Arthrosis is a chronic pathology affecting the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course, with gradual destruction of cartilage tissue.Arthrosis is detected in most patients after the age of 65, as one of the causes of its development is the natural aging of the body.
The occurrence of degenerative-dystrophic pathology is caused by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, a sedentary lifestyle.The main symptoms of arthrosis are joint pain, swelling and limited movement.
To diagnose the pathology, instrumental tests are performed - radiography, arthroscopy, MRI, CT.Arthritis of severity 1 and 2 is treated conservatively with medication, physiotherapy and massage treatments, as well as exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is required - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
In the case of arthrosis, pronounced changes occur in the internal connective tissue structures.Deforming erosions are formed on cartilage tissues, which cause the destruction of collagen fibers and proteoglycans consisting of proteins (5-10%) and glycosaminoglycans (90-95%).As a result, the collagen network loses its stability and metalloproteinases begin to be released, destroying all types of extracellular matrix proteins.Decay is accelerated by increasing the biosynthesis of collagenases and stromelysin.Normal quantitative values of enzymes are usually regulated by cytokines - small peptide information molecules.But as arthrosis progresses, the concentration of these proteins decreases, which causes the release of a large number of enzymes that damage the cartilage tissue.
Proteoglycans with a changed structure begin to absorb the water molecules that they cannot hold.Therefore, excess fluid enters the collagen fibers.They "swell", lose strength and elasticity.Negative changes occur in the qualitative and quantitative composition of the synovial fluid.In the case of arthrosis, the concentration of hyaluronic decreases.Hyaline cartilage no longer receives enough nutrients and oxygen for regeneration.Foci of softening are formed in the cartilaginous tissues, followed by cracks and specific necrotic growths.The bony heads become exposed and suffer microtrauma as they move relative to each other.
Causes and provoking factors
The causes of primary (idiopathic) arthrosis have not yet been established.It occurs in the absence of provoking factors, which is why theories are put forward about a hereditary tendency to the premature destruction of cartilage.Secondary arthrosis develops as a result of other joint pathologies or previous injuries.What can cause degenerative-dystrophic disease:
- injury to joints or nearby connective tissue structures - fracture, dislocation, damage to the meniscus, partial tearing or complete separation of muscles, ligaments, tendons from the base of the bone;
- congenital dysplastic disorders of joint development;
- disruption of endocrine glands, disruption of metabolic processes;
- rheumatism or rheumatic fever;
- rheumatic, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococci, epidermal or Staphylococcus aureus;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative diseases such as osteochondritis dissecans.
The hypermobility of the joints, which is caused by the production of special collagen, predisposes to the development of arthrosis.This condition is observed in 10% of the inhabitants of the planet and is not considered a pathology.However, hypermobility is accompanied by weakness of the tendon-ligament apparatus, which leads to frequent injuries, especially in the ankle joint (ligament sprains and tears, dislocations).
Osteoarthritis is sometimes caused by blood-forming disorders such as hemophilia.Hemarthrosis, or bleeding into the joint cavity, causes deterioration and destruction of the articular cartilage.
Predisposing factors include old age, frequent loading of joints beyond their strength limits, excess weight, surgical interventions and hypothermia.
The risk group includes women living during menopause, people living in unfavorable environmental conditions or people in contact with toxic chemical compounds.If there is a lack of foods containing vitamins and microelements in the diet, the prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of arthrosis lies in the absence of symptoms in the first stage of development.The pathology manifests clinically gradually, the first signs appear against the background of significant destruction of cartilage tissue.Initially, a person feels mild pain, which does not have a clear localization.Appears after physical activity - weight lifting, sports training.Sometimes the first clinical manifestation is a cracking or clicking sound when flexing or extending the joint.One begins to notice that certain movements are difficult.However, in the initial stages of arthrosis, stiffness appears in the morning and soon disappears.
