Osteoarthritis: causes of development, symptoms, treatment
The content of the article:
- Causes
- Stages of osteoarthritis
- Pathogenesis
- Osteoarthritis symptoms
-
Diagnostics
- X-ray diagnostics
- Other diagnostic methods
-
Osteoarthritis treatment
- Physical activity and physiotherapy exercises
- Pharmacological therapy
- Surgical treatment and physiotherapy
- Forecast and prevention
- Video
Osteoarthritis is a common joint disorder characterized by degenerative-dystrophic changes in cartilage tissue with the development of deformities, leading to disability and disability.
Osteoarthritis is characterized by gradual degenerative-dystrophic changes in cartilage tissue
The term osteoarthritis (deforming osteoarthritis, deforming arthrosis, osteoarthritis) unites a group of diseases that differ in etiological factor, but have similar pathogenesis, morphological changes and clinical outcome.
Often, osteoarthritis affects the joints of the hand, toes (especially the first metatarsophalangeal), intervertebral joints in the cervical and lumbar spine, large joints (knee and hip).
The incidence increases with age, reaching a third of the population in older people, more often in women. Clinically, the pathology is manifested by articular pain syndrome, limitation of movement, inflammatory changes in the affected joint.
Causes
Osteoarthritis is a polyetiological disease, which is based on three mechanisms: trauma, dysplasia, inflammation. Depending on the etiological factor, arthrosis is divided into primary and secondary. If the cause could not be established, then the disease is called primary (idiopathic).
The development of pathology may be associated with trauma, dysplasia or inflammation.
Causes of secondary osteoarthritis:
- exposure to a traumatic agent (post-traumatic);
- dysmetabolic conditions, neuroendocrine dysfunctions;
- necrotic process: aseptic necrosis, Koenig's disease, Perthes disease, etc.;
- acute or chronic inflammatory process caused by bacterial or viral pathogens: tuberculosis, purulent staphylococcal fusion of cartilage, syphilis, etc.;
- autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus, etc.
Factors that increase the risk of developing the disease include:
- elderly age;
- obesity;
- period of menopause and postmenopause;
- congenital anomalies in the development of joint structures, anatomical disorders;
- negative environmental factors: exposure to toxins, hypothermia, repetitive microtrauma, joint surgery, etc.
Stages of osteoarthritis
A movable joint is formed by the articular surfaces covered with cartilage and synovial membrane, some joints have menisci in their composition.
Chondrocytes are the main cells of cartilage tissue
Cartilage is made up of chondrocytes that are embedded in a matrix of glucosamine and collagen. The ratio of these substances is stable in healthy people, which makes it possible to evenly distribute the load on the cartilage and restore its shape after their exposure.
With an insufficient amount of glucosamine, the slightest load on the matrix leads to injury, loss of the cushioning function of the cartilage. At first, it thickens compensatory, but as it progresses, it gradually becomes thinner, loosened, ulcers form in it. This progressive pathological process is called osteoarthritis.
There are three stages of the disease:
- It is characterized by unexpressed morphological changes in cartilage and biochemical composition of the synovium, a slight weakening of the muscular apparatus. As a result, the joint becomes sensitive to damaging factors.
- It is characterized by visual signs of cartilage and meniscus destruction. Osteophytes, marginal growths of bone growths, are formed compensatory. Muscle neurotrophism worsens, they progressively lose strength.
- It is a consequence of severe arthrosis. It is characterized by a pronounced deformation of the bone, a change in the support area of the joint, as a result, a change in the axis of the limb.
Against the background of severe joint damage, its pathological mobility may appear
Additional signs indicating severe joint damage are:
- pathological mobility of the articulation: due to failure and shortening of the ligamentous apparatus;
- the formation of contractures: a sharp limitation of active and passive movements in the joint;
- a decrease in the amplitude of muscle contraction: as a result of a change in the normal attachment of tendons, a shortening or stretching of the muscle fiber occurs, as a result of which a full contraction is impossible.
Pathogenesis
The disease is a consequence of an imbalance between the formation of a new building material and its destruction. Soft, elastic cartilage loses its properties, turning into a thin, dry, rough object.
Periarticular bone structures begin to grow, which aggravates the process, immobilizing the joint and leading to its deformation. The cells of the non-functional joint capsule are replaced by the cells of the connective tissue, which leads to its fibrosis and aseptic inflammation.
The joint cavity is filled with inflammatory exudate, stretching its capsule and ligaments. Increased pressure and reduced elasticity of the cartilage lead to pain, stiffness, and the acquisition of a specific sparing position of the joint.
Ultimately, the process leads to joint stiffness and the formation of contractures. The affected joint is completely turned off, its motor activity is lost, it becomes non-functional.
Osteoarthritis symptoms
The main symptom that worries patients from the very onset of the disease is articular pain syndrome.
If at the beginning of the disease the patient was worried only about pain that pass after a period of rest, then as the disease progresses, other symptoms appear:
- joint stiffness after waking up in the morning (no more than 30 minutes);
- limitation of active and passive movements in the joint;
- the presence of signs of joint deformation due to bone growths;
- a feeling of tension in the joint, its instability;
- crepitus.
Diagnostics
To establish the degree of damage, a special melody is used to assess the severity of the dysfunction of the lower extremities. It is presented in the form of a table with six characteristics, their characteristics and the integration of answers in percentage.
