Arthrosis - Symptoms, Treatment, Diet, Gymnastics, Exercise, Degree

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-11 02:57

Arthrosis

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Stages of arthrosis
4. Symptoms of arthrosis
5. Diagnostics
6. Arthrosis treatment
7. Possible complications and consequences
8. Forecast
9. Prevention

Arthrosis is a collective name for dystrophic-degenerative diseases of the articular apparatus of different localization and etiology, with a similar clinical and morphological picture and outcome and manifested by the defeat of articular cartilage, subchondral bone formations, capsules, ligamentous apparatus.

Joint changes in arthrosis

Arthrosis is the most common pathology in rheumatological practice; according to medical statistics, up to 1/5 of the entire population suffers from it. Osteoarthritis is the cause of a significant decrease in the quality of life in about half of patients, most of whom are disabled. The incidence directly depends on age: arthrosis rarely occurs at a young age, debuts most often after 40-45 years, while in people over 70 years of age, radiological signs are determined in the vast majority of cases. At a young age, the incidence is approximately 6.5%, after 45 years - 14-15%, after 50 years - 27-30%, in people over 70 years old - from 80 to 90%.

Most often, with arthrosis, the pathological process involves the small joints of the hand (in women 10 times more often than in men), the big toe, the intervertebral joints of the thoracic and cervical spine, as well as the knee and hip joints. Arthrosis of the knee and hip joints takes the leading place in terms of the severity of clinical manifestations and a negative impact on the quality of life.

Arthrosis is characterized by a complex lesion of the articular and auxiliary apparatus:

• chondritis - inflammatory changes in the cartilage of the joint;
• osteitis - involvement of underlying bone structures in the pathological process;
• synovitis - inflammation of the inner shell of the joint capsule;
• bursitis - damage to the periarticular bags;
• reactive inflammation of soft tissues (muscles, subcutaneous tissue, ligamentous apparatus) located in the projection of the involved joint (periarticular inflammation).

Since the root cause of arthrosis is inflammatory changes, in a number of Western countries it is customary to call the disease arthritis (from Latin -itis - a suffix denoting an acute inflammatory process). In Russian medicine, the terms arthritis and arthrosis are found equally often and imply the same pathological process. Recently, in rheumatological practice, the most commonly used term is "osteoarthritis" (from ancient Greek.

For the first time the allocation of degenerative-dystrophic lesions of the joints in a separate group was proposed in 1911 by Muller ("arthrosis deformans"). All subsequent years, arthrosis was considered to be a chronic progressive non-inflammatory lesion of the joints of unknown etiology, manifested by degeneration of the articular cartilage and structural changes in the subchondral bone in combination with overt or latent moderately expressed synovitis. A clear connection between the disease and aging was emphasized, which was indirectly proved by the increase in the number of diagnosed arthrosis with increasing age of patients.

Currently, the approach to understanding arthrosis has changed dramatically: the disease is viewed as an aggressive process of destruction of the cartilage tissue of the joint under the influence of inflammation, which requires mandatory active anti-inflammatory therapy.

Synonyms: arthritis, osteoarthritis, osteoarthritis, osteoarthritis deformans.

Causes and risk factors

In the scientific community, there is a controversy about the root cause of joint damage. Some researchers assign the main role to damage to the cartilage covering of the articular surfaces under the influence of various factors, which leads to a violation of the biomechanics of the joint and dystrophic changes in the structures surrounding it. Others, on the other hand, see the root cause in the defeat of the surface layer of the articulating bone structures that form the joint (for example, due to a violation of microcirculation), and consider dystrophy and degeneration of cartilage as secondary changes.

A more consistent theory seems to be that inflammatory changes develop in parallel and in the thickness of the bones that form the articular surfaces, and in the tissues of the corresponding cartilage. In this case, the joint affected by arthrosis is considered not as a set of cartilaginous and bone structures with an auxiliary ligamentous-muscular apparatus, but as a single organ with common immune, trophic, and metabolic characteristics.

The mechanism of development of arthrosis

Arthrosis of any joint develops according to a single scheme: an imbalance of anabolic and catabolic processes (neoplasms and destruction) in the cartilage and adjacent bone tissue leads to irreversible damage to the articular structures. If in a normal joint the processes of synthesis are much more active than the processes of degradation, then with arthrosis this balance shifts towards an increase in dystrophy and subsequent degeneration of tissues. Changes at the cellular level lead to a disruption in the constancy of the internal environment, the microstructure of the articular cartilage is damaged (foci of opacity, thinning and razvlecheniya, microcracks and ruptures are revealed). In foreign literature, these processes are referred to as "wear and tear" - abrasion and cracking.

The consequence of degenerative tissue degeneration is the loss of elasticity of the articular cartilage, its compaction, depreciation function becomes insolvent, the interposition (congruence) of the articular surfaces is disturbed, which provokes the progression of pathological changes, a kind of vicious circle is formed. Compensatory, in response to the thinning of the cartilaginous layer, the compaction and growth of the adjacent bone tissue begins, bone outgrowths and spines are formed, complicating the adequate functioning of the joint and aggravating the course of the disease.

