Arthrosis (Deforming osteoarthritis, folk name - deposition of salts) is a chronic disease of the joints of degenerative -dystrophic, in which the destruction of articular cartilage, joint capsules and deformation of the bone itself occurs.
It should be noted that osteoarthritis is a whole group of joint diseases that have different origin and close development mechanisms.Most of the time there is great joints:
- Deformation of the arthrosis of the knee joint (gonarthrosis),
- Deforming osteoarthritis of the hip joint (Coksartrose),
- as well as osteoarthritis of the shoulder joint.
These are the most serious types of osteoarthritis.
The osteoarthritis of small joints is less common.Most of the time there is a deforming osteoarthritis of the interfalation connections of the hands and the metacarpophale joints of the thumb.The patients notice the pain in the interfalancing joints, a decrease in their mobility, the appearance near the joints of the seals (nodules of the berons and BUSHAR).This type of osteoarthritis occurs more often in old age.There are often osteoarthritis of the foot fuks.
Polyrthrosis or generalized osteoarthritis is marked at the same time by damage to several joints.
Arthrosis The joints of the spine - spondylarthrosis - belong to the group of vertebral diseases, although it has a similar development mechanism with other osteoarthritis.
The main clinical symptom for osteoarthritis is the pain in the joint, a decrease in its mobility.Specific symptoms are determined in the stage of arthrosis and depend on the degree of destructive changes in the joint.
The causes of osteoarthritis
Arthrosis It is common to divide yourself into primary and secondary ones.The primary (idiopathic) arthrosis is a result of a violation of the recreational processes and an increased degeneration in the cartilage tissue of the joint without deviations in the work of the entire organism.Secondary osteoarthritis occurs as a result of other pathological processes in the body or in the joint, which have already been damaged by an external effect, with partial destruction of the joint surfaces.
Most of the time, traumatic osteoarthritis is diagnosed in young patients.And in older patients it is anything but always possible to draw a clear limit between primary and secondary osteoarthritis.
Although the exact cause of osteoarthritis cannot be determined, factors that contribute to the occurrence and development are known.
The following types of causes that contribute to the development of primary and secondary deforming arthrosis can be distinguished.
The causes of primary arthrosis are hereditary factors
The following hereditary diseases were identified that can cause the development of primary osteoarthritis:
- genetic disorders in the composition of the cartilage tissue of the joint, which leads to its accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermobile from joints, dysplasia, flat feet and others), which are the cause of the trauma of certain sections of the cartilage tissue of the joint and, as a result, the occurrence of osteoarthritis.
It was also found that the deformation of the osteoarthritis of the interpalanxes joints of the upper extremities mainly occurs in women and is inherited from the female line.
The causes of secondary osteoarthritis
Secondary arthrosis is a result of joint damage.These damage can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various joint injuries, intra -karticular broken bones, with the joint structure being disturbed.The same result is caused by constant microtraumatization of the joints as a result of excessive constant loads of both static and dynamic (for example in the case of athletes).Obesity also leads to overload and trauma.
Another factor that has a negative effect on the joints (mainly on the hip) is an incorrect attitude.
The structure of the joint can also disrupt surgical intervention. - Common illnesses.Arthrosis can be due to inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of the bone tissue, etc.)
- Violations of the metabolism, diseases of the endocrine system, lack of minerals in the body.Various disorders of metabolism, the lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bones and cartilage, synovial fluid, which leads to a violation of the recovery processes and the gradual destruction of the composition.
- Autoimmune diseases(Gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), Hormonal disorders, a lack of estrogen In postmenopause, women lead to changes in the tissue of the joints and their gradual destruction.
- Vascular diseases (Atheriosclerosis of the vessels of the lower extremities, the triggered of endarteritis, varicose veins) as well Hypodynamy They cause circulatory disorders in periartic tissues, poor blood supply to the joint fabric and, as a result, dystrophic changes.
The development mechanism of arthrosis
Development Arthrosis It begins with the destruction of the cartilage.It is believed that there is a violation of the blood circulation in the capillaries of the cornea's cornea.Since the nutrition of the cartilage occurs due to the absorption of nutrients from intra -articular liquids and adjacent bone tissue, the circulation disorder leads to the fact that the cartilage gradually loses elasticity.As a result, it appears Pain and crunch during the movements.The width of the joint column gradually decreases, the bone along the edges of the articular surfaces formed Osteophyta Spikes.
Ultimately, the joint is deformed, the amplitude of the movements in IT decreases.In this way, an integrated arthrosis in connection with the aging of the body develops.The development of this type of osteoarthritis is usually gradually taking place over the years.
Other forms of arthrosis of large joints, such as post -tumatic, post -infectious, metabolic, unforgettable, intoxication, have several other development mechanisms, but as a result we receive similar changes in the joint.
Symptoms of arthrosis of the joints.Stages and degrees of arthrosis
"Classic" is the classification of osteoarthritis based on clinical and radiological characteristics.In accordance with this, three stadiums are distinguished in the development of the disease.It corresponds to the classification by the degree of conservation of the disability, which distinguishes 3 degrees osteoarthritis:
- I degree of osteoarthritis - the disease does not prevent work, even though it complicated.
- II degree of arthrosis - the disease prevents the work of the work,
- III degree of arthrosis - loss of work ability.
