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Arthrosis

Arthrosis, the symptom of which is joint pain

Arthrosis - what is it in simple words?

Arthrosis is a chronic pathology in which the gradual destruction of the cartilage plate occurs. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) develop. The joint capsule reacts to the events that occur and reactive vasculitis develops.






About the disease and possible complications

The incidence of pathology depends on age. The first signs of arthrosis usually appear at the earliest at the age of 30-35, and by the age of 70, about 90% of the population suffers from this pathology. Arthrosis shows no gender differences. The only exception is degenerative damage to the joints between the carpal bones. This form of the disease is 10 times more common in women than in men. Arthrosis most often affects the large joints of the legs and arms.

The pathological process begins with the interstitial material of the cartilage tissue, which contains type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is ensured by maintaining the balance of anabolism and catabolism. If the process of cartilage tissue degradation dominates its synthesis, the conditions for the development of osteoarthritis are created. This simply explains what arthrosis is.

Most often, the first signs of the disease develop in places with the greatest mechanical load, and limited areas of softening of the cartilage plate appear. As the pathological process progresses, cartilage fragments and cracks, as well as local deposition of calcium salts, are possible. During cartilaginous defects, the underlying bone becomes exposed, the separated pieces of cartilage enter the joint cavity and can lead to so-called "jamming" (symptoms of the "joint mouse").

Damage to the cartilage covering the joint processes of the bones leads to the fact that they lose their ideal shape, repeating each other's contours. For this reason, the joint surfaces suffer non-physiological stress during movement. In response to this, compensatory resynthesis processes are stimulated in the bone tissue. The bone thickens (subchondral osteosclerosis develops), irregularly shaped marginal growths (osteophytes) appear, which further changes the deviation between the joint surfaces. The resulting pathological changes gradually limit the range of motion of the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasms occurring in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead fragments of cartilage and bone activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, such long-term inflammation is accompanied by sclerosis of the periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthrosis is pain, which is accompanied by limited mobility of the joint over time. The limitation of mobility is first of a compensatory functional nature, and then can be traced back to organic changes. Additional imaging diagnostic methods (radiography, ultrasound scanning, computed tomography or magnetic resonance imaging) help to establish the correct diagnosis.

Depending on the stage and extent of arthrosis, treatment can be carried out with conservative or surgical methods. The orthopedic traumatologist helps to choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of arthrosis

There are two types of arthrosis:

  1. The primary variant is the result of a violation of the relationship between synthesis and degeneration in cartilage tissue and is accompanied by a malfunction of chondrocytes - the main cells of cartilage.
  2. The secondary variant occurs in a previously modified joint, when the normal connection (congruence) of the joint surfaces is broken, then the load is redistributed and the pressure is concentrated in certain areas.

Symptoms of joint arthrosis

The main symptom of joint arthrosis is pain. It has certain characteristics that allow the primary diagnosis of the disease.

  1. Mechanical pain, which is caused by the loss of the cartilage's shock-absorbing properties. Painful sensations occur during physical activity and subside during rest.
  2. Pain at night.It is caused by stagnation of venous blood and increased pressure of the blood flowing inside the bone.
  3. Incipient pain.It is short-lived and appears in the morning when a person gets out of bed (the patient says that it "must fall apart"). These pains are caused by debris deposited on the cartilage plates, during movement, these fragments are pressed into joint inversions, so the unpleasantfeelings disappear.
  4. Meteor addiction.The pain may intensify when the weather conditions change (increased air pressure, cold weather, excessive humidity).
  5. Blockage is pain.These are sudden painful sensations associated with the pinching of a piece of bone or cartilage between joint surfaces. In the background of the "blockade", the smallest movements stop in the joint.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person is bothered by joint stiffness. The signs of the inflammatory process are determined objectively - swelling and a local increase in skin temperature.

Osteoarthritis usually begins slowly, with pain in one of the affected joints. At first, the pain only bothers you during physical activity, but later it also appears at rest and during night sleep. Over time, the pain can also be felt in the joints of the opposite side, which is accompanied by a compensatory increase in the load. An important distinguishing feature of arthrosis is the frequency with which short periods of exacerbation are followed by periods of remission. The progression of the pathological process is indicated by the shortening of the period between relapses, as well as by adverse consequences in the form of contractures and a sharp limitation of joint mobility.

