osteoarthritis

Osteoarthritis: what is it in simple words?

Osteoarthritis is a chronic pathology in which there is a gradual destruction of the cartilage plate. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) develop. The joint capsule reacts to the events that occur and reactive vasculitis develops.

About the disease and possible complications.

The incidence of the pathology depends on age. The first signs of osteoarthritis usually do not appear before the age of 30-35, and by the age of 70, approximately 90% of the population suffers from this pathology. Osteoarthritis does not show gender differences. The only exception is degenerative damage to the joints between the carpal phalanges. This form of the disease is 10 times more common in women than in men. Osteoarthritis most frequently affects the large joints of the legs and arms.

The pathological process begins with the interstitial substance of cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by balancing the processes of anabolism and catabolism. If the degradation process of cartilage tissue dominates its synthesis, conditions are created for the development of osteoarthritis. This explains in simple terms what osteoarthritis is.

Most often, the first signs of the disease develop in places of greatest mechanical load, with limited areas of softening of the cartilage plate appearing. As the pathological process progresses, the cartilage fragments and cracks, and local deposition of calcium salts is possible. Below the cartilage defects, the underlying bone is exposed; Separate fragments of cartilage enter the joint cavity and can cause the so-called "jam" (symptoms of a "joint mouse").

Damage to the cartilage lining the articular processes of bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, when moving, the articular surfaces experience non-physiological loading. In response to this, compensatory resynthesis processes in bone tissue are stimulated. The bone becomes denser (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further changes the discrepancy between the articular surfaces. The developing pathological changes gradually limit the range of motion in the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Osteoarthritis becomes the background for the development of synovitis, inflammation of the synovial membrane of the joint. This is due to the fact that dead fragments of cartilage and bone activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, this prolonged inflammation is accompanied by sclerosis of the periarticular tissues: the joint capsule thickens and the surrounding muscles atrophy.

The main symptom of osteoarthritis is pain, which over time is accompanied by limited mobility in the joint. The limitation of mobility is first of a compensatory functional nature and then is due to organic changes. Additional imaging methods (radiography, ultrasound, CT scan, or MRI) help establish the correct diagnosis.

Depending on the stage and degree of osteoarthritis, treatment can be carried out using conservative or surgical methods. An orthopedic traumatologist will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of osteoarthritis

There are 2 types of osteoarthritis:

1. The primary variant is a consequence of a violation of the relationship between the processes of synthesis and degeneration in cartilage tissue and is accompanied by a disorder in the function of chondrocytes, the main cartilage cells.
2. The secondary variant occurs in a previously modified joint when the normal relationship (congruity) of the articular surfaces is altered, followed by a redistribution of the load on them and with a concentration of pressure in certain areas.

Symptoms of joint osteoarthritis.

The main symptom of joint osteoarthritis is pain. It has certain distinctive characteristics that allow the primary diagnosis of the disease.

1. mechanical pain, caused by the loss of the shock absorption characteristics of cartilage. Painful sensations occur during physical activity and are relieved during rest.
2. Night pain.Caused by stagnation of venous blood and increased pressure of blood flowing within the bone.
3. Initial pain.It is short-lived and appears in the morning, when the person gets out of bed (the patient says that he needs to "disperse"). These pains are caused by the deposit of debris in the cartilaginous plates; during movement, these fragments are pushed towards the joint inversions, due to which unpleasant sensations cease.
4. Meteorite dependence.The pain may intensify when weather conditions change (increased atmospheric pressure, cold weather, excess humidity).
5. Blockage pain.These are sudden painful sensations that are associated with the pinching of a bone or cartilage fragment between the joint surfaces. Against the background of "locking", the slightest movements in the joint stop.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person is bothered by stiffness in the joints. Signs of the inflammatory process are determined objectively: swelling and local increase in skin temperature.

Osteoarthritis usually begins slowly with the development of pain in an affected joint. At first, the pain only bothers during physical activity, but then it appears even at rest and during night sleep. Over time, pain is also felt in the joints on the opposite side, which is associated with a compensatory increase in load. An important distinguishing feature of osteoarthritis is its frequency, when short periods of exacerbation are followed by periods of remission. The progression of the pathological process is indicated by a shortening of the period between relapses and the development of adverse consequences in the form of contractures and a strong limitation of mobility in the joint.

Course of osteoarthritis during pregnancy.

During pregnancy, osteoarthritis can present in different ways. Usually, up to 12-13 weeks, an exacerbation of the pathological process may occur, associated with hormonal changes occurring in the woman's body. The second and third trimesters are usually relatively stable. Pregnancy management is carried out by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint osteoarthritis.

