Osteoarthritis (arthrosis deformans, popular name - the deposition of salts) - is a progressive chronic disease of the joints-degenerative in character, in which occurs the destruction of the articular cartilage, the articular capsule, the deformation is more bones.
It should be noted that osteoarthritis is a group of diseases of the joints, have various origins and intimate mechanisms of development. Most often found osteoarthritis of the large joints:
- deforming arthrosis of the knee (gonarthrosis),
- deforming arthrosis of the hip (were),
- and also osteoarthritis of the shoulder joint.
This is the most heavy types of arthritis.
Osteoarthritis of the small joints are less common. More often meet in deforming arthrosis joints interphalangeal brushes, and joints, and metacarpophalangeal mp joints large joints of the fingers brush. Patients indicate pain in the interphalangeal joints, thus decreasing their mobility, the appearance near the joints of the gaskets (nodules Heberdena and Bouchard). This type of arthritis common in old age. Often osteoarthritis of the joints of the foot.
The polyarthrosis, or osteoarthritis generalized, is characterized by a defeat once more the joints.
Osteoarthritis of the joints of the spine - spondiloartrosi - refers to a group of diseases of the spine, although it is similar to other arthritis mechanism of development.
The main clinical symptom of osteoarthritis is pain, the reduction of mobility. The specific symptoms determined stage of osteoarthritis and depend on the degree of destructive changes in the joint.
The causes of osteoarthritis
Osteoarthritis is divided into primary and secondary. Primary (idiopathic) osteoarthritis is the result of violations of the reconstruction processes and gain degeneration of the cartilage in the hip without any anomalies in the functioning of the whole organism. Secondary osteoarthritis occurs as the result of other pathological processes in the body, already damaged external joint, with partial destruction of the articular surfaces.
Often traumatic arthritis diagnosed in young patients. And in patients over the age it is not always possible to make a clear distinction between primary and secondary osteoarthritis.
Although the exact cause of the osteoarthritis is not possible to determine the factors that contribute to the birth and development are well known.
It is possible to distinguish the following types of reasons that contribute to the development of the primary and secondary deforming arthrosis.
Causes of osteoarthritis primary - genetic factors
Identified the following hereditary that can cause the development of primary osteoarthritis:
- genetic diseases in the composition of the cartilage tissue of the joints, which leads to its destruction accelerated;
- congenital defects of the musculoskeletal system (hypermobility of the joints, dysplasia, flat feet and others), which are the cause of the trauma the individual sections of tissues, articular cartilage, and, consequently, the onset of osteoarthritis.
Observed, also, that of deforming arthrosis joint interphalangeal of the upper limbs and is found mainly in women and is transmitted by inheritance in the female line.
The causes of secondary osteoarthritis
Secondary osteoarthritis is a result of joint damage. These damages can be caused by several factors.
- Mechanical damage to the joints. This group of factors include a variety of lesions of the joints, intra-articular fractures of the bones, which disrupts the structure of the joint. The same result is a constant micro-fractures joints following excessive permanent loads, such as static and dynamic (e.g., for athletes). Also the stress and trauma to the joint leads to obesity.
Another factor that has a negative impact on the joints (especially the hips), is a poor posture.
The structure of the joint can also stop the surgery. - 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.)
- Disorders of metabolism, diseases of the endocrine system, the lack of minerals in the body. Various disorders of the metabolism, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause a change in the composition of the bones and the cartilage, the synovial fluid, which leads to the rupture and reconstruction of processes and the progressive destruction of the composition.
- Autoimmune diseases (gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in post-menopausal women lead to changes in the tissues of the joints and gradual destruction.
- Vascular disease (atherosclerosis of the blood vessels of the lower limbs, endocarditis obliterans, varicose veins), as well as lack of exercise cause circulatory disorders in periarticular tissues, poor blood perfusion of the tissues of the joint and consequently dystrophic changes.
