Arthrosis

Arthrosis - what is it in simple words?

Arthrosis is a chronic pathology in which the gradual destruction of cartilage plates occurs. Pathological changes affect the underlying bone, which becomes denser and marginal growths (osteophytes) develop. The articular capsule responds to the incident, and reactive vasculitis develops.

About the disease and possible complications

The incidence of pathology depends on age. The first signs of arthrosis usually appear no earlier than 30-35 years, and by the age of 70, about 90% of the population suffers from this pathology. Arthrosis does not show any gender difference. The only exception is degenerative damage to the joint between the carpal phalanges. This form of the disease is 10 times more common in women than in men. Arthritis most often affects the large joints of the feet and arms.

The pathological process begins with the interstitial substance of cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by balancing the processes of anabolism and catabolism. If the breakdown process of cartilage tissue dominates its synthesis, then conditions are created for the development of osteoarthritis. This briefly explains what arthrosis is.

Often, early signs of the disease develop in places with the greatest mechanical load, with a limited softening area of the cartilage plate appearing. As the pathological process progresses, cartilaginous fragments and cracks, and local deposition of calcium salts are possible. Under cartilage defects, the underlying bone is exposed; Separated fragments of cartilage enter the articular cavity and can lead to so-called "jamming" ("joint rat" symptom).

Damage to the cartilage lining the articular processes of the bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, when moving, the articular surface experiences a non-physiological load. In response to this, compensatory resynthesis processes are stimulated in the bone tissue. The bones become denser (subchondral osteosclerosis develops), and irregularly shaped marginal growths (osteophytes) appear, which in turn change the discrepancy between the articular surfaces. Developing pathological changes gradually limit the range of motion in the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasms that occur in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead cartilage and bone fragments activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, the long-term inflammation is accompanied by sclerosis of the periarticular tissue - the joint capsule thickens, atrophy of the muscles around it.

The main symptom of arthrosis is pain, which over time is accompanied by limited mobility in the joints. Mobility limitations are first of all a compensatory function, and then due to organic changes. Additional imaging diagnostic methods (radiography, ultrasound scanning, computed tomography or magnetic resonance imaging) help establish the correct diagnosis.

Depending on the stage and degree of arthrosis, treatment can be carried out using conservative or surgical methods. Orthopedic traumatologists will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of arthrosis

There are 2 types of arthrosis:

1. The main variant is the result of a violation of the relationship between the process of synthesis and degeneration in the cartilage tissue and is accompanied by a disruption of the function of chondrocytes - the main cells of cartilage.
2. Secondary variants occur in previously modified joints when the normal (congruent) contact of the articular surfaces is disturbed, followed by a redistribution of the load on them and with a concentration of stress in certain areas.

Symptoms of joint arthrosis

The main symptom of joint arthrosis is pain. It has its own characteristics that allow the main diagnosis of this disease.

1. Mechanical pain, due to the loss of the shock-absorbing properties of cartilage. Painful sensations occur during physical activity and relieve during rest.
2. Night pain.Caused by stagnation of venous blood and increased blood pressure flowing in the bones.
3. Start pain.It is short-lived and appears in the morning when a person gets out of bed (the patient says that he needs to "disperse"). This pain is caused by the deposition of detritus on the cartilaginous plate; during movement, this fragment is pushed into the articular inversion, so the unpleasant sensation stops.
4. Meteor dependency.Pain may increase when weather conditions change (increased atmospheric pressure, cold weather, excessive humidity).
5. Restriction pain.This is a sudden painful sensation associated with pinching fragments of bone or cartilage between the articular surfaces. Against the background of "restrictions", a slight movement in the joint stops.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person is disturbed by joint stiffness. Signs of the inflammatory process are determined objectively - swelling and increased local skin temperature.

Osteoarthritis usually begins slowly with the onset of pain in one affected joint. At first, the pain only bothers you during physical activity, but later it appears even at rest and during night sleep. Over time, pain is also felt in the joint on the opposite side, which is associated with a compensatory increase in the load. An important distinguishing feature of arthrosis is its frequency, when short periods of exacerbation are followed by periods of remission. The progress of the pathological process is indicated by the shortening of the period between relapses and the development of adverse consequences in the form of contractures and sharp limitations of mobility in the joints.

Course of arthrosis during pregnancy

During pregnancy, arthrosis can occur in different ways. Usually, up to 12-13 weeks, an exacerbation of the pathological process may occur, associated with hormonal changes occurring in the female body. The second and third trimesters are usually relatively stable. Pregnancy management is carried out by obstetrician-gynecologist and orthopedic traumatologist.

Causes of joint arthrosis

The main mechanism that triggers the destruction of cartilage is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthrosis is preceded by a period of metabolic disorders, which occur hidden. This metabolic imbalance is characterized by damage to proteoglycans and their constituent components (chondroitin, glucosamine, keratin), which is accompanied by the breakdown and breakdown of the cartilage matrix. Collagen fibers break in the cartilage plate, the supply of metabolites necessary for life is disrupted, and the water balance also changes (first the cartilage is hydrated, and then the number of water molecules decreases dramatically, which in turn stimulates cracking).