The main mechanism that triggers cartilage destruction is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of osteoarthritis is preceded by a period of metabolic disorders, which occur latently. This metabolic imbalance is characterized by damage to proteoglycans and their components (chondroitin, glucosamine, keratan), which is accompanied by disintegration and degradation of the cartilage matrix. Collagen fibers break down in the cartilage plate, the supply of metabolites necessary for life is disturbed, and the water balance also changes (first the cartilage is hydrated, and then the number of water molecules decreases sharply, which further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. In osteoarthritis, a cytokine "surge" is also observed: the released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of osteoarthritis can be varied:

• "excess" weight, which increases the load on the joints;
• wearing low quality shoes;
• concomitant diseases of the musculoskeletal system;
• suffered joint injuries.

Signs and diagnosis of joint osteoarthritis.

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are performed.

1. Bone scan.At an early stage, radiological signs of the disease are of little importance: they may be an uneven narrowing of the joint space, slight compaction of the underlying bone, and small cysts in this area. At a later stage, the x-ray is more informative: marginal bone growths appear, the shape of the articular surfaces changes, joint "mice" and areas of calcification in the capsule can be determined.
2. Joint ultrasound.Ultrasound is more informative in detecting early signs of osteoarthritis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilaginous plate and secondary reactions of the capsule, musculotendinous and ligamentous compartments can be visualized.
3. Computed magnetic or nuclear tomography.This diagnosis of joint osteoarthritis is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilaginous plate, the subchondral region of the bone and determine the volume of synovial fluid, incl. in joint investments.

Expert opinion

Deforming osteoarthritis of the joints is one of the most common pathologies of the musculoskeletal system, affecting 10-15% of the world's population. The insidious thing about the disease is that it develops slowly and gradually. At first, these are brief pains in a joint, to which the person often does not pay attention. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain becomes constant. In the absence of treatment, the disease continues to progress and is accompanied by serious degeneration of the cartilage, which no longer responds to conservative therapy and to solve this problem only arthroplasty is required, a complex and expensive intervention to replace the joint destroyed by a complete articulation. -full implant. However, targeted drug therapy and lifestyle modification can help significantly delay this operation or avoid it altogether. Therefore, if joint pain occurs, it is important to visit the doctor as soon as possible.

Osteoarthritis treatment

According to clinical guidelines, the main objective of osteoarthritis treatment is to slow the progression of degenerative lesions of the cartilage plate. To achieve this, measures are taken that reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

Joint unloading is achieved in the following ways:

• loss of body weight (if excessive);
• carry out physiotherapy that excludes prolonged similar postures;
• refusal to lift large loads or remain on one's knees for long periods of time (relevant for some professions).

In the initial stages of the disease, in addition to physiotherapy, swimming and cycling are useful. In the later stages, to unload the joint during an exacerbation, it is recommended to walk with an orthopedic cane or use crutches.

To relieve pain, incl. Against the background of secondary synovitis, non-steroidal anti-inflammatory drugs, both local and systemic, are used. Intra-articular injections of corticosteroids can be used for the same purpose.

To improve the anatomical and functional state of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help improve the metabolism of cartilage tissue, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progression of the pathological process and improve mobility in the joint.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

• Joint puncture– indicated for severe reactive synovitis. It allows not only to eliminate the inflammatory fluid, but also to introduce corticosteroids that interrupt the pathological chain.
• Arthroscopic operations, which involve the introduction of instruments into the joint cavity through small punctures and their subsequent visualization with magnification. These interventions allow washing the joint and its inversions, leveling the cartilaginous plate, eliminating necrotic areas, "polishing" the articular surfaces, etc.
• endoprostheses– is considered a radical operation, which is performed in case of an advanced pathological process. It is typically used for osteoarthritis of the knee or hip joint.

Osteoarthritis prevention

Prevention of osteoarthritis aims to maintain a normal weight, use orthopedic footwear, avoid knee work, lift heavy objects in doses and follow a physical activity regimen.

Rehabilitation of osteoarthritis of the joints.

Rehabilitation of osteoarthritis of the joints involves a set of procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and gymnastics are used to improve health.

Questions and answers

What doctor treats osteoarthritis?

Diagnosis and treatment is carried out by a traumatologist-orthopedist.

Does radiography always allow the correct diagnosis to be made?

The severity of clinical signs of osteoarthritis does not always correlate with radiological changes. Often in practice there are cases when, with severe pain, the X-ray does not reveal significant changes, and vice versa, when a "bad" radiological picture is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for osteoarthritis?

If osteoarthritis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to look for causes that may lead to impaired functional status of the joint (for example, damage to the menisci of the knee joint and intra-articular ligaments) . .