Knee arthritis
The content of the article:
- Knee arthritis causes
- Forms of the disease
- Stages
- Knee arthritis symptoms
- Diagnostics
- Knee arthritis treatment
- Possible complications and consequences
- Forecast
- Prevention
Arthritis is a degenerative-dystrophic disease of the connective tissue that affects the articular apparatus in conjunction with the adjacent tissues and auxiliary structures.
Knee arthritis, a common degenerative disease of the musculoskeletal system
Arthritis is characterized by:
- chondritis - inflammation of the articular cartilage;
- osteitis - inflammatory changes in bone structures adjacent to cartilaginous tissues;
- synovitis - inflammation of the joint capsule;
- inflammatory changes in soft tissues and ligamentous apparatus in the projection of the joint.
In the structure of degenerative joint diseases, arthritis of the knee joint occupies a dominant position: it is diagnosed in approximately 10–20% (in some age groups - up to 80%) of the population of mature and old age (women get sick 2 times more often), accounting for a third of all osteoarthritis. By 2020, the number of patients with arthritis of the knee is projected to double, which is associated with increased workload and an aging population.
Every 8 out of 10 people suffering from this disease note a significant deterioration in the quality of life, in 2 out of 10 it leads to the formation of disability.
Synonyms: gonarthritis, gonarthrosis, osteoarthritis or osteoarthritis of the knee joint, deforming osteoarthritis.
Knee arthritis causes
Gonarthritis, like any other degenerative joint disease, develops due to an imbalance between the processes of synthesis and degradation in the cartilaginous and adjacent bone tissues, resulting in the destruction of cartilage.
If normally neoplasm processes prevail, then with arthritis this balance shifts towards an increase in dystrophy and subsequent tissue degeneration. Initial changes at the cellular level lead to disruption of tissue hemostasis, the fine structure of the knee joint cartilage is modified (foci of turbidity, thinning and razvlecheniya, microcracks and ruptures are revealed). Due to the ongoing structural rearrangements, the cartilage loses its elasticity, its amortization function suffers, the interposition of the articulating surfaces is disturbed, aggravating the degradation.
Compensatory, in response to the thinning of the cartilaginous layer, compaction and growth of the adjacent bone tissue begins, bone outgrowths and spines are formed, complicating the adequate functioning of the knee joint and aggravating the course of the disease.
In addition to the theory of the development of arthritis of the knee joint, in which the fundamental role is played by degenerative changes in the articular cartilage, there is an assumption about the primary damage to the bone tissue of the articular surfaces.
According to this concept, microcirculation is disturbed in the thickness of the heads of the bones that form the articulation, venous stasis develops, and foci of intraosseous microinfarctions are formed. Against the background of blood supply disturbances, there is a depletion of the mineral composition of the bone tissue, its rarefaction and micro-restructuring. The spectrum of such changes cannot but affect the state of the nearby cartilage tissue, leading to its pathological changes.
The main causes of knee arthritis are:
- previous injury (contusion, intra-articular fracture, rupture of ligaments, menisci, penetrating injuries of the knee joint);
- chronic trauma (professional arthritis of the knee joint in parachuting sportsmen, athletes, hockey players, football players, gymnasts, dancers, manual workers, etc.);
- postponed acute inflammatory diseases of the knee joints;
- autoimmune diseases of the connective tissue;
- chronic diseases in which inflammation of the knee joint is one of the symptoms (psoriasis, tuberculosis, syphilis, etc.).
Factors Contributing to the Development of Knee Arthritis
In addition to acquired causes, the development of arthritis of the knee joint can be caused by mutations in the collagen type II gene (COL2A1) or the VDR gene that controls the vitamin D-endocrine system, which are passed from parents to offspring in an autosomal recessive or dominant manner (X-linked inheritance is not excluded).
Risk factors for arthritis of the knee joint are more often associated with increased stress on the axial skeleton or with impaired trophism of the articular apparatus:
- female sex (the risk of developing gonarthritis increases during menopause);
- overweight;
- metabolic diseases;
- diseases of the vascular system, accompanied by local blood supply disorders, increased capillary fragility;
- elderly age;
- endocrine disorders;
- anomalies in the structure of the joints;
- scoliosis;
- connective tissue dysplasia;
- O- and X-shaped installation of the thigh (curvature of the axis of the lower limb);
- flat feet;
- vascular disease of the lower extremities.
Forms of the disease
Depending on the reasons, the following forms of pathology are distinguished:
- primary (idiopathic gonarthritis);
- secondary.
