Osteoarthritis of the knee joint: symptoms, treatment, prevention
The content of the article:
- Classification
-
The reasons
- The mechanism of pathology formation
- Secondary osteoarthritis
-
Symptoms
- Crunch
- Stiffness of movement
- Pain
- Other signs
-
Treatment of osteoarthritis of the knee
- Non-steroidal anti-inflammatory drugs
- Chondroprotectors
- Corticosteroids
- Operative treatment
- Prevention
- Video
Osteoarthritis of the knee joint (deforming arthrosis, gonarthrosis) is a degenerative-dystrophic disease in which there is a gradual destruction of the knee cartilage.
Osteoarthritis is characterized by the gradual destruction of the knee cartilage
Pathology occurs quite often, along with arthrosis of the intervertebral joints and coxarthrosis. If signs of illness are detected, it is necessary to seek advice from a traumatologist or rheumatologist.
Classification
There are primary and secondary forms of the disease.
There are the following clinical stages of arthrosis:
| Severity | Description |
| Easy | The patient feels a crunch in the knee joints when moving, there is a feeling of stiffness in the morning and pain is observed when the leg is fully bent at the knee |
| Average | The patient develops knee pain after exercise. Morning stiffness lasts no more than a quarter of an hour. Knee flexion range is reduced by 10-15 degrees |
| Heavy | There is constant aching pain in the knees, which increases with movement. Morning stiffness lasts up to half an hour, and even longer during an exacerbation. Joint mobility is impaired, and the range of passive and active movement is significantly reduced |
The reasons
There are many reasons for the development of the disease. If one of them cannot be distinguished, idiopathic (primary) arthrosis of unknown etiology is diagnosed.
Depending on the area in which the cartilage is damaged, the following types of pathology are distinguished:
- arthrosis of the femoral-patellar joint;
- arthrosis of the lateral part of the femoral-tibial joint;
- arthrosis of the medial part of the femoral-tibial joint.
Normally, aging of the whole body leads to the destruction of the articular cartilage. If the process starts ahead of time, this is a pathology. The first signs of degenerative changes (joint stiffness after sleep, mild pain during exercise) may appear after 40 years.
With deforming arthrosis, these symptoms occur in young people (16-18 years old), and in severe cases, the joints begin to suffer even earlier.
The mechanism of pathology formation
The cartilage in the knees is under maximum stress on a daily basis, as they are shock absorbers. The result is the appearance of microscopic cracks in the subchondral layer. Gradually they are filled with synovial fluid and turn into cavity formations (microcysts). The adjacent cavities merge and the cysts enlarge.
With arthrosis, the process of cartilage tissue restoration is disrupted
Large cysts compress blood capillaries, which feed and oxygenate cartilage tissue. As a result, type 2 collagen synthesis slows down and the process of cartilage destruction is accelerated. Instead of regaining its shape, after each load, the cartilage tissue begins to compress until it becomes thinner at all.
Chondroblasts (young cells that synthesize cartilage tissue) are activated, but the bulk of the cartilage tissue is formed not in the place where the cartilage is most destroyed, but in areas where it does not experience special stress. This results in excessive and chaotic growth of cartilage tissue along the edges of the articular surfaces and the formation of chondrophytes (cone-shaped growths).
At the initial stage, chondrophytes do not manifest themselves in any way, but later the process of ossification occurs and they turn into osteophytes (thorns). This causes damage to the cartilage tissue and synovium, resulting in the development of an inflammatory process and pain. The composition of the synovial fluid changes, the inflamed joint receives less nutrients, and edema appears.
Against the background of pathology, there is a high probability of dislocation of the patella
The person tries to reduce the stress on the knee, which leads to the formation of new osteophytes and adhesions, which cause a decrease in the range of motion. Due to the increase in pressure in the cavity, the articular surfaces are separated from each other, therefore there is a high risk of dislocation in case of unsuccessful movement.
Secondary osteoarthritis
In secondary osteoarthritis, the cause of the development of the disease is known, but the mechanism of development of the pathology is the same as in the primary form.
Joints can be damaged in the following cases:
- limb injuries. With fractures of the legs, an acute form of the disease most often develops, while with frequent and minor injuries of the joint, a chronic form of osteoarthritis occurs;
- congenital hallux valgus. In this case, there is a load on the lateral or inner sides of the joint and premature erasure of the joint occurs, which is accompanied by an inflammatory process;
- congenital shortening of one leg. In this case, a normal limb takes on an additional load, and the cartilaginous tissue of a healthy leg changes;
- knee dysplasia. Structural changes in bones lead to joint instability and the development of post-traumatic arthrosis;
- rheumatoid arthritis. This is a systemic disease in which the immune system attacks the body's own structures, which leads to the development of an inflammatory process;
- diabetes mellitus. Due to the fragility of the capillaries, the nutrition of the cartilage tissue is disturbed, as a result of which osteoarthritis develops;
- osteomyelitis. This is a purulent-necrotic process caused by pathogenic microorganisms. If it develops in the bone near the knee, then its fistular course opens directly into the joint cavity, which leads to the appearance of purulent arthritis;
- acromegaly. An excess of the hormone growth hormone in the body leads to a pronounced growth of bone and cartilage tissue, as a result of which the shape of the joints changes, and the condition of the cartilage deteriorates;
- obesity. The increase in body weight increases the load on the knee joints, which further leads to the compression and erasure of the cartilage tissue and the disruption of its nutrition. Since the knee joints are quite massive and complex, they are the first to suffer;
- frostbite. With prolonged exposure to low temperatures, the growth cells are damaged. Externally, the joint is restored, while internally, the process is irreversible and leads to the gradual destruction of tissues.
