Osteoarthritis (osteoarthrosis, deforming osteoarthritis) is a process of slow degeneration and destruction of the cartilage of the joint. The articular ends of the bones become deformed and grow, and the periarticular tissues become inflamed. The general diagnosis of "osteoarthritis" means a group of diseases that are similar in symptoms, but differ in origin. The joint, the affected area, consists of articular surfaces covered by cartilaginous tissue, a cavity with synovial fluid, a synovial membrane and a joint capsule. With advanced disease, mobility is lost and the patient feels pain due to inflammatory processes.
Causes
Osteoarthritis of the joints develops due to the discrepancy between the amount of stress and the body's capabilities. Lack of nutrients, excess body weight, intense physical work and even sports can cause this.
Factors that influence the development of the disease:
- genetics, hereditary predisposition;
- age over 40 years;
- obesity, overweight;
- sedentary work, passive lifestyle;
- hard work, work that involves constant physical activity;
- inflammatory diseases;
- congenital joint pathologies (dysplasia);
- injuries, wounds;
- malfunctioning of the body (poor blood circulation, hormonal imbalance, microelements).
The disease can be primary or secondary. The causes of primary osteoarthritis are still not well understood. Doctors believe that it develops in the presence of genetic factors (predisposition) and unfavorable external conditions.
Secondary osteoarthritis occurs against the background of inflammatory diseases, dysplasia and as a result of injuries, including occupational ones.
Representatives of working professions and athletes have a higher chance of developing the disease. Representatives of the arts are also at risk: dancers (especially ballerinas), pianists. Osteoarthritis of the wrist and finger joints most often affects people whose work involves fine motor skills: mechanics, mechanics and pianists. "Professional" osteoarthritis of porters is located in the knees, collarbones and elbows. Drivers, painters and miners suffer from elbow and shoulder joints. The weak point of ballet flats is the ankle. Athletes are also more likely to suffer injuries to the ankle and other joints in the arms and legs, depending on the type of sporting activity. For example, a tennis player will be at high risk for shoulder and elbow joint diseases.
Pathogenesis
Structural changes in cartilage occur due to an imbalance between tissue breakdown and repair. Collagen and proteoglycans are gradually "removed" from the body and no new nutrients are added. Cartilage tissue loses elasticity, becomes soft and cannot withstand stress.
Regardless of the location and root cause, the disease develops in the same way. Gradually, the cartilage is completely destroyed and the ends of the bone "rub" against each other. The patient experiences pain, the intensity of which increases depending on the stage. The mobility of the joint gradually decreases, the patient has limited movements.
p>Classification
Orthopedists use the classification formulated by the professor in 1961:
- Stage I. The bone becomes denser, the joint space narrows slightly. Discomfort during physical activity, which disappears after rest;
- Stage II. The joint space narrows noticeably, the bone edges grow, and the connective tissue becomes denser. The pain becomes constant, the muscles hypertrophy, the joint is much less mobile, specific symptoms appear at the site;
- Stage III. The joint space is virtually absent, the bone growths are extensive, and the bone beneath the cartilage is likely to be destroyed. The joint is completely deformed and immobile. Sharp or constant pain may occur depending on the type and location of the disease;
Depending on the location and form of the disease, symptoms, speed of development and treatment methods will vary.
Forms
The disease is characterized by a chronic form, but it can also occur acutely.
When the disease spreads to several joints (for example, to the fingers), it is called generalized.
Anatomical shapes:
- deforming (osteoarthrosis). Leads to bone growths;
- uncovertebral. Destroys discs and intervertebral tissue in the cervical region;
- post-traumatic. It develops as a result of trauma, injury;
- rheumatoid. Autoimmune disease, inflammation of the connective tissue. It may be a consequence of previous arthritis;
- psoriatic. It develops against the background of psoriatic arthritis.
Locations
Osteoarthritis is a disease that affects joints throughout the body.
Spine. The causes may be autoimmune diseases, back diseases, increased stress, injuries, lack of microelements and hormonal imbalance.
Locations:
- coccyx;
- Lumbar region;
- thoracic spine;
- cervical region
Legs. The knees and ankles are most susceptible to osteoarthritis. The reasons are injuries, excess weight, incorrect and excessive loads. Location types:
- gonarthrosis - knees;
- patellofemoral - femur and patella;
- ankle;
- talonavicular joint;
- feet and fingers.
