows a significant narrowing of the joint gap, a significant number of bone growths. The bone tissue in the pericartilaginous area is sclerotic due to pronounced dystrophic processes; cystic cavities can form in it.
At this stage of the disease, the patient's ability to work decreases; he cannot perform a series of works due to severe pain during movements in the affected joint or its contracture.
Arthrosis of the joints of the 3rd degree corresponds to the advanced stage of the pathological process.Pain is constantly disturbing, both during movement and in a state of complete rest, which is associated with a number of factors: inflammation of the joint tissues, deformation of the joint surfaces, muscle spasm around it. The range of motion is markedly limited, in some cases they are generally impossible. Movement in the affected joint is accompanied by a loud crunch, audible not only by the patient, but also by those around him. The joint at this stage is noticeably deformed, fluid accumulates in the joint capsule due to the intense inflammatory process. Severe meteosensitivity develops - intensification of pain due to weather changes. The muscles in the area of the large joints are spasmodic, due to the lack of mobility, their atrophy can develop. With 3rd degree osteoarthritis of the knee joints, curvature of the legs can be noted: varus (in the form of the letter "O") or valgus (in the form of the letter "X").
X-ray images reveal an almost complete absence of the joint space, the joint surfaces are noticeably deformed, and large bony growths are located at their edges. Intra-articular structures (menisci, ligaments) are destroyed, bone tissue is sclerotic. The tissues around the joint are calcified, joint mice can appear in the joint cavity - fragments of bone tissue.
With arthrosis of the joints of the third degree, there is a persistent decrease in the patient's ability to work, her disability.
4 degrees of arthrosis - the stage of complete destruction of the affected joint.The "block" of him develops - the impossibility of even the slightest movement due to severe pain. Pain cannot be relieved even by powerful non-narcotic analgesics, they are not relieved by physiotherapy procedures. With the defeat of the knee joints, the patient loses the ability to move independently. Intense inflammation in the tissues of the joint can result in fusion of the joint (ankylosis) or the formation of false joints (neoarthrosis).
On the roentgenogram, the strongest sclerosis of the bones that form the joint, their fusion, a large number of osteophytes and intense calcification of the joint tissues can be seen.
How is osteoarthritis treated?
The scope of therapeutic measures for the treatment of arthrosis of the joints depends on the stage of the disease and the prevalence of the pathological process. There is a simple scheme: the earlier the treatment of osteoarthritis is started, the more effective it is. Therefore, it is very important to consult a doctor in a timely manner, at the first signs of discomfort in the joint area, at the slightest morning stiffness or the appearance of a creak during movements. In the initial stages of the pathological process, it is effective to take vitamin-mineral complexes and chondroprotectors - drugs that improve metabolism in cartilage tissue and its structure. For example, a drug whose active ingredient is crystalline glucosamine sulfate, a natural component of healthy cartilage. It stimulates the production of proteoglycans and at the same time inhibits the processes of destruction of the cartilage tissue.
A good addition to the listed measures for the treatment of osteoarthritis will be physiotherapy exercises, physiotherapy techniques, it is important to have a good diet with a sufficient amount of protein and fat in the diet. Timely therapeutic and prophylactic measures allow not only to eliminate pain and discomfort, but also to prevent the progression of the disease, the passage of the pathology to more severe stages.
Osteoarthritis of the second and most severe degree cannot be completely cured. In these stages, the treatment of osteoarthritis comes down to eliminating or reducing pain, as well as suppressing inflammation in the tissues of the joint. To relieve pain, non-steroidal anti-inflammatory drugs and non-narcotic analgesics are used, in the form of local agents (ointments, gels with anesthetic and anti-inflammatory effect), as well as systemic drugs. An important role is played by relieving the load on the diseased joint, which allows to reduce mechanical damage to the joint surfaces.
After eliminating acute pain, an important task is to normalize metabolic processes in the cartilage tissue, slow down the destructive processes in it, for which it is also recommended to take chondroprotective drugs. In addition, drugs that stimulate tissue microcirculation have proven themselves well. In the remission stage of arthrosis (in the absence of severe pain), physiotherapy, physiotherapy exercises are useful, which will reduce the likelihood of another exacerbation and reduce the need for analgesics and NSAIDs.
The list of physiotherapeutic measures in the treatment of arthrosis of the joints includes electrophoresis, ultrasound exposure, radiation therapy and magnetic therapy. The most important condition for the effectiveness of such measures is to carry out physiotherapeutic treatment of arthrosis only during the period outside the exacerbation of the disease, otherwise there is a high probability of activating the inflammatory process and increasing theache.
How to treat osteoarthritis in the fourth stage of the disease? The joint tissues at this stage are practically destroyed, the only effective solution is surgical intervention, during which the damaged joint is replaced with a special endoprosthesis. Not always, such an operation allows you to completely restore the range of motion in the joint, however, after the completion of the recovery period, the patient can return to active life, work, get rid of pain.
Osteoarthritis, the symptoms and treatment of which are described in this article, is a serious pathology that can lead to disability, significantly reducing the quality of his life. Timely initiated treatment can significantly slow down the progression of the disease, avoid the development of serious complications, and maintain the patient's activity and ability to work.