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Osteoarthritis

Ankle joint osteoarthritis

Arthrosis is a complete group of depth diseases of the articular apparatus with various etiology, but a similar clinical image of pathological changes.The hyaline cartilage of the joint, then the drunk bone tissue, the articular capsule and the ligament apparatus, are exposed to destruction and deformation.The disease is progressive chronic and without proper treatment can significantly limit the patient's motor activity.

The diagnosis and treatment of pathology are dedicated to a arthrologist, rheumatologist, surgeon, orthopedist.



General Information

Arthrosis is diagnosed in approximately 1/5 of the population of the planet, but the disease is more characteristic of the elderly.This proves the statistics of its propagation between different ages:

  • Young up to 40 years, no more than 6-7 %;
  • Mature faces after 45 years to 20-25%;
  • After 70 years, up to 80%.

The disease affects the tissues that are under a constant load: small joints of the hands and more of the legs, hip and knee joints, areas in the cervical and thoracic parts of the column, a little less often of ankle and joint.

Note! The defeat of the interphant joints of the hands in women occurs 10 times more often than in men.

In many western countries, the term "osteoarthritis" is not used, replacing it with the concept of "arthritis".Such substitution is quite justified, since inflammatory processes in most cases precede osteoarthritis or accompany it.In domestic medicine, the terms "osteoarthritis" and "arthritis" sonially mean the same disease, but with a different etiology of the process.In addition, the concepts of osteoarthritis, osteoarthrosis, deforming osteoarthrosis are used to designate the pathology.

Note! The difference between arthritis and osteoarthritis lies in the cause of the disease.In the first case, these are inflammatory processes (suffix -it means inflammation), in the second metabolic disorders (protein, mineral). 

The development mechanism and the causes of osteoarthritis

The main cause of osteoarthritis is a violation of balance in the processes of anabolism and catabolism of the cartilage and bone tissues.If the synthesis processes normally prevail, during the changes in arthrose, the destruction processes go faster.As a result, rapid aging and degeneration of tissue structures is observed.They begin to collapse first at the cellular level, then in the tone of organs.The first destructive changes appear:

  • cartilage cloud;
  • superficial cornego;
  • microcks and tears;
  • The focal and general thinning of the cartilage layer.

The cartilage loses elasticity and natural density and can no longer serve as a shock absorber during movements.The mutual correspondence of the shape of the articular surfaces is disturbed, which leads to the deformation of the connection.This exacerbates the development of pathological changes and triggers a series of irreversible processes.In exchange for the lost cartilage, the bone tissue begins to grow with the formation of peaks and overlaps, that Fetter's movements can lead to a severe disability of the patient.

Reasons for this scenario:

  • Mineral metabolism violations can lead to Gotos changes in joints, osteoporosis, etc.
  • The disadvantage of tissue nutrition is venous stagnation and poor microcirculation slows down the blood supply and lymphatic drainage.The mineral composition of the bone is exhausted, becomes osteoporosa and loses the capacity of self -heleal.The phenomenon is characteristic of the lack of movement, with vascular pathologies, hormonal failures.
  • Inflammatory processes: a consequence of acute infectious diseases, body hypothermia, altered hormonal history.
  • Autoimmune reactions are chronic spotlights of inflammation, nervous stress, endocrine pathologies and other causes can cause aggression of the body's immune system against their own cells, including joint tissues.The most common autoimmune lesions with rheumatoid arthritis, scleroderma and red lupus.
  • Increase in joint wear and tear: an mismatch between functionality and placed load slows synthesis processes and accelerates destruction.The phenomenon is characteristic of athletes, dancers, overweight people, as well as all those who participate in a great physical work or are associated with long static loads (standing work).
  • Injuries: bruises, dislocations, fractures, penetrating wounds, tears) violate the structure of the tissues and give impetus at the beginning of the deformation.
  • Genetically determined pathologies: Connective tissue dysplasia, a violation of collagen synthesis initially form an unstable and low functioning joint.