In addition to the concept of arthrosis development, in which the leading role is assigned to dystrophic changes in the cartilage tissue of the joint, there is an assumption about the primary lesion of the bone tissue of the articular surfaces.

In accordance with this theory, microcirculation is disturbed in the thickness of the heads of the bones that form the mobile connection, venous stasis develops, and foci of intraosseous microinfarctions are formed. Against the background of impaired blood supply, depletion of the mineral composition of the bone occurs, which leads to structural restructuring of the tissue, the appearance of microscopic foci of osteoporosis. The spectrum of such changes cannot but affect the state of the nearby cartilaginous tissue, leading, accordingly, to its pathological changes.

A significant role in the formation of arthrosis is assigned to pathological reactions from the synovial membrane, the inner lining of the joint capsule: microfragments of the destroyed cartilage enter the intra-articular fluid, activating inflammatory mediators, lytic enzymes, and autoimmune mechanisms, and thereby intensify destructive processes.

The main trigger for arthrosis of any localization is an acute or chronic discrepancy between the load to which the joint is exposed and its functional capabilities, the ability to adequately withstand this load.

Causal factors that most often provoke the development of arthrosis:

• previous acute traumatic injury to the joint (rupture or tear of ligaments, contusion, dislocation, intra-articular fracture, penetrating wounds);
• excessive systematic loads associated with a certain type of activity (for professional athletes, dancers, persons involved in hard physical labor, etc.);
• obesity;
• local exposure to low temperatures;
• chronic diseases in which local microcirculation suffers (endocrine pathology, pathology of the vascular bed, etc.);
• suffered acute infectious diseases;
• changes in hormonal levels (pregnancy, premenopausal and menopause);
• autoimmune diseases involving damage to connective tissue;
• connective tissue dysplasia (congenital weakness of this type of tissue, accompanied by hypermobility of the joints);
• genetic pathology - a defect in a gene localized on chromosome 12 and encoding type II procollagen (COL2A1) or VDR of the gene that controls the vitamin D-endocrine system;
• congenital structural and functional anomalies of the articular apparatus;
• mature, old and senile age;
• bone loss (osteoporosis);
• chronic intoxication (including alcohol);
• transferred surgical interventions on the joints.

Factors contributing to the development of arthrosis

In most cases, arthrosis has a polyetiological nature, that is, it develops under the combined influence of several causal factors.

Forms of the disease

Depending on the etiological factor, there are two main forms of arthrosis:

• primary, or idiopathic arthrosis - develops independently against the background of complete well-being, without connection with the previous pathology;
• secondary - is a manifestation or consequence of any disease (psoriatic, gouty, rheumatoid or post-traumatic arthrosis).

Depending on the number of joints involved:

• local, or localized - monoarthrosis with damage to 1 joint, oligoarthrosis - 2 joints;
• generalized, or polyarthrosis - arthrosis of 3 joints or more, nodular and non-nodular.

By the predominant localization of the inflammatory process:

• arthrosis of the interphalangeal joints (nodes of Heberden, Bouchard);
• coxarthrosis (hip joint);
• gonarthrosis (knee joint);
• crusarthrosis (ankle joint);
• spondyloarthrosis (intervertebral joints of the cervical, thoracic or lumbar spine);
• other joints.

Types of arthrosis by localization of the inflammatory process

Depending on the intensity of the inflammatory process:

• no progression;
• slowly progressing;
• rapidly progressive arthrosis.

By the presence of concomitant synovitis:

• no reactive synovitis;
• with reactive synovitis;
• with often recurrent reactive synovitis (more than 2 times a year).

Depending on the compensation of the process:

• compensated arthrosis;
• subcompensated;
• decompensated.

The degree of arthrosis is determined by the nature of the violation of the functional activity of the joints (FTS - functional insufficiency of the joints):

• 0 degree (FTS 0) - joint activity is fully preserved;
• 1 degree (FTS 1) - deterioration in the functioning of the affected joint without significant changes in social activity (the ability to self-service, non-work activities are not impaired), while work activity is limited to one degree or another;
• 2 degree (FTS 2) - the ability to self-service is preserved, professional activity and social activity suffer;
• 3 degree (FTS 3) - limited labor, non-labor activities and the ability to self-service.

With the 3rd degree of arthrosis, the patient is disabled, self-care is significantly difficult or impossible, constant care is required.

Stages of arthrosis

According to the classification of Kellgren and Lawrence (I. Kellgren, I. Lawrence), depending on the objective X-ray picture, there are 4 stages of arthrosis:

1. Doubtful - the presence of small osteophytes, a dubious X-ray picture.
2. Minimal changes - the obvious presence of osteophytes, the joint space is not changed.
3. Moderate - there is a slight narrowing of the joint space.
4. Severe - the joint space is narrowed and deformed to a large extent, areas of subchondral sclerosis are determined.

