Arthrosis (arthrosis deformans national title - salts) is a chronic disease of the joints degenerative-dystrophic character, in which there is destruction of articular cartilage, the capsule of the joint, deformity of the bone.
It should be noted that arthritis is a group of diseases of the joints, of different origins and mechanisms of close. The most common knee arthritis of large joints:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis)
- as well as arthrosis of the shoulder joint.
This is the most severe types of arthritis.
Arthrosis of the small joints are less common. More often deforming arthrosis of the interphalangeal joints of the hands and metacarpophalangeal joints of the fingers. Patients report pain in the interphalangeal joints, reducing their mobility, the emergence of near joints seals (nodules Heberden and Bouchard). This form of arthritis are more common in the elderly. Often found in arthritis joints of the foot.
The polyarthrosis, or generalized osteoarthritis, is characterized by lesions of multiple joints.
Arthrosis of the joints of the spine - spondylosis - belongs to the group of diseases of the spine, although is similar to other arthritis mechanism of development.
The main clinical symptom of osteoarthritis is pain in the joint, reducing its mobility. Specific symptoms are determined by the stage of osteoarthritis and are dependent on the degree of destructive changes in the joint.
Causes of osteoarthritis
Osteoarthritis is divided into primary and secondary. Primary (idiopathic) osteoarthritis is the consequence of disturbance of regenerative processes and increased degeneration of the cartilage in the joint without any abnormalities in the whole body. Secondary osteoarthritis occurs as a result of other pathologic processes in the organism, or in already damaged in any external impact joint, with partial destruction of the articular surfaces.
Often traumatic arthrosis is diagnosed in young patients. And in patients older not always possible to draw a clear line between primary and secondary osteoarthritis.
Although the exact cause of the arthritis cannot be determined, the factors contributing to the emergence and development is well known.
You can select the following types of reasons contributing to the primary and secondary deforming arthrosis.
Causes of primary osteoarthritis hereditary factors
Revealed the following inherited disorders that can cause the development of primary osteoarthritis:
- genetic disorders in the cartilage tissue of the joint leading to its rapid destruction;
- congenital defects of musculoskeletal system (joint hypermobility, dysplasia, flat feet, etc.), which cause trauma to the individual sections of the cartilage tissue and, consequently, to the onset of osteoarthritis.
It was also noted that deforming arthrosis of the interphalangeal joints of the upper limbs is found predominantly in women and is inherited through the female line.
The causes of secondary osteoarthritis
Secondary osteoarthritis is the result of damage to the joint. These injuries can be caused by various factors.
- Mechanical damage of the joints. This group of factors includes various joint injuries, intraarticular fractures, which affects the structure of the joint. The same result is obtained by constant micro-traumas of the joints due to excessive permanent loads, both static and dynamic (e.g., in athletes). Also overloading and trauma to the joints causes obesity.
Another factor having a negative impact on the joints (especially hip) is incorrect posture.
The structure of the joint can also disrupt surgery.
- Diseases of the joints. Arthrosis may be a consequence of inflammatory joint diseases (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone, etc.)
- Of metabolic disorders, endocrine diseases, lack of minerals in the body. Various disorders of metabolism, deficiency of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage, synovial fluid, leading to disruption of the restorative processes and the gradual destruction of the whole.
- Autoimmune diseases (gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in postmenopausal women lead to changes in the tissues of the joints and their progressive destruction.
- Vascular diseases (atherosclerosis of vessels of lower extremities, obliterating endarteritis, varicose disease), and physical inactivity cause poor circulation in periarticular tissues, poor blood supply to the tissues of the joint resulting in degenerative changes.
The mechanism of development of osteoarthritis
The development of osteoarthritis begins with cartilage loss. It is believed that in the beginning there is an infringement of blood circulation in the capillaries Podhradie layer of the periosteum. As the power of cartilage is due to the receipt of nutrients from the synovial fluid and adjacent bone tissue, the blood circulation causes the cartilage gradually loses its elasticity, becomes thinner, it cracks, smoothness of the articular surfaces is disturbed, reduces the amount of synovial fluid, providing the sliding in the joint. The result is pain and crunching when moving. The width of the joint space is gradually reduced, the edges of the articular surfaces formed bone spikes-osteophytes.
Ultimately, the joint becomes deformed, the amplitude of motion decreases. So developing involutive osteoarthritis associated with aging. The development of this form of osteoarthritis usually happens gradually over many years.
Other forms of arthritis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication have slightly different mechanisms of development, but the result is the same changes in the joint.
The symptoms of osteoarthritis of the joints. The stage and degree of osteoarthritis
"Classic" is the classification of osteoarthritis based on clinical and radiographic features. In accordance with it, there are three stages of disease development. It corresponds to classification according to the degree of preservation of working capacity, distinguish 3 degrees of osteoarthritis:
- I degree of osteoarthritis - a disease does not preclude the execution of the work, though, and makes it,
- II the degree of osteoarthritis - a disease prevents the execution of the work
- Grade III osteoarthritis - disability.