Symptoms
The disease develops gradually, its symptoms depend on the stage of the disease.
Crunch
Initially, the patient experiences a crunching and clicking sound of the joint during certain movements. Usually, a person does not pay attention to him for a long period, considering it insignificant.
Stiffness of movement
Stiffness of movement is another symptom of osteoarthritis. This symptom can be observed within half an hour after waking up in the morning. If, after this period, the stiffness does not disappear, this indicates an inflammatory process.
During inactivity of the joint, fibrin films are formed that envelop the exposed nerve fibers. Until they are partially erased, a person feels stiffness in movements. The inflammatory process is an aggravating factor, since the synovial fluid becomes cloudy, and the internal ligaments swell and shorten.
Pain
The main symptom of osteoarthritis of the knee joint is pain. It is initially mild and occurs after physical exertion or heavy lifting. The appearance of this symptom is based on the erasure of the upper layer of cartilage and the exposure of nerve endings.
Pain is the main symptom of the disease
If a person rests for several hours, the exposed nerve endings are covered with a thin layer of fibrin, which makes it possible to reduce irritation and dull pain.
Usually, pain in osteoarthritis is observed only with limb movements. If pain at rest appears, this indicates the addition of an inflammatory process.
Other signs
As the disease progresses, the patient develops other signs of osteoarthritis, which include:
- decreased range of motion. In order to reduce pain, the person tries to minimize the load on the knee. After a while, the ligamentous apparatus adjusts to a minimum of movements, and the ligaments themselves are shortened. In order to develop them, it will take a long time to do special exercises;
- jamming. In some cases, the knee can be locked in one position and an attempt to bend or straighten the leg leads to severe pain. This symptom occurs when the internal ligaments go beyond the projections of the pineal glands and are tightly pulled. You can return the joint to its place only if they move back;
- increase in knee size. The reason for this may be tissue edema or the proliferation of osteophytes, which can reach large sizes and form masses.
Treatment of osteoarthritis of the knee
Therapy for the disease should be comprehensive, the patient is prescribed drugs that eliminate the inflammatory process, reduce pain and restore cartilage tissue. In addition to the main treatment, the patient should take vitamin complexes, which include calcium, vitamin D 3, and B vitamins.
Non-steroidal anti-inflammatory drugs
Drugs in this group can reduce pain and eliminate the inflammatory process. For the treatment of the disease, drugs are prescribed based on ibuprofen, diclofenac, meloxicam, nimesulide. They are available in the form of tablets, powders, ointments, suppositories or injections. The course of treatment usually lasts 5 to 14 days.
Non-steroidal anti-inflammatory drugs are used to relieve pain and inflammation
Nonsteroidal anti-inflammatory drugs (NSAIDs) can negatively affect the digestive system. Therefore, they are often prescribed in combination with proton pump inhibitors (Omeprazole, Pantoprazole, Lansoprazole).
Preparations for external use do not create a high concentration of the active substance in the blood, so they can be used for a long time.
Chondroprotectors
For the treatment of gonarthrosis, agents from the group of chondroprotectors are used, which help accelerate the regeneration of cartilage tissue. Such preparations include glucosamine hydrochloride, chondroitin sulfate or hyaluronic acid derivatives (Teraflex, Mucosat, Artiflex, Alflutop).
Chondroprotectors are prescribed to restore cartilage tissue
In the acute form of the disease, drugs are used, which, in addition to the main active ingredient, include ibuprofen or diclofenac. In some cases, injections are prescribed.
In order to obtain the desired effect, chondroprotectors are taken over a long period. Their effectiveness can be assessed 2-3 months after the start of treatment. Long-term clinical studies show that drugs in this group slow down the destruction of cartilage tissue and make it possible to delay the appearance of complications.
Corticosteroids
Glucocorticoid hormones have a pronounced anti-inflammatory effect. They are used when non-steroidal anti-inflammatory drugs do not give the desired effect.
Intra-articular administration of glucocorticosteroids is effective for the treatment of arthrosis
In osteoarthritis, hormonal drugs are prescribed in the form of injections (including intra-articular) or ointments. These drugs include betamethasone, hydrocortisone, dexamethasone, or prednisolone.
With severe pain syndrome, hormones are injected directly into the joint cavity. Such treatment allows you to get rid of pain very quickly (within half an hour). The duration of the effect depends on the amount of the injected substance and the duration of its presence in the articular cavity. In order for the medicine to remain there as long as possible, the patient is advised not to load the affected limb within 48 hours.
Despite the fact that the effect of corticosteroids is pronounced, intra-articular injections are recommended to be done with caution, since with frequent administration, the likelihood of infection of the articular cavity increases and, as a result, the development of purulent arthritis.
Operative treatment
Drug therapy cannot completely relieve the patient of the problem. Symptoms of the disease are not so pronounced, but at this time the cartilage tissue is gradually destroyed.
If drug therapy is ineffective, knee arthroplasty is performed
Prevention
In order to prevent the development of osteoarthritis of the knee joint, it is necessary:
- Strengthen muscles, exercise regularly, go for walks and go in for swimming;
- avoid strenuous physical activity;
- monitor body weight;
- eat properly;
- do not lift weights;
- avoid injuries to the lower extremities;
- get rid of bad habits.
Fulfillment of all recommendations, taking chondroprotectors and doing therapeutic exercises can significantly improve the condition and slow down the development of the disease.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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