Osteoarthritis(osteoarthritis) is a joint disease characterized by degenerative changes in the cartilage covering the bone, in other words, its destruction.
The vast majority of affected joints are the knee, hip, shoulder and the first metatarsophalangeal. Damage to other joints is much less common and is often secondary. Disability caused by osteoarthritis has doubled in recent years.
Like any disease, osteoarthritis also has risk factors for its development, which are being actively studied today and the list is expanding every year. The main ones are considered to be:
- metabolic disorders;
- increased body weight;
- improper and improper nutrition;
- endocrine disorders;
- frequent hypothermia;
- arthritis (inflammation of the joint);
- outbreaks of chronic infection or inflammation (eg chronic tonsillitis).
- Varicose veins.
If you find such symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of osteoarthritis
Common symptoms of osteoarthritis include:
- pain during exercise;
- restriction of movement in the joint;
- feeling of stiffness in the morning, feeling of "crunching";
- pain after a long rest (so-called "starting").
Joint pain is rarely sharp, more often painful or dull, and usually stops during rest. Symptoms are often wavy and can come and go without trying to heal. They can be mild, moderate or severe. Complaints of osteoarthritis may remain roughly the same for many years, but over time they progress and the condition worsens. Minor and moderate symptoms can be controlled at the same level, but the severe course of the disease can lead to chronic pain, inability to perform daily household activities, leading to disability, to disability.
Pathogenesis of osteoarthritis
The main nutrient medium for the joint is synovial fluid. It also acts as a lubricant between the joint surfaces. A huge and major role in the development of osteoarthritis is given to metabolic processes in the joint and its structures. In the initial stage, when biochemical disorders develop in the synovial fluid, its properties decrease, which triggers the mechanism of destruction. The first affects the synovial membrane of the joint, which plays an important role as a membrane and is a kind of filter for the most important nutrient of cartilage - hyaluronic acid, preventing it from leaving its main place of work - the joint cavity. . The saturation of the properties of the joint fluid determines its circulation, which cannot be without regular movement of the joint itself. Hence the well-known phrase "movement is life". The constant circulation of synovial fluid in the joint cavity is the key to full metabolism in it. In the absence of nutrients, cartilage becomes thinner, the formation of new cells stops, the joint surface becomes uneven, roughThe relationship between diseases of the veins of the lower extremities (eg varicose veins) and the development of metabolic disorders in the joints, mainly of the knee, is known. zone, as a result of which exostoses and osteophytes are formed, which is the main cause of the limitations and deformations of the joint. Synovial fluid is saturated with inflammatory cells and decaying elements, the joint capsule in response thickens, roughens and loses elasticity, softtissues literally dry out (dehydration occurs), hence the complaints of morning stiffness, "initial pain". The pathological process in the last stages provokes the body to include the last compensatory mechanism - immobilization. At rest and in the so-called physiological position the pain is minimal, the ligament apparatus is maximally upright. In this position, the joint tends to fixate and quickly manages to form coarser exostoses that "fix" the joint and the patient loses the ability to move it completely. The muscles of such a limb are hypotrophied, become weaker and smaller. changes are now considered irreversible.
Classification and stages of development of osteoarthritis
The disease is divided into 2 major groups: primary (or idiopathic) and secondary. The first group develops as a result of either an unclear cause or as a result of age-related changes. The second is characterized by clear causes and develops as a result of their pathological process (for example, against the background of tuberculosis, dissect osteochondritis, subchondral necrosis, etc. ).
Regardless of the reasons that were a factor in the development of osteoarthritis, there are 4 stages of its development:
- Stage 1: the hard structures of the joint do not participate in the process of destruction, there are initial changes in its soft structures and in the composition of the joint fluid (which is a nutrient medium and reduces joint friction), there is malnutrition of the joint.
- Stage 2: accompanied by "starting" the mechanism of destruction of the rigid structures of the joint, marginal rigid formations (exostoses, osteophytes) are formed. Moderate complaints of changes in range of motion.
- Stage 3: accompanied by narrowing of the joint lumen, marked destruction of the loaded surface with the formation of osteochondral defects, severe restriction of movement, constant feeling of "crunching" during movement, initial changes in the axis of the limb.
- Stage 4: severe, in which movements are clearly limited in the joint to its complete absence (ankylosis), pronounced inflammatory process, its deformation, formation of bone defects (as a result of the complete absence of cartilage).
Complications of osteoarthritis
Without treatment, any disease causes complications and osteoarthritis is no exception. If this is the main form, then the main complications include:
- damage to the soft structures of the joint (degenerative ruptures of the menisci, ruptures of ligaments, etc. );
- chronic inflammatory process;
- ankylosis (complete lack of movement in the joint);
- joint deformation.