Let us consider the clinical symptoms and signs of arthrosis at each of these stages
Osteoarthritis of 1 degree (the initial stage of arthrosis)
In the initial stage of the disease in the morning, after a rest, marked stiffness, difficulty of movement in the joints, which gradually takes place some time after the beginning of the movement. There may be some limitation in the joint. Periodically there are "start-up" pain (pain when you start moving after a long stay at rest). The sharp movements joint tingling, but I would not. The pain at this stage of osteoarthritis appears only when significant and prolonged stress, and subsides after rest. At rest and at light loads there is no pain. At this stage of the disease, patients rarely go to the doctor.
On x-ray for osteoarthritis of 1 degree, significant changes in the joint are not visible, can sometimes be seen with small osteophytes on the edges of the joint, the joint space is slightly narrowed.
Arthrosis of 2 degrees (second stage of arthrosis)
With further development of osteoarthritis pain becomes significant, becomes acute. A distinct crunching in the joint appears in all movements, there is a noticeable limitation in the joints (contracture), functional shortening of the limb, disorders of biomechanics of movement, but mobility is still maintained. This stage is characterized by a marked increase in the starting pains, they become acute and more prolonged. Under the influence of daily physical activity appears constant fatigue, sense of pressure in the affected joints, there are the so-called "mechanical pain", caused by a decrease in amortization of ability of cartilage tissue.
The destruction of the joint are quite significant, the joints are already starting to partially deform.
The x-ray visible visible osteophytes, narrowing of the joint space by 2-3 times compared to the norm, there is sclerosis of subchondral bone and formation of cystic cavities in the epiphyseal area.
Osteoarthritis of degree 2 is characterized by a decrease of working capacity, inability to perform certain types of work.
Arthrosis of grade 3 (the third stage of arthrosis)
The osteoarthritis grade 3 is severe, advanced stage of the disease. At this stage, there are:
- significant deformity of the joint (due to growth of the bones and accumulation of fluid in the articular cavity);
- the sharp restriction of movements, including keeping only oscillation;
- a sharp pain not only when moving but also in a state of complete rest - persistent pain associated with reflex spasm of the nearby muscles, as well as the development of reactive synovitis;
- inflammation of the joints
- the sensitivity of joints to weather changes.
- the muscles around the knee spasmatic and atrophied;
The axis of the limb is deformed, noticeably varus or valgus curvature of the foot (i.e. in the form of the letter "O" or "X").
On radiographs in osteoarthritis grade 3 there is almost complete disappearance of the joint space, severe deformity of the articular surfaces, extensive multiple marginal osteophytes. Unable to determine joint mice calcification and paraartikulyarnye tissues.
In grade 3 disease has progressed very far, often it is already a cause of permanent disability. Manifested in the following ways:
- the pain becomes constant and painful walking, especially downhill and climbing stairs can be an ordeal for the patient;
- a loud crunching sound in all movements, very audible to others;
- deformation of joints strongly expressed, movement is limited to only a small amplitude or even impossible;
The images show the destruction of articular structures (ligaments and meniscus), and a complete abrasion of the cartilage and signs of sclerosis (replace the functioning of the organs and structures of connective tissue).
Arthrosis of 4 degrees
A state of complete destruction of the joint with osteoarthritis, when the joint stops functioning completely often singled out - 4 the degree of osteoarthritis. There is a so-called "blockade of the joint" - acute pain, which is not possible with even a limited patient movement in the joint. The fourth degree of osteoarthritis is accompanied by unbearable pains in the joints, which can not be removed even with potent painkillers, and intensive physical therapy. Possible total ankylosis (fusion of joint) or newartriot (formation of a false joint between the displaced ends of the bones). Independent movement in both cases is almost impossible.
In pictures visible rough surfaces soslanovna sclerosis with severe cystic enlightenment, the accretion of the connecting bones in the region of the joint space. The development of the disease to this stage almost always means a disability, which can prevent only the implantation of artificial prosthetic joint.
Treatment of osteoarthritis
Treatment of arthrosis in the initial stage of the disease
Begin to treat the osteoarthritis better as soon as possible, at the first signs of a crunch in joints, difficulty in movement. At this stage, useful products - chondroprotectors that improve the structure of cartilage, and vitamin-mineral complexes.
Important is therapeutic exercise, proper nutrition and preventive measures. It should be noted that prevention of osteoarthritis is of great importance to prevent worsening of the disease.
The treatment of arthritis 2 - 3 degrees
Although fully cured arthrosis of 2-3 degrees is impossible, but the process of development can significantly slow. Treatment of arthrosis at this stage involves the following steps:
- removal or to reduce pain
- to relieve the inflammation in the joint.
- to improve the regeneration of cartilage and slow down degenerative processes in it.
In the acute phase treatment of osteoarthritis starts with pain relief. For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs), analgesics. Possible intra-articular injections of corticosteroids. It is necessary to reduce the load on the joint, you can't walk or stand, lift heavy objects.
After the withdrawal of acute pain main task is to ensure, to the extent possible, the activation of regenerative processes in the joint and periarticular tissues: improved circulation, increased metabolism, elimination of inflammatory processes. Assigned chondroprotectors, vasodilator drugs, as well as remedial gymnastics and physiotherapy.
Treatment of osteoarthritis 4 degree
At this stage of the disease the joint has almost completely destroyed. In this case, is left with one option - surgery and replace the diseased joint with a prosthesis. The implant significantly improves the mobility of the joint, allowing the patient to resume an active life, at least, getting rid of the pain.