Arthrosis is a chronic pathology affecting the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course with gradual destruction of cartilage tissue.Arthrosis is detected in most patients after the age of 65, because one of the reasons for its development is the natural aging of the body.
The occurrence of degenerative-dystrophic pathology is related to previous injuries, endocrine and inflammatory diseases, excessive physical activity or, conversely, a sedentary lifestyle.The leading symptoms of arthrosis are joint pain, swelling and limitation of movement.
Instrumental studies are carried out for pathological diagnosis - X-ray, arthroscopy, MRI, CT.1st and 2nd degree arthrosis is treated with a course of conservative treatment, drug treatment, physiotherapeutic and massage procedures, and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprosthetic.
Pathogenetic mechanisms
With arthrosis, there are obvious changes in the internal connective tissue structures.Deforming erosions occur in the cartilage tissue, which leads to the destruction of collagen fibers, as well as proteoglycans consisting of protein (5-10%) and glycosaminoglycans (90-95%).As a result, the collagen network loses its stability and metalloproteinases begin to be secreted, destroying all types of extracellular matrix proteins.Destruction is accelerated by increased biosynthesis of collagenases and stromelysin.Typically, normal quantitative values of enzymes are controlled by cytokines - small peptide information molecules.However, as arthrosis progresses, the concentration of these proteins decreases, which leads to the release of a large number of enzymes that damage the cartilage tissue.
Proteoglycans with a changed structure begin to absorb water molecules that they cannot hold.Therefore, excess liquid enters the collagen fibers.They "swell" and lose strength and elasticity.There are also negative changes in the quality and quantity of synovial fluid.With arthrosis, the concentration of hyaluronic acid in it decreases.Hyaline cartilage no longer receives enough nutrients and oxygen to regenerate.Softening foci are formed in cartilage tissue, followed by cracks and specific necrotic growths.When the bone heads are displaced relative to each other, they are exposed and begin to experience microtrauma.
Causes and precipitating factors
The causes of the development of primary (idiopathic) arthrosis have not yet been determined.It occurs in the absence of any provoking factor, therefore, theories are put forward about the hereditary tendency to premature destruction of cartilage.Secondary arthrosis develops as a result of other joint pathologies or previous injuries.What can cause degenerative-dystrophic disease:
- damage to the joint or nearby connective tissue structures - fracture, dislocation, meniscus damage, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of endocrine glands, disruption of metabolic processes;
- rheumatism or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococci, epidermal or Staphylococcus aureus;
- tuberculosis of any location, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative disease, for example, osteochondritis dissecans.
Hypermobility of the joints caused by the production of special collagen leads to the development of arthrosis.This condition is found in 10% of the planet's inhabitants and is not considered a pathology.However, hypermobility is accompanied by weakness of the tendon-ligament apparatus, which often leads to injuries, especially to the ankle joint (ligament sprains and ruptures, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders such as hemophilia.Hemarthrosis or bleeding into the joint cavity leads to deterioration of cartilage trophism and its destruction.
Predisposing factors include old age, frequent loads on joints that exceed strength limits, excess weight, surgical interventions, and hypothermia.
The risk group includes women during menopause, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.If there is a lack of foods containing vitamins and trace elements in the diet, prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of arthrosis is the absence of symptoms in the first stage of its development.The pathology manifests itself gradually clinically, the first signs appear against the background of significant destruction of cartilage tissue.At the beginning, a person feels a mild pain that does not have a clear localization.Appears after physical activity - weight lifting, sports exercises.Sometimes the first clinical manifestation is a crackling or clicking sound when the joint is flexed or extended.One begins to notice that some actions are difficult.But in the initial stage of arthrosis, stiffness occurs in the morning and disappears soon.
