Arthrosis (arthrosis deformans, popular name - salt deposit) is a chronic disease of the joints of a degenerative-dystrophic nature, where the destruction of joint cartilage, joint capsule and deformation of the bone itself occurs.
It should be noted that arthrosis is a whole group of joint diseases with different origins and similar development mechanisms.The most common arthrosis of large joints:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
These are the most severe types of arthrosis.
Arthrosis of small joints is less common.Deforming arthrosis of the interphalangeal joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients note pain in the interphalangeal joints, a decrease in their mobility and the appearance of seals near the joints (Heberden's and Bouchard's nodes).This type of arthrosis is more common in old age.Arthrosis of the foot joints is common.
Polyarthrosis or generalized arthrosis is characterized by damage to several joints at once.
Arthrosis joints of the spine - spondyloarthrosis - belongs to the group of diseases of the spine, although it has a development mechanism similar to other arthrosis.
The main clinical symptom of arthrosis is joint pain and reduced mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree of joint destructive changes.
Causes of arthrosis
Arthrosis It is customary to divide it into primary and secondary.Primary (idiopathic) arthrosis is the result of impaired regeneration processes and increased degeneration in the cartilage tissue of the joint without any deviation in the activity of the whole body.Secondary arthrosis occurs as a result of other pathological processes in the body or in a joint already damaged by some external influences, with partial destruction of articular surfaces.
Traumatic arthrosis is often diagnosed in young patients.It is not always possible to draw a clear line between primary and secondary arthrosis in elderly patients.
Although it is not possible to determine the exact cause of arthrosis, the factors that contribute to its formation and development are well known.
The following types of causes contributing to the development of primary and secondary deforming arthrosis can be identified.
Causes of primary arthrosis - hereditary factors
The following hereditary disorders that can lead to the development of primary arthrosis have been identified:
- genetic disorders in the composition of joint cartilage tissue, causing its accelerated destruction;
- congenital defects of the musculoskeletal system (joint hypermobility, dysplasia, flat feet, etc.) that cause trauma to certain parts of the cartilage tissue of the joint, resulting in the appearance of arthrosis.
It is also noted that deforming arthrosis of the interphalangeal joints of the upper limbs occurs mainly in women and is inherited through the female line.
Causes of secondary arthrosis
Secondary arthrosis is the result of damage to the joint.These damages can be caused by various factors.
- Mechanical damage to joints.This group of factors includes various joint injuries, intra-articular bone fractures, as a result of which the structure of the joint is disturbed.The same result is caused by constant microtrauma of the joints as a result of extremely constant loads, both static and dynamic (for example, in athletes).Obesity also causes overuse and joint damage.
Another factor that negatively affects the joints (primarily the hip joints) is incorrect posture.
The structure of the joint can also be disrupted by surgery. - Joint diseases.Arthrosis can be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.).
- Metabolic disorders, diseases of the endocrine system, mineral deficiency in the body.Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage tissue, synovial fluid, which leads to disruption of recovery processes and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency causes changes in joint tissues and their gradual destruction in postmenopausal women.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins), as well physical inactivity it causes blood circulation disorders in periarticular tissues, poor blood supply of joint tissues and, as a result, degenerative changes.
Mechanism of development of arthrosis
Development arthrosis begins with the destruction of cartilage.At the beginning, it is believed that there is a blood circulation disorder in the capillaries of the subcartilaginous layer of the periosteum.Since the nutrition of the cartilage takes place due to the supply of nutrients from the intra-articular fluid and adjacent bone tissue, poor blood circulation causes the cartilage to gradually lose its elasticity, to thin, to form cracks, to break the smoothness of the joint surfaces, and to reduce the amount of synovial fluid in the joints.As a result, it seems pain and wheezing when moving.The width of the joint space gradually decreases and bones are formed along the edges of the articular surfaces. osteophyte spines.
Eventually, the joint deforms and the range of motion within it decreases.This is how involutional arthrosis develops due to the aging of the body.The development of this form of arthrosis usually occurs gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication, have slightly different development mechanisms, but as a result, we get similar changes in the joint.
Symptoms of joint arthrosis.Stages and degrees of arthrosis
Classification of arthrosis based on clinical and radiological signs is considered "classic".Accordingly, three stages of disease development are distinguished.According to the classification according to the degree of preservation of working capacity, which distinguishes 3 degrees of arthrosis:
- Arthrosis I degree - the disease does not prevent the performance of work, although it complicates it,
- Grade II arthrosis - the disease interferes with work performance,
- III degree arthrosis - loss of working capacity.
Let's consider in more detail the clinical signs and symptoms of arthrosis in each of the indicated stages.