In accordance with the objective picture of changes in the articular apparatus, arthritis of the knee joint is classified in several ways.
Radiological classification according to Ahlbäck:
- Narrowing of the joint space (less than 3 mm).
- Closure of the joint space.
- Minimal bone defect (0–5 mm).
- Moderate bone defect (5–10 mm).
- Severe bone defect (> 10 mm).
X-ray classification according to Kellgren (Kellgren & Lawrence):
- Doubtful stage (minor osteophytes).
- The minimum stage (pronounced osteophytes).
- Moderate stage (moderate narrowing of the joint space).
- Severe stage (pronounced narrowing of the joint space with subchondral sclerosis).
Stages of rheumatoid arthritis of the knee joint
Depending on the severity:
- compensated gonarthritis - pain syndrome is absent or appears after intense exertion, the joint is stable, its functioning is not disturbed;
- subcompensated - the pain syndrome is more pronounced, there is a partial drug dependence, periodically when walking, auxiliary means are used, there is a slight instability of the joint and a partial limitation of its functionality;
- decompensated - constant pain syndrome requiring medical correction, dependence on analgesics, the need for constant orthopedic unloading (cane, crutches), the joint is unstable, its mobility is sharply limited.
Stages
Determination of the stage of arthritis of the knee joint is based on an assessment of the clinical signs of the disease and radiological data in the aggregate:
- A slight narrowing of the joint space, determined by X-ray examination, moderate subchondral sclerosis; clinically characterized by pain after or during exercise, which stops at rest, active and passive movements in the joint are preserved in full.
- The joint gap is narrowed by 2-3 times, signs of pronounced subchondral osteosclerosis, single bony growths along the edges of the joint space and / or in the area of the intercondylar eminence; clinically - moderate pain syndrome, limited joint mobility, gait disturbance, mild frontal deformity of the axis of the affected limb.
- The clinical picture is characterized by persistent flexion-extensor contractures, pain is constant, aggravated by a slight load, the change in gait is pronounced, there is joint instability, atrophy of the muscles of the thigh and lower leg; radiographically - significant deformation and sclerosis of the articular surfaces, local foci of rarefaction of bone tissue, the joint space is slightly preserved or closed, extensive bone growths and free articular bodies are determined.
Knee arthritis symptoms
The most significant symptoms of the disease include:
- soreness in the projection of the affected joint;
- dysfunction of the joint;
- changing the habitual walking stereotype.
Pain in arthritis of the knee joint initially worries patients exclusively during exertion (especially when walking uphill, descending and climbing stairs, while playing sports, prolonged standing) and subsides at rest. Often, soreness in the affected joint appears in the late afternoon, sometimes in damp, cold weather. Painful sensations are associated with patients' complaints about the need for additional support (for example, a cane), difficulty in trying to sit down or get up from a chair or chair. Arthritis of the knee joint is characterized by local tenderness to palpation, especially in the projection of the joint space.
With arthritis of the knee joint pain worries
Functional disorders are manifested by a decrease in the amplitude of both passive and active movements (initially - flexion, and later extension of the affected joint), a feeling of "jamming".
Other symptoms of knee arthritis include:
- swelling, local temperature rise in the projection of inflammation;
- deformation of the affected joint;
- change in the axis of the limb;
- lameness;
- crunch when moving;
- morning stiffness (limitation of mobility after waking up, disappearing within 10-30 minutes after the start of active movements).
Knee arthritis is a chronic progressive disease that has a wave-like course and occurs with alternating periods of remission and exacerbation, which can be triggered, for example, by physical exertion or exposure to environmental factors.
Diagnostics
The diagnosis of "arthritis of the knee joint" is confirmed on the basis of the characteristic clinical picture of the disease and the results of instrumental and laboratory research methods.
With this disease, there are no specific laboratory indicators, general signs of inflammation are characteristic - leukocytosis, accelerated ESR in the general blood test and indicators of the acute phase in the biochemical. Currently, a search is underway for laboratory markers of arthritis that would allow diagnosing the disease at an early preclinical stage.
The main instrumental diagnostic method for arthritis of the knee joint is X-ray. The study is carried out in 3 projections: straight, standing, lateral lying with the joint bent at 20–35 °, axial (along the long axis). There are a number of specific criteria that confirm the presence of the disease:
- narrowing of the joint space;
- thinning of the cartilage;
- osteophytes (pathological bone outgrowths), "articular mice" (fragments of osteophytes);
- sclerotherapy of bone tissue of articular surfaces, bone cysts;
- flattening and deformation of articular surfaces;
- curvature of the axis of the limb.
