In the structure of the pathology of the osteoarticular system, arthrosis occupies a leading place - about 70% of cases fall on its share. A similar problem most often occurs in people after 50 years, but the first signs of the disease also appear in young people. This disease has serious medical and social importance, as in many cases it becomes the cause of dysfunction in working age.
Many people are familiar with such a pathology as arthrosis of the joints, but not every patient understands why it develops, how it manifests itself and what is needed to combat the disease. And increased awareness and caution can prevent the occurrence and progression of harmful changes.
The reasons
Arthrosis is characterized by the development of degenerative-dystrophic processes in all joint tissues: cartilage, subchondral bone, ligaments, muscles and tendons. The disease is considered one of the "companions of aging" because it often affects elderly patients. But the age factor is far from the only cause of deforming arthrosis. The origin of the disease is quite heterogeneous and is based on both external and internalTypes of pathological effects on the body.
For each patient there are certain risk factors that contribute to the occurrence of joint pathology. Therefore, the causes of osteoarthritis combine the following conditions:
- Hard physical work.
- Inactivity.
- traumatic injuries.
- joint dysplasia.
- inflammation (arthritis).
- overweight.
- Estrogen deficiency during menopause.
- Thyroid diseases.
- Consequences of operations on the joints.
- inheritance.
As you can see, the development of arthrosis is mediated by heterogeneous factors, which are mostly of a mechanical or reciprocal nature. The lifestyle of the patient and his job play a not insignificant role, because loaders, craftsmen and athletes often suffer from arthrosis.
The causes of arthrosis are very diverse, they are characterized by a local effect on the joints and a general effect on the body.
development mechanism
The normal functioning of the joint is ensured by the harmonious work of all its structures. But the main component of any joint is cartilage. It provides a shock absorbing function and resists pressure on the joint. Cartilage tissue consists of cells (chondrocytes) and a matrix, the main components of which are proteoglycans and collagen.
If the load on the joint exceeds the allowable, then first of all there are structural disorders in the cartilage. The proteoglycans that hold the collagen strands are lost, which increases the tissue's sensitivity to external influences. Destructive processes begin to override synthesis. This is facilitated by a decrease in cartilage trophism when the synovial fluid contains an insufficient amount of nutrients. The imbalance in tissue renewal is supported by inflammatory reactions and hormonal imbalances.
All this leads to thinning of the cartilage, it becomes rough and loses its elasticity. Due to the growth of the underlying bone tissue, the joint space narrows and osteophytes form - marginal growths. The synovial membrane thickens, the ligaments thicken and shorten, the function of the muscles is impaired.
Pathological processes in the joint develop gradually, but do not pass without a trace. Disorders in the cartilage and other structures inevitably influence the clinical picture of arthrosis.
classification
Osteoarthritis, like other diseases, has certain variants. This must be taken into account in the clinical classification of the disease. The pathology is primary when it develops in healthy joints, or secondary when it occurs against the background of other diseases. If the cause cannot be determined, it is referred to as idiopathic arthrosis. Depending on the number of joints involved, the following varieties are distinguished:
- monoarthrosis.
- Oligoarthrosis - no more than 2 joints are affected.
- Polyarthrosis - involved in 3 groups of joints.
If the pathological process has a generalized character, then we can talk about the defeat of almost all joints of the body, including the spine, where spondylarthrosis is observed. In this case, the disease can proceed in a nodular or nodular form.
It is important to understand what processes are occurring in the joint and to adequately assess their severity. Therefore, be sure to consider the stage of arthrosis. It does not depend on the cause and is determined by pathological changes in the joint tissues:
- Stage 1 - inflammation of the synovial membrane, loss of the ability of the cartilage to withstand the load.
- Stage 2 - destruction of cartilaginous tissue, bone proliferation, dystrophy of the articular bag.
- Stage 3 - bone deformity, contractures, joint instability.
