Osteoarthritis

Osteoarthritis – a chronic degenerative disease of the joints, resulting in degraded cartilage, pathological changes in the capsule, synovial membrane, ligaments and adjacent bone structures. The main cause of the disease is the disruption of metabolic processes. However, play a role, trauma, congenital malformations, inflammatory diseases of the joints, excessive stress, excessive weight and several other factors. Osteoarthritis is manifested by pain, morning stiffness and limitation of mobility.

osteoarthritis

Osteoarthritis

Osteoarthritis – a chronic disease in which the joint is due to metabolic abnormalities develop progressive degenerative changes. The basis of the disease is a lesion of the articular cartilage, however, the pathological process of osteoarthritis involves not only the cartilage but also adjacent anatomical structures: the capsule, ligaments, synovial membrane, located under the cartilage of the bone structures and the periarticular muscles.

The prevalence

Osteoarthritis is the most common disease of the joints. According to the American physicians in the States this disease is observed in approximately 7% of the population. Russian specialists voiced almost the same figures – according to extensive research by osteoarthritis suffers of 6.43% of Russians. Men and women suffer equally often arthritis, but among younger patients, there is a predominance of men, and among older women. The exception to the overall picture – arthrosis of the interphalangeal joint, which occurs in women 10 times more often than men.

Reasons

In some cases, the disease appears for no apparent reason, such a arthritis is called idiopathic or primary. There is also a secondary osteoarthritis developed as a result of some pathological process. The most common causes of secondary osteoarthritis:

  • Trauma (fractures, damage to the meniscus, torn ligaments, dislocations, etc.).
  • Dysplasia (congenital disorders joint).
  • Disorders of metabolism.
  • Autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus).
  • Nonspecific inflammation (acute purulent arthritis).
  • Specific inflammation (tuberculosis, encephalitis, gonorrhea, syphilis).
  • Some endocrine diseases.
  • Degenerative-dystrophic processes (Perthes disease, dissecting osteochondritis).
  • Diseases and conditions in which increased mobility of the joints and weakness of the ligamentous apparatus.
  • Hemophilia (arthrosis develops as a result of frequent hemarthrosis).

Among the risk factors for developing osteoarthritis include:

causes of osteoarthritis
  • Old age.
  • Excessive weight (due to increased load, the joint is continuously overloaded, the articular surface prematurely "wear out").
  • Excessive load on the joints or a particular joint. May be due to working conditions, improper training (especially if you have a history of joint injuries), certain diseases, and consequences of diseases and injuries (e.g., lameness, which increases the load on the healthy leg, and the use of the cane on the hand).
  • Surgery on the joint, especially altus traumatica operation to remove large amount of tissue, causing the joint surfaces become incongrua, and the load on them increases.
  • Genetic predisposition (presence of osteoarthritis in the immediate family).
  • Endocrine balance in postmenopausal women.
  • The deficit of microelements.
  • Neurodystrophic disorders in the cervical or lumbar spine (scapular-humeral periarthritis, syndrome of lumbar-iliac muscle).
  • Exposure to toxic substances.
  • Unfavorable ecological situation.
  • Hypothermia.
  • Repetitive microtrauma to the joint.

Pathogenesis

Osteoarthritis – polietiologic disease, which, regardless of specific causes, is a violation of normal formation and repair of cells of cartilage.

Normal articular cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, provides the necessary shock absorption and thereby reduces the load on adjacent structures (bones, ligaments, muscles, and capsule). In osteoarthritis the cartilage becomes rough joint surfaces begin to "cling" to each other during the movements. The cartilage more and more non-fibrosum. It is separated from the small pieces that fall into the joint cavity and move freely in the joint fluid, damage to the synovium. In the superficial zones of the cartilage there are small foci of calcification. In the deeper layers there are areas of ossification. In the Central zone formed cysts that communicate with the joint cavity, which due to the pressure of the synovial fluid are also formed zones of ossification.

Because of the constant trauma to the capsule and synovium of the joint with arthrosis thicken. On synovial membrane of the villi appear, in the capsule pockets formed fibrous degeneration. Over time, due to the thinning and disruption of normal form and function of the cartilage surrounding the bone surfaces are deformed at their edges appear bony prominences. Due to the increased load in the ligaments and muscles there are pockets of fibrous degeneration. Increases the likelihood of damage to the ligamentous-muscular apparatus (sprains, tears, ruptures), sometimes a joint is "out" in a state of subluxation'. With significant cartilage damage, movement severely restricted, the formation of ankylosis.

Classification

There are three stages of arthritis:

  • The first stage of osteoarthritis is expressed by morphological changes are absent, broken only synovial fluid. Less fluid supplies the cartilage with nutrients, resistance of cartilage to normal loads is reduced. Due to overload of the articular surfaces causes inflammation, pain.
  • The second stage of arthrosis and articular cartilage begins to break down, appear boundary bony growths on the edges of the joint area. The pain become regular, habitual, inflammatory process then calms down, then escalates. There is little or moderate dysfunction of the periarticular muscles.
  • The third stage of osteoarthritis articular cartilage is thinned, there are large pockets of destruction. There is a significant deformation of the joint areas with change of the axis of the limb. Because of the violation of normal relations between the anatomical structures of the joint and extensive pathological changes in the connective tissue ligaments become insolvent and shortened, thereby developing abnormal mobility of the joint in combination with the restriction of the natural range of motion. There are contractures and subluxations. Periarticular muscles are stretched or shortened, the ability to reduce weakened. Food joint and surrounding tissues disturbed.
pain in osteoarthritis

Pain syndrome

Pain is the most constant symptom of osteoarthritis. The most obvious signs of pain associated with arthrosis are the relationship with physical activity and with weather, night pain, starting pain and a sudden sharp pain in combination with blockade of the joint. A certain rhythm of pain in osteoarthritis is directly associated with the stress on the joint. During prolonged exercise (walking, running, standing) pain intensifies, and subsides at rest. This is due to the decreased ability of cartilage to provide shock absorption during movement. Cause night pain associated with osteoarthritis is venous stasis, and increased intraosseous pressure of the blood. The pain intensified, and under the action of adverse weather conditions: high humidity, low temperature and high atmospheric pressure.

