Osteoarthritis is a chronic pathology, connective tissue, affecting structures of the musculoskeletal system. For the disease is typically progressive with gradual destruction of the cartilaginous tissue. Osteoarthritis in most patients after the age of 65, since one of the reasons for its development is the natural aging of the body.
To the emergence of degenerative-dystrophic pathology more previous trauma, endocrine and inflammatory diseases, excess movement or, on the contrary, a sedentary way of life led to advance. Leading symptoms of osteoarthritis pain in joints, its swelling, limitation of movement are.
For the diagnosis of the pathology of instrumental studies, x-rays, arthroscopy, MRI and CT scans performed. Osteoarthritis 1, and 2 severity treated conservatively the course of the taking of medication, physiotherapy and massage, exercise therapy. In the case of irreversible destructive changes in the joints of the surgical Intervention — arthrodesis, arthroplasty.
Pathogenetic Mechanisms
In osteoarthritis, significant changes in connective tissue occur in the inner structures. On the cartilage tissue to deform Erosion formed what is the reason for the destruction of the collagen fibers, and proteoglycans consisting of proteins (5-10%), and glycosaminoglycans (90-95%). As a result of the collagen Mesh lose stability, begin to challenge Metalloproteinase form, destroy all kinds of proteins of the extracellular Matrix. Destruction accelerated by the increase in the biosynthesis of collagenase and stromelysin. In General, normal quantitative enzyme-values to control cytokines are small peptide molecules. But with the osteoarthritis progresses reduces the concentration of these proteins, which causes the release of large amounts of enzymes, effects on the cartilage tissue.
Proteoglycans with a modified structure does not begin to absorb water molecules, to keep the able. Therefore, the excess fluid flows into the collagen fibers. They stretch, lose their strength and elasticity. In the qualitative and quantitative composition of the joint fluid is also negative changes. In osteoarthritis the concentration of hyaluronic acid is reduced. The hyaline cartilage of stop coming in sufficient for the Regeneration amount of nutrients and oxygen. In the cartilage tissue lesions formed is softening, and then the cracks appear, the specific necrotic growths. Bony head bare, you will be begin to micro traumatic in the case of a displacement relative to each other.
The causes and triggering factors
The reasons for the development of the primary (idiopathic) osteoarthritis is not yet installed. It occurs when no triggering factors, therefore, theories about the hereditary predisposition to premature destruction of the cartilage. Secondary osteoarthritis arises as a consequence of other diseases of the joints or from injuries. What is the cause of degenerative-dystrophic diseases can:
- Injury to the joint or nearby tissue structures — fracture, dislocation, injury to the meniscus, a partial rupture of muscles, ligaments, tendons, or their complete separation from the bone on the benefit Basis;
- congenital dysplastic developmental disorders of articulation;
- Dysfunction of the endocrine glands, disturbance of metabolic processes;
- Rheumatism or rheumatic fever;
- rheumatoid, reactive, metabolic, Psoriasis or gout, Polyarthritis;
- purulent Arthritis caused by Streptococcus, Epidermis or Golden-staph;
- Tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, Syphilis;
- degenerative-dystrophic diseases, e.g., dissecans Legg.
To the development of osteoarthritis, Hyper mobility of the joints, predispose due to the development of specific collagen. Such a condition is 10% of the inhabitants of the planet, and not as a pathology. However, Hyper-mobility, accompanied by weakness of the muscle-tendon-ligament apparatus, to hide what frequent injuries, special ankle (sprains and ruptures of ligaments, sprains).
The reason for the development of osteoarthritis sometimes, disorders of blood formation in hemophilia, for example. Hemarthrosis, hemorrhage, or in the cavity of the articulation, provoking the deterioration of the trophic cartilage and its destruction.
To predispose include old age, frequent stress on the joints, which is beyond the limits of your strength, obesity, surgery, hypothermia.
At risk are women in menopause, people living in adverse environmental conditions, or contact with poisonous chemical compounds. With a deficit in the diet of foods with vitamins and trace elements, the conditions for the gradual destruction of the hyaline articular cartilage creates creates cartilage.
The Disease
The risk of osteoarthritis, the lack of symptoms in the first Phase of its development. Pathology clinically, the first symptoms manifested themselves gradually against the backdrop of the substantial destruction of the cartilaginous tissue. First of all, the people feel mild pain, the clear localization. It appears after the workout — weight lifting, sports Training. Sometimes the first clinical Manifestation is a crunch is, POPs in flexion or extension of the joint. The person begins to notice that some movements are given hardly. However, in the initial stage of the osteoarthritis joint stiffness hours occurs in the morning and soon disappears.