Hands. Hand and finger injuries are more common and in most cases are associated with professional activities, injuries, hormonal and age-related changes. Additionally, the disease is localized in the shoulder, wrist and elbow joints.
Torso. Location on the trunk is less common compared to osteoarthritis of the extremities. The injuries are associated with professional activity, sedentary lifestyle (stagnation).
Location types:
- clavicle. When moving, "clicks" and pain are felt. Athletes involved in weightlifting and military personnel are at risk for possible injuries;
- hip joints (coxarthrosis). The disease manifests itself as pain in the groin.
Head>. Sometimes dental problems, autonomic disorders, and even hearing loss are caused by damage to the temporomandibular joint. The swelling alters the symmetry of the face, can affect the hearing and cause headaches.
Symptoms
The symptoms of the disease depend on its location. Common manifestations for all types are:
- pain in the affected area. In the early stages - during movement, work, in the later stages - at rest;
- inflammation, swelling. The periarticular tissues swell, the skin turns red;
- "clicks", creaks. When moving, characteristic sounds are heard;
- difficulty moving. As the disease progresses, the mobility of the affected area is affected;
- Reaction to cold. Many types of osteoarthritis are characterized by exacerbations in rainy and cold weather.
Exacerbations of the disease are associated with a general weakening of health. Due to viral diseases and increased stress, it acquires an acute form and develops many times faster. During an exacerbation, symptoms, especially pain, become more pronounced. The patient finds it difficult to move, to the point of completely losing mobility, and perform normal work.
Possible complications
The main danger is the loss of joint mobility, its deformation beyond the possibility of recovery. Due to the displacement of the axis, the posture is altered and the figure loses symmetry. Possible increase in pressure on internal organs, their displacement, compression. Concomitant diseases and failures of the body's systems appear. For example, with osteoarthritis of the coccyx in women, gynecological complications are possible, and osteoarthritis of the temporomandibular joint or cervical spine causes disturbances in the autonomic system: dizziness, sleep disturbances. A patient with osteoarthritis can become disabled.
Diagnosis
To make a diagnosis, a comprehensive examination is performed:
- taking anamnesis;
- x-ray in various projections;
- MRI and CT to exclude tumors and obtain a three-dimensional image;
- blood and urine tests to exclude concomitant diseases and assess general health status.
Depending on the cause of the disease, the patient is referred to a rheumatologist, traumatologist, surgeon or orthopedist.
Treatment
Stage I of the disease is best treated. Stage II patients can expect long-term relief from bone destruction. Stage III usually requires surgical intervention.
Conservative treatment (non-surgical):
- physiotherapy, use of orthoses, canes, crutches to reduce the load. Elimination of accompanying and aggravating factors (for example, weight loss, stress, change in activity);
- taking non-steroidal anti-inflammatory drugs. Selective COX-2 inhibitors are the most effective. As auxiliary agents, chondroprotectors and atypical antidepressants are prescribed;
- intra-articular injections of glucocorticoid hormones to reduce severe pain and inflammation.
Surgical methods:
- arthroscopy - internal examination of the joint and removal of cartilage fragments;
- arthroplasty: implantation of artificial cartilage;
- osteotomy: removal or dissection of bone tissue;
- chondroplasty - restoration of cartilage;
- arthrodesis: artificial immobilization of a joint (usually the ankle);
- endoprostheses: removal and replacement of damaged joints with artificial joints.
Cardinal treatment allows you to stop the disease even at a late stage. It is possible to recover mobility in isolated cases (after replacement with an artificial one). However, this method is effective in combating pain. After surgery, recovery is required using physiotherapeutic and pharmacological methods.
Prognosis and prevention
After starting the treatment of osteoarthritis in stages I and II, a lasting improvement occurs: pain and inflammation disappear. In this case, complete relief of the disease or its long-term preservation is possible.
When stage III osteoarthritis is treated, improvements do not occur immediately. In some cases, pain relief is only possible after surgery. Often the joint remains immobilized or deformed. Patients with severe forms of osteoarthritis of the hip and knee joints receive disability group I or II.
It has been shown that there is no effective prevention against osteoarthritis. Weight control, a balanced diet and a moderate amount of exercise will help reduce the risk of developing the disease. An examination at the first signs of osteoarthritis (especially after injuries and infectious diseases) and careful attention to health will allow you to identify the disease at an early stage.