Arthritis is a chronic pathology that affects the connective tissue structure of the musculoskeletal system.The disease is characterized by a progressive course with the gradual destruction of cartilage tissue.Arthrosis is detected in most patients after the age of 65, because one of the reasons for its development is the natural aging of the body.
The occurrence of degenerative-dystrophic pathology is caused by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, an inactive lifestyle.The main symptoms of arthrosis are joint pain, swelling, and limitation of movement.
To diagnose pathology, instrumental studies are performed - radiography, arthroscopy, MRI, CT.Arthrosis of the first and second degree is treated conservatively with a course of drugs, physiotherapeutic procedures and massage and exercise therapy.In case of irreversible destructive changes in the joint, surgical intervention is indicated - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
With arthrosis, significant changes occur in the structure of the internal connective tissue.Deformation erosion is formed in cartilage tissue, 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, destroying all types of extracellular matrix proteins.Destruction is accelerated by increasing the biosynthesis of collagenase and stromelysin.Normally, normal quantitative values of enzymes are regulated by cytokines - small peptide information molecules.But when arthrosis develops, the concentration of this protein decreases, which causes the release of a large number of enzymes that damage cartilage tissue.
Proteoglycans with altered structure begin to absorb water molecules that cannot be stored.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 synovial fluid.With arthrosis, the concentration of hyaluron in it decreases.Hyaline cartilage no longer receives enough nutrients and oxygen for their regeneration.A focus of softening forms in the cartilaginous tissue, and then cracks and certain necrotic growths appear.Bone heads become exposed and begin to experience microtrauma when displaced relative to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) arthrosis have not been established.It occurs without any provoking factor, therefore the theory is put forward about the hereditary tendency to premature destruction of cartilage.Secondary arthrosis develops as a result of other joint pathologies or previous injuries.What can cause degenerative-dystrophic disease:
- injuries to joints or nearby connective tissue structures - fractures, dislocations, damage to the meniscus, partial rupture of muscles, ligaments, tendons or their complete separation from the base of the bone;
- congenital dysplastic disorder of joint development;
- endocrine gland function disorders, metabolic process disorders;
- rheumatism, or rheumatic fever;
- rheumatoid arthritis, reactive, metabolic, psoriatic or gouty, polyarthritis;
- purulent arthritis caused by streptococci, epidermis or Staphylococcus aureus;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative diseases, for example, osteochondritis dissecans.
Joint hypermobility, caused by the production of special collagen, is prone to the development of arthrosis.This condition is detected in 10% of the planet's population and is not considered a pathology.But hypermobility is accompanied by weakness of the tendon-ligamentous apparatus, which leads to 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 bleeding into the joint cavity, causes deterioration of cartilage trophism and its destruction.
Predisposing factors include old age, frequent loads on joints that exceed their strength limits, excess body weight, surgical interventions, and hypothermia.
Risk groups include 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 food with vitamins and microelements, prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of arthrosis lies in the absence of symptoms in the first stage of its development.Pathology clinically manifests itself gradually, the first signs appear against the background of significant destruction of cartilage tissue.At first, 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 pulsating or clicking sound when bending or extending the joint.One begins to realize that some movements are difficult.However, in the early stages of arthrosis, stiffness occurs 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 the pain syndrome in the second stage increases with weather changes, the severity of chronic pathologies, and acute respiratory viral infections.The range of motion is significantly reduced.The cause of stiffness is the thinning of cartilage, as well as the conscious restriction of a person's movement in an effort to avoid pain.This leads to increased load on the opposite joint, which causes further damage.Arthritis is also characterized by other specific symptoms:
- pain causes spasms of skeletal muscles and the development of muscle contractures (limitation of passive movement in joints);
- throbbing in the joints, clicks, crackles when moving becomes constant, occurs with almost every displacement of bones relative to each other;
- painful muscle spasms often occur;
- deformed joints, which lead to disturbances in posture and gait;
- in the third stage of arthrosis, the deformation is so significant that the joint is bent, and various movements in it are significantly reduced or completely absent;
- with third-degree arthrosis of the knee, ankle, hip joint, the patient uses crutches or crutches when moving.
In the absence of treatment, pathology develops, and during remission its course is replaced by relapses, and the frequency of exacerbations increases all the time.Stiffness in movement in the morning now does not go away for a long time, it becomes permanent.
When examining a patient with grade 1 arthrosis, the doctor noted only slight swelling of the joints and complete preservation of 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.
Arthritis is characterized by the development of synovitis - an inflammatory process in the synovial membrane of the hip, knee, ankle, and shoulder joints.Their main symptom is the formation of a round seal in the joint area, when pressure is applied where fluid movement (fluctuation) is felt.Acute synovitis can be accompanied by an increase in temperature to 37-38 °C, headache, and indigestion.
Diagnostics
Diagnosis is made based on the results of instrumental studies, characteristics of the clinical picture, anamnesis, and patient complaints.General blood and urine tests are not very informative - all values remain within normal limits if arthrosis 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.Changes in biochemical and immunological parameters occur in the secondary form of arthrosis.
The most informative method for diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral projections.
| Stage of arthrosis according to the Kellgren-Lawrence classification (1957) | Pathological X-ray signs |
|---|---|
| The beginning | No radiological signs |
| First | Narrowing of the joint space that is not clear and uneven.Slight flattening of the edges of the bone plate, early osteophyte formation or its absence |
| Second | Marked narrowing of the joint space, 2-3 times higher than normal, the formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic discharge in the epiphysis |
| Third | The appearance of obvious subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| Fourth | Formation of large coarse osteophytes, almost complete fusion of the joint space, deformation and compaction of the epiphyses of the bones that make up the joint |
If, after studying the X-ray image, the doctor has doubts about making a diagnosis, a CT scan is prescribed.And to assess the structural condition of the connective tissue located near the joint, MRI is performed.When using contrast, it is possible to dynamically evaluate the blood supply to the tissue and establish the level of the inflammatory process during the development of synovitis.
Basic methods of therapy
Arthrosis is still an incurable disease, as there are no pharmacological drugs for the regeneration of cartilage tissue.The main goal of therapy is to prevent the development of pathology and maintain joint mobility.Treatment is long-term, complex, using both local and systemic drugs.Patients should avoid severe pressure on the joints 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 lose weight and follow the diet.
After achieving a stable remission, the patient is shown daily physical therapy exercises.The first exercise session is conducted under the guidance of a physical therapist, then the patient performs a set of exercises at home.Exercise therapy can be supplemented 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;
- injection into the joint of an anesthetic solution in combination with glucocorticosteroids;
- muscle relaxants to relieve muscle spasms and tight contractures.
The therapeutic regimen includes B vitamins, sedatives, and, if necessary, tranquilizers and antidepressants.Chondroprotectors are needed for long-term use.This is the only group of drugs that has the ability to partially restore cartilage tissue.
To increase their clinical activity, physiotherapeutic procedures are carried out - laser therapy, magnetic field, UHF therapy.
Any pain in the joints should be a signal for immediate consultation with a doctor.Therapy carried out in the early stages of arthrosis will stop the destruction of cartilage and prevent loss of performance and disability.