Osteoarthritis is the most common joint disease. According to experts 6, 43% of the population of our country suffers from it. Men and women suffer from osteoarthritis equally often, but among young patients there is a slight predominance of men, and among adults - women. An exception to the general picture is arthrosis of the interphalangeal joints, which develops in women 10 times more often than in men.
With age, the frequency increases dramatically. Thus, according to studies, osteoarthritis is found in 2% of people under the age of 45, in 30% of people aged 45 to 64 and in 65-85% in people aged 65 and over. Osteoarthritis of the knee, hip, shoulder and ankle joint is of the greatest clinical importance due to its negative impact on the standard of living and working capacity of patients.
Reasons
In some cases, the disease occurs for no apparent reason, such osteoarthritis is called idiopathic or primary.
There is also secondary arthrosis - developed as a result of some pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, ligament tears, sprains, etc. ).
- Dysplasia (congenital disorders of joint development).
- Degenerative-dystrophic processes (Perthes' disease, dissect osteochondritis).
- Diseases and conditions in which there is increased joint mobility and weakness of the ligament apparatus.
- Hemophilia (arthrosis develops as a result of frequent hemarthrosis).
Risk factors for developing osteoarthritis include:
- Adult age.
- Overweight
- Excessive stress on the joints or a specific joint.
- Surgical interventions of the joint,
- Hereditary predisposition (presence of osteoarthritis in close relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (shoulder arthritis, lumbar-iliac muscle syndrome).
- Recurrent microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease which, regardless of the specific reasons for its occurrence, is based on a violation of the normal formation and recovery of cartilage tissue cells.
The articular cartilage is usually smooth and elastic. This allows the joint surfaces to move freely relative to each other, provides the necessary shock absorption and thus reduces the load on adjacent structures (bones, ligaments, muscles and capsule). In osteoarthritis, the cartilage becomes rough, the joint surfaces begin to "stick" to each other during movement. Cartilage is losing more and more. Small pieces are released from it, which fall into the joint cavity and move freely in the joint fluid, injuring the synovium. Small foci of calcification appear in the superficial areas of cartilage. Ossification zones appear in the deep layers. In the central zone, cysts are formed, communicating with the joint cavity, around which, due to the pressure of the intra-articular fluid, areas of ossification are formed.
Pain syndrome
Pain is the most constant symptom of osteoarthritis. The most striking signs of pain in osteoarthritis are the connection with physical activity and time, night pain, initial pain and sudden sharp pain in combination with joint block. With prolonged exercise (walking, running, standing) the pain intensifies and at rest subsides. The cause of nocturnal pain in osteoarthritis is venous congestion, as well as increased intraosseous blood pressure. The pain is exacerbated by adverse weather factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of osteoarthritis is initial pain - pain that occurs during the first movements after a state of rest and disappears while maintaining physical activity.
Symptoms
Osteoarthritis develops gradually, gradually. Initially, patients are concerned about mild, short-term pain without a clear location, aggravated by exercise. In some cases, the first symptom is crunching when moving. Many patients with osteoarthritis report a feeling of discomfort in the joint and transient stiffness during the first movements after a period of rest. Subsequently, the clinical picture is supplemented by nocturnal and meteorological pain. Over time, the pain becomes more pronounced, there is a noticeable restriction of movement. Due to the increased load, the joint on the opposite side begins to hurt.
Periods of exacerbations alternate with remissions. Exacerbations of osteoarthritis often occur against a background of increased stress. Due to pain, the muscles of the limbs reflexively spasm, muscle contractures can form. The crunch in the joint is becoming more constant. At rest, muscle cramps and discomfort in the muscles and joints appear. Lameness occurs due to increasing joint deformity and severe pain syndrome. In the later stages of osteoarthritis the deformity becomes even more pronounced, the joint is bent, the movements in it are significantly limited or absent. Maintenance is difficult, when moving the patient with osteoarthritis should use a cane or crutches.
Diagnosis
The diagnosis is made on the basis of characteristic clinical signs and X-ray picture of osteoarthritis. X-rays of the diseased joint are taken (usually in two projections): in gonarthrosis - X-ray of the knee joint, in coxarthrosis - X-ray of the hip joint, etc. X-rays of osteoarthritis consist of signs of dystrophic changes in the area of articular cartilage and adjacent bone. The joint space is narrowed, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis and osteophytes are revealed. In some cases, osteoarthritis shows signs of joint instability: curvature of the limb axis, subluxation.
Taking into account the radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of arthrosis (Kellgren-Lawrence classification):
- Stage 1 (suspected arthrosis) - suspected narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild osteoarthritis) - suspected narrowing of the joint space, osteophytes are clearly defined.
- Stage 3 (moderate arthrosis) - clear narrowing of the joint space, there are pronounced osteophytes, bone deformities are possible.
- Stage 4 (severe osteoarthritis) - marked narrowing of the joint space, large osteophytes, severe bone deformities and osteosclerosis.
Sometimes X-rays are not enough to accurately assess the condition of the joint. CT examination of the joint is performed to examine the bone structures, and MRI of the joint is performed to assess the condition of the soft tissues.
Treatment
The main goal of treating patients with osteoarthritis is to prevent further destruction of cartilage and to preserve joint function.
During remission, the patient with osteoarthritis is sent to physiotherapy. The complex of exercises depends on the stage of osteoarthritis.
Drug treatment in the exacerbation phase of osteoarthritis involves the administration of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation and eliminate muscle spasms, a patient with osteoarthritis is referred to physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet radiation are prescribed, in the remission phase - electrophoresis with dimexid, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermy, thermal procedures (ozokerite and morphine, paraffin, suffin). Electrical stimulation is performed to strengthen the muscles.
When destroying joint surfaces with pronounced joint dysfunction, arthroplasty is performed.