Arthrosis

Arthrosis - what is it in simple words?

Arthritis is a chronic pathology in which the cartilage plate is gradually destroyed. Pathological changes affect the underlying bone, it becomes more compact and marginal growths (osteophytes) develop. The articular capsule reacts to the events and reactive vasculitis develops.

About the disease and possible complications

The frequency of pathology depends on age. The first signs of arthrosis usually appear no later than 30-35 years of age, and by the age of 70, about 90% of the population suffers from this pathology. Arthrosis does not show any gender differences. The only exception is degenerative damage to the joints between the carpal phalanges. This form of the disease is 10 times more common in women than in men. Arthrosis mostly affects the large joints of the feet and arms.

The pathological process begins with the interstitial substance of the cartilage tissue, which contains type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is ensured by balancing the processes of anabolism and catabolism. If the process of breakdown of cartilage tissue dominates its synthesis, conditions are created for the development of arthrosis. This explains what osteoarthritis is in simple terms.

Often, the first signs of the disease develop where there is the greatest mechanical load, limited areas of softening of the cartilage plate appear. As the pathological process progresses, cartilage fragments and cracks, local deposition of calcium salts are possible. Under cartilage defects, the underlying bone is exposed, separated pieces of cartilage enter the articular cavity and can result in the so-called "squeezing" ("joint mouse" symptoms).

Damage to the cartilage surrounding the articular processes of the bones causes them to lose their ideal shape and repeat each other's contours. As a result, when moving, the articular surfaces experience a non-physiological load. In response to this, compensatory resynthesis processes in bone tissue are stimulated. The bone becomes dense (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further changes the misalignment between the joint surfaces. Developing pathological changes gradually limit the range of motion in the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the joint synovial membrane. This is due to the fact that dead fragments of cartilage and bones activate phagocytic leukocytosis, which is accompanied by the release of proinflammatory mediators. Over time, such long-term inflammation is accompanied by sclerosis of periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthrosis is pain, accompanied by limited mobility in the joint over time. Limitation of mobility is primarily of a compensatory functional nature, and then it is related to organic changes. Additional imaging diagnostic methods (x-ray, ultrasound scan, computed tomography or magnetic resonance imaging) help to make a correct diagnosis.

Depending on the stage and degree of arthrosis, treatment can be carried out by conservative or surgical methods. An orthopedic traumatologist will help to choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of arthrosis

There are 2 types of arthrosis:

1. The primary variant is the result of the disruption of the connection between the processes of synthesis and degeneration in the cartilage tissue and is accompanied by the disruption of the function of chondrocytes, the main cells of the cartilage tissue.
2. The secondary option occurs in a previously modified joint, when the normal connection (fit) of the articular surfaces is disturbed, then redistribution of the load to them and concentration of pressure in certain areas.

Symptoms of joint arthrosis

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

1. Mechanical pain, resulting from the loss of shock absorption properties of cartilage. Painful sensations arise during physical activity and are relieved during rest.
2. Night pain.It causes stagnation of venous blood and an increase in the pressure of the blood flowing inside the bone.
3. Onset pain.It is short-lived and appears in the morning when a person gets out of bed (the patient says that he needs to "break down"). These pains are caused by the deposition of detritus in the cartilaginous plates, during movement, these fragments are pushed into the articular inversions, so the unpleasant sensations stop.
4. Addiction to Meteor.Pain can intensify when weather conditions change (increased atmospheric pressure, cold weather, excessive humidity).
5. Blocked pain.These are sudden painful sensations associated with the compression of a piece of bone or cartilage between the articular surfaces. Against the background of "blockage", the smallest movements in the joint stop.

When secondary synovitis occurs, the nature of the pain changes slightly. In this case, the pain is constant. In the morning, a person is worried about joint stiffness. Signs of the inflammatory process are determined objectively - swelling and a local increase in skin temperature.

Osteoarthritis usually starts slowly with the onset of pain in one affected joint. At first, the pain bothers you only during physical activity, but later it appears even at rest and during night sleep. Over time, pain is also felt in the joints of the opposite side, which is associated with a compensatory increase in load. An important distinguishing feature of arthrosis is the frequency of short periods of exacerbation followed by periods of remission. The progression of the pathological process is indicated by the shortening of the inter-relapse period and the development of negative results in the form of contracture and a sharp limitation of mobility in the joint.