The most characteristic feature of osteoarthritis is the starting pain is pain that occurs during first movements after rest, and passing while maintaining physical activity. The reason for starting the pain associated with osteoarthritis becomes detritus film of the components of the destroyed cartilage, which is deposited on the articular surfaces. As a result of movements detritus moves out of the cartilage in the joint inversions of bags, so the pain disappear. Blockade is a sudden sharp pain and inability to make movement in the joint. Their cause is pinching of the synovial mouse – a piece of cartilage or bone lying loose in the joint cavity. In addition to these types of pain with the development of reactive synovitis in patients with osteoarthritis may occur and another pain – constant, aching, bursting, independent of the movements.

Symptoms

Osteoarthritis develops gradually, gradually. Initially, patients concerned about the weak, short-term pain without clear localization, aggravated by exertion. In some cases, the first symptom becomes the crunch movements. Many people with arthritis report a feeling of discomfort in the joint, and transient stiffness in the first movements after a period of rest. In the subsequent clinical picture is supplemented by night aches and pains "weather". Over time, the pain becoming more pronounced, there is a noticeable limitation of movement. Due to the increased load starts to hurt the joint on the opposite side.

The periods of exacerbation alternate with remissions. Exacerbation of osteoarthritis often occur on the background of increased exertion, exacerbations develop synovitis. Because of the pain muscle-limb reflex spazmiruyutsya can form muscle contractures. The crunch in the joint becoming more permanent. Alone appear muscle cramps and discomfort in muscles and joints. Due to the increasing deformation of the joint and significant pain syndrome is caused lameness. In the later stages of arthritis the deformity becomes more severe, the joint is bent, the movement in it is significantly limited or absent. Prop is difficult, when moving the patient with osteoarthritis have to use a cane or crutches.

On examination, the patient with arthrosis in the early stages of the visual changes are not detected. Joint normal forms, possible slight swelling. Determined by palpation mild or moderate pain. Traffic almost in full. In subsequent deformation becomes more prominent to palpation revealed severe tenderness, the patient, as a rule, clearly notes the most painful point. At the edge of the articular slits are defined thickening. Movements are limited, detected instability in the joint. May reveal the curvature of the axis of the limb. With the development of reactive synovitis the joint is increased in volume, has a spherical form, palpation is determined by the fluctuation.

diagnosis

Diagnosis

The diagnosis put on the basis of characteristic clinical signs and radiographic progression of osteoarthritis. Are the pictures of the diseased joint (usually in two projections): in gonarthrosis x – ray examination of the knee joint, coxarthrosis in the hip joint x – ray, etc. x-ray picture of osteoarthritis consists of signs of degenerative changes in the articular cartilage and adjacent bone. The joint space narrows, bone area deformed and flattened, revealing the cystic formation, subchondral osteosclerosis and osteophytes. In some cases, when the arthritis show signs of joint instability: the curvature of the axis of the limb, subluxation.

Sometimes x-rays are insufficient to accurately assess the condition of the joint. To study the bone structures perform a CT scan of the joint, to evaluate the state of soft tissues is a MRI of the joint. If you suspect the presence of chronic diseases causing secondary osteoarthritis, orthopedic assigns appropriate consultation of specialists: endocrinologist, ophthalmologist, gynecologist, etc. If necessary to make a differential diagnosis of osteoarthritis from rheumatoid diseases the patient sent for consultation to a rheumatologist.

Treatment

The primary goal of treatment of patients with arthritis is to prevent further destruction of cartilage and preservation of joint function. Therapy is long and comprehensive, and includes both local and shared events. One of the major problems in osteoarthritis is to optimize the load on the joint. You must avoid prolonged walking, repetitive stereotyped movements, long stay on his feet a long stay in a fixed position and carrying heavy loads. A huge role in minimizing the load on the articular surface plays a weight loss in obesity.

In the period of remission of a patient with osteoarthritis of the guide to physical therapy. A set of exercises depends on the stage of osteoarthritis. In the initial stages allowed swimming and Cycling in patients with severe osteoarthritis should perform the specially designed exercises in lying position or sitting. In the period of exacerbation of osteoarthritis assigned to polupostelny mode. In the later stages it is recommended to walk with crutches or a cane.

therapy for osteoarthritis

Drug treatment in acute phase of osteoarthritis involves the prescription of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants. Dose of NSAID is selected individually, taking into account contraindications. Along with the preparations for oral administration are appointed by intramuscular injection and rectal suppositories. In the remission phase of arthritis take NSAIDs is not recommended due to their negative impact on the gastrointestinal tract and the metabolism of cartilage. In reactive synovitises performed puncture of the joints, followed by administration of corticosteroids. The number of injections of corticosteroids should not exceed 4 times during the year.

05.12.2018