Osteoarthritis of the joint
A variety of systemic pathologies can lead to a significant deterioration in quality of life, a complete loss of ability to work and even severe disability. Diseases related to the musculoskeletal system do not only occur in old age. All 2-3 cases are observed in patients of working age. The most dangerous and difficult to correct condition is osteoarthritis.
This degenerative disease is accompanied by a thinning of the cartilage tissue in the large and small joints, resulting in a decrease in the range of motion and severe pain when attempting to perform it. Serious consequences can only be prevented by the appointment of adequate treatment at the earliest stages of the development of the disease. In this article we will find out the causes of development, pathogenesis, clinical manifestations, modern methods of diagnosis and the treatment of osteoarthritis.
Prevalence of osteoarthritis
If you pay attention to the statistical indicators, you can see that osteoarthritis is a very urgent disease and the frequency of its occurrence is increasing every year. According to the World Health Organization, pathology is seen in seven percent of the world's population. In terms of frequency of detection, it therefore comes first in comparison to other musculoskeletal disorders.
Arthrosis is a chronic joint disease with a non-inflammatory etiology that leads to deformities in the affected areas of the osteoarticular apparatus.
Cartilage degeneration is often seen in young people, more often in men. Interphalangeal osteoarthritis is often found in young girls. After reaching the age of 50, the incidence of the lesion and the location of the lesion become approximately the same in both sexes and amount to approximately 60%.
From the data presented, it appears that it is extremely important to identify the pathology early on in order to conduct the most effective drug therapy. Otherwise, the treatment of advanced osteoarthritis will not be accessible to most elderly patients due to the financial component.
Causes and risk factors for developing osteoarthritis
The frequency of occurrence of the presented joint disease has made the problem acute in the medical community of highly developed countries. Leading clinics spend hundreds of millions of dollars annually on osteoarthritis research. Gradually studying the problem made it possible to find out the pathogenesis of the process and the factors that can increase the likelihood of disease.
A modern and more complete classification of joint degeneration is presented below. At this stage it is enough to understand that there are primary and secondary forms.
Some of the reasons that can lead to the development of secondary joint disease include:
- congenital changes related to the blood supply to the joint joints;
- trauma to the cartilage lip, ligamentous apparatus or bone growth zones;
- metabolic disorders, especially with the mineral compound;
- autoimmune pathologies;
- infections that affect bone tissue;
Primary osteoarthritis is an independent disease that can develop due to the influence of such provoking factors:
- be overweight;
- excessive physical activity;
- joint surgery;
- genetic predisposition;
- insufficient intake of calcium and other minerals;
- chronic poisoning;
- long and frequent stay at low temperatures;
- frequent trauma to bone articulation.
Mechanism of osteoarthritis development
The normal bony articulation consists of two or more joint heads, a ligamentous apparatus, a cartilage lip and a synovial fluid. All of these structures provide mobility in a specific area of the musculoskeletal system without painful sensations. They also make it possible to absorb and relieve the load absorbed while walking and jumping without harming the body.
Osteoarthritis of the joints belongs to a group of diseases of polyetiological origin. This means that most of the time the cause of development is the influence of a number of triggers, including occupational hazards, obesity, age, and poor diet. The pathogenesis lies in the fact that certain influences lead to a significant deterioration in blood supply and lymphatic outflow from the specified area.
In addition, chondrocytes lose the ability to regenerate quickly and produce a normal amount of intra-articular fluid, which reduces the friction of the surfaces during movement. Gradually, the cartilage becomes rough and begins to wear out under the influence of pressure during active body movements.
Gradually the compensatory abilities of the tissue are exhausted and the layer of chondrocytes is gradually erased. When the degeneration reaches the bone, severe pain develops and mobility is severely reduced. Without adequate treatment, the patient can completely lose the ability to actively move and even to meet his needs independently.
A person does not immediately learn what osteoarthritis is, the disease begins gradually and does not manifest itself in the initial stages. Over time, the patient notes the appearance of minor pain without a specific localization, which is aggravated against the background of significant physical exertion. The increasing degeneration leads to the fact that pain occurs with small movements and is given a clear place.
The less noticeable symptoms of osteoarthritis include:
- "aching" pain when the weather changes;
- crunching when moving;
- morning stiffness;
- muscle cramps.
