Arthrosis (Deformation of osteoarthritis, folk name - deposition of salts) is a chronic disease of degenerative joints -Dystrofi, in which the destruction of the joint cartilage, the joint capsules and the deformation of the bone itself occurs.
It should be noted that arthrosis is an entire group of joint diseases that have different origins and close development mechanisms.Very often there are arthrosis of large joints:
- Deforming of arthrosis of the knee joint (gonartrosis),
- Deforming of the arthrosis of the hip joint (Coksartrosis),
- As well as the arthrosis of the shoulder joint.
These are the most serious types of arthrosis.
The arthrosis of small joints is less common.Very often there are deforming arthrosis of the hands interface joints, as well as the metacarpoflance and thumb joints.Patients notice pain in the interfacenaction joints, a decrease in their mobility, the appearance close to the joints of the seals (nodules of Geberden and Babbar).This type of arthrosis is more common in old age.The arthrosis of the foot joints often occurs.
Polyrtrosis, or generalized arthrosis, is characterized by damage to several joints simultaneously.
Arthrosis The joints of the spine - spondylartosis - belong to the group of diseases of the spine, although it has a similar development mechanism with other arthrosis.
The main clinical symptom of arthrosis is pain in the joint, a decrease in its mobility.Specific symptoms are determined by the arthrosis stadium and depend on the degree of destructive changes in the articulation.
The causes of osteoarthritis
Arthrosis It is customary to divide in the primary and secondary.Primary arthrosis (idiopathic) is a consequence of a violation of the recovery processes and greater degeneration in the fabric of the cartilage of the joint without deviations in the work of the entire body.Secondary arthrosis occurs following other pathological processes in the body or articulation already damaged by any external effect, with partial destruction of the joint surfaces.
Very often, traumatic arthrosis is diagnosed in young patients.And in older patients, it is far from possible to draw a clear border between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, the factors that contribute to the occurrence and development are well known.
The following types of causes that contribute to the development of primary and secondary deformation can be distinguished.
The causes of primary arthrosis are hereditary factors
The following hereditary disorders have been identified, which can cause the development of primary arthrosis:
- genetic disorders in the composition of the tissue of the cartilage of the joint, leading to its accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermobile of joints, dysplasia, plates and others), which are the cause of the trauma of some sections of the fabric of the cartilage of the joint and, consequently, the appearance of arthrosis.
It was also noted that deforming arthrosis of the joints between the phalanx of the higher ends is mainly found in women and is inherited from the female line.
The causes of secondary osteoarthritis
Secondary arthrosis is a consequence of joint damage.These damages can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various joint lesions, intra -articular bone fractures, following which the joint structure is disturbed.The same result is caused by the constant microtraumatization of the joints following constant excessive loads, both static and dynamic (for example, in athletes).In addition, obesity leads to overload and trauma.
Another factor that has a negative effect on the joints (mainly on the hip) is an incorrect posture.
The structure of the joint can also stop surgery. - Joint diseases.Arthosis can be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Violations of metabolism, diseases of the endocrine system, lack of minerals in the body.Various metabolism disorders, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage, synovial fluid, which leads to a violation of the recovery processes and the gradual destruction of the composition.
- Autoimmune diseases(Gout, Condrocalcinosis, Emochromatosis, Psoriasis, Rheumatoid arthritis), Hormonal disorders, lack of estrogen In postmenopause, women lead to changes in the tissues of the joints and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower ends, cancel the endarteritis, varicose veins), as well as Hypodynamia They cause circulatory disorders in periarticular tissues, low blood supply to joint tissues and, consequently, dystrophic changes.
The mechanism of arthrosis development
Development arthrosis Begins with the destruction of cartilage.It is believed that at the beginning there is a violation of the blood circulation in the capillaries of the corneal layer of the periosteum.Since cartilage nutrition occurs due to the intake of nutrients with an intra -articular fluid and adjacent bone tissue, the circulatory interruption leads to the fact that the cartilage gradually loses elasticity, becomes thinner, the cracks appear on it, the smoothness on it, the smoothness on it, the smoothness is the smoothness, the smoothness is reduced.Consequently, it appears Pain and creak during the movements.The width of the joint gap gradually decreases, the bone is formed along the edges of the joint surfaces Osteophyta peaks.
In the end, the articulation is deformed, the breadth of the movements in it decreases.Thus develops the entertainment arthrosis associated with body aging.The development of this form of arthrosis usually occurs gradually, over the years.
Other forms of arthrosis of the large joints, for example post -traumatic, post -infective, metabolic, intoxication have many other development mechanisms, but consequently we obtain similar changes in the joint.
Symptoms of arthrosis of the joints.Phase and degree of arthrosis
"Classico" is the classification of arthrosis on the basis of clinical and radiological characteristics.In agreement with it, three phases of the development of the disease are distinguished.Corresponds to the classification for the degree of maintenance of disability, which distinguishes 3 degrees of arthrosis:
- The degree of arthrosis: the disease does not prevent the work, although it complicates it,
- The degree of arthrosis - the disease prevents work performance,
- III degree of arthrosis - loss of work capacity.
We consider the clinical symptoms and the signs of arthrosis in each of these phases in more detail
Osteoarthritis of the 1st degree (initial stage of arthrosis)
In the initial phase of the disease in the morning, after rest, rigidity, difficulty in the movement of the joints, which gradually passes some time after the start of the movement.Perhaps a certain restriction of mobility in the joint.Periodically, "beginning" pains appear (pain at the beginning of the movement after a long stay at rest).With acute movements, joint creaks, but there is no pain during movement.Pain in this phase of arthrosis appears only with a significant and prolonged load and attenuates after rest.There is no pain alone and at low loads.At this stage of the disease, patients rarely see a doctor.