As the disease progresses, the pain can also be felt at night, which causes not only sleep disturbance, but also the appearance of chronic fatigue.The severity of the pain syndrome increases in the second stage with changes in the weather, aggravation of chronic pathologies and acute respiratory viral infections.The range of motion is noticeably reduced.The reason for the stiffness is the thinning of the cartilage, as well as the person's conscious restriction of movement in order to avoid pain.This leads to increased stress on the opposite joint, causing further damage.Arthrosis is also characterized by other specific symptoms:
- pain causes spasms of skeletal muscles and the development of muscle contractures (restriction of passive joint movements);
- the crunching, clicking, crackling of the joints becomes constant during movement, which occurs with almost every movement of the bones relative to each other;
- painful muscle spasms often occur;
- the joints are deformed, which leads to disturbances in posture and walking;
- in the third stage of arthrosis, the deformation is so pronounced that the joints bend and the range of motion is significantly reduced or completely absent;
- with third-degree arthrosis of the knee, ankle, and hip joints, the patient uses a stick or crutches while moving.
In the absence of treatment, the pathology progresses, and during its course, remissions are replaced by relapses, and the frequency of exacerbations constantly increases.The stiffness of morning movements does not disappear for a long time, it becomes permanent.
When examining a patient with grade 1 arthrosis, the doctor notices only slight swelling of the joint and complete preservation of the range of motion.In grade 2 pathology, palpation reveals pain and mild deformity.Bone thickening can be observed in the area of the joint space.
Arthrosis is characterized by the development of synovitis - inflammatory processes in the synovial membrane of the hip, knee, ankle and shoulder joints.Their main symptom is the formation of a rounded seal in the area of the joint when pressure is applied, which can be felt by the movement of the fluid (fluctuation).Acute arthritis can be accompanied by a temperature rising to 37-38 °C, headache, and indigestion.
Diagnostics
The diagnosis is made based on the results of instrumental tests, the characteristics of the clinical picture, the anamnesis and the patient's complaints.General blood and urine tests are not very informative - all values remain within normal limits if arthrosis is not caused by metabolic pathology.With the development of synovitis, the sedimentation rate of red blood cells increases (30 mm/hour), the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.In secondary forms of arthrosis, the biochemical and immunological parameters change.
The most informative method of diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral views.
| Stages of arthrosis according to the Kellgren-Lawrence classification (1957) | X-ray signs of pathology |
|---|---|
| Initial | No radiological sign |
| First of all | A vague, uneven narrowing of the joint space.Slight flattening of the edges of the bone plates, formation or absence of initial osteophytes |
| Second time | Marked narrowing of the joint space, 2-3 times larger than normal, large number of osteophyte formation, subchondral osteosclerosis.The appearance of cystic spaces in the epiphyses |
| Third | Marked subchondral osteosclerosis and appearance of large marginal osteophytes, significant narrowing of the joint space |
| Fourth | Formation of rough massive osteophytes, almost complete fusion of the joint space, deformation and compaction of the epiphyses of the bones that make up the joint |
If, after studying the X-rays, the doctor has doubts about the diagnosis, a CT scan is prescribed.And to assess the condition of the connective tissue structures located near the joint, an MRI is performed.When contrast is applied, the blood supply to the tissues can be dynamically evaluated, and the stage of the inflammatory process during the development of synovitis can be determined.
Basic methods of therapy
Arthrosis is still an incurable disease, as there is no drug to regenerate the cartilage tissue.The main goal of therapy is to prevent the progression of the pathology and maintain joint mobility.The treatment is long-term, complex, with both local and systemic medication.Patients should avoid heavy stress on the joint and, if necessary, limit the range of motion with orthopedic devices - orthoses, elastic bandages.Overweight patients should adjust their diet to gradually lose weight and follow a diet.
After achieving stable remission, patients are introduced to daily physical therapy exercises.The first training sessions are carried out under the guidance of a physiotherapist, after which the patient performs a series of exercises at home.Exercise therapy can be supplemented with swimming, yoga, and cycling.
To reduce the severity of pain, drugs belonging to different clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- injections of anesthetic solutions into the joint in combination with glucocorticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic regimens include B vitamins, tranquilizers, sedatives, and antidepressants if necessary.Long-term use requires chondroprotectors.This is the only group of drugs that can partially restore cartilage tissue.
In order to increase their clinical activity, they perform physiotherapy procedures - laser therapy, magnetic fields, UHF therapy.
Any pain in the joints should indicate an immediate consultation with a doctor.Therapy in the early stages of arthrosis stops cartilage destruction and prevents loss of performance and disability.