Osteoarthritis (deforming arthrosis, popular name - the deposition of salts) - a chronic disease of the joints degenerative-degenerative nature, involving the destruction of articular cartilage, the joint, the deformation of the bone itself.
It should be noted that osteoarthritis - it is a whole group of diseases of the joints, which have different origins and close mechanisms of development. The most commonly occur arthrosis of the large joints:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
This is the most severe forms of arthritis.
Osteoarthritis of the small joints occur less frequently. More often occur deforming arthrosis of the interphalangeal joints of the hands, and also the metacarpal-phalangeal major joints of the fingers of the hand. Patients note pain in the interphalangeal joints, reducing their mobility, the formation in the vicinity of the joints of the seal (nodes Heberdena and Bouchard). It is a kind of arthritis occur more frequently in older age. Often occurs in arthrosis of the joints of the foot.
On polyarthrosis, helena generalized osteoarthritis, is characterized by the defeat of several of the joints.
Arthrosis of the joints of the spine - spondiloartrozom - belongs to a group of diseases of the spine, even if it has similar with other arthritis mechanism of development.
The main clinical symptom of osteoarthritis is pain in the joint, reduces its mobility. The specific symptoms are defined by the degree of arthrosis and depends on the degree of destructive changes in the joint.
The causes of arthrosis
Osteoarthritis accepted divided into primary and secondary. Primary (idiopathic) osteoarthritis is a consequence of the disruption of the processes of recovery and amplification of the degeneration of the cartilage in the joint and without any deviations in the work of the whole organism. Secondary osteoarthritis arises as a result of other pathological processes in the body, helena has already affected by any external influence of the joint, when the partial destruction of the joint surfaces.
The most traumatic arthrosis is diagnosed in young patients. And more patients of older age is not always possible to establish a clear boundary between the primary and secondary joint arthrosis suffer.
Although the exact cause of the arthritis cannot be determined, the factors supporting the emergence and development, are well known.
Can distinguish the following types of reasons that contribute to the development of the primary and secondary deformation of the flow arthrosis.
Causes of primary osteoarthritis - hereditary factors
Detection of the following hereditary disorders that can become a cause of the development of primary osteoarthritis:
- genetic disorders in the composition of the cartilage of the joint, which sees to its speedy destruction;
- congenital defects of the musculoskeletal system (hypermobility of the joints, hip dysplasia, flat feet and more), which are the cause of the trauma to the individual sites of cartilage tissue of the joint, and as a result, the occurrence of arthrosis.
He also noted that the deforming arthrosis of the interphalangeal joints of the upper extremities occurs mostly in women and passed through the female line.
The causes of secondary arthrosis
Secondary osteoarthritis is the result of damage to the joint. These damages can be caused by various factors.
- Mechanical damage to the joints. In this group of factors include various injuries of the joints, intra-articular bone fractures, which may result in disturbed structure of the joint. To the same result see a constant microfracture of the joints due to excessive sustained load, both static and dynamic (e.g. in athletes). Also on the knees and the trauma of the joints sees obesity.
One more factor that have a negative impact on the joints (especially the hip), is the bad posture of your body.
The structure of the joint can also interfere with operative intervention. - Diseases of the joints. Osteoarthritis may be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of the bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, the lack of minerals in the body. Various disorders of metabolism, deficiency of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage, the synovial fluid, which sees to the disruption of the recovery processes and the gradual destruction of the composition.
- Autoimmune diseases (gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in menopausal women lead to changes in the tissues of the joints and their progressive destruction.
- Vascular disease (atherosclerosis of vessels of lower extremities, obliterating endarteritis, varicose disease), as well as lack of exercise cause disorders of the blood circulation in periarticular tissues, poor blood supply to the tissues of the joint resulting in degenerative changes.
The mechanism of development of arthrosis
The development of arthrosis starts with the destruction of cartilage. It is assumed that at the beginning there is an infringement of blood circulation in the capillaries Podhradie layer of the periosteum. So as the nutrition of the cartilage is done by the intake of nutrients from the intra-articular fluid and adjacent bone tissue, it is a violation of blood circulation sees to it that the cartilage gradually loses its elasticity, becomes more delicate, it cracks appear, the smoothness of the articular surfaces is disturbed, it reduces the amount of synovial fluid to ensure sliding in the joint. Consequently, it appears the pain and crunching when you move. The width of the joint space gradually decreases at the edges of the joint surfaces are formed by the bone spikes-osteophytes.
Eventually the joint is deformed, the amplitude of the movements in it decreases. So develops with involutive osteoarthritis, age-related of the organism. The development of this form of arthritis usually happens gradually, over many years.
Other forms of arthritis of the large joints, such as post-traumatic, post-infectious, metabolic, intoxication have slightly different mechanisms of development, but in the result, we get similar changes in the joint.
The symptoms of the arthrosis of the joints. Phase and the degree of arthrosis
The "classic" considers the classification of osteoarthritis on the basis also of clinical-x-ray signs. In accordance with her posing three stages of development of the disease. Suits her classification according to the degree of preservation of working capacity, issue 3 degrees of arthrosis:
- Even the degree of arthrosis - a disease of the does not prevent the performance of the work, although, and obstruct it,
- II. the degree of arthrosis - a disease of the does not prevent the performance of work,
- III. the degree osteoarthritis - medical indisposition.