If it is a secondary form, then the complications depend on the process that caused the development of osteoarthritis. For example, it can lead to osteoporosis, a chronic disease characterized by a progressive disorder of bone metabolism. As a result, the bones become brittle, their nutrition is disrupted, as a result of which osteoarthritis is complicated by the threat of intra-articular fractures. That is why it is so important to visit a doctor on time. As the eminent surgeon wrote: "The future belongs to preventive medicine. "
Diagnosis of osteoarthritis
The diagnosis of osteoarthritis often begins with a doctor (usually an orthopedic traumatologist) from the first line of medical care (clinic), where a clinical examination is performed and the examination data (CT, MRI, X-rays, etc. ) are interpreted to determine the diagnosis. degree and type of osteoarthritis. . . The diagnosis and diagnosis are usually simple. If the diagnosis is unclear or the doctor suggests a secondary development of the disease, then for clarification the patient is referred to doctors from other specialties (eg rheumatologist). It is very difficult to determine the degree of osteoarthritis without the results of the examination. The history of the disease, methods and attempts at treatment are also important for diagnosing and determining treatment tactics, as the physician is often faced with the difficult task of differential diagnosis (for example, the symptoms of osteoarthritis and arthritis often coincide).
Treatment of osteoarthritis
The initial stagesof osteoarthritis amenable to conservative treatment, provided an integrated approach. Treatment takes a long time and pursues the main goal: either to stop the process of destruction at the stage at which treatment has begun, or to slow down this process. The complex includes medical and non-drug treatment, which includes courses of exercise (physiotherapy and gymnastics), physiotherapy (usually phonophoresis and magnetic therapy), swimming, anti-inflammatory therapy (ingestion or topically in the form of gels or creams), chondroprotective therapybased on cartilage components) and intra-articular injections (these can be both homeopathic medicines and hyaluronic acid preparations). Chondroprotectors are still used by orthopedic traumatologists, prescribed by internal courses, but the results of recent research in Western countries refute the positive effect compared to the placebo effect. In severe symptoms and severe stages, conservative treatment becomes ineffective, which puts surgical treatment first. Given the indications, this can be both minimally invasive treatment - arthroscopy and endoprosthesis. With arthroscopy (endoscopy of the joint) it is repaired under the control of video optics, exostoses are removed (if possible) and damage to soft structures, which is often observed at such stages. Recently, however, the benefits of this type of intervention for osteoarthritis are increasingly being questioned, as it does not have the desired effect in chronic pain, and in some cases can cause significant harm if performed incorrectly.
Endoprosthesis is a technically difficult and difficult operation, the purpose of which is to create an artificial, completely new joint. Requires clear indications and identification of risks in the presence of contraindications. Today, endoprostheses for knee, hip and shoulder joints are successfully used. Further outpatient monitoring by a doctor reduces the risks and time for rehabilitation, improves the quality and efficiency of the operation.
The prognosis depends on the timely visit to the traumatologist-orthopedist and the beginning of a complex of treatment. With regard to the elimination of morphological changes in osteoarthritis, the prognosis is unfavorable, as it is impossible to completely restore the cartilaginous structure of the joint. In old age, the course of the disease is more severe than in young people. However, with timely access to a doctor and compliance with all recommendations, it is possible to eliminate all complaints and restore full motor function of the joint.
- Regular physical activity.It is a misconception that physical activity can "wear out". Increased - yes, but not regularly and moderately. According to recent data, any activity aimed at strengthening and maintaining muscle mass, improving coordination, supports the motor function of the joints and theirAny physical activity allows you to achieve regular circulation of joint fluid, which is the main source of nutrition for the joint and its structures. It is known that people who use public transport every day and have pedestrian traffic are less likely todevelop osteoarthritis.
- Weight control and adequate weight loss.The increased mass increases the load on the joints of the lower limbs and spine. Therefore, any protocol for rehabilitation and conservative treatment of osteoarthritis includes a course of LFT (physiotherapy and gymnastics).
- Correction and removal of congenital deformities.An important role is played by the flat foot, which over the years leads to a violation of the axis of the legs, which leads to an increased disproportionate load on certain parts of the joints and spine, deforming them.
- Good nutrition.Allows you to create conditions for complete enrichment of the joint with nutrients. Therefore, the rejection of a large number of foods, frequent diets, irregular eating of low-nutrient foods (fast food, etc. ) can become a "trigger" for the development of osteoarthritis.
- Timely elimination of concomitant diseases.The already forgotten medical examinations made it possible to identify and eliminate diseases at an early stage. Concomitant diseases can be a significant cause of the development and progression of osteoarthritis (eg diseases of the endocrine system, gastrointestinal tract, chronic foci of infection or inflammation).