We take into account the clinical symptoms and signs of osteoarthritis in each of these stages in more detail
Osteoarthritis of the 1st degree (initial stages of arthrosis)
In the early stages of the disease in the morning after calm, stiffness and difficulty movement in the joints, which gradually refers some time after the start of the movement.Perhaps a restriction of mobility in the joint."Starting pain" occurs at regular intervals (pain at the beginning of the movement after a long stay at peace).Crunches with sharp movements, but there is no pain during movement.The pain at this stage of arthrosis only occurs with significant and longer stress and prevent calm.There is no pain alone and at low loads.At this stage of the disease, patients rarely see a doctor.
There is no visible in the X radiation image with arthrosis of the 1,4th degree of special changes in the joint.Sometimes small osteophytes along the edges of the joint are visible, the joint gap is slightly narrowed.
2 -degree arthrosis (second stage of osteoarthritis)
With the further development of osteoarthritis, the pain becomes more important and acquires an acute character.A pronounced crisis in the connection appears in all movements, there is a noticeable restriction of mobility in the joint (contractual agreement), a functional shortening of the limbs, an impaired biomechanics of movements, but the common mobility is still preserved.This level is characterized by a noticeable strengthening of the pain from starting skills, they become more acute and longer.Under the influence of physical activity during the day, constant tiredness, a feeling of pressure in the affected joints, the so -called "mechanical pain" appears from a decrease in the shock absorption capabilities of cartilage tissue of the joint.
The destruction in the joint is already very important, the joints are already partially deformed.
In the X-rays, striking osteophytes are visible, the narrowing of the joint column compared to the norm 2-3 times, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphysal zone are observed.
The osteoarthritis of the 2nd degree is characterized by a decrease in work ability to perform certain types of work.
Arthrosis of 3 degrees (third arthrosis level)
Arthrosis 3 degrees are a serious, negligible stage of the disease.At this point there is:
- significant deformation of the joint (due to the growth of bones and the accumulation of liquid in the joint cavity);
- A sharp restriction of movements to the preservation of only rocking movements;
- Sharp pain not only when moving, but also in a state full of rest - constant pain in connection with reflex cramps of the nearby muscles and the development of reactive synovitis;
- Joint inflammation,
- Sensitivity of the joints compared to the change in the weather.
- The muscles around the knee are evil and atrophied;
The axis of the limbs is deformed, noticeably varus or valgus curvature of the legs (i.e. in the form of the letter "O" or "X").
In the case of X -rays with osteoarthritis of the 3rd degree, almost complete disappearance of the joint column, a severe deformation of the articular surfaces are observed.The joint mice and the calcification of paraarticular tissues can be determined.
The disease went very far in 3 degrees, often the cause of persistent disability.It manifests itself as follows:
- The pain becomes constant and painful: walking and especially the descent and climbing the stairs - a difficult test for the patient;
- Loud crunch in some movements, checked well to others;
- The deformation of the joints is strongly expressed, the movements are only limited by a small amplitude or even impossible;
The images show the destruction of intra -articular structures (ligaments and meniscus) as well as the complete abrasion of cartilage and signs of sclerosis (replacement of functioning organs and structures of the connective tissue).
Arthrosis of the 4th degree
The condition of the complete destruction of the joint ArthrosisIf the joint stops fully, it is often differentiated into a separate degree of osteoarthritis.There is a so -called "joint blockade" - an acute pain syndrome, in which even restricted movement in a sick joint is impossible.The fourth degree of osteoarthritis is accompanied by unbearable joint pain that is not removed even by strong medication and intensive physiotherapy.A complete ankylose (joint fusion) or neoart rose (the formation of a false joint between the displaced ends of the bones) is possible.The independent movement in both cases is almost impossible.
In the pictures, the merger of the connecting bones in the common gap is visible.The development of the disease at this stage almost always means a disability that can only be prevented by implantation of the artificial joint prosthesis.
Treatment of osteoarthritis
Treatment of osteoarthritis in the initial stages of the disease
It is better to treat osteoarthritis as early as possible with the appearance of the first signs - crunch in the joints, difficulties of movement.At this stage, medication are useful chondroprotectors that improve the structure of the cartilage and vitamin mineral complexes.
Medical physical education, appropriate nutrition and preventive measures are important.It should be noted that the prevention of osteoarthritis is also of great importance to prevent the disease from deteriorating.
Treatment of osteoarthritis 2 - 3 degrees
Although it is already impossible to heal the osteoarthritis of 2-3 degrees completely, the process of its development can be noticeably inhibited.The treatment of osteoarthritis at this stage includes the following phases:
- Remove or reduce pain syndrome
- Remove inflammation in the joint.
- Improve the restoration of the cartilage and slow down the degenerative processes in it.
In acute time, the treatment of osteoarthritis begins with the elimination of pain.For this purpose, non -hormonal anti -inflammatory drugs (NSAIDS) are used.Injections of corticosteroids are possible.It is necessary to reduce the load on the connection.You cannot run or stand long and lift heavy objects.
After removing the acute pain syndrome, the main task is to ensure the activation of recovery processes in the joint and periartic tissue as far as possible: improvement of blood circulation, increased metabolism, elimination of inflammatory processes.Chondroprotectors, vasodilating medication as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of osteoarthritis 4 degrees
At this stage of the disease, the joint is almost completely destroyed.In this case, there is an outcome - the operation and the replacement of the diseased connection with an endoprosthesis.The endoprosthesis significantly improves the mobility of the joint and enables the patient to resume active life in order to get rid of pain.