As the disease progresses, to feel pain and in the night, and not provoked only sleep disorders, but also the emergence of chronic fatigue syndrome. Severity of pain in the second stage increases when the weather changes, exacerbation of chronic diseases, SARS. Significantly reduced the volume of movements. The cause of stiffness, thinning of the cartilage, as well as the deliberate restriction of a Person's movements in an attempt to avoid the occurrence of pain. This leads to an increase in the load on the other joint, which causes it to further damage. For osteoarthritis characteristic and other specific symptoms:
- Pain provoked by cramps of the skeletal muscle and the development of muscle contractures (restrictions of passive movements in the joint);
- Crunch in joints, cracking, crackling when driving, permanently, almost any displacement of the bone use to each other;
- often painful muscle occur cramps;
- the joints to deform that results in impairment of posture and gait;
- in the third stage of the arthrosis deformation is expressed so brightly, that the joints bent, and the volume of movements in them significantly reduced or completely lacking;
- in the case of osteoarthritis of the third degree king's meadow, ankle joint, hip joint Patient movement using walking stick or crutches.
If untreated, the pathology progresses, and during the Remission switch cases with a return, wherein the frequency of exacerbations increases constantly. Stiffness in the morning don't disappear now for a long time constant is.
Seeing patients with osteoarthritis of 1 degree, the doctor provides only slight swelling of the joint and the full preservation of the mobility. In the case of pathology 2 degrees Palpation, deformation, pain, isolated, and weak. In the area of the joint gap, the formation of bony protrusions observed.
For the arthritis characteristic of the development of synovitis is the inflammatory processes in the synovial sheaths of the hip, king's meadow, ankle joint, shoulder joints. The leading symptom is the formation of rounded thickening in the area of the articulation to feel the pressure on the movement of fluid (fluctuation) is. Acute Synovitis may be due to increase in temperature to 37-38°C, headache, impaired digestion.
Diagnosis
The diagnosis is made on the basis of the results of instrumental studies of the peculiarities of the clinical picture, anamnesis, complaints of patients. Blood and urine senseless — all the values remain in the normal range, if the osteoarthritis is not due to metabolic disorders. In the development of Synovitis increased erythrocyte sedimentation rate (30 mm/h), in the blood of leukocytes increases Fibrinogen. This indicates a leaking in the body, an acute or chronic inflammation. Changes in the biochemical and immunological parameters is carried out in secondary forms of osteoarthritis.
The most informative method of the diagnosis of degenerative-dystrophic pathology x — ray in frontal and lateral projection.
| The stage of osteoarthritis according to the classification of Kellgren-Lawrence (1957) | Radiographic signs of pathology |
| In operation | No radiological signs |
| The first | Indistinct, uneven joint space narrowing. A small flattening of the edges of the bony plates, the formation of the first osteophytes or their absence |
| The second | Pronounced joint space narrowing, as is the Norm in 2-3 times, the formation of large amounts of osteophytes, subchondral osteosclerosis. The emergence of kistevidnyj enlightenment in the epiphyses |
| The Third | The emergence of pronounced subchondral osteosclerosis and large regional osteophytes, marked joint space narrowing |
| The fourth | The formation of coarse massive osteophytes, almost complete fusion of the joint pan for cracks, deformation and hardening of the epiphyses of the bone use, the form, the joint |
If, after studying the x-ray images to the doctor's doubts as to the nomination of the diagnosis, a CT is assigned to it. And for the purpose of assessment in the vicinity of the connective tissue structures of the wrist MRI performed. With the use of contrast to evaluate the dynamics of blood circulation in the tissue, which can install the stage of the inflammatory process in the development of Synovitis.
The basic methods of
Osteoarthritis is still incurable disease, as there is no pharmacological drugs for the Regeneration of cartilage tissue. The main task of the therapy is the prevention of the Progression of the pathology, the preservation of the mobility of the joints. Treatment of long, complex, with the use of local and systemic drugs. Patients should be avoided to reduce the large loads on the joint, if necessary, the movements of orthopedic devices — orthoses, elastic with cable, stand, ties on Monday. Patients with obesity have to be adjustments in the diet for a step-by-step reduction of body weight and diet.
After reaching a stable Remission patients, the daily shows exercises physiotherapy. The first training will be under the direction of the physician LFK, then the Patient a series of exercises leads to your home. Movement therapy is complemented by swimming, Yoga, Cycling.
For decrease of pain syndrome prescribers various clinical and pharmacological groups:
- non-steroidal anti-inflammatory drugs in the Form of ointments, tablets, solutions for parenteral administration with active substances;
- Injections in the joint solutions of local anesthetics in combination with corticosteroids;
- Muscle relaxants for elimination of muscle spasms and restrictive contractures.
In the therapeutic scheme of B-group vitamins, sedatives, if necessary, anxiolytics and antidepressants. Necessarily chondro appointed protectors for a longer course approval. This is the only group of drugs to the tissue, the ability to partial restoration of cartilage.
To improve your clinical work, physiotherapy, laser therapy, magnetic fields, UVCH-therapy is carried out.
No pain in the joints, a Signal for an immediate treatment to a doctor should. Therapy, the stop is in the early stages of osteoarthritis, the destruction of cartilage, avoid the loss of work ability and disability.