Some reasons are very close to each other and form a complex complex.

Attention! Hormonal deviations play a particularly important role in the violations of bone tissue metabolism.A fault in the thyroid gland, menopause, take contraceptives, corticosteroids: all this is a direct path to osteoporous changes and osteros in the skeleton.

CLASSIFICATION OF CHANGES

In the systematics of osteoarthritis, several definition criteria are used: causes and etiology, location, coverage area.

By etiology:

  • Primary osteoarthritis: Develop independently, with damage to completely healthy joints, without the participation of previous pathologies;
  • Secondary are formed in the context of a disease (gout, psoriasis, rheumatism), as well as in the presence of existing deformations or articular injuries.

For the degree of coverage:

  • Local forms with damage to a limited number of joints: monoarthros-1 articulation, oligoarthritis-2-3;
  • Generalized forms are several types of polyartrosis, when 3 large and more structures are involved in the pathological process.

According to the location of the process, the names of the osteoarthritis of each joint separately are given:

  • Coksarrosis: disable the hip connection;
  • Spondilatrosis: affects intervertebral discs, mainly cervical, chest and lumbar;
  • gonarrosis: with deteriorated work of the knee joint;one of the most common species;
  • Crossing: with participation in the pathological process of the ankle.

Arthosis can be progressive, compensated or decompensated quickly or slowly.

The main symptoms and signs

Arthosis is a complex disease.Conventionally, it can be divided into several pathologies together with each other:

  • Condritis and Condrosis: Inflammatory and degenerative lesion of cartilage tissue;
  • Osteoporosis is also osteoporosis, a pathological process in bone structures;
  • Synovitis: the affectation of the coating layer of the joint capsule;
  • Bursit - General inflammation of the joint bag;
  • Reactive damage to soft tissues in the adjacent area: affects muscles, ligaments, fiber.
Stock and pain in the osteoarthritis of the joints of the hands

Depending on the stage, the degree and the form, they are observed simultaneously or selectively.With this in mind, a complex of symptomatic changes is formed.Among them:

  • Pokhrutzhazing is a symptom of a rape of mineral metabolism and the first sign of the disease.It can happen at any age.
  • Stock: It manifests intensely in the morning.It is short -term and can be expressed by the effect of joint interference.
  • Limit mobility: reducing the amplitude of movements in the commission of active or passive actions.
  • The pain has a different manifestation, starting with unpleasant and painful, which, after intense loads, acquires a background character and ending acute acute movements when they make movements.The "initial pains" called so are especially characteristic, which manifest after a long rest period and last until the articulation develops completely.
  • Swelling: with inflammation of soft tissues, synovitis, bursitis.
  • DEFORMATION: It is observed with complete degeneration of the cartilage and the lack of a shock exorbitant factor.

Note! Bushara and Geberden nodules are a characteristic sign of deforming osteoarthritis of the hands.They are bone growth with osteophyte processes.

Stages and degree of osteoarthritis

In terms of intensity of the changes of arthrose, 4 stages of the disease are distinguished:

  • First stage: with slight cartilage replication (violation of structure and functionality in collagen fibers).In X -rays, the image is practically not visible.
  • Stage 2: The bite of the cartilage fabric in the joint of the joint is up to 50%.It is covered with cracks, a slight pain appears in the damaged complex area.Osteophytic complexes appear in the X line;The joint space slightly reduces its size.
  • Stage 3: The cartilage injury almost reaches the bone base, the joint space is drastically reduced.
  • 4 Stages: The cartilage is completely damaged, which leads to a partial or complete degeneration of the synovial fluid, the abrasion of bone tissues with each other and the deformation of the compound.In some areas, sclerosis changes are developed.The extreme manifestation of osteoarthritis is the fusion of joint tissues with the ossification of structures and a complete loss of mobility.

In some sources, stage 1 and 2 are combined in one.

