Osteoarthritis (osteoarthritis, deforming osteoarthritis) is a process of slow degeneration and destruction of the cartilage of the joint. The articular ends of the bones become deformed and enlarged, and the periarticular tissues become inflamed. The general diagnosis of "osteoarthritis" refers to a group of diseases that are similar in symptoms, but differ in origin. The joint - the affected area - consists of articular surfaces covered with cartilaginous tissue, a cavity containing synovial fluid, a synovial membrane and a joint capsule. At an advanced stage of the disease, he loses mobility and the patient experiences pain due to inflammatory processes.
Causes
Osteoarthritis of the joints develops due to the mismatch between the level of stress and the body's capabilities. Lack of nutrients, excess weight, intense physical work and even sports can be the cause.
Factors that influence the development of the disease:
- genetics, hereditary predisposition;
- age over 40;
- obesity, overweight;
- sedentary work, passive lifestyle;
- hard work, work that involves constant physical activity;
- inflammatory diseases;
- congenital joint pathologies (dysplasia);
- injuries, injuries;
- dysfunction of the body (poor blood circulation, imbalance of hormones, microelements).
The disease can be primary or secondary. The causes of primary osteoarthritis are not yet well understood. Doctors believe that it develops in the presence of genetic factors (predisposition) and unfavorable external conditions.
Secondary osteoarthritis occurs against the background of inflammatory diseases, dysplasia and as a result of injuries, especially occupational ones.
Representatives of working professions and athletes have an increased risk of developing the disease. Representatives of the arts are also at risk: dancers (especially ballerinas), pianists. Osteoarthritis of the wrist and finger joints most often affects people whose work requires fine motor skills: mechanics, mechanics and pianists. "Occupational" osteoarthritis of loaders is localized at the knees, collarbones 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 suffer injuries to the ankle and other joints of the arms and legs, depending on the type of sporting activity. For example, a tennis player will be at high risk of shoulder and elbow joint disease.
Pathogenesis
Structural changes in cartilage occur due to an imbalance between tissue breakdown and repair. Collagen and proteoglycans are gradually "washed out" from the body, new nutrients are not supplied. Cartilage tissue loses its elasticity, becomes soft and cannot withstand stress.
Regardless of the location and root cause, the disease develops in the same way. Little by little, the cartilage is completely destroyed, the ends of the bones "rub" against each other. The patient feels pain, the intensity of which increases depending on the stage. The mobility of the joint gradually decreases, the patient is limited in his movements.
p>Classification
Orthopedists use the classification formulated by the professor in 1961:
- Stage I. The bone becomes denser, the joint space is slightly narrowed. Discomfort during physical activity, which disappears after rest;
- Stage II. The joint space is noticeably narrowed, the bony edges expand, and the connective tissue becomes denser. The pain becomes constant, the muscles are hypertrophied, the joint is much less mobile, specific symptoms appear in the area;
- Stage III. Joint space is virtually absent, bony overgrowths are extensive, and destruction of bone beneath the cartilage is likely. The joint is completely deformed and immobile. Acute or constant pain is possible depending on the type and location of the disease;
Depending on the localization and form of the disease, symptoms, speed of development and treatment methods vary.
Shapes
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 the fingers), it is called generalized.
Anatomical shapes:
- deforming (osteoarthritis). Leads to bone growths;
- non-covertebral. Destroys the discs and intervertebral tissues of the cervical region;
- Posttraumatic. Develops as a result of trauma, injury;
- rheumatoid. Autoimmune disease, inflammation of connective tissue. May be a consequence of previous arthritis;
- psoriatic. Develops against the background of psoriatic arthritis.
Locations
Osteoarthritis is a disease that affects joints throughout the body.
Spine. The causes may be autoimmune diseases, back diseases, increased stress, injuries, lack of microelements, hormonal imbalance.
Locations:
- coccyx;
- lumbar region;
- thoracic spine;
- cervical region
Legs. The knees and ankles are more susceptible to osteoarthritis. The reasons are injuries, excess weight, incorrect and excessive loads. Types of location:
- gonarthrosis - knees;
- patellofemoral - femur and patella;
- ankle;
- talavicular joint;
- feet and toes.
Hands. Lesions of the hands and fingers are more common and in most cases are associated with professional activities, injuries, age-related and hormonal changes. In addition, the disease is localized in the shoulder, wrist and elbow joints.
Torso. Location in the trunk is less common than osteoarthritis of the extremities. The lesions are associated with professional activity and a sedentary lifestyle (stagnation).
Types of location:
- clavicle. During movement, "clicks" and pain are felt. Athletes involved in weightlifting and military personnel are at risk due to possible injuries;
- hip joints (coxarthrosis). The disease manifests itself by pain in the groin.
Heade>. Sometimes dental problems, autonomic disorders, and even hearing loss are caused by damage to the temporomandibular joint. The 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;
- "clicks", crackles. When moving, characteristic sounds are heard;
- difficulty moving. As the disease progresses, the mobility of the affected area is impaired;
- reaction to cold. Many types of osteoarthritis are characterized by exacerbations in rainy and cold weather.
Exacerbations of the disease are associated with a general weakening of health. Due to viral diseases and increased stress, it takes an acute form and develops several times faster. During an exacerbation, symptoms, especially pain, become more pronounced. It is difficult for the patient to move, to the point of completely losing mobility, and to carry out their usual work.
Possible complications
The main danger is the loss of joint mobility, its deformation beyond any possibility of recovery. Due to the movement of the axis, the posture is disturbed and the figure loses its symmetry. Possible increase in pressure on internal organs, their displacement, compression. Concomitant diseases and failures of body systems appear. For example, with osteoarthritis of the coccyx in women, gynecological complications are possible, and osteoarthritis of the temporomandibular joint or cervical spine causes disorders of the autonomic system: dizziness, sleep disturbances. A patient suffering from osteoarthritis can become disabled.
Diagnostic
To make a diagnosis, a complete examination is carried out:
- take the history;
- radiography in several projections;
- MRI and CT scan to exclude tumors and obtain a three-dimensional image;
- blood and urine tests to exclude concomitant diseases 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. Stage II patients can expect long-term relief from bone destruction. Stage III most often requires surgery.
Conservative (non-surgical) treatment:
- physiotherapy, use of orthotics, canes, crutches to reduce the load. Elimination of accompanying and aggravating factors (for example, weight loss, stress, change in activity);
- take non-steroidal anti-inflammatory drugs. Selective COX-2 inhibitors are the most effective. Chondroprotectors and atypical antidepressants are prescribed as auxiliary agents;
- 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);
- endoprostheses - removal and replacement of damaged joints with artificial joints.
Cardinal treatment allows you to stop the disease even at an advanced stage. It is possible to restore mobility in isolated cases (after replacing it with artificial mobility). However, this method is effective in combating pain. After surgery, recovery is necessary using physiotherapeutic and drug methods.
Prognosis and prevention
After the start of treatment for stage I and II osteoarthritis, lasting improvement occurs: pain and inflammation disappear. In this case, complete relief from 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 pain is possible only after surgery. Often the joint remains immobilized or deformed. Patients with severe forms of osteoarthritis of the hip and knee joints are assigned disability group I or II.
It has been proven that there is no effective prevention against osteoarthritis. Weight control, a balanced diet and moderate physical activity will help reduce the risk of developing the disease. Examination at the first signs of osteoarthritis (especially after injuries and infectious diseases) and close attention to health will allow you to identify the disease at an early stage.