The primary pathological process has a negative effect on chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of damaged proteoglycan molecules and short chains of collagen fibers. These damaged molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. With arthrosis, a cytokine "boom" is also observed - released cytokines interfere with the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of arthrosis can be changed:

• "excess" weight, which increases the load on the joints;
• wear low-quality shoes;
• concomitant diseases of the musculoskeletal system;
• have a joint injury.

Signs and diagnosis of joint arthrosis

Based on clinical symptoms, radiologists make an initial diagnosis. To confirm this, additional imaging tests were conducted.

1. Radiography.In the early stages, the X-ray signs of this disease are not very important - this may be an uneven narrowing of the joint space, a little compaction of the underlying bone and small cysts in this area. At the next stage, radiography is more informative - marginal bone growth appears, the shape of the articular surface changes, articular "rats" and areas of calcification in the capsule can be determined.
2. Joint ultrasound.Ultrasound scanning is more informative to detect early signs of arthrosis. Signs such as intra-articular effusion, changes in the thickness and structure of cartilage plates, and secondary reactions of the capsule, musculotendinous compartment and ligaments can be visualized.
3. Computed or nuclear magnetic tomography. The diagnosis of arthrosis of this joint is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilaginous plate, the subchondral area of the bone, and determine the amount of synovial fluid, including. in articular inversion.

Expert opinion

Deformed joint arthrosis is one of the most common pathologies of the musculoskeletal system, occurring in 10-15% of the world's population. The peculiarity of this disease is that it develops slowly and gradually. At first, this is a short-term pain in one joint, which is often not noticed by a person. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain changes to constant. In the absence of treatment, the disease continues to develop and is accompanied by severe cartilage degeneration, which no longer responds to conservative therapy and to solve this problem only arthroplasty is required - a complex and expensive intervention to replace the destroyed joint in full. -mature implants. However, targeted drug therapy and lifestyle modifications can significantly help delay this operation or avoid it altogether. Therefore, if joint pain occurs, it is important to visit a doctor as soon as possible.

Treatment of arthrosis

According to clinical guidelines, the main goal of arthrosis treatment is to slow the progression of degenerative lesions on the cartilage plate. To achieve this goal, measures are taken to reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

Unloading the connection is achieved in the following way:

• weight loss (if excessive);
• perform physical therapy that does not include prolonged similar poses;
• reluctance to lift heavy loads or kneel for long periods of time (relevant for some professions).

In the early stages of the disease, in addition to physical therapy, swimming and cycling are useful. In the final stage, to unload the joint during exacerbation, walking with orthopedic crutches or using crutches is recommended.

For pain relief, incl. against the background of secondary synovitis, non-steroidal anti-inflammatory drugs are used, both local and systemic. Intra-articular injections of corticosteroids can be used for the same purpose.

To improve the anatomical condition and function of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help increase the metabolism of cartilage tissue, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the development of the pathological process and increase mobility in the joints.

Surgery

The choice of surgical treatment depends on the stage and activity of the pathological process.

• Joint puncture– indicated for severe reactive synovitis. It allows not only to remove inflammatory fluid, but also to introduce corticosteroids that disrupt the pathological chain.
• Arthroscopic surgery, which involves inserting an instrument into the joint cavity through a small puncture and subsequent visualization under magnification. This intervention makes it possible to wash the joint and its inversion, flatten the cartilaginous plate, remove necrotic areas, "polish" the articular surface, etc.
• Endoprosthetics– is considered a radical operation, which is performed in the case of advanced pathological processes. Usually used for arthrosis of the knee or hip joints.

Prevention of arthrosis

Prevention of arthrosis is aimed at maintaining a normal body weight, wearing orthopedic shoes, avoiding work on the knees, lifting heavy objects with dosage and adherence to the physical activity regime.

Rehabilitation for joint arthrosis

Rehabilitation for joint arthrosis involves a set of procedures that can improve the functional state of the joint and surrounding tissue. Physiotherapy, therapeutic massage and health-enhancing gymnastics are used.

Question and answer

Which doctor treats arthrosis?

Diagnosis and treatment are carried out by a traumatologist-orthopedic.

Do radiographs always allow the correct diagnosis to be made?

The severity of clinical signs of arthrosis is not always associated with radiological changes. Often in practice there are cases when, with severe pain, radiography does not reveal significant changes, and vice versa, when a "bad" X-ray picture is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for arthrosis?

If arthrosis is suspected, arthroscopy is usually performed not to make a diagnosis, but to find the cause that can cause a disturbance in the functional state of the joint (for example, damage to the meniscus of the knee joint and intra-articular ligaments).