Arthrosis is the most common joint disease. According to experts, 6, 43% of the population of our country suffers from it. Men and women suffer from arthrosis with the same frequency, however, among young patients, there is a slight predominance of men, and among the elderly - women. An exception to the general picture is arthrosis of the interphalangeal joints, which develops in women 10 times more often than in men.
With age, the incidence increases dramatically. Thus, according to studies, arthrosis is detected in 2% of people under 45 years of age, in 30% of people between 45 and 64 years of age, and in 65-85% of people aged 65 and over. Arthrosis of the knee, hip, shoulder and ankle joints is of great clinical significance due to its negative impact on patients' standard of living and work capacity.
causes
In some cases, the disease occurs for no apparent reason, this arthrosis is called idiopathic or primary.
There is also secondary arthrosis - developed as a result of some pathological process. The most common causes of secondary arthrosis are:
- Injuries (fractures, meniscal injuries, ligament tears, dislocations, etc. ).
- Dysplasia (congenital disorders of joint development).
- Degenerative-dystrophic processes (Perthes' disease, osteochondritis dissecans).
- Diseases and conditions in which there is increased mobility of the joints and weakness of the ligament apparatus.
- Hemophilia (arthrosis develops as a result of frequent hemarthrosis).
Risk factors for developing arthrosis include:
- Age of the elderly.
- Overweight
- Excessive tension in the joints or in a specific joint.
- Surgical interventions on the joint,
- Hereditary predisposition (presence of arthrosis in the closest relative).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (shoulder arthritis, lumboiliac muscle syndrome).
- Repetitive microtrauma of the joint.
pathogenesis
Arthrosis is a polyetiological disease that, regardless of the specific causes of its occurrence, is based on the violation of the normal formation and restoration of cartilage tissue cells.
Normally, articular cartilage is smooth and elastic. This allows the joint surfaces to move freely with each other, provides the necessary shock absorption and thereby 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 loses more and more. It separates small pieces that fall into the joint cavity and move freely in the joint fluid, injuring the synovia. In the superficial areas of the cartilage, small foci of calcification appear. In the deep layers, areas of ossification appear. In the central area, cysts form, communicating with the joint cavity, around which, due to the pressure of the intra-articular fluid, zones of ossification also form.
pain syndrome
Pain is the most constant symptom of arthrosis. The most striking signs of pain in arthrosis are the connection with physical activity and the weather, night pain, initial pain and sudden sharp pain in combination with joint blockage. With prolonged efforts (walking, running, standing), the pain intensifies and at rest it decreases. The cause of nocturnal pain in osteoarthritis is venous congestion, as well as increased intraosseous blood pressure. The pain is aggravated by unfavorable climatic factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of arthrosis is the onset of pain - pain that occurs during the first movements after a state of rest and disappears while motor activity is maintained.
Symptoms
Arthrosis develops gradually, gradually. Initially, patients are concerned about mild, short-lived pain without a clear location, aggravated by physical exertion. In some cases, the first symptom is crushing when moving. Many patients with arthrosis report a feeling of joint discomfort and transient stiffness during the first movements after a period of rest. Later, the clinical picture is complemented by nocturnal and climatic pain. Over time, the pain becomes more and more pronounced, there is a noticeable restriction of movement. Due to the increased load, the joint on the opposite side starts to ache.
Periods of exacerbations alternate with remissions. Arthrosis exacerbations usually occur in a context of increased stress. Due to the pain, the muscles in the limbs suffer reflex spasms and muscle contractures can form. The crack in the joint becomes more and more constant. At rest, muscle cramps and discomfort in muscles and joints appear. Due to the increasing deformation of the joint and the severe pain syndrome, lameness occurs. In the more advanced stages of arthrosis, the deformity becomes even more pronounced, the joint is bent, movement in it is significantly limited or absent. Support is difficult; when moving, the patient with arthrosis must use a cane or crutches.
Diagnosis
Diagnosis is based on the characteristic clinical signs and radiological picture of the arthrosis. X-rays are taken of the diseased joint (usually in two views): with gonarthrosis - radiograph of the knee joint, with coxarthrosis - radiograph of the hip joint, etc. The radiographic image of arthrosis consists of signs of dystrophic changes in the area of the 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, in arthrosis, signs of joint instability are found: curvature of the limb axis, subluxation.
Taking into account the radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of arthrosis (Kellgren-Lawrence classification):
- Stage 1 (doubtful osteoarthritis) - suspected joint space narrowing, osteophytes are absent or present in small numbers.
- Stage 2 (mild osteoarthritis) - a suspected joint space narrowing, osteophytes are clearly defined.
- Stage 3 (moderate osteoarthritis) - a clear narrowing of the joint space, there are clearly pronounced osteophytes, bone deformities are possible.
- Stage 4 (severe arthrosis) - pronounced narrowing of the joint space, large osteophytes, pronounced bone deformities, and osteosclerosis.
Sometimes X-rays are not enough to accurately assess the condition of the joint. To study the bone structures, CT of the joint is performed to assess the state of the soft tissue - MRI of the joint.
Treatment
The main goal of treating patients with arthrosis is to prevent cartilage destruction and preserve joint function.
During the period of remission, the patient with arthrosis is referred for physical therapy. The set of exercises depends on the stage of the arthrosis.
Drug treatment in the exacerbation phase of arthrosis includes the indication of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation and eliminate muscle spasms, the patient with arthrosis is referred to physical therapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet irradiation are prescribed, in the remission phase - electrophoresis with dimexide, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermia, thermal procedures (ozocerite, paraffin), sulfide, radon and baths. sea. Electrical stimulation is performed to strengthen the muscles.
In case of destruction of joint surfaces with pronounced joint dysfunction, arthroplasty is performed.