With the progress of the symptoms, the motor activity of a person suffers.Given the violations of the functional performance of the joint, 4 degrees of possible pathology development are distinguished:

  1. 0 degrees: mobility and performance are preserved in its entirety;
  2. 1 grade: The patient retains the self -service capacity and manifests social activity, but cannot participate in work activity;
  3. 2 degrees: the difficulties in the manifestation of social activity are added to a violation of work activity;
  4. 3 degrees: All types of activities are limited or completely impossible: work, social and self -compliance;The patient needs constant attention.

What are the possible complications

By hardening with treatment, it can cause a series of unpleasant consequences:

  • Constant pain syndrome;
  • limp;
  • vertebrates (with spondilartrosis);
  • pronounced joint deformation;
  • Complete immobility with the ossification of structures.

What includes the survey procedure?

For the diagnosis of osteoarthritis, a medical examination with the collection of an anamnesis is sufficient.To determine the degree of damage, an instrumental exam is carried out.The main ways to obtain a clear image of the disease:

  • radiography;
  • CT, magnetic resonance;
  • ultrasonography;
  • gammography;
  • Diagnostic arthroscopy with cartilage tissue and synovial liquid tissue.

In an acute inflammatory process, the doctor prescribes additional analysis: a general blood, rheumat, biochemistry analysis (glucose level, protein compounds, electrolytes).

Treatment

It is impossible to completely eliminate the disease.The timely treatment of osteoarthritis allows you to maintain the functionality of the joint, normal motor activity and prevent pain.To exclude complications, you must start in the first stage.

Drug therapy Includes:

  • anti -inflammatory medications, mainly NSAIDs;
  • Intra -articular steroid blocks of pain and inflammation (with pronounced synovitis, bursitis);
  • Proteolysis inhibitors: Decrease speed and suspend the process of destruction of bone and cartilage;
  • Antispasmodics: Prevent muscle cramps;
  • Angioprotectors and drugs to improve the microcirculation of blood in affected tissues;
  • condoprotectors;
  • Synthetic substitutes for synovial fluid;
  • Vitamin and mineral compositions.
Exercise therapy for the treatment of arthrosis of the joints

A physiotherapy complex prescribed in parallel to improve the effect of drugs.The main physiotherapy: 

  • Magnetotherapy;
  • electrophoresis;
  • UHF;
  • mud;
  • spa;
  • massage;
  • Exercise and kinesiotherapy therapy using special simulators.



Surgery - The only way to treat in the posterior stages, when the cartilage tissue is completely destroyed.The following solutions to the problem are possible:

  • Endoscopy: with a partial or complete replacement of the joint by an artificial analogue;
  • Arthroscopy: a minimally invasive operation to eliminate osteophytes or partial cartilage replacement;
  • Arthrodesis: the closure of the articulation and the fixation in the most convenient position;The motivated connected joint surfaces grow over time.

Forecast 

Arthrosis does not threaten the patient's life, but lack of treatment can significantly limit freedom of movement and worsen the quality of life.Timely and competent therapy in the early stages can restore the joint to a healthy state.In other cases, only a deceleration in the degeneration process is possible with the help of conservative treatment and compensation for lost functions due to prostheses.

Disease prevention

A complete recovery is almost impossible, therefore, prevention must be given to special attention.The main requirement is a healthy lifestyle and a complete treatment of inflammatory processes:

  • Do not allow hypothermia and treat infectious diseases in a timely manner;
  • Avoid physical overload and long static loads;
  • Maintain normal body weight;
  • Adhering to the correct diet: the balanced composition of vitamins and minerals is very important for the health of the musculoskeletal system;
  • Totally (if possible, until complete recovery), treat any damage to the joints;
  • Practice systematic physical exercises to stimulate blood circulation (bicycle, hiking, light trot, Scandinavian walk).

If you are at risk (elderly, bad inheritance, physical overload) be sure to undergo a regular radiographic examination.