Arthrosis (deforming arthrosis, popular name - salt deposition) is a chronic disease of the joints of a degenerative-dystrophic nature, in which the destruction of the articular cartilage, joint capsule and deformation of the bone itself occurs.
It should be noted that arthrosis is a whole group of joint diseases that have different origins and similar mechanisms of development.The most common arthrosis of the large joints is:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
These are the most serious types of osteoarthritis.
Osteoarthritis of small joints is less common.More common are deforming arthrosis of the interphalangeal joints of the hands and the metacarpophalangeal joints of the thumbs.Patients note pain in the interphalangeal joints, a decrease in their mobility and the appearance of seals near the joints (Heberden and Bouchard's nodes).This type of osteoarthritis is more common in older age.Osteoarthritis of the foot joints is common.
Polyarthrosis, or generalized arthrosis, is characterized by damage to multiple joints at the same time.
Arthrosis joints of the spine - spondyloarthrosis - belongs to the group of diseases of the spine, although it has a mechanism of development similar to other arthrosis.
The main clinical symptom of osteoarthritis is joint pain and reduced mobility.Specific symptoms are determined by the stage of osteoarthritis and depend on the degree of destructive changes in the joint.
Causes of osteoarthritis
Arthrosis It is customary to divide it into primary and secondary.Primary (idiopathic) arthrosis is a consequence of disruption of the recovery processes and increased degeneration of the cartilaginous tissue of the joint without any deviations in the functioning of the entire organism.Secondary arthrosis occurs as a result of other pathological processes in the body or in a joint already damaged by some external influence, with partial destruction of the joint surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in older patients it is not always possible to draw a clear line between primary and secondary osteoarthritis.
Although the exact cause of osteoarthritis cannot be determined, the factors that contribute to its onset and development are well known.
The following types of reasons can be identified that contribute to the development of primary and secondary deforming arthrosis.
Causes of primary arthrosis - hereditary factors
The following hereditary diseases have been identified that can cause the development of primary arthrosis:
- genetic disorders in the composition of the cartilaginous tissue of the joint, leading to its accelerated destruction;
- congenital defects of the musculoskeletal system (hypermobility of the joints, dysplasia, flat feet and others), which cause trauma in some areas of the cartilaginous tissue of the joint and, as a result, the appearance of arthrosis.
It is also noted that deforming arthrosis of the interphalangeal joints of the upper extremities occurs predominantly in women and is inherited through the female line.
Causes of secondary arthrosis
Secondary arthrosis is a consequence of damage to the joint.This damage can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various joint injuries, intraarticular bone fractures, as a result of which the structure of the joint is disrupted.The same result is caused by constant microtraumas of the joints due to excessive constant loads, both static and dynamic (for example in athletes).Obesity also leads to overload and joint injuries.
Another factor that negatively affects the joints (especially those of the hip) is poor posture.
The structure of the joint can also be compromised by surgery. - Joint diseases.Osteoarthritis can be a consequence of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, deficiency of minerals in the body.Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone and cartilage tissue, synovial fluid, which leads to disruption of recovery processes and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in postmenopausal women lead to changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower limbs, obliterans endarteritis, varicose veins), as well physical inactivity cause circulatory disorders in the periarticular tissues, poor blood supply to the joint tissues and, consequently, degenerative changes.
The mechanism of development of arthrosis
Development arthrosis begins with the destruction of cartilage.It is believed that initially there is a circulatory disorder in the capillaries of the subcartilaginous layer of the periosteum.Since the nourishment of the cartilage occurs due to the supply of nutrients from the intra-articular fluid and adjacent bone tissue, poor circulation leads to the fact that the cartilage gradually loses its elasticity, becomes thinner, cracks appear, the smoothness of the joint surfaces is disrupted, and the amount of synovial fluid that ensures sliding in the joint decreases.As a result, it appears pain and crunching during movement.The width of the joint space gradually decreases, and bones form along the edges of the joint surfaces. osteophytic spines.
Eventually, the joint becomes deformed and the range of motion within it decreases.This is how involutional arthrosis develops, associated with the aging of the body.The development of this form of osteoarthritis usually occurs gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication, have slightly different mechanisms of development, but as a result we get similar changes in the joint.
Symptoms of joint arthrosis.Stages and degrees of osteoarthritis
The classification of osteoarthritis based on clinical and radiological signs is considered “classical”.In accordance with it, three stages of development of the disease are distinguished.It corresponds to a classification based on the degree of preservation of working capacity, distinguishing 3 degrees of arthrosis:
- I degree of arthrosis: the disease does not interfere with performing work, although it makes it difficult,
- II degree of arthrosis: the disease interferes with work performance,
- III degree of arthrosis - loss of working capacity.
Let us consider in more detail the symptoms and clinical signs of arthrosis at each of the indicated stages.