The presence of signs of inflammation should also be reflected in the classification. Therefore, arthrosis with and without synovitis is differentiated. Also important is the functional state of the joint, which is determined by the degree of insufficiency:
- 1 degree - temporary functional impairment.
- Degree 2 - disability.
- 3 degrees - the impossibility of self-service.
All of these characteristics should be taken into account when diagnosing arthrosis, as they are important for later therapy.
symptoms
Among joint pathologies, the symptoms of arthrosis have quite tangible specificity. They develop gradually, but steadily progress and lead to a restriction in the patient's physical activity. Therefore, it is particularly important to suspect the disease in time in order to be able to stop its development, as well as prevent complications.
When contacting a doctor, complaints from patients are first analyzed. And most people worry about pain in the joints. But with arthrosis, unlike other pathologies, such as arthritis, they have the following character:
- Mechanical - appear against the background of the load and decrease at rest.
- Beginning - the appearance of pain is associated with the beginning of movement (walking).
- "Joint mouse" - periodic sharp pains with blockage of the joint, caused by injury to the synovial membrane between the cartilaginous surfaces.
At first, patients may experience only vague discomfort in the joints, accompanied by a feeling of fatigue. But over time, it develops into pain. And if at the initial stage it worries after a load, then in the future - during movement and in advanced cases - it becomes constant and remains even at rest and at night.
In addition to pain, the patients have other arthrosis symptoms. They are both subjective and objective in nature, including the following characteristics:
- Stiffness in the joints in the morning for no more than 30 minutes.
- Crunching (crepitus) when moving.
- Deformation of the periarticular region.
- restriction of mobility.
With arthrosis of the hands, characteristic formations in the region of the proximal and distal phalanges can be identified during the examination - Bouchard and Heberden nodules. Touching the affected joints is often painful. When contractures are formed, fixation of certain parts of the limbs in a flexed position occurs more often.
The pronounced nature of osteoarthritis leads to a significant decrease in the physical activity of patients, which leads to a decrease in their quality of life.
diagnosis
To understand why the clinical picture develops, it is necessary to confirm the pathology of the joints. This can be done by conducting the necessary diagnostic examination, which includes instrumental and laboratory methods. First, they try to see structural changes in the affected areas to assess their severity and prevalence. It is also necessary to determine the metabolic disorders in the body, which have become a favorable background for the occurrence of arthrosis. Therefore, the survey complex consists of the following activities:
- radiography.
- Magnetic resonance imaging.
- ultrasonic procedure.
- arthroscopy.
- Biochemical blood tests (hormone spectrum, inflammatory markers, calcium metabolism, rheumatism tests).
After the examination, a consultation with an orthopedist-traumatologist is required, who will help to develop the right treatment tactics for each patient.
treatment
Osteoarthritis of the joints must be treated comprehensively. This means that all available therapeutics are used to alleviate the patient's condition. But you need to understand that their effectiveness directly depends on the duration of treatment. In advanced forms of the disease, conservative measures are of little help. With early treatment, a pronounced and lasting result can be achieved. For the treatment of arthrosis, the following methods are used:
- Medical therapy.
- Physical therapy.
- Physical therapy.
- Massage.
- Operation.
The doctor decides which remedies are suitable for a particular patient. The selection is made on the basis of the test results and the individual characteristics of the organism.
The best effect of treatment can be achieved if correction is started in the early stages of the disease, when the first symptoms are just beginning to appear.
General recommendations
Since the development of degenerative changes in the joints is mediated by an increased load, it is first necessary to reduce the mechanical impact on the cartilage tissue. To do this, you should stop carrying heavy, intense sports training. To relieve the joint, any method is suitable - from walking with a cane to special fixation orthoses. But it is impossible to completely abandon movements, physical activity should be dosed. Walking short distances, swimming are useful.
