Arthrosis (arthrosis deformans, popular name - salt deposition) is a chronic disease of the joints of a degenerative-dystrophic nature, which results in the destruction of the joint cartilage, joint capsule and deformation of the bone itself.
It should be noted that arthrosis is a whole group of joint diseases that have different origins and similar mechanisms of development.The most common arthrosis of large joints is:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
These are the most severe types of arthrosis.
Arthrosis of small joints is less common.More common are deforming arthrosis of the interphalangeal joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients notice pain in the interphalangeal joints, a decrease in their mobility and the appearance of seals near the joints (Heberden's and Bouchard's nodes).This type of arthrosis is more common in old age.Arthrosis of the foot joints is common.
Polyarthrosis, or generalized arthrosis, is characterized by damage to several joints at once.
Arthrosis joints of the spine - spondyloarthrosis - belongs to the group of diseases of the spine, although it has a mechanism of development similar to other arthrosis.
The main clinical symptom of arthrosis is joint pain and reduced mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree of destructive changes in the joint.
Causes of arthrosis
Arthrosis It is customary to divide it into primary and secondary.Primary (idiopathic) arthrosis is the result of disruption of the restoration process and increased degeneration in the cartilage tissue of the joint without any deviations in the functioning of the whole organism.Secondary arthrosis occurs as a result of other pathological processes in the body, or in a joint that has already been damaged by some external influence, with partial destruction of joint surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in elderly patients, it is not always possible to draw a clear line between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, the factors that contribute to its occurrence and development are well known.
The following types of reasons can be identified that contribute to the development of primary and secondary deforming arthrosis.
Causes of primary arthrosis - hereditary factors
The following hereditary disorders that can cause the development of primary arthrosis have been identified:
- genetic disorders in the composition of the cartilage tissue of the joint, which leads to its accelerated destruction;
- congenital defects of the musculoskeletal system (hypermobility of the joints, dysplasia, flat feet and others), which cause trauma to certain areas of the cartilage tissue of the joint, and as a result, the appearance of arthrosis.
It is also noted that deforming arthrosis of the interphalangeal joints of the upper extremities occurs predominantly in women and is inherited through the female line.
Causes of secondary arthrosis
Secondary arthrosis is the result of joint damage.These damages can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various joint injuries, intra-articular bone fractures, due to which the structure of the joint is disturbed.The same result causes constant microtrauma of the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).Obesity also leads to joint overuse and injury.
Another factor that negatively affects the joints (primarily the hip joints) is incorrect posture.
The structure of the joint can also be disturbed by surgery. - Joint diseases.Arthrosis can be a consequence of inflammatory joint diseases (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, lack of minerals in the body.Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone and cartilage tissue, synovial fluid, which leads to disruption of the recovery process and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, lack of estrogen in postmenopausal women, they lead to changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins), as well as physical inactivity they cause circulation disorders in the periarticular tissues, poor blood circulation of the joint tissues and as a result degenerative changes.
Mechanism of arthrosis development
Development arthrosis it begins with the destruction of cartilage.It is believed that initially there is a disturbance of circulation in the capillaries of the subcartilaginous layer of the periosteum.Since the nutrition of the cartilage occurs due to the supply of nutrients from the intra-articular fluid and the adjacent bone tissue, poor circulation leads to the fact that the cartilage gradually loses its elasticity, becomes thinner, cracks appear on it, the smoothness of the joint surfaces is impaired, and the amount of synovial fluid that ensures the gliding of the joint decreases.As a result, it appears pain and grinding when moving.The width of the joint space gradually decreases, and bones are formed along the edges of the joint surfaces. osteophyte spines.
Eventually, the joint deforms and the range of motion in it decreases.This is how involutive arthrosis develops, associated with the aging of the body.The development of this form of arthrosis usually occurs gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication, have slightly different mechanisms of development, but as a result we get similar changes in the joint.
Symptoms of arthrosis of the joints.Phases and degrees of arthrosis
Classification of arthrosis based on clinical and radiological signs is considered "classic".Accordingly, three stages of disease development are distinguished.Corresponds to the classification according to the degree of preservation of working ability, distinguishing 3 degrees of arthrosis:
- And the degree of arthrosis - the disease does not interfere with the performance of work, although it makes it difficult,
- II degree of arthrosis - the disease interferes with work performance,
- III degree of arthrosis - loss of working ability.
Let's consider in more detail the clinical symptoms and signs of arthrosis in each of the mentioned stages.
Arthrosis of the 1st degree (initial stage of arthrosis)
In the initial stage of the disease, in the morning, after rest, there is stiffness and difficulty in movement in the joints, which gradually disappear some time after the start of movement.There may be some limitation of mobility in the joint."Initial" pain (pain when starting to move after a long period of rest) occurs periodically.With sudden movements, the wrist creaks, but there is no pain when moving.Pain in this stage of arthrosis occurs only with significant and long-term stress, and disappears after rest.There is no pain at rest and with light exertion.At this stage of the disease, patients rarely visit a doctor.