Let's discuss the clinical symptoms and signs of arthrosis at each of these stages
Osteoarthritis of 1 degree (the initial stage of arthrosis)
In the initial stage of the disease is in the morning, after a rest, celebrate stiffness, difficulty in movements of joints, which gradually passes some time after the beginning of the movement. Maybe some limitation of motion in the joint. Periodically there are "starter" pain (pain at the beginning of the movement, after a long search in the idle state). During sudden movements of the joint of the armor, but the pain in motion no. The pain at this stage arthrosis occurs only in large and long-term load, and resolves after rest. At rest and during small exertion pain is missing. In this stage of the disease, patients rarely go to the doctor.
On the x-ray image in osteoarthritis of 1 degree of specific changes in the joint is not visible, sometimes they can be visible small osteophytes on the edges of the joint, the joint space slightly narrowed.
Arthrosis of the 2 stage (the second stage of arthrosis)
In the further development of arthrosis, the pain becomes significant, acquires a spicy character. Clear crunching in the joint occurs in all movements, there has been a significant restriction of motion in the joint (contracture), functional shortening of the limbs, disorders of the biomechanics of the movements, but the mobility of the joint is still maintained. At this stage it is typical of the significant strengthening of the starting pains, which become acute and more long-term. Under the influence of daily physical activity appears constant fatigue, a feeling of pressure in the affected joints, arise the so-called "mechanical pain", caused by a decrease in depreciation of ability of cartilage tissue of the joint.
Fracture in the joint is already quite substantial, the joints begin to partially deform.
On x-ray images visible noticeable osteophytes, joint space narrowing 2-3 times in comparison with the norm, there was sclerosis of subchondral bone and formation of a cystic cavity in the epiphysis of the zone.
Osteoarthritis of 2 the degree is characterized by a decrease in working capacity, inability to perform some types of work.
Osteoarthritis of the 3 degrees (third degree arthrosis)
Osteoarthritis of the 3 degrees - it's hard, the running stage of the disease. In this stage are observed:
- significant deformation of the joint (due to the growths of the bones and accumulation of fluid in the articular cavity);
- the drastic restriction in the movement, and it's up to the store only to rocking movements;
- a sharp pain not only when driving but also in a state of complete stillness - the constant pain associated with reflex spasm of the surrounding muscles, but also on the development of reactive synovitis;
- inflammation of the joints,
- the sensitivity of joints to weather change.
- the muscles around the knee spasmatic and atrophy;
The axis of the limb deformed, significantly varus helena valgus curvature of the foot (it is in the shape Of the letter "o" helena "X").
On radiographs in osteoarthritis of the 3 grades there has been an almost complete disappearance of joint space, expressed deformation of the joint surfaces, extensive more marginal osteophytes. May be determined by the joint mouse and calcification of the para-articular tissues.
3 degrees of the disease have gone very far, often that's a reason to open a disability. It manifests itself as follows:
- the pain becomes constant and unbearable: walking, and especially rappelling and climbing the ladder - the suffering for the patient;
- the loud crunching in all the movements, well hear another;
- the deformation of the joints, is strongly expressed, the movements are only limited to a small amplitude, or even impossible;
On the pictures is to see the destruction of the intra-articular structures (ligaments and meniscus), as well as a complete abrasion of the cartilage and symptoms of sclerosis (spare the functioning of the organs and structures of the connective tissues).
Arthrosis of 4 degrees
The status of the complete destruction of the joint in osteoarthritis, when the joint completely ceases to function often be issued in a separate - 4 stage osteoarthritis. There has been a so-called blocking of the joint" - an acute painful, in which it is not possible or limited movement in the diseased joint. The fourth degree of arthrosis is accompanied by unbearable pain in the joints, which are not removed even hardcore painkillers, and intensive physical therapy. Is it possible to full ankylosis (fusion of the joint) helena newartriot (formation of a false joint between the offset money of the bones). A separate motion is in both cases practically impossible.
Below is a rough sclerosis soslanovna surfaces with pronounced cystic enlightenment, the accretion of the connection of the bones in the area of the joint space. The development of the disease up to this stage almost always means disability, prevent you can only the implantation of artificial prosthesis joint.
Treatment of arthrosis
Treatment of arthrosis in the initial stage of the disease
Start to treat osteoarthritis it is better as soon as possible, upon the occurrence of the first symptoms - the crunch of the joints, difficulty in movement. At this point it is useful to medications - chondroprotectors, improve the structure of cartilage, as well as vitamin-mineral complexes.
Essential therapeutic physical training, proper nutrition, as well as preventive measures. It should be noted that the prevention of osteoarthritis is of great importance and to prevent worsening of the disease.
Treatment of arthritis of 2 - 3 degrees
Even when fully cured arthrosis of 2-3 degrees is no longer possible, but the process of its development can be slow down significantly. Arthritis treatment at this stage includes the following steps:
- the removal of the helena reduction of pain syndrome
- reduce inflammation in the joint.
- improve the recovery of the cartilage and slow down degenerative processes in it.
In the acute period of treatment of arthritis begins with removal of pain. For this purpose, are non-hormonal anti-inflammatory drugs (NSAIDS), analgesics. It is possible to intra-articular corticosteroid injections. It is necessary to reduce the load on the joint, can not long walk helena to stand, lift heavy objects.
After the elimination of acute pain syndrome the main task becomes to ensure, if possible, the activation of regenerative processes in the joint and periarticular tissues, improve blood circulation, improvement of metabolism, removal of inflammatory processes. Called chondroprotectors, vasodilator drugs, but also to physiotherapy and physical therapy.
Treatment of arthritis of the 4 degree
In this stage of the disease the joint is already almost completely destroyed. In this case, there remains one way out - surgery and replacement of the affected joint endoprosthesis. Total replacement significantly improves the mobility of the joint, allowing the patient to resume an active life, at least by how to get rid of painful sensations.