As the disease progresses, the pain is also felt at night, causing not only sleep disturbances, but also the appearance of chronic fatigue.In the second stage, the severity of the pain syndrome increases with changes in weather conditions, exacerbation of chronic pathologies, and acute respiratory viral infections.The range of motion is noticeably reduced.Stiffness is caused by the thinning of the cartilage, as well as by a person's conscious restriction of movement to avoid pain.This causes an increased load on the opposing joint, which leads to more damage.Arthrosis is also characterized by other specific symptoms:
- pain causes spasms of skeletal muscles and the development of muscle contractures (restriction of passive movements in the joint);
- creaking, clicking, cracking sounds in the joints are constant when moving, occur with almost every displacement of the bones relative to each other;
- painful muscle cramps often occur;
- the joints are deformed, which leads to a violation of posture and gait;
- in the third stage of arthrosis, the deformation is so obvious that the joints bend and the range of motion in them is significantly reduced or completely absent;
- with third-degree arthrosis of the knee, ankle, hip joint, the patient uses a cane or crutches when moving.
In the absence of treatment, the pathology progresses, and in its course remissions are replaced by relapses, and the frequency of exacerbations increases all the time.The stiffness in the morning movements does not disappear for a long time, it becomes permanent.
When examining a patient with grade 1 arthrosis, the doctor notes only slight swelling of the joint and complete protection of the range of motion.In the 2nd degree pathology, pain and slight deformation are detected during palpation.Bone thickening is observed in the area of the joint space.
Arthrosis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Their leading symptom is the formation of a round seal in the joint area when pressure is applied, where fluid movement (shift) is felt.Acute synovitis may be accompanied by an increase in temperature up to 37-38 °C, headaches, digestive system disorders.
Diagnostics
The diagnosis is based on the results of instrumental studies, characteristics of the clinical picture, anamnesis and patient complaints.A general blood and urine test is not very informative - if arthrosis is not caused by metabolic pathology, all values remain within the normal range.With the development of synovitis, the rate of sedimentation of erythrocytes increases (30 mm/h), the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.Changes in biochemical and immunological parameters occur in secondary forms of arthrosis.
The most informative method for the diagnosis of degenerative-dystrophic pathology is radiography in frontal and side projection.
| Stages of arthrosis according to the Kellgren-Lawrence classification (1957) | X-ray signs of pathology |
|---|---|
| Primary | No radiological signs |
| First | Indefinite, uneven narrowing of the joint cavity.Slight straightening of the edges of the bone plates, the formation of primary osteophytes or their absence |
| Second | Marked narrowing of the joint cavity, which is 2-3 times higher than normal, the formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic cavities in the epiphyses |
| the third | The appearance of clear subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| The fourth | The formation of rough massive osteophytes, almost complete fusion of the joint cavity, deformation and compression of the epiphyses of the bones forming the joint. |
After studying the X-ray images, if the doctor doubts the diagnosis, a CT scan is prescribed.And MRI is performed to assess the condition of the connective tissue structures located near the joint.When using contrast, it is possible to dynamically evaluate the blood supply of tissues and determine the stage of the inflammatory process during the development of synovitis.
Basic therapy methods
Arthritis is still an incurable disease, because there are no pharmacological drugs for the regeneration of cartilage tissue.The main goal of therapy is to prevent the development of pathology and maintain joint mobility.Treatment is long-term, complex, using both local and systemic drugs.Patients should avoid heavy stress on the joint and, if necessary, limit the range of motion with orthopedic devices - orthoses, elastic bandages.Overweight patients should gradually adjust their diet to reduce body weight and adhere to the diet.
After achieving stable remission, patients are shown daily physiotherapy exercises.The first exercises are conducted under the guidance of a physiotherapist, then the patient performs a series of exercises at home.Exercise therapy can be supplemented with swimming, yoga and cycling.
Medicines of various clinical and pharmacological groups are prescribed to reduce the severity of pain:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active substances;
- injections of a combination of anesthetic solutions with glucocorticosteroids;
- muscle relaxants to relieve muscle spasms and restrictive contractures.
Therapeutic regimens include B vitamins, sedatives and, if necessary, tranquilizers and antidepressants.Chondroprotectors are required for long-term use.This is the only drug group that has the ability to partially restore cartilage tissue.
To increase their clinical activity, physiotherapeutic procedures - laser therapy, magnetic fields, UHF therapy are performed.
Any pain in the joints should be a signal to consult a doctor immediately.Therapy in the early stages of osteoarthritis will stop cartilage destruction and prevent loss of performance and disability.