Osteoarthritis is a chronic disease in which the structure of the connective tissues of the musculoskeletal system is damaged. The disease is characterized by a progressive course, against the background of which the cartilage tissue is gradually destroyed. This pathology is diagnosed in many people over 65 years of age, since one of the factors that contribute to the formation of this condition is the natural aging process in the body.
Description of the disease
Post-traumatic, endocrine and inflammatory disease, excessive physical overload or vice versa, inactivity can lead to the development of a degenerative-dystrophic disease. The main signs of osteoarthritis: pain in the joint with swelling and limited activity in it.
To diagnose a disease, they resort to instrumental techniques: X-rays, arthroscopy, computed tomography and magnetic resonance imaging. In the treatment of osteoarthritis of stages 1 and 2, conservative methods are used: taking drugs, physical therapy, massage and physical therapy exercises. If irreversible destructive changes have occurred in the joint tissue, an operation is required - arthrodesis or endoprosthesis.
Pathogenesis
Osteoarthritis is characterized by pronounced changes in the structure of connective tissue. The formation of deforming erosions occurs in the cartilage, thus destroying the collagen fibers and proteoglycans, which contain proteins (5-10%) and glycosaminoglycans (90-95%).
As a result, the stability of the collagen network decreases, metalloproteinase is released, and all forms of protein in the extracellular matrix are destroyed. Acceleration of destruction occurs due to the fact that collagenase and stromelysin biosynthesis increases.
As a general rule, if the body's enzymes are in normal amounts, they keep the level of cytokines (small informational peptide molecules) under control. If osteoarthritis progresses, the concentration of this protein decreases, so the enzymes that affect cartilage are released in large volume.
As a result, proteoglycans with a distorted structure absorb water, which they cannot retain. For this reason, excess fluid penetrates the collagen fiber, which begins to "swell", leading to a loss of strength and elasticity.
The qualitative and quantitative composition of joint fluid also undergoes changes for the worse. Against the background of osteoarthritis, a decrease in the concentration of hyaluronic acid is observed. The transport of nutrients and oxygen to the hyaline cartilage tissue stops at the volume necessary for its restoration. In the cartilage, softened foci are formed, followed by the formation of cracks, specific necrotic growths. Then the bare heads begin to be exposed, microtrauma appears against the background of displacement from each other.
What causes the development of the disease
Why primary (idiopathic) osteoarthritis develops has not yet been established. Such a disease develops without the influence of any factor, so doctors are of the opinion that the cause of such a problem lies in the propensity at the genetic level to premature destructive processes in the cartilage. The formation of secondary osteoarthritis occurs as a complication of other joint diseases or in the context of injury.
The presence of the following can lead to the formation of degenerative-dystrophic pathology:
- damage to joint tissue or located close to the connective tissue structure in the form of fracture, dislocation, trauma to the meniscus, partial rupture or complete separation of the bone from the muscle and ligament tissue, tendons;
- congenital dysplastic disorder in joint development;
- disorders in the functionality of the glands of the endocrine system, metabolic disorders;
- rheumatism or rheumatic fever;
- polyarthritis, rheumatoid, reactive, metabolic, gouty, or psoriatic arthritis;
- purulent arthritis, the cause of which lies in the effects of streptococci, epidermal or Staphylococcus aureus;
- tuberculosis of any site, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative-dystrophic pathologies, for example, osteochondritis dissecants.
Increased mobility of joint tissue, seen in the context of the production of special collagen fibers in the body, can contribute to the formation of osteoarthritis.A similar phenomenon is observed in 10% of the people who live on the planet, it is not considered a disease.Although, in the context of hypermobility, there is weakness in the tendon-ligamentous system, so a person is susceptible to injuries, especially in the ankle joint, in the form of sprains and ruptures of the ligamentous tissue, dislocations.
In some cases, problems with hematopoietic function (for example, the presence of hemophilia) can lead to the formation of osteoarthritis. Against the background of hemarthrosis (bleeding into the joint cavity), the blood supply to the cartilage tissue deteriorates, due to which it begins to collapse.
Among the predisposing factors, it is worth highlighting the presence of old age, frequent loads on the joint tissue that exceed the limits of its strength, excessive body weight, undergoing operations, hypothermia.
The risk group includes women during menopause, citizens living in adverse environmental conditions or in contact with toxic chemicals. If the diet contains insufficient vitamins and minerals, conditions for the gradual destruction of hyaluronic cartilage tissue appear.
Symptoms
Osteoarthritis is dangerous because the first stage of formation is asymptomatic. The manifestation of the clinical picture of the disease occurs over time, the primary symptoms appear with significant cartilage destruction.At first, the patient feels a mild pain syndrome without a clear localization.It occurs after physical effort: lifting heavy objects, sports training.
In some cases, the first sign of a person notices the appearance of cracking and clicking during flexion or extension of the joints. The patient notes that it is sometimes difficult to move. Although in the early stage of the formation of arthrosis, mobility problems appear only in the morning and pass quickly.
With the further development of pathology, painful sensations begin to bother at night, which is why sleep function is disturbed, and chronic fatigue also appears. When the disease progresses to grade 2, the intensity of pain increases against the background of changes in weather conditions, exacerbations of chronic diseases, acute respiratory viral infections.