If the dysfunction of the lower extremities is more than 20%, it is regarded as severe and corresponds to the third or more disability group.
| Sign | 0-20% | 21-40% | 41-60% | 61-80% | 80-100% |
| Physical activity | Lameness is slight | Lameness pronounced | Lameness pronounced | Pathological type of movement | Walking is not possible |
| Additional support | Absent | Cane | Two canes | Crutches | Special means |
| Performing household functions | Not limited | Limited slightly | Limited | Sharply difficult | Impossible |
| Self service | Not limited | Limited slightly | Limited | Sharply difficult | Impossible |
| Using public transport | Not limited | Limited slightly | Limited | Sharply difficult | Impossible |
| Performing professional duties | Not limited | Limited slightly | Limited | Sharply difficult | Impossible |
X-ray diagnostics
X-ray diagnostics is the most informative and does not require large financial costs.
The most informative method for diagnosing a disease is X-ray.
Currently, an X-ray classification of osteoarthritis is used, which includes 4 stages of the development of the process:
- Doubtful narrowing of the articular space, possibly the appearance of osteophytes.
- Clear signs of osteophytes and questionable joint space narrowing.
- Osteophytes of medium size, the presence of a narrowing of the joint space, possibly deformation of the bones.
- Large osteophytes, obvious narrowing of the joint space, bone deformity, signs of osteosclerosis.
Osteophytes - bone growths - are an early x-ray sign of the disease. They are among the first to appear and indicate the active proliferation of the junction structures. As they progress, they thicken, turning into massive bony spines.
The narrowing of the joint space is a sign of pathological processes in the cartilage. Sometimes the gap takes on a wedge-shaped shape, in which one half narrows and the other expands. This indirectly indicates instability of the articulation and insufficiency of the ligamentous apparatus.
The appearance of signs of osteosclerosis indicates a progressive loss of shock-absorbing function by cartilage, atrophy, which leads to flattening and expansion of the heads of the articular surfaces, and an increase in bone density. The result of cartilage damage is the emergence of focal dystrophic, necrotic processes in the cancellous bone and, as a consequence, the appearance of cystic formations.
Other diagnostic methods
It is possible to use other diagnostic methods, such as ultrasound, magnetic resonance imaging and computed tomography of the affected joint.
In rare cases, a joint puncture with a collection of synovial fluid or arthroscopy is performed.
Arthroscopy is used for both diagnostic and therapeutic purposes
Arthroscopy is one of the methods of examining the articular cavity using optical fiber, which allows visualizing and assessing the degree of joint damage. It can be used for diagnostic and therapeutic purposes.
Osteoarthritis treatment
Treatment of osteoarthritis is mainly conservative and is carried out on an outpatient basis.
Therapy principles:
- limiting excessive stress on the joint;
- physiotherapy;
- pharmacotherapy, including anti-inflammatory, analgesic drugs, drugs that improve the condition of the cartilage;
- physiotherapy procedures;
- Spa treatment.
Physical activity and physiotherapy exercises
Due to the fact that the affected joint causes a pain syndrome that increases with movement, the patient tries to spare the affected area in every possible way. Hypodynamia leads to a decrease in the release of synovial fluid, which is necessary for the normal functioning of the joint, which worsens the course of the disease: the pathological circle is closed (cartilage damage - pain - hypodynamia - disease progression).
Physical therapy helps to normalize physical activity
Therefore, one of the most important goals of osteoarthritis therapy is the normalization of physical activity and exercise therapy (therapeutic physical culture).
Exercises are selected individually by a doctor depending on the severity of the underlying process and associated diseases. The goal of the treatment is to restore mobility, the desired range of motion, muscle strength and endurance.
Pharmacological therapy
The main goal of drug therapy is to reduce intra-articular inflammation, eliminate or subside the pain syndrome. For this, non-steroidal anti-inflammatory drugs (NSAIDs) are used, which are available in different pharmacological forms: tablets, suppositories, gels, ointments, solutions for injection, etc.
To relieve pain, non-steroidal anti-inflammatory drugs are used, for example Meloxicam
Non-selective anti-inflammatory drugs include: Diclofenac, Ibuprofen, Paracetamol, Ketorolac, etc. The advantage in arthrosis is given to selective NSAIDs, for example Meloxicam, since it has a sufficient analgesic effect and has a relatively small spectrum of side effects.
The expediency of intra-articular administration of hormonal agents remains in question. There are a number of studies showing that steroid drugs have a negative effect on cartilage. Therefore, this method of treatment is resorted to only in extreme cases, when intense pain syndrome is not relieved by conventional NSAIDs.
According to some reports, one injection of hyaluronic acid into the knee joint is enough for a year. The effectiveness of the drug depends on the stage of development of the process and the individual susceptibility of the organism.
In the initial stage of the disease, it is possible to prescribe chondroprotectors (glucosamine and chondroitin sulfate). The drugs stop the destruction of cartilage and partially restore its structure.
Surgical treatment and physiotherapy
With arthrosis of the ankle joint of a severe course, it is possible to prescribe arthrodesis - surgery to immobilize the joint.
In severe pathology, arthroplasty is performed
In osteoarthritis, physiotherapy is mainly local. Electrophoresis, paraffin therapy, magnetotherapy, laser therapy, etc. are used.
Forecast and prevention
With timely diagnosis and treatment, in many cases it is possible to eliminate pain and improve joint function. However, complete recovery is not possible in adults. Self-medication and the use of traditional medicine methods without the agreement of a doctor negatively affects the prognosis.
To prevent the development of the disease, you should adhere to preventive recommendations:
- try to avoid injuries of the osteoarticular apparatus, treat them in a timely manner;
- do gymnastics;
- limit excessive stress on the joints;
- maintain optimal body weight.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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!