Course of arthrosis during pregnancy

During pregnancy, arthrosis can occur in different ways. Usually, up to 12-13 weeks, an exacerbation of the pathological process associated with hormonal changes in a woman's body may occur. The second and third trimesters are usually relatively stable. Pregnancy management is performed by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint arthrosis

The main mechanism that causes the destruction of cartilage is the disruption of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthrosis is related to the cycle of metabolic disorders that occur secretly. This metabolic imbalance is characterized by damage to proteoglycans and their constituents (chondroitin, glucosamine, keratan) accompanied by breakdown and disintegration of the cartilage matrix. In the cartilage plate, collagen fibers are broken, the supply of metabolites necessary for life is disturbed, and the water balance changes (at first, the cartilage is hydrated, and then the number of water molecules decreases sharply, which further stimulates cracking).

Primary pathological processes have a negative effect on chondrocytes, which are very sensitive to the surrounding matrix. Changes in the quality characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. With arthrosis, a cytokine "boom" is also observed - released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of arthrosis can be different:

• "excess" weight, which increases the load on the joints;
• wearing low-quality shoes;
• accompanying diseases of the musculoskeletal system;
• injured his joints.

Symptoms and diagnosis of joint arthrosis

Based on clinical symptoms, the radiologist makes a preliminary diagnosis. Additional imaging tests are performed to confirm this.

1. Radiography.In the early stage, X-ray signs of the disease are of little importance - they can be uneven narrowing of the joint cavity, some compression of the main bone, and small cysts in this area. At a later stage, radiography is more informative - marginal bone growths are visible, the shape of the articular surfaces changes, articular "mice" and areas of calcification in the capsule can be identified.
2. Ultrasound of joints.Ultrasound examination is more informative to detect the initial signs of arthrosis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate, and secondary reactions of the capsule, muscle and ligament parts may be seen.
3. Computer or nuclear magnetic tomography. This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilage plate, the subchondral region of the bone, and determine the volume of synovial fluid. in articular inversions.

Expert opinion

Deforming arthrosis of the joints is one of the most common pathologies of the musculoskeletal system, occurring in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. At first, these are short-term pains in a joint that a person often does not pay attention to. Gradually, the severity of the pain syndrome becomes more intense, and the periodic nature of the pain becomes stable. In the absence of treatment, the disease continues to progress and is accompanied by severe degeneration of cartilages that no longer respond to conservative therapy, and only arthroplasty is required to solve this problem - a complex and expensive intervention to replace the destroyed joint with a complete one. -legal implant. However, targeted drug therapy and lifestyle changes can help significantly delay or prevent this surgery altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Treatment of arthrosis

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

Conservative treatment

Unloading the connection is carried out in the following ways:

• decrease in body weight (if there is excess);
• conducting physical therapy that excludes long-term similar poses;
• refusal to lift large loads or stay on the knees for a long time (suitable for some professions).

In the early stages of the disease, along with physical therapy, swimming and cycling are useful. In the later stages, it is recommended to walk with an orthopedic stick or use crutches to loosen the joint during exacerbation.

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

To improve the anatomical and functional condition of the cartilage 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 to slow down the development of the pathological process and improve mobility in the joint.

Surgery

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

• Joint puncture- indicated for severe reactive synovitis. This allows not only the removal of inflammatory fluid, but also the administration of corticosteroids, which interrupt the pathological chain.
• Arthroscopic operations, insertion of instruments into the joint cavity through small punctures and subsequent visualization under magnification. These interventions include washing the joint and its inversions, straightening the cartilaginous plate, removing necrotic areas, "polishing" the articular surfaces, etc.
• Endoprostheses- is considered a radical operation performed during an advanced pathological process. It is typically used for osteoarthritis of the knee or hip joint.

Prevention of arthrosis

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

Rehabilitation of arthrosis of joints

Rehabilitation of arthrosis of the joints includes a number of procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and rehabilitation gymnastics are used.

Questions and answers

Which doctor treats arthrosis?

Diagnosis and treatment is carried out by a traumatologist-orthopedic.

Does X-ray always make the correct diagnosis?

The severity of clinical signs of arthrosis is not always associated with radiological changes. Often in practice, with severe pain, radiography does not reveal significant changes, and vice versa, a "bad" X-ray image is not accompanied by significant symptoms.

Is diagnostic arthroscopy done for arthrosis?

If you suspect arthrosis, arthroscopy is usually performed not to make a diagnosis, but to look for the causes that may cause the functional state of the joint to be impaired (for example, damage to the meniscus of the knee joint and intra-articular ligaments).