Osteoarthritis

Osteoarthritis (osteoarthritis, arthrosis deformans) is a process of slow degeneration and destruction of cartilage in the joint. The joint ends of the bones become deformed and grow, and the periarticular tissue becomes inflamed. The general diagnosis of "arthrosis" means a group of diseases that are similar in symptoms but differ in origin. The joint - the affected area - consists of joint surfaces covered by cartilaginous tissue, a cavity with synovial fluid, a synovial membrane and a joint capsule. With advanced disease, he loses mobility, and the patient experiences pain due to inflammatory processes.

Reasons

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, heavy physical work and even sports can cause this.

Factors influencing 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;
• malfunctions in the body (poor blood circulation, imbalance of hormones, 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 (disposition) and external adverse conditions.

Secondary arthrosis occurs on the basis of inflammatory diseases, dysplasia and as a result of injuries, including professional ones.

Representatives of working professions and athletes have an increased chance of developing the disease. Representatives of the arts are also at risk: dancers (especially ballerinas), pianists. Osteoarthritis of the wrist joints and fingers most often affects people whose work involves fine motor skills: mechanics, mechanics and pianists. "Professional" arthrosis of loaders is localized in knees, clavicles and elbows. Drivers, painters and miners suffer from elbow and shoulder joints. The weak point of ballerinas is the ankle. Athletes are also more likely to have injuries to the ankle and other joints in the arms and legs, depending on the type of sports activity. For example, a tennis player will be at high risk of 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 "washed" out of the body, new nutrients are not supplied. Cartilage tissue loses elasticity, becomes soft and cannot withstand stress.

Regardless of location and root cause, the disease develops in the same way. Gradually, the cartilage is completely destroyed, the bone ends "grind" 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 is limited in movements.

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Classification

Orthopedists use the classification formulated by the professor in 1961:

• Phase I. The bone becomes denser, the joint space is slightly narrowed. Discomfort during physical activity, which disappears after rest;
• Phase II. The joint space is noticeably narrowed, the bone edges grow and the connective tissue becomes denser. The pain becomes constant, the muscles are hypertrophied, the joint is much less mobile, specific symptoms appear at the site;
• Phase III. The joint space is virtually absent, bone growth is extensive, and destruction of the bone beneath the cartilage is likely. The joint is completely deformed and immobile. Acute or constant aching pain is possible depending on the type and location of the disease;

Depending on the location and form of the disease, symptoms, rate of development and treatment methods will vary.

Forms

The disease is characterized by a chronic form, but it can also occur in an acute form.

When the disease spreads to several joints (for example fingers), it is called generalized.

Anatomical shapes:

• deformation (osteoarthritis). Leads to bone growth;
• uncovertebral. Destroys discs and intervertebral tissue in the cervical region;
• post-traumatic. Develops as a result of trauma, injury;
• rheumatoid. Autoimmune disease, connective tissue inflammation. May be a consequence of previous arthritis;
• psoriasis. Developed on the basis of psoriatic arthritis.

Locations

Osteoarthritis is a disease that affects joints throughout the body.

Spine. The causes can be autoimmune diseases, back diseases, increased stress, injuries, lack of microelements, hormonal imbalance.

Locations:

• coccyx;
• lumbar region;
• thoracic spine;
• the cervical region

Leg. Knees and ankles are more susceptible to osteoarthritis. The causes are injuries, excess weight, wrong, excessive load. Types of localization:

• gonarthrosis - knee;
• patellofemoral - femur and patella;
• ankle;
• talonavicular joint;
• feet and toes.

Hands. Lesions in the hands and fingers are more common, and in most cases they are associated with professional activities, injuries, age-related and hormonal changes. In addition, the disease is localized in the shoulder, wrist and elbow.

Torso. Localization in the trunk is less common compared to osteoarthritis in the extremities. The lesions are associated with professional activity, a sedentary lifestyle (stagnation).

Types of localization:

• collarbone. When moving, "click" and pain are felt. At risk are athletes involved in weightlifting and military personnel due to possible injuries;
• hip joint (coxarthrosis). The disease manifests itself as pain in the groin area.

Head>. Sometimes dental problems, autonomic disorders and even hearing loss are caused by damage to the jaw joint. Swelling disrupts the symmetry of the face, can affect the ear 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 becomes red;
• "click", crunchy. When moving, characteristic sounds are heard;
• difficulty moving. As the disease progresses, the mobility of the affected area deteriorates;
• reaction to cold. Many types of osteoarthritis are characterized by exacerbations in rainy and cold weather.

Exacerbations of the disease are associated with general weakening of health. Due to viral diseases and increased stress, it takes an acute form and develops many times faster. During an exacerbation, symptoms, especially pain, become more pronounced. It is difficult for the patient to move, to the point of complete loss of mobility, and to perform usual work.

Possible complications

The greatest danger is loss of joint mobility, its deformation beyond the possibility of recovery. Due to the displacement of the axis, the posture is disturbed and the figure loses symmetry. Possible increased pressure on internal organs, their displacement, compression. Simultaneous diseases and failure of the body's systems occur. For example, with coccyx arthrosis in women, gynecological complications are possible, and arthrosis of the temporomandibular joint or cervical spine causes disturbances in the autonomic system: dizziness, sleep disturbances. A patient with osteoarthritis can become disabled.

Diagnostics

To make a diagnosis, a comprehensive examination is carried out:

• take medical history;
• radiography in multiple projections;
• MRI and CT to rule out tumors and obtain a three-dimensional image;
• blood and urine tests to rule out co-morbidities and assess general health.

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. Patients with stage II can expect long-term relief of bone destruction. Stage III most often requires surgical intervention.

Conservative (non-surgical) treatment:

• physiotherapy, use of orthoses, canes, crutches to reduce the load. Elimination of accompanying and aggravating factors (for example, weight loss, stress, change of activity);
• taking non-steroidal anti-inflammatory drugs. Selective COX-2 inhibitors are the most effective. Chondroprotectors and atypical antidepressants are prescribed as aids;
• 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);
• endoprosthetics - removal and replacement of damaged joints with artificial ones.

Cardinal treatment allows you to stop the disease even at a late stage. It is possible to restore mobility in isolated cases (after replacing it with an artificial one). However, this method is effective in combating pain. After the operation, recovery is required using physiotherapeutic and medication methods.

Prognosis and prevention

After starting treatment for stage I and II osteoarthritis, there is a lasting improvement: pain and inflammation disappear. In this case, complete relief of the disease or its long-term preservation is possible.

When treating stage III osteoarthritis, improvements do not occur immediately. In some cases, the disappearance of the pain is possible only after the operation. Often the joint remains immobilized or deformed. Patients with severe forms of osteoarthritis in the hip and knee joints receive disability group I or II.

It has been proven that there is no effective prevention against osteoarthritis. Weight control, a balanced diet and moderate amounts of exercise will help reduce the risk of developing the disease. An examination at the first signs of arthrosis (especially after injuries and infectious diseases) and careful attention to health will allow you to identify the disease at an early stage.