In recent years, arthroscopic classification of the stages of arthrosis, depending on the morphological changes in the cartilage tissue, has become widespread:

1. Slight dissociation of the cartilage.
2. Razvlecheniya cartilaginous tissue captures up to 50% of the thickness of the cartilage.
3. Fibering covers more than 50% of the cartilage thickness, but does not reach the subchondral bone.
4. Complete loss of cartilage.

Symptoms of arthrosis

Arthrosis is not characterized by an acute clinical picture, changes in the joints are progressive, slowly increasing in nature, which is manifested by a gradual increase in symptoms:

• pain;
• intermittent crunching in the affected joint;
• joint deformity, which appears and intensifies as the disease progresses;
• stiffness;
• limitation of mobility (a decrease in the volume of active and passive movements in the affected joint).

The main symptoms of arthrosis are pain, crunching, stiffness in the affected joint

The pain in arthrosis is dull, transient, appears when moving, against the background of intense stress, by the end of the day (it can be so intense that it does not allow the patient to fall asleep). The permanent, non-mechanical nature of pain for arthrosis is uncharacteristic and indicates the presence of active inflammation (subchondral bone, synovial membrane, ligamentous apparatus or periarticular muscles).

Most patients note the presence of so-called starting pains that occur in the morning after waking up or after a long period of inactivity and pass during physical activity. Many patients define this condition as the need to "develop a joint" or "diverge".

Arthrosis is characterized by morning stiffness, which has a clear localization and is of a short-term nature (no more than 30 minutes), sometimes it is perceived by patients as a "jelly feeling" in the joints. There may be a feeling of jamming, stiffness.

With the development of reactive synovitis, the main symptoms of arthrosis are joined by:

• soreness and local increase in temperature, determined by palpation of the affected joint;
• persistent pain;
• enlargement of the joint in volume, swelling of soft tissues;
• progressive decrease in range of motion.

Arthrosis is characterized by an increase in joint volume, swelling of soft tissues

Diagnostics

Diagnosis of arthrosis is based on the assessment of anamnestic data, characteristic manifestations of the disease, the results of instrumental research methods. Indicative changes in general and biochemical blood tests are not typical for arthrosis, they appear only with the development of an active inflammatory process.

The main instrumental method for diagnosing arthrosis is radiography; in diagnostically unclear cases, computed or magnetic resonance imaging is recommended.

Additional diagnostic methods:

• atraumatic arthroscopy;
• ultrasonography (assessment of the thickness of the articular cartilage, synovium, the condition of the joint capsules, the presence of fluid);
• scintigraphy (assessment of the state of the bone tissue of the heads of the bones that form the joint).

Arthors mild, moderate, severe on radiography

Arthrosis treatment

Medication therapy:

• non-steroidal anti-inflammatory drugs - relief of pain syndrome and signs of inflammation during exacerbation;
• glucocorticosteroid hormones - intra-articular injection for relief of synovitis; limited use, in cases where it is necessary to eliminate painful symptoms as soon as possible;
• antienzyme agents (proteolysis inhibitors) - prevent the progression of degenerative and degenerative processes in cartilage and bone tissue;
• 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 their widespread use in the treatment of arthritis, the clinical efficacy of this group of drugs has not been proven in large placebo-controlled studies.

Physiotherapy techniques used to treat arthrosis:

• massage of regional muscles, which improves blood circulation and relieves local spasm;
• active kinesiotherapy, i.e. exercise for arthrosis using special simulators;
• therapeutic exercises for arthrosis;
• laser therapy;
• ultrasound treatment;
• therapeutic baths, mud, paraffin therapy; etc.

Therapeutic exercises for arthrosis inhibits the progression of the disease and improves joint mobility

With the ineffectiveness of the listed methods of exposure, in the presence of complications, they resort to surgical treatment of arthrosis:

• decompression of the metaepiphysis and prolonged intraosseous blockade (decrease in intraosseous pressure in the affected area);
• corrective osteotomy;
• endoprosthetics of joints.

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

The consequences of arthrosis, especially in the absence of adequate treatment, are:

• a progressive decrease in the range of motion in the affected joint;
• immobilization.

Forecast

The prognosis for life is favorable. The favorableness of the social and labor prognosis depends on the timeliness of diagnosis and the initiation of treatment; it decreases when the decision on the issue of surgical treatment of the disease is delayed, if necessary.

Prevention

1. Refusal from intense loads, prolonged static stress of the affected joint.
2. Wearing orthoses as needed.
3. Compliance with a diet for arthrosis, aimed at reducing body weight.
4. Avoiding hypothermia.
5. Complete treatment of acute joint injuries until complete recovery with mandatory rehabilitation.
6. Dispensary observation when signs of arthrosis appear.

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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!