Physical activity decreases significantly. Mobility is hampered by the thinning of the cartilage tissue and deliberate restriction of the patient's movement in an attempt to prevent pain. This increases the load on the tissue of the opposite joint, which contributes to its further destruction.
Osteoarthritis is characterized by other specific characteristics:
- pain that causes spasms of skeletal muscles and the formation of muscle contracture (limited passive motor function of the joint);
- cracks in the joint tissue, popping, cracking during movement of a constant nature, arising practically during each displacement of the bones relative to each other;
- frequent painful muscle cramps;
- joint deformation, leading to posture and gait disturbances;
- Pronounced deformity up to the curvature of the joints with a significant decrease or complete absence of motor activity in the context of grade 3 osteoarthritis.
If osteoarthritis in the knee, ankle, or hip joint has developed to stage 3, the person should use a cane or crutches to get around.
If you do not start treatment in a timely manner, the disease begins to progress, relapses begin to bother you regularly, in addition, exacerbations appear more and more frequently over time. Stiffness in the morning hours does not go away for a long time, gradually it becomes permanent.
When examining a person with stage 1 osteoarthritis, the doctor notices only a slight edema of the joint tissue with complete preservation of motor function. Stage 2 disease manifests as pain and mild deformity on palpation. Bony thickenings form near the synovial cavity.
Osteoarthritis is characterized by the formation of synovitis: inflammation of the synovium in the hip, ankle, knee or shoulder joint. The main symptom of this disease is the development of a rounded seal near the joint, when you press it, you can feel the liquid content move. With acute synovitis, the temperature can rise to 37-38 degrees, headaches and digestive problems can occur.
Diagnostic measures
The disease is diagnosed based on the results of the study by instrumental methods, clinical characteristics, anamnestic data, patient complaints. In this case, a clinical study of blood and urine is not very informative: all indicators remain within the normal range, if the cause of osteoarthritis does not lie in metabolic problems.
If synovitis develops, there is an increase in the sedimentation rate of erythrocytes (up to 30 mm / h), increased leukocytes and fibrinogen in the bloodstream.This indicates the presence of acute or chronic inflammation in the body.Biochemical and immunological parameters change with osteoarthritis of the secondary form.
The most informative way to detect degenerative-dystrophic diseases is radiography in 2 projections (lateral and straight).
In the X-ray image, osteoarthritis is visualized as follows:
- In the initial stage, there are no radiological signs.
- In the first stage, the pathology is visualized as an uneven and indistinct narrowing of the joint cavity. The edges of the bone plates are slightly flattened, initial osteophytes are formed (sometimes they are absent).
- At the second stage, the picture shows an image in the form of a pronounced narrowing of the cavity in the joint, exceeding the norm by 2-3 times. Osteophytes are formed in large numbers, the formation of subchondral osteosclerosis is observed. Cystic illuminations appear on the appendages.
- In the third stage, the image shows a pronounced subchondral osteosclerosis and large marginal osteophytes. Joint space is significantly reduced.
- In the fourth stage, thick solid osteophytes are formed, the joint space fuses almost completely, the bony appendages that make up the joint are deformed and compacted.
If the doctor has any doubts about the diagnosis after examining the X-ray images, the patient is prescribed a CT scan. To assess the condition of the connective tissue located near the joint, an MRI is performed. The use of a contrast agent allows you to dynamically monitor how blood is supplied to the tissues to determine the degree of inflammation in the synovitis.
Treatment for osteoarthritis
At the moment, it is impossible to completely cure osteoarthritis, as there are no pharmacological agents that restore cartilage tissue.The main goal of treatment is to prevent further development of the disease, to keep the joints mobile.The therapy for osteoarthritis is long-term, complex, and involves the use of local and systemic drugs.
Patients should not overload the joints; it will be necessary to limit motor activity with the help of orthopedic devices - orthotics, elastic bandages. Overweight people will have to adjust their diet to lose weight over time and begin dieting.
When stable remission is achieved, the patient should perform therapeutic gymnastic exercises every day. At first you will have to do it under the supervision of a specialist, and in the future you will have to do gymnastics at home yourself. In addition to physical therapy, you can join the pool, do yoga or ride a bike.
To reduce the intensity of pain, the use of drugs belonging to different pharmacological groups is prescribed:
- Non-steroidal anti-inflammatory drugs in tablets, ointments, solutions for intravenous injections.
- Intra-articular injections of anesthetics with the addition of glucocorticosteroids.
- Muscle relaxants to relieve muscle spasms and contractures.
In addition, the treatment regimen for osteoarthritis involves the use of B vitamins, sedatives, if necessary, antidepressants, and tranquilizers. It is mandatory to appoint chondroprotectors in the form of a long course.The media in this group contribute to the partial restoration of cartilage.
To increase the clinical activity of joint tissue, it is necessary to perform physiotherapeutic procedures: laser therapy, magnetotherapy, UHF.
Any painful manifestation in the joint area should be the basis for an immediate visit to the doctor. Treatment carried out in the early stages of the development of osteoarthritis makes it possible to stop the destructive processes in the cartilage to prevent disability and disability.