No special changes in the joint are visible on the X-ray with arthrosis of the 1st degree;sometimes small osteophytes can be seen on the edges of the joint, the joint space is slightly narrowed.
Arthrosis of the 2nd degree (second stage of arthrosis)
With the further development of arthrosis, the pain becomes more pronounced and acute.Pronounced crunching in the joint occurs with every movement, there is noticeable limitation of joint mobility (contracture), functional shortening of the limb, disturbances in the biomechanics of movement, but joint mobility is still preserved.In this phase, initial pains noticeably intensify, become acute and last longer.Under the influence of daily physical activity, there is constant fatigue, a feeling of pressure in the affected joints, and the so-called"mechanical pain", caused by a decrease in the cushioning ability of the cartilage tissue of the joint.
The destruction in the joint is already quite significant, the joints are already partially deformed.
X-rays show osteophytes, narrowing of the joint space by 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal zone.
Arthrosis of the 2nd degree is characterized by reduced working capacity and inability to perform certain types of work.
Arthrosis 3 degrees (third stage of arthrosis)
Arthrosis Stage 3 is the severe, advanced stage of the disease.At this stage, the following is observed:
- significant joint deformation (due to bone growth and accumulation of fluid in the joint cavity);
- severe restriction of movement, up to maintaining only rocking movements;
- sharp pain not only during movement, but also in a state of complete rest - constant pain associated with reflex spasm of nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- joint sensitivity to weather changes.
- the muscles around the knee are spasmed and atrophied;
The limb axis is deformed, varus or valgus curvature of the legs is noticeable (that is, in the shape of the letter "O" or "X").
On X-ray images with arthrosis of the 3rd degree, the almost complete disappearance of the joint space, pronounced deformation of the joint surfaces and extensive multiple marginal osteophytes can be observed.Joint mice and paraarticular tissue calcification can be detected.
In the 3rd stage, the disease has advanced and is often the cause of permanent disability.It appears as follows:
- the pain becomes constant and painful: walking, and especially going up and down stairs, is a difficult trial for the patient;
- loud creaking during any movement, clearly audible to others;
- joint deformation is severe, movements are limited only to a small amplitude or even impossible;
The photographs show destruction of intra-articular structures (ligaments and menisci), as well as complete abrasion of cartilage and signs of sclerosis (replacement of functional organs and structures by connective tissue).
Arthrosis 4 degrees
The state of complete destruction of the joint with arthrosisWhen the joint stops functioning completely, it is often classified as a special 4th degree arthrosis.There is a so-called "joint block" - an acute pain syndrome in which even limited movement in the affected joint is impossible.The fourth degree of arthrosis is accompanied by unbearable pain in the joints, which cannot be alleviated even by strong painkillers and intensive physiotherapy.Complete ankylosis (joint fusion) or neoarthrosis (formation of a false joint between displaced bone ends) is possible.Independent movement in both cases is almost impossible.
The photographs show gross sclerosis of joint surfaces with pronounced cystic clearances, fusion of connecting bones in the area of the joint space.The development of the disease to this stage almost always means disability, which can only be prevented by installing an artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis in the initial stage of the disease
It is better to start treatment of arthrosis as soon as possible, when the first signs appear - creaking in the joints, difficulty in movement.At this stage, drugs are useful - chondroprotectors that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physical therapy, proper nutrition and preventive measures are important.It should be noted that the prevention of arthrosis is of great importance for the prevention of worsening of the disease.
Treatment of 2 - 3 degree arthrosis
Although it is no longer possible to completely cure stage 2-3 arthrosis, the process of its development can be significantly slowed down.Treatment of arthrosis at this stage includes the following steps:
- relieve or reduce pain
- relieve inflammation in the joint.
- they improve the regeneration of cartilage tissue and slow down degenerative processes in it.
In the acute period, the treatment of arthrosis begins with pain relief.Non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used for this purpose.Intra-articular corticosteroid injections are possible.It is necessary to reduce the load on the joint;you should not walk or stand for a long time, or lift heavy objects.
After alleviating the acute pain syndrome, the main task becomes to ensure, as far as possible, the activation of the restoration process in the joint itself and periarticular tissues: improving blood circulation, increasing metabolism, removing inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of 4th degree arthrosis
In this stage of the disease, the joint is almost completely destroyed.In this case, there is only one way out - surgery and replacement of the diseased joint with an endoprosthesis.Endoprosthesis significantly improves joint mobility and allows the patient to continue an active life, at least without pain.