X-rays for arthritis of the knee
In addition to X-ray examination, the following methods are also used to confirm the diagnosis:
- atraumatic arthroscopy;
- ultrasonography (assessment of the thickness of the articular cartilage, synovium, the size of the supra- and intrapatellar bursae, the presence of fluid);
- CT scan;
- magnetic resonance imaging;
- scintigraphy (assessment of the state of the bone tissue of the heads of the bones that form the joint).
Knee arthritis treatment
Treatment of the disease is carried out in several directions: pharmacological correction, physiotherapeutic effects, lifestyle modification. Operative methods of treatment are used not only with the ineffectiveness of the conservative, there are a number of manipulations carried out even in the early stages of the disease in order to minimize clinical manifestations.
Lifestyle modification is understood as a change in the stereotype of physical activity, elimination of risk factors, a rational mode of work and rest, weight loss with the help of diet, and rejection of bad habits.
Drug treatment of knee arthritis is carried out with the following drugs:
- non-steroidal anti-inflammatory drugs - used to relieve pain, relieve signs of inflammation during exacerbation of the disease;
- glucocorticosteroid hormones (intra-articular injection to stop the symptoms of synovitis) - are used limited, in cases where it is necessary to eliminate painful symptoms as soon as possible;
- anti-enzyme agents (proteolysis inhibitors) - prevent the progression of dystrophic and degenerative processes in cartilage and bone tissues;
- antispasmodics - allow you to eliminate local muscle spasm in the damaged segment;
- anabolic drugs - accelerate the regeneration of damaged tissues;
- angioprotectors - help to strengthen the walls of the vessels of the microvasculature, providing adequate blood supply to the damaged area;
- agents that improve microcirculation;
- chondroprotectors (despite the massive distribution of chondroprotectors in the treatment of arthritis, their clinical efficacy has not been proven in large placebo-controlled studies).
Intra-articular glucocorticosteroid injections help relieve symptoms of knee arthritis
Physiotherapy techniques used to treat gonarthritis are very diverse:
- massage of regional muscles, which improves blood circulation and relieves local spasm;
- acupuncture;
- active kinesiotherapy using simulators;
- physiotherapy;
- laser therapy;
- UHF exposure;
- ultrasound treatment;
- diadynamic therapy (exposure to direct currents with a frequency of 50 and 100 Hz);
- amplipulse therapy (action on the joint area with alternating sinusoidal current with a frequency of 5 kHz);
- darsonvalization (use of high frequency pulsed current);
- interference therapy (exposure to alternating current pulses of two different frequencies);
- therapeutic baths, mud, paraffin therapy.
With the ineffectiveness of the listed methods of exposure, in the presence of complications, they resort to surgical treatment of arthritis of the knee joint:
- decompression of the metaepiphysis and prolonged intraosseous blockade (decrease in intraosseous pressure in the affected area);
- corrective osteotomy;
- endoprosthetics of joints.
Knee replacement surgery can eliminate arthritis
In the early stages of the disease, mechanical, laser or cold plasma debridement is used (smoothing the surface of damaged cartilage, removing non-viable areas). This method effectively relieves pain, but has a temporary effect - 2-3 years.
Possible complications and consequences
Knee arthritis can have the following complications:
- stiffness or immobility of the knee joint;
- lesion of the hip joint both on the side of the lesion and on the opposite side (due to the redistribution of the load).
Forecast
Unlike coxarthrosis, which leads to disability, arthritis of the knee joint is much easier, however, due to the developing synovitis, a decrease in working capacity is possible, social activity suffers, sometimes very significantly.
The favorableness of the prognosis directly depends on the timeliness of the diagnosis and the initiation of drug and physiotherapy treatment. The prognosis worsens when the decision on the issue of surgical treatment of the disease is delayed, if necessary.
Prevention
- Timely full-fledged treatment of acute injuries of the knee joint in the event of their occurrence with mandatory subsequent rehabilitation.
- Treatment of the underlying disease associated with the risk of secondary arthritis.
- Body weight control.
- Dosed physical activity.
- Correction of existing violations of the biomechanics of the axial skeleton (flat feet, scoliosis).
- Elimination of the impact of damaging factors (wearing shoes with excessively high heels, hypothermia of the joints, prolonged static load).
- Dynamic outpatient observation by a rheumatologist, orthopedist when making a diagnosis.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