The course of arthrosis during pregnancy

During pregnancy, arthrosis can occur in different ways. As a rule, for 12-13 weeks, an exacerbation of the pathological process may occur, which is associated with hormonal changes in the woman's body. The second and third trimesters are usually relatively stable. Pregnancy is treated by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint arthrosis

The main mechanism that causes the destruction of cartilage is the violation of the synthesis of proteoglycan molecules in the cells of the cartilage tissue. The development of arthrosis is preceded by a period of metabolic disturbances, which occurs in secret. This metabolic imbalance is characterized by damage to proteoglycans and their constituents (chondroitin, glucosamine, keratan), which is accompanied by disintegration and degradation of the cartilage matrix. The collagen fibers in the cartilage plate break, the supply of metabolic products necessary for life is disrupted, and the water balance also changes (first the cartilage hydrates, then the number of water molecules decreases sharply, which further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the quality characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. During arthrosis, a cytokine "boom" can also be observed - the released cytokines disrupt the synthesis of collagen and proteoglycans and stimulate the inflammation of the joint membrane.

The main causes of arthrosis can be many:

  • "extra" weight, which increases the load on the joints;
  • wearing poor quality shoes;
  • simultaneous diseases of the locomotor system;
  • suffered joint injuries.

Signs and diagnosis of joint arthrosis

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. Further imaging studies are performed to confirm this.

  1. Radiography.In the early stage, the X-ray signs of the disease are of little significance - they can be uneven narrowing of the joint space, slight compaction of the underlying bone and small cysts in this area. At a later stage, radiography is more informative - marginal bone growths appear, the shape of the joint surfaces changes, joint "mice" and areas of calcification can be determined in the capsule.
  2. Ultrasound of joints.Ultrasound examination is more informative for detecting the initial signs of arthrosis. Signs such as intra-articular fluid accumulation, changes in the thickness and structure of the cartilage plate, and secondary reactions of the capsule, muscles and ligaments can be seen.
  3. Computed or nuclear magnetic tomography.This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilage plate, the subchondral region of the bone, and determine the volume of synovial fluid, including the amount of synovial fluid. in joint inversions.

Expert opinion

Deforming arthrosis of the joints is one of the most common pathologies of the musculoskeletal system, occurring in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. At first, these are short-term pains in one joint, which a person often does not pay attention to. Gradually, the severity of the pain syndrome becomes more intense, while the periodic character of the pain becomes permanent. In the absence of treatment, the disease continues to develop and is accompanied by severe degeneration of the cartilage, which no longer responds to conservative therapy, and to solve the problem, only arthroplasty is required - a complex and expensive intervention to replace the damaged joint. -exclusive implant. However, targeted drug therapy and lifestyle modification can significantly delay this operation or avoid it altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Treatment of arthrosis

According to clinical guidelines, the main goal of arthrosis treatment is to slow down the progression of degenerative changes in the cartilage plate. To achieve this, measures are taken to reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

The joint is relieved in the following ways:

  • weight loss (if overweight);
  • performing physical therapy, which excludes prolonged similar poses;
  • refusal to lift heavy loads or stay on the knees for long periods of time (applies to some professions).

In the initial stages of the disease, in addition to physical therapy, swimming and cycling are useful. In the later stages, walking with an orthopedic cane or crutches is recommended to relieve the joint during exacerbation.

To relieve pain, e. g. against the background of secondary synovitis, local and systemic non-steroidal anti-inflammatory drugs are used. Intra-articular injections of corticosteroids can also be used for the same purpose.

To improve the anatomical and functional condition of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help to improve the metabolism of cartilage tissue, increase the resistance of cartilage cells to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progress of the pathological process and improve mobility in the joint.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

  • Joint puncture- recommended for severe reactive arthritis. It allows not only the removal of the inflammatory fluid, but also the introduction of corticosteroids that interrupt the pathological chain.
  • Arthroscopic surgeries, which involves introducing instruments into the joint cavity through small punctures followed by magnification. These interventions allow washing the joint and its inversions, leveling the cartilaginous plate, removing necrotic areas, "polishing" the joint surfaces, etc.
  • Endoprosthesis– it is considered a radical surgery, which is performed in the case of an advanced pathological process. It is typically used for arthrosis of the knee or hip joint.

Prevention of arthrosis

The prevention of arthrosis is aimed at maintaining a normal body weight, wearing orthopedic shoes, avoiding knee work, lifting heavy objects in moderation and following a physical activity regime.

Rehabilitation in case of joint arthrosis

The rehabilitation of arthrosis of the joints includes procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and health-improving gymnastics are used.

Questions and answers

Which doctor treats arthrosis?

Diagnosis and treatment are carried out by a traumatologist-orthopedic.

Does radiography always allow the correct diagnosis to be made?

The severity of clinical symptoms of arthrosis does not always correlate with radiological changes. In practice, there are often cases when, in the case of intense pain, radiography does not reveal significant changes, and vice versa, when a "bad" X-ray does not show significant symptoms.

Is diagnostic arthroscopy performed for arthrosis?

If arthrosis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to look for causes that may lead to disturbances in the functional state of the joint (for example, damage to the menisci of the knee joint and intra-articular ligaments). .