Osteoarthritis is a chronic pathology that affects the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course with gradual destruction of cartilage tissue.Osteoarthritis is detected in the majority of patients after the age of 65, since one of the reasons for its development is the natural aging of the body.
The appearance of degenerative-dystrophic pathology is provoked by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, conversely, a sedentary lifestyle.The main symptoms of osteoarthritis are joint pain, swelling and limitation of movement.
To diagnose pathology, instrumental studies are performed: x-ray, arthroscopy, magnetic resonance imaging, computed tomography.Osteoarthritis of the first and second severity is treated conservatively with a course of medications, physiotherapy procedures and massage and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated: arthrodesis, endoprostheses.
Pathogenetic mechanisms
With osteoarthritis, pronounced changes occur in the internal structures of the connective tissue.Deforming erosions form in the cartilage tissues, which causes the destruction of collagen fibers, as well as proteoglycans consisting of proteins (5-10%) and glycosaminoglycans (90-95%).As a result, the collagen network loses stability and metalloproteinases begin to be released that destroy all types of proteins in the extracellular matrix.The destruction is accelerated by increasing the biosynthesis of collagenases and stromelysin.Typically, normal quantitative values of enzymes are controlled by cytokines, small molecules of peptide information.But as osteoarthritis progresses, the concentration of these proteins decreases, causing the release of a large amount of enzymes that damage cartilage tissue.
Proteoglycans with an altered structure begin to absorb water molecules that they cannot retain.Therefore, excess fluid enters the collagen fibers.They “swell” and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of the synovial fluid.With osteoarthritis, the concentration of hyaluron decreases.Hyaline cartilages no longer receive enough nutrients and oxygen for regeneration.Focuses of softening form in the cartilaginous tissues, and then cracks and specific necrotic growths appear.The heads of the bones become exposed and begin to suffer microtrauma when they move relative to each other.
Causes and provoking factors.
The causes of the development of primary (idiopathic) osteoarthritis have not yet been established.It occurs in the absence of provoking factors, which is why theories about a hereditary predisposition to premature destruction of cartilage are proposed.Secondary osteoarthritis develops as a consequence of other joint pathologies or previous injuries.What can cause a degenerative-dystrophic disease:
- injury to a joint or nearby connective tissue structures: fracture, dislocation, damage to the meniscus, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of the functioning of the endocrine glands, disorder of metabolic processes;
- rheumatism or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococcus, epidermal or Staphylococcus aureus;
- tuberculosis of any location, brucellosis, chlamydia, gonorrhea, syphilis;
- Degenerative disease, for example osteochondritis dissecans.
Joint hypermobility, caused by the production of special collagen, predisposes to the development of osteoarthritis.This condition is detected in 10% of the planet's inhabitants and is not considered a pathology.But hypermobility is accompanied by weakness of the tendon-ligamentous apparatus, which causes frequent injuries, especially in the ankle joint (sprains and ruptures of ligaments, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders, such as hemophilia.Hemarthrosis or hemorrhage in the joint cavity causes a deterioration in cartilage trophism and its destruction.
Predisposing factors include old age, frequent loads on the joints that exceed their strength limits, excess weight, surgical interventions and hypothermia.
The risk group includes women during menopause, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.If there is a deficiency in the diet of foods with vitamins and microelements, preconditions are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of osteoarthritis lies in the absence of symptoms in the first stage of its development.Pathology manifests itself clinically gradually, the first signs appear against the background of significant destruction of cartilaginous tissue.Initially, a person feels a slight pain that does not have a clear localization.It appears after physical activity: weight lifting, sports training.Sometimes the first clinical manifestation is a cracking or clicking sound when bending or extending the joint.A person begins to notice that some movements are difficult.However, in the initial stage of osteoarthritis, stiffness appears in the morning and soon disappears.