Arthrosis 1st degree (initial stage of arthrosis)
In the initial stage of the disease, there is stiffness in the joints in the morning, after rest, and difficulty in movement, which gradually disappears after a while.There may be certain limitations in the mobility of the joint."Starting" pain (pain when starting to move after a long period of rest) appears from time to time.The joints snap with sudden movements, but there is no pain when moving.At this stage of arthrosis, pain appears only with significant and long-term stress and decreases after rest.No pain at rest and mild exertion.At this stage of the disease, patients rarely consult a doctor.
With grade 1 arthrosis, no special changes in the joint are visible on X-ray;sometimes small osteophytes can be seen on the edges of the joint, the joint space narrows a little.
Arthrosis 2 degrees (the second stage of arthrosis)
With the further development of arthrosis, the pain becomes more significant and sharp.With any movement, a different crisis appears in the joint, there is a noticeable limitation of mobility in the joint (contracture), functional shortening of the limb, violations in the biomechanics of movements, but the mobility of the joint is still preserved.At this stage, there is a noticeable increase in the initial pains, they become sharper and last longer.Under the influence of daily physical activity, constant fatigue appears, there is a feeling of pressure in the affected joints, and "mechanical pain" occurs, which is caused by a decrease in the ability of the cartilage tissues of the joint to absorb shock.
The destruction in the joint is already quite significant, the joints begin to partially deform.
On the radiographs, noticeable osteophytes, narrowing of the joint space 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cyst cavities in the epiphyseal zone are observed.
Grade 2 arthrosis is characterized by reduced work capacity and inability to perform certain types of work.
Arthrosis 3 degree (the third stage of arthrosis)
Arthrosis Stage 3 is the severe, advanced stage of the disease.At this stage, the following are observed:
- significant deformation of the joint (due to bone growth and accumulation of fluid in the joint cavity);
- severe limitation of movements, up to maintaining only swaying movements;
- acute pain not only when moving, but also at complete rest - constant pain associated with reflex spasm of nearby muscles, as well as the development of reactive synovitis;
- inflammation of the joints,
- joint sensitivity to weather changes.
- the muscles around the knee undergo spasm and atrophy;
The axis of the limb is deformed, varus or valgus curvature of the legs is noticeable (that is, in the form of the letter "O" or "X").
In X-rays with arthrosis of the 3rd degree, the almost complete disappearance of the joint cavity, open deformation of the articular surfaces, and extensive multiple marginal osteophytes are observed.Calcification of articular cartilage and paraarticular tissues can be detected.
By grade 3, the disease has progressed and is often the cause of permanent disability.It looks like this:
- the pain is constant and painful: walking, especially going up and down stairs, is a difficult test for the patient;
- loud creaking sound clearly audible to others during any movement;
- joint deformation is severe, movements are limited to a small amplitude or even impossible;
Photographs show the destruction of intra-articular structures (ligaments and menisci), as well as complete erosion of cartilage and signs of sclerosis (replacement of functioning organs and structures by connective tissue).
Arthrosis 4 degrees
The state of complete destruction of the connection with the year arthrosisWhen the joint stops functioning completely, it is often classified as a separate 4th degree of arthrosis.There is a so-called "joint block" - an acute pain syndrome in which even limited movement is impossible in the affected joint.The fourth degree of arthrosis is accompanied by unbearable pain in the joints, which cannot be eliminated even with strong painkillers and intensive physiotherapy.Complete ankylosis (union of the joint) or neoarthrosis (formation of a false union between the displaced ends of the bones) is possible.In both cases, independent action is almost impossible.
Photographs show gross sclerosis of joint surfaces with obvious cystic spaces, fusion of connecting bones in the joint cavity.The development of the disease to this stage almost always means disability, which can be prevented only by the implantation of an artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis in the initial stage of the disease
It is better to start treatment of arthrosis as early as possible, when the first signs appear - creaking in the joints, difficulty in movement.Medicines are useful at this stage - chondroprotectors that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physical therapy, proper nutrition and preventive measures are important.It should be noted that the prevention of arthrosis is of great importance to prevent the aggravation of the disease.
Treatment of arthrosis 2 - 3 degrees
Although it is no longer possible to completely treat 2-3 degree arthrosis, its development process can be significantly slowed down.Treatment of arthrosis at this stage includes the following steps:
- relieve or reduce pain
- eliminate inflammation in the joint.
- improving cartilage tissue regeneration and slowing down degenerative processes in it.
Treatment of arthrosis in the acute period begins with pain relief.For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular corticosteroid injections are possible.It is necessary to reduce the joint load;you should not walk for a long time, stand, or lift heavy objects.
After eliminating the acute pain syndrome, the main task is to ensure the activation of recovery processes in the joint itself and periarticular tissues as much as possible: improve blood circulation, increase metabolism, eliminate inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of grade 4 arthrosis
At this stage of the disease, the joint is almost completely destroyed.In this case, there is only one way out - surgery and replacement of the diseased joint with an endoprosthesis.Endoprosthesis significantly improves the mobility of the joints and allows the patient to continue an active life at least without pain.