If the cartilage is badly affected, signs of local inflammation appear, such as swelling, reddening of the skin and localized fever. If a person does not see a doctor, symptoms progress and appear not only during exercise, but also at rest.
A thinning of the chondrocyte layer leads to a deformation of the joints and a disruption of the normal function of the extremity. When the patient feels the pathological focus, it marks the points of greatest pain. In addition, the lip of cartilage is significantly thickened along its edge, which indicates compensatory hypertrophy.
A large number of diseases in the area of the bone joints lead to certain difficulties in the differential diagnosis. However, by assessing the nature of the pain, osteoarthritis can be distinguished from arthritis of another etiology. In the described state, as a rule, painful sensations appear when trying to make active movements. Its intensity gradually increases as attempts are made to increase the load on the damaged joint.
The clinical picture described corresponds to the first stage of the process. In the second and third stages of progression, pain also occurs in a state of complete rest. They can only be stopped by indicating a position that is comfortable for the limb. The difference between arthritis is the constant presence of pain that does not go away when you change position, and it also intensifies at night.
The destruction of the natural structure of the cartilage leads to the active proliferation of chondroblasts, but every pluripotent cell in our body has a certain limit of division. This is known as the equalization buffer. This means that after a certain number of mitotic divisions, the cell dies and can no longer reproduce its own species.
After a while, this leads to a change in the normal shape of the joint space, the appearance of so-called "crystals" or outgrowths in its lumens and depressions. This phenomenon only exacerbates the process, since the spikes formed during the destruction cause additional damage when moving.
Due to changes in the smoothness of the joint surface, the appearance of tuberosity and irregularities, the amplitude of active and passive movements is significantly reduced. It is this symptom that most often prompts the patient to seek medical help. Unfortunately, at this stage, the effectiveness of drug treatment becomes too low, the situation can only be corrected by surgical correction of the joint.
The functions include:
- high probability of developing a "contracture" or completely disappearing the active and passive movements in the extremity;
- Stiffness is observed throughout the day, not just in the morning like with arthritis.
- In some cases the limb must be stretched manually to achieve a more comfortable position.
Many have heard the characteristic "crispy" sound when kneading joints. There is a theory that this phenomenon is observed in a healthy person when the pressure in the capsule of the bone articulation changes, as a result of which the density of the synovial fluid changes dramatically, and the gas bubbles contained in it quickly expand and burst, causing a kind of crunch. This phenomenon is not dangerous, but with osteoarthritis, a similar sound occurs as a result of other processes.
The crystals formed in the course of the cartilage destruction injure the joint and the joint lip, which leads to the formation of cracks and dissociation of the ligamentous apparatus. Even an inexperienced person can distinguish the sound in a joint with osteoarthritis - it is coarser and "dry". The severity and loudness of the symptom described is directly proportional to the stage of the disease.
The specificity of the noises in the joint with osteoarthritis is:
- their presence only in the painful joint;
- is always associated with a deterioration in mobility; The severity
- increases in the later stages of the disease.
Change the appearance of the joint
In the initial stages of the development of osteoarthritis, the process does not lead to a change in the shape of the bony articulation. A noticeable change can only be seen in advanced disease, when one part of the joint is completely worn out while the other is still producing cartilage cells. As a result, the pathological area increases significantly and loses its natural appearance. This symptom is extremely unfavorable since the presence of a deformation in the area, for example the knee or hip joint, invariably leads to changes in the area of the underlying structures due to the displacement of the axis of the applied load.
Types and stages of osteoarthritis
The modern classification of osteoarthritis is quite ramified due to the extensive list of possible localizations of the pathological focus.
In order to facilitate communication between specialists from different medical centers and even countries regarding the diagnosis and treatment of this disease, the main ones are highlighted:
- osteoarthritis of the hand;
When making a diagnosis, a very important phase is precisely defining the phase of the destructive process. There are stages in the development of osteoarthritis:
Stage 1 - there are no visible changes in the shape of the joint, there are violations in the biochemical composition of the intra-articular fluid, there is a mild pain syndrome, supplemented by inflammatory manifestations in the area of articulation.
Stage 2 - A degenerative process is observed in the cartilage tissue, "crystals", stiffness and a significant pain syndrome develop during movements. Dystrophy of the muscles surrounding the joint develops.
