Osteoarthritis 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 osteoarthritis equally often, however, among young patients there is a slight predominance of males, and among the elderly - females. An exception to the general picture is osteoarthritis of the interphalangeal joints, which develops in women 10 times more often than in men.
With age, the incidence increases dramatically. So, according to studies, osteoarthritis is detected in 2% of persons younger than 45 years, in 30% of persons from 45 to 64 years and in 65-85% in ages 65 and older. Osteoarthritis of the knee joints, hips, shoulders and ankle has the greatest clinical importance due to the negative impact on the standard of living and work capacity of patients.
Causes
In some cases, the disease appears for no apparent reason, such arthrosis is called idiopathic or primary.
There is also a secondary osteoarthritis - developed as a result of a pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, ligament ruptures, 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 osteoarthritis include:
- Old age.
- Overweight
- Excessive stress on the joint or on a specific joint.
- Joint surgical interventions,
- Hereditary predisposition (presence of osteoarthritis in relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (shoulder arthritis, lumbar-iliac muscle syndrome).
- Recurrent microtrauma of the wrist.
Pathogenesis
Osteoarthritis is a polyetiological disease, which, despite the specific causes of its occurrence, is based on the violation of the normal formation and restoration of cartilage tissue cells.
Normally, the articular cartilage is smooth and elastic. This allows the articular surfaces to move freely in relation to each other, provides the necessary shock absorption and, thus, reduces the load on adjacent structures (bones, ligaments, muscles and capsule). With osteoarthritis, the cartilage becomes stiff, the articular surfaces begin to "catch" with each other during movement. Cartilage is lost more and more. From it separate small pieces, which fall into the joint cavity and move freely in the joint fluid, damaging the synovium. Small foci of calcification appear in the superficial areas of the cartilage. Bone areas appear in the deeper layers. In the central area, cysts form that communicate with the joint cavity, around which ossification zones are created due to the pressure of the intra-articular fluid.
Pain syndrome
Pain is the most constant symptom of osteoarthritis. The most prominent signs of pain in osteoarthritis are the connection with physical activity and weather, night pains, initial pains and sudden sharp pains in combination with joint blockage. With prolonged exertion (walking, running, standing), the pain intensifies and at rest they subside. The cause of nocturnal pain in osteoarthritis is venous congestion as well as increased intracranial blood pressure. Pain is exacerbated by adverse weather factors: high humidity, low temperature, and high atmospheric pressure.
The most characteristic sign of osteoarthritis is the initial pain - pain that appears during the first movements after a state of rest and disappears while maintaining motor activity.
Symptoms
Osteoarthritis develops gradually, gradually. Initially, patients worry about mild, short-term pain without a clear localization, aggravated by physical exertion. In some cases, the first symptom is cracking during movement. Many patients with osteoarthritis report a feeling of discomfort in the joints and transient stiffness during the first movements after a rest period. Subsequently, the clinical picture is complemented by night and weather pains. Over time the pain becomes more pronounced, a noticeable restriction of movement is observed. Due to the added load, the joint on the opposite side starts to hurt.
Periods of exacerbations alternate with remissions. Osteoarthritis exacerbations often occur against a background of increased stress. Due to the pain, the muscles of the limbs reflex spasms, muscle contractures may form. Chewing in the joints becomes more and more constant. At rest, muscle cramps and muscle and joint discomfort appear. Due to the increased deformity of the joint and severe pain syndrome, lameness appears. In the later stages of osteoarthritis, the deformity becomes even more pronounced, the joint is bent, the movements in it are noticeably limited or absent. Support is difficult; when moving, a patient with osteoarthritis should use a cane or crutches.
Diagnosing
Diagnosis is made on the basis of characteristic clinical signs and X-ray picture of osteoarthritis. X-rays are taken of the diseased joint (usually in two projections): with gonarthrosis - X-ray of the knee, with coxarthrosis - X-ray of the thigh, etc. The x-ray image of osteoarthritis consists of the sign of dystrophic changes in the area of articular cartilage and adjacent bone. The joint gap narrows, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis, and osteophytes are detected. In some cases, with osteoarthritis, signs of joint instability are found: curvature of the limb shaft, subluxation.
Considering the radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of osteoarthritis (Kellgren-Lawrence classification):
- Stage 1 (suspected arthrosis) - suspicion of a narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild osteoarthritis) - suspicion of narrowing of the joint space, 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 osteoarthritis) - marked 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 wrist. To study the bone structures, CT of the joint is performed, to assess the condition of the soft tissue - MRI of the joint.
Treatment
The main purpose of treating patients with osteoarthritis is to prevent further destruction of the cartilage and preserve joint function.
During the remission period, a patient with osteoarthritis is sent to physical therapy. The set of exercises depends on the stage of osteoarthritis.
Medication treatment in the osteoarthritis exacerbation phase involves the appointment of non-steroidal anti-inflammatory drugs, sometimes in combination with muscle relaxants and relaxants.
Long-term use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation, and eliminate muscle spasms, an osteoarthritis patient is referred for physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet radiation are described, in the remission phase - electrophoresis with dimexid, trimecaine or novocaine, phonophoresis with hydrocortisone, inductotherm, thermal procedures (ozokerite, radon, paraffin), sulfide. Electrical stimulation is performed to strengthen the muscles.
In case of destruction of articular surfaces with pronounced joint dysfunction, arthroplasty is performed.