In the X -ray image with arthrosis of the 1st degree of special changes in the articulation is not visible, sometimes small osteophytes can be visible along the edges of the joint, the joint gap is slightly restricted.
Osteoarthritis at 2 degrees (second phase of arthrosis)
With the further development of arthrosis, the pain becomes more significant, acquires an acute character.A distinct crunch in the joint appears with any movements, there is a remarkable restriction of mobility in the joint (contracture), functional shortening of the limb, biomechanics compromised of the movements, but joint mobility is still preserved.This phase is characterized by a remarkable strengthening of initial pain, they become acute and longer.Under the influence of daytime physical activity, a constant effort appears, a feeling of pressure in the affected joints, the "mechanical pains" so called derive from a decrease in shock -basorption skills of the tissues of the cartilage of the joint.
The destruction in the joint is already significant enough, the joints are already partially deformed.
On the radiographs, evident osteophytes are visible, the narrowing of the joint gap is 2-3 times compared to the norm, the sclerosis of the sub-controlle bone and the formation of cystic cavities in the epiphary area are observed.
The osteoarthritis of the 2nd degree is characterized by a decrease in work capacity, by the inability to perform certain types of work.
Osteoarthritis of 3 degrees (third arthrosis stadium)
Arthrosis 3 degrees are a serious and neglected stage of the disease.In this phase there are:
- significant deformation of the joint (due to the growth of the bones and the accumulation of fluid in the joint cavity);
- a strong restriction of movements, up to the conservation of only rocking movements;
- Acute pain not only when it moves, but also in a complete state of rest - constant pain associated with the cramps reflections of the nearby muscles, as well as the development of reactive synovitis;
- Joint inflammation,
- Sensitivity of the joints to change of time.
- The muscles around the knee are bad and atrophilic;
The axis of the limbs is deformed, significantly varus or curvature of the valgus of the legs (ie in the form of the letter "or" or "x").
On radiographs with arthrosis of the 3rd degree, almost complete with the joint gap, a serious deformation of the joint surfaces, vast multiple regional osteophytes are observed.It is possible to determine the joint mice and the calcification of the Paraarticular tissues.
At 3 degrees, the disease has gone very far, often it is already the cause of persistent disability.It manifests itself as follows:
- The pain becomes constant and painful: walking, and in particular the descent and climbing the stairs - a difficult test for the patient;
- Strong crew in any movements, well cared for for others;
- The deformation of the joints is strongly expressed, the movements are limited only by a small breadth or even impossible;
The images show the destruction of intra -articular structures (ligaments and meniscus), as well as the complete abrasion of the cartilage and the signs of sclerosis (replacement of functioning organs and connective tissue structures).
Arthrosis of the 4th degree
The state of complete destruction of the joint arthrosis, when the joint completely stops operation, it often distinguishes itself in a separate degree - 4 degree of arthrosis.There is a "joint block" so called - a acute pain syndrome, in which even a limited movement in a sick articulation is impossible.The fourth degree of arthrosis is accompanied by unbearable joint pain, which are not even removed from powerful drugs and intensive physiotherapy.Complete (joint fusion) or neoartrosis (the formation of a false articulation between the ends moved of the bones) is possible.The independent movement in both cases is almost impossible.
In the images, the rough sclerosis of the saturated surfaces with pronounced cystic lighting is visible, the merger of the connection bones in the joint gap is visible.The development of the disease in this phase almost always means disability, which can only be prevented by the implantation of the artificial joint prosthesis.
Treatment of osteoarthritis
Treatment of osteoarthritis in the initial phase of the disease
It is better to start treating arthrosis as soon as possible, with the appearance of the first signs: creak in the joints, difficulty in the movement.At this stage, the drugs are useful -condoprotectors who improve the structure of the cartilage, as well as mineral complexes of vitamin.
Medical physical education, correct nutrition and preventive measures are important.It should be noted that arthrosis prevention is also of great importance to prevent the exacerbation of the disease.
Hisch treatment 2 - 3 degrees
Although it is already impossible to completely take care of the arthrosis of the 2-3 degrees, however, the process of its development can be considerably inhibited.The treatment of osteoarthritis at this stage provides for the following phases:
- removal or reduce pain syndrome
- Remove inflammation in the joint.
- It improves the restoration of the cartilage and slows down the degenerative processes.
In the acute period, the treatment of arthrosis begins with the elimination of pain.For this, non -hormonal anti -inflammatory drugs (NSAIDs), analgesics are used.Intra -articular corticosteroid injections are possible.It is necessary to reduce the load on the joint, it is not possible to walk or stand for a long time, raise heavy objects.
After removing the acute pain syndrome, the main task is to guarantee, as far as possible, the activation of recovery processes in joint and periarticular tissues: improvement of blood circulation, increase in metabolism, elimination of inflammatory processes.Condroprotectors, vasodilated drugs, therapeutic exercises and physiotherapy are prescribed.
Treatment of arthrosis of 4 degrees
At this stage of the disease, the articulation is almost completely destroyed.In this case, an exit remains: the operation and replacement of the sick articulation with an endoprotesis.Endoprothesis significantly improves the mobility of the joint, allows the patient to resume active life, at least, get rid of pain.