Stage 3 - the presence of extensive foci of cartilage destruction is determined, the shape of the joint is changed, the amplitude of active and passive movements in the limb is significantly reduced or completely absent. At this stage, patients often develop contractures that completely stop movement in the affected area.
An uncontrolled process of destruction can lead to serious complications, which, in addition to a deterioration in the quality of life, can lead to a complete inability to take care of themselves.
The most serious are:
- complete destruction of the cartilage tissue of the joint;
- the appearance of hernia protrusions in the area of the intervertebral discs;
- severe disability of the patient;
- significant deformity of the extremities.
Unfortunately, many patients learn what osteoarthritis is and how to treat it in the stages in which it is no longer possible to achieve a significant effect with tablets. It is necessary to deal with the correction of the state of the musculoskeletal system after the onset of the first symptoms and for life. This is due to the fact that the effects of factors that contribute to the development of the disease can rarely be prevented. For example, age-related changes in the blood supply and lymphatic drainage from the joint require the constant use of vascular drugs. Given the pathogenesis, therapy should be comprehensive and comprehensive. First, contact a rheumatologist or a traumatologist after experiencing unpleasant sensations while moving. On the basis of the data of laboratory and instrumental diagnostics, the doctor will make an accurate diagnosis and decide on the appointment of appropriate treatment.
In the early stages of osteoarthritis, the situation can be corrected with the help of medication. For this purpose, the following groups of drugs are used:
- hormones of the adrenal cortex;
- nonsteroidal anti-inflammatory drugs;
- Drugs with a chondroprotective effect.
The complex effect makes it possible to relieve the patient of pain in the shortest possible time, to balance the inflammatory process and to restore the normal blood supply.
Advanced developments in drug treatment have led to the development of new drugs that actually replace the natural synovial fluid. The developed molecules can significantly reduce the process of cartilage degeneration, relieve pain and free the patient from inflammation. Artificial synovial fluid is injected directly into the joint capsule every week. The duration of one treatment is 3-5 weeks. Usually the result obtained is enough for normal human activity for 6-12 months. Patients claim that comfort and quality of life are significantly improved. Unfortunately, this tactic is only applicable to people with stage 1-2 osteoarthritis.
If there is severe damage to large joints such as the hips or knees at a relatively young age of up to 60 years, patients are offered an operation for a complete joint replacement. Today ceramic and titanium grafts are used, which can fully restore the lost functions. These devices are powerful enough to provide a patient with a lifespan of up to 20 years with no problems with the mobility of the replaced joint.
Alternative medicine is widely used in the treatment of osteoarthritis. This is due to the fact that after the acute process has stopped, lifelong therapy is required to restore and maintain the natural structure of the cartilage. To achieve the goals set, the means used must be safe and as natural as possible.
Compresses and lotions with a decoction made from the following plants are very popular:
- ginger root;
Diet against osteoarthritis
In the treatment of the presented pathology, it is extremely important to constantly supply the body with nutrients. This can only be achieved if the diet is complete in terms of the content of proteins, fats, carbohydrates, vitamins and microelements. In order to create the most suitable nutritional regimen, you should consult a nutritionist. Fast carbohydrates and alcohol should be removed from the diet. The basis of the table should be dishes made from fish, red meat and fresh fruit.
It is very important to observe the following dietary rules for osteoarthritis:
- Food intake 5-6 times a day in small portions;
- do not eat after 19: 00;
- Get rid of excess weight.
Today there is no specific arthrosis prophylaxis that can be traced back to the polyetiological nature of the disease.
The disease can be prevented by following the general recommendations:
- proper nutrition;
- moderate physical activity 2-3 times a week;
- normalization of body weight;
- frequent shared meals;
- compliance with the rules of personal hygiene;
- give up bad habits.
The pathological condition of the musculoskeletal system is often observed in older patients. It is necessary to increase the frequency of early detection of the disease, since only in this case a successful result of conservative treatment can be expected. The prognosis for the ability to work, subject to early detection and compliance with all medical regulations, is favorable. The presence of osteoarthritis in the third stage is associated with an unfavorable prognosis and can mean that the patient is no longer able to take care of himself.
Nevertheless, even the most severe form of the disease is corrected with the help of surgical treatment, the disadvantages of which are:
- Invasiveness of the operation;
- high cost;
- long rehabilitation phase;
- cannot be used in patients over 60 years of age.