1st degree arthrosis (initial stage of arthrosis)
In the initial stage of the disease, in the morning, after rest, stiffness and difficulty in moving the joints appear, which gradually disappear some time after the start of movement.There may be some limitation of mobility in the joint.“Initial” pain (pain when starting to move after a long period of rest) appears periodically.With sudden movements the joint creaks, but no pain is felt during the movement.Pain at this stage of arthrosis appears only with significant and prolonged stress and disappears after rest.At rest and with light efforts no pain is felt.At this stage of the disease, patients rarely see a doctor.
On an x-ray with 1st degree arthrosis no particular changes in the joint are visible;sometimes small osteophytes may be visible at the edges of the joint, the joint space is slightly narrowed.
Osteoarthritis 2 degrees (second stage of arthrosis)
With the further development of arthrosis, the pain becomes more significant and becomes acute.With any movement, a sharp creaking of the joint appears, a noticeable limitation of the mobility of the joint (contracture), a functional shortening of the limb, disturbances in the biomechanics of movements is observed, but the mobility of the joint is still preserved.In this phase there is a notable increase in initial pain, which becomes acute and longer lasting.Under the influence of daily physical activity, constant fatigue appears, a feeling of pressure in the affected joints and the so-called "mechanical pain" occurs, which is caused by a decrease in the shock-absorbing capacity of the cartilaginous tissues of the joint.
The destruction of the joint is already quite significant, the joints are already starting to partially deform.
Radiographs show evident osteophytes, a narrowing of the joint space 2-3 times compared to normal is observed, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal area are observed.
2nd degree osteoarthritis is characterized by reduced working capacity and the inability to carry out certain types of work.
3 degree arthrosis (third stage of arthrosis)
Arthrosis Stage 3 is a severe and advanced stage of the disease.In this phase we observe:
- significant deformation of the joint (due to bone growth and accumulation of fluid in the joint cavity);
- strong restriction of movements, to the point of maintaining only oscillating movements;
- sharp pain not only during movement, but also in a state of complete rest - constant pain associated with reflex spasm of nearby muscles, as well as the development of reactive synovitis;
- inflammation of the joints,
- joint sensitivity to climate change.
- the muscles around the knee are spasmed and atrophied;
The axis of the limb is deformed, the varus or valgus curvature of the legs is noted (i.e. in the shape of the letter "O" or "X").
On radiographs with grade 3 arthrosis, an almost complete disappearance of the joint space, pronounced deformation of the articular surfaces and extensive multiple marginal osteophytes are observed.It is possible to detect joint mice and calcification of paraarticular tissues.
In grade 3 the disease has progressed significantly and often already causes permanent disability.It looks like this:
- the pain becomes constant and painful: walking, and especially going up and down stairs, represents a hard test for the patient;
- a loud creak during any movement, clearly audible to others;
- joint deformation is severe, movements are limited to a small amplitude or even impossible;
The photographs show the destruction of intraarticular structures (ligaments and menisci), as well as complete abrasion of cartilage and signs of sclerosis (replacement of functioning organs and structures with connective tissue).
Arthritis 4 degrees
The state of complete destruction of the joint with arthrosisWhen the joint completely ceases to function, it is often classified as a separate 4th degree osteoarthritis.There is a so-called "joint lock", an acute pain syndrome in which even limited movement in the affected joint is impossible.The fourth degree of arthrosis is accompanied by unbearable joint pain, which cannot be relieved even with strong painkillers and intensive physiotherapy.Complete ankylosis (fusion of the joint) or neoarthrosis (formation of a false joint between the displaced ends of the bones) is possible.Independent movement in both cases is almost impossible.
The photographs show gross sclerosis of the joint surfaces with obvious cystic clearings, fusion of the connecting bones in the area of the joint space.The development of the disease at this stage almost always means disability, which can only be prevented by implanting an artificial joint prosthesis.
Treatment of osteoarthritis
Treatment of arthrosis in the initial stage of the disease
It is better to start treating arthrosis as soon as possible, when the first signs appear: creaking of the joints, difficulty in movement.Drugs are useful at this stage: chondroprotectors that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physical therapy, proper nutrition and preventive measures are important.It should be noted that the prevention of arthrosis is of great importance to prevent exacerbation of the disease.
Treatment of arthrosis 2 - 3 degrees
Although it is no longer possible to completely cure grade 2-3 arthrosis, the process of its development can be significantly slowed down.Treatment of arthrosis at this stage involves the following steps:
- relieve or reduce pain
- relieve inflammation in the joint.
- improve the restoration of cartilaginous tissue and slow down the degenerative processes contained therein.
In the acute period, treatment of arthrosis begins with pain relief.For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular injections of corticosteroids are possible.It is necessary to reduce the load on the joint;you should not walk or stand for long periods of time, or lift heavy objects.
After relieving acute pain syndrome, the main task becomes to ensure, as far as possible, the activation of recovery processes in the joint itself and in the periarticular tissues: improving blood circulation, increasing metabolism, eliminating inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of 4th degree arthrosis
At this stage of the disease the joint is almost completely destroyed.In this case there is only one way out: surgical intervention and replacement of the diseased joint with an endoprosthesis.The endoprosthesis significantly improves joint mobility and allows the patient to resume an active life, at least without pain.