Proper nutrition plays an important role in correcting arthritic changes. Diet helps to improve the condition of cartilage, but it is also the main component in the fight against excess weight. Patients are recommended to consume lean meat and poultry, fish, cereals; You need to enrich the diet with fresh vegetables and fruits, as well as herbs. But in return, you should refrain from smoked, spicy, fatty foods, marinades and pickles. It is better to pay attention to foods rich in collagen fibers, elastin and gelatin: meat jelly, hashish, aspic dishes, fruit jellies.
Medical therapy
Traditional treatment for osteoarthritis begins with medication. Using various drugs, it is possible not only to eliminate the symptoms of the disease, but also to affect the mechanisms of its development. This is particularly important in chronic degenerative joint pathology when it comes to achieving a structure-changing effect on the cartilage tissue. The following medications are generally recommended:
- Nonsteroidal anti-inflammatory.
- chondroprotectors.
- Vessel.
- vitamins and antioxidants.
- Metabolism (oestrogens, thyroid hormones).
With severe pain in arthrosis, intra-articular injections of glucocorticosteroids can be performed. However, such treatment should be short-term, since with prolonged use hormonal drugs have the opposite effect - they stimulate dystrophic processes. Systemic therapy should be combined with topical medications.
Taking medication for osteoarthritis is carried out on the recommendation of a doctor and under his control. Independent use of drugs is not allowed.
physical therapy
Methods of physical influence help to eliminate acute signs of joint pathology. Together with drugs, they can reduce the severity of pain and inflammation, and also stimulate biochemical processes in the cartilage itself. In the complex treatment of arthrosis, the following procedures are used:
- electrophoresis.
- ultrasonic treatment.
- wave therapy.
- magnetotherapy.
- laser treatment.
- mud and hydrotherapy.
Such methods affect not only the joint, but also the surrounding tissues. This contributes to the activation of blood circulation, the improvement of trophic processes and the weakening of muscle contractures. Many elements of the cure have a general health-promoting effect. At the same time, one should not forget about contraindications to physiotherapy: infectious diseases, tumors, cardiovascular diseases, kidney failure, bleeding, the patient's severe condition.
physical therapy
An important aspect of non-drug therapy for arthrosis is movement therapy. It is known that the metabolism of cartilage tissue is clearly dependent on the mechanical factor. But his strength must be enough. Only then growth processes triumph over destruction. Therefore, gymnastics is indicated for all patients with joint diseases. But for each person, their own exercises are developed - taking into account the localization and severity of the lesion, as well as the general condition of the body.
There should be no pain during the lesson. The exercises are carried out at a slow pace and only after eliminating the acute symptoms. Avoid sudden and strong movements that can cause discomfort. Physical education classes should be conducted under the supervision of a doctor, and having acquired the necessary skills, you can start home exercises.
Remedial gymnastics is an integral part of the correction of degenerative-dystrophic processes in the joint. Only regular classes have a positive result.
massage
To improve the condition of the musculoskeletal system, massage sessions are shown. Manual action on the joints allows you to relax spasmodic muscle groups, stimulate blood circulation in soft tissues and prepare them for active exercises (before therapeutic exercises). The classic massage includes the following elements:
- Stroke.
- trituration.
- Knead.
- Print.
- Iron.
It is often combined with passive movements in the affected joints. The duration of therapy is determined by the doctor and can range from 7 to 15 sessions.
operation
If the desired effect cannot be achieved by conservative measures in the advanced stage of arthrosis, surgical treatment is necessary. Its essence is the replacement of the joint with an artificial one - arthroplasty. This operation is open and performed under general anesthesia. After its completion, you need to undergo rehabilitation, which begins as early as possible. And with surgical intervention, the patient can completely get rid of arthrosis and return to active life. True, the operation is not available to everyone.
Osteoarthritis is a common problem that requires a timely and active solution. In order not to trigger the disease and to be able to hope for the success of conservative measures, treatment should be started as early as possible. This avoids exacerbations, prevents the progression of joint changes and largely restores the functionality of the musculoskeletal system. Otherwise, surgical correction must be considered.