As the disease progresses, the pain is also felt at night, causing not only sleep disturbances, but also the appearance of chronic fatigue.The severity of pain syndrome in the second stage increases with changes in weather, exacerbation of chronic pathologies and acute respiratory viral infections.The range of motion is significantly reduced.The cause of stiffness is the thinning of the cartilage, as well as the conscious restriction of the person's movements in an attempt to avoid pain.This leads to greater loading on the opposite joint, causing further damage.Osteoarthritis is also characterized by other specific symptoms:
- pain causes spasms of skeletal muscles and the development of muscle contractures (limitation of passive movements in the joint);
- creaks in the joints, clicks and creaks when moving become constant and occur with almost every displacement of the bones relative to each other;
- painful muscle cramps often occur;
- the joints become deformed, causing alterations in posture and gait;
- in the third stage of osteoarthritis, the deformation is so pronounced that the joints bend and the range of motion in them is significantly reduced or completely absent;
- with third degree osteoarthritis of the knee, ankle, hip joint, the patient uses a cane or crutches when moving.
In the absence of treatment, the pathology progresses, and during its course, remissions are replaced by relapses, and the frequency of exacerbations constantly increases.The stiffness in movements in the morning now does not disappear for a long time, it becomes permanent..
When examining a patient with first degree osteoarthritis, the doctor notes only slight swelling of the joint and complete preservation of the range of motion.In grade 2 pathology, palpation reveals pain and mild deformity.In the area of the joint space, the formation of bone thickening is observed.
Osteoarthritis is characterized by the development of synovitis, inflammatory processes in the synovial membranes of the hip, knee, ankle and shoulder joints.Its main symptom is the formation of a rounded seal in the joint area, when pressure is applied on which the movement of fluid (fluctuation) is felt.Acute synovitis can be accompanied by an increase in temperature up to 37-38 °C, headaches and digestive disorders.
Diagnosis
The diagnosis is made on the basis of the results of instrumental studies, the characteristics of the clinical picture, anamnesis and the patient's complaints.A general blood and urine analysis is not very informative: all values remain within normal limits if osteoarthritis is not caused by metabolic pathology.With the development of synovitis, the erythrocyte sedimentation rate increases (30 mm/hour) and the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.In secondary forms of osteoarthritis, changes occur in biochemical and immunological parameters.
The most informative method for diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral projection.
| Stages of osteoarthritis according to the Kellgren-Lawrence classification (1957) | Radiological signs of pathology. |
|---|---|
| Initial | No radiological signs |
| first | Indistinct and unequal narrowing of the joint space.Slight flattening of the edges of the bone plates, formation of initial osteophytes or their absence. |
| second | Marked narrowing of the joint space, 2-3 times greater than normal, formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic gaps in the epiphyses. |
| third | The appearance of pronounced subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space. |
| room | Formation of massive and thick osteophytes, almost complete fusion of the joint space, deformation and compaction of the epiphyses of the bones that form the joint. |
If, after studying the X-ray images, the doctor has doubts about the diagnosis, a CT scan is prescribed.And to assess the state of the connective tissue structures located near the joint, an MRI is performed.When using contrast, it is possible to dynamically assess the blood supply to the tissues and establish the stage of the inflammatory process during the development of synovitis.
Basic therapy methods.
Osteoarthritis remains an incurable disease, since there are no pharmacological drugs for the regeneration of cartilage tissue.The main goal of therapy is to prevent the progression of pathology and maintain joint mobility.Treatment is complex and long-term, and uses both local and systemic medications.Patients should avoid strong stress on the joint and, if necessary, limit the range of motion with orthopedic devices: orthoses, elastic bandages.Overweight patients need to make adjustments to their diet to gradually reduce body weight and follow a diet.
After achieving stable remission, patients are shown daily physiotherapy exercises.The first training sessions are carried out under the guidance of a physiotherapist, then the patient performs a series of exercises at home.Exercise therapy can be complemented with swimming, yoga and cycling.
To reduce the severity of pain, drugs of various clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- injections into the joint of anesthetic solutions in combination with glucocorticosteroids;
- Muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic regimens include vitamin B, sedatives and, if necessary, tranquilizers and antidepressants.Chondroprotectors are required for long-term use.This is the only group of drugs that have the ability to partially restore cartilage tissue.
To increase its clinical activity, physiotherapeutic procedures are carried out: laser therapy, magnetic fields, UHF therapy.
Any joint pain should be a signal for immediate consultation with a doctor.Therapy performed in the early stage of osteoarthritis will stop cartilage destruction and prevent loss of performance and disability.