Osteoarthritis is the most common joint disease. According to expert estimates, 6, 43% of the population of our country suffers from it. Men and women are equally likely to suffer from osteoarthritis, however, there is a slight predominance of men among young patients and women among the elderly. The exception to the general picture is arthrosis of the interphalangeal joints, which develops 10 times more often in women than in men.
Over the years, the incidence increases dramatically. Thus, according to studies, arthrosis is detected in 2% of people under the age of 45, in 30% of people aged 45 to 64 and in 65-85% in people aged 65 and over. Osteoarthritis of the knee, hip, shoulder and ankle is of the greatest clinical importance due to the negative impact on the standard of living and working ability of patients.
Causes
In some cases, the disease occurs for no reason, such arthrosis is called idiopathic or primary.
There is also secondary arthrosis - caused by a pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, ligament ruptures, dislocations, etc. ).
- Dysplasia (congenital disorders in the development of joints).
- Degenerative-dystrophic processes (Perthes' disease, osteochondritis dissecans).
- Diseases and conditions in which there is increased joint mobility and weakness of the ligament apparatus.
- Hemophilia (arthrosis develops as a result of frequent hemarthrosis).
Risk factors for developing osteoarthritis include:
- Older years.
- Overweight
- Excessive stress on the joints or a particular joint.
- Surgical interventions on the joint,
- Hereditary predisposition (presence of arthrosis in close relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders in the cervical or lumbar spine (shoulder arthritis, lumbar-iliac muscle syndrome).
- Recurrent microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease which, regardless of the specific causes, is based on the violation of the normal formation and renewal of cartilage tissue cells.
Normally, articular cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, ensures the necessary shock absorption and thus reduces the load on adjacent structures (bones, ligaments, muscles and capsule). With arthrosis, the cartilage becomes rough, the joint surfaces begin to "stick" to each other during movement. Cartilage is losing more and more. From it separate small pieces that fall into the joint cavity and move freely in the joint fluid, injuring the synovium. Small foci of calcification appear in the surface zones of the cartilage. Areas of ossification appear in the deep layers. In the central zone, cysts are formed that communicate with the joint cavity, around which, due to the pressure of the intra-articular fluid, ossification zones are formed.
Pain syndrome
Pain is the most constant symptom of osteoarthritis. The most striking signs of pain in osteoarthritis are the connection with physical activity and weather conditions, night pains, initial pains and sudden sharp pains in combination with joint blockade. With prolonged exertion (walking, running, standing), the pain intensifies, and at rest it subsides. The cause of night pain in arthrosis is venous congestion, as well as an increase in intraosseous blood pressure. Pain is aggravated by unfavorable weather factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of arthrosis is the initial pain - pain that occurs during the first movements after the state of rest and disappears when maintaining motor activity.
Symptoms
Osteoarthritis developed gradually, gradually. At first, patients are concerned about mild, short-term pain without a clear localization, which is exacerbated by physical exertion. In some cases, the first symptom is a squeak when moving. Many patients with osteoarthritis report a feeling of discomfort in the joint and transient stiffness during the first movements after the rest period. After that, the clinical picture is completed by night and weather pain. Over time, the pain becomes more pronounced, there is a noticeable limitation of movement. Due to the increased load, the joint on the opposite side starts to hurt.
Periods of exacerbations alternate with remissions. Exacerbations of osteoarthritis often occur in the background of increased stress. Due to the pain, the muscles of the limbs reflexively spasm, and muscle contractures can occur. The creaking in the wrist is becoming more and more constant. Muscle cramps and muscle and joint discomfort occur at rest. Due to the increasing deformation of the joint and the strong pain syndrome, lameness occurs. In the later stages of arthrosis, the deformation becomes even more pronounced, the joint is bent, the movements in it are significantly limited or absent. Support is difficult, a patient with osteoarthritis must use a cane or crutches when moving.
Diagnosis
The diagnosis is made on the basis of characteristic clinical signs and X-ray image of arthrosis. X-rays are taken of the diseased joint (usually in two projections): in gonarthrosis - X-ray of the knee joint, in coxarthrosis - X-ray of the hip joint, etc. The X-ray image of arthrosis consists of signs of dystrophic changes in the area of articular cartilage and adjacent bone. The joint gap is narrowed, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis and osteophytes are revealed. In some cases, with osteoarthritis, there are signs of joint instability: curvature of the limb axis, subluxation.
Taking into account radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of arthrosis (Kellgren-Lawrence classification):
- Stage 1 (suspected arthrosis) - suspected narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild arthrosis) - suspected narrowing of the joint space, osteophytes are clearly defined.
- Stage 3 (moderate arthrosis) - clear narrowing of the joint space, osteophytes are clearly expressed, bone deformities are possible.
- Stage 4 (severe arthrosis) - marked narrowing of the joint space, large osteophytes, severe bone deformities and osteosclerosis.
Sometimes X-rays are not enough to accurately assess the condition of the joint. CT of the joint is used to study the bone structures, and MRI of the joint is used to assess the condition of the soft tissues.
Treatment
The main goal of treating patients with osteoarthritis is to prevent further destruction of cartilage and preserve joint function.
During the period of remission, the patient with arthrosis is sent for physical therapy. The set of exercises depends on the stage of arthrosis.
Drug treatment in the exacerbation phase of osteoarthritis involves the administration of nonsteroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of osteoarthritis includes chondroprotectors and prostheses for synovial fluid.
To alleviate pain, reduce inflammation, improve microcirculation and eliminate muscle cramps, a patient with osteoarthritis is referred to physiotherapy. In the phase of exacerbation, laser therapy, magnetic fields and ultraviolet radiation are prescribed, in the phase of remission - electrophoresis with dimexid, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermy, thermal procedures (ozokerite, paraffin), sulfide, radon and sea bath. Electrical stimulation is performed to strengthen muscles.
In the case of destruction of joint surfaces with pronounced joint dysfunction, arthroplasty is performed.