The mechanism of the development of osteoarthritis
The development of osteoarthritis begins with the destruction of the cartilage. The fact that at the beginning occurs a violation of the circulation of the blood in the capillaries Podhradie level of the periosteum. As well as the nutrition of the cartilage occurs because of the revenue of nutrients from the synovial fluid and adjacent bone tissue, is a circulatory disturbance leads to the fact that the cartilage gradually loses its elasticity, becomes more thin, on it appear the cracks, and the smoothness of the articular surfaces is broken, it decreases the amount of synovial fluid, because it allows you to slip in the knee. The result is the pain and the creaking during movement. The width of the joint space decreases gradually along the edges of the surfaces of the joints form bone spikes-osteophytes.
At the end of the joint is deformed, the amplitude of the movements, it decreases. So you spread backlash osteoarthritis, associated with the aging of the body. The development of this form of arthritis usually happens gradually over many years.
Other forms of arthritis of the large joints, for example, post-traumatic, post-infectious, metabolic, intokshikaie have a series of other mechanisms of development, but the result is a similar change in the joint.
The symptoms of the arthrosis of the joints. Phase and the degree of osteoarthritis
A "classic" is considered to be classification of osteoarthritis based on clinical and radiological signs. In accordance with her distinguish three phases of the development of the disease. The corresponding classification according to the degree of preservation of working capacity, gives 3 degrees of osteoarthritis:
- The degree of osteoarthritis is a disease it does not prevent the execution of the work, even if difficult,
- Grade II osteoarthritis is a disease that prevents the execution of the work,
- III the degree of osteoarthritis - the loss of ability to work.
Let's consider the symptoms and clinical signs of osteoarthritis in each of the stages
Osteoarthritis of grade 1 (the initial stage of arthrosis)
In the initial phase of the disease in the morning, after resting, we celebrate the morning stiffness, and movement difficulties in the joints, which gradually passes through a little bit of time after the beginning of the movement. Perhaps a certain limitation of mobility of the joint. Periodically appear "starter" of pain (pain at the beginning of movement after a long period spent in a state of rest). A sudden movement joint cracks, but the pain during the movement. The pain in this stage of osteoarthritis appears only if it is a large and long load, and disappears after rest. In peace, and for small loads the pain does not exist. In this stage of the disease, patients rarely turn to the doctor.
The x-ray with osteoarthritis of grade 1 specific changes in the joint are not seen, they can sometimes be visible as small osteophytes on the edges of the joint, joint a crack in a little bit reduced.
Osteoarthritis of degree 2 (the second stage of arthrosis)
With the further development of osteoarthritis pain becomes considerable, it assumes the character of acute. Separate crunch in the articulation appears in any movement, there has been a significant limitation of mobility in the joints (contracture), functional shortening of a limb, of the violation of the biomechanics of the movements, but the mobility of the joint persists. In this phase it is typical of a considerable increase of starting pain, and become sharp and long. Under the influence of days of physical activity appears constant fatigue, a feeling of pressure of the affected joints, there are the so-called "mechanical pain", caused by a decrease in the capability of depreciation tissues the articular cartilage.
The destruction of the joint is already significant enough, the joints are already beginning partially deformed.
In the x-rays are visible, significant osteophytes, reduction of the joint space 2-3 times compared to the norm, observes sclerosis, subchondral bone and the formation of cystic cavities in the epiphyseal area.
Osteoarthritis of degree 2 is characterized by the reduction of the working capacity, inability to perform some jobs.
Osteoarthritis grade 3 (the third stage of arthrosis)
Osteoarthritis grade 3 is heavy, in the execution stage of the disease. At this stage, we observe:
- considerable deformation of the joint (due to the growth of the bones and accumulation of fluid in the articular cavity);
- the drastic limitation of the movements, save only rocking movements;
- severe pain not only when driving, but also in a state of rest, persistent pain, the papal legate with a spasm reflex in the vicinity of the muscles, but also the development of reactive synovitis;
- inflammation of the joints,
- the sensitivity of joints to weather change.
- the muscles around the knee spasmatic and atrophied;
The axis of the limb is deformed, visibly varus or valgus curvature of the foot (i.e. in the shape of a letter "o" or "X").
In the x-ray with osteoarthritis of degree 3, one can observe the almost total disappearance of the joint line, severe deformation of the articular surfaces, vast multiples of the edge osteophytes. Can be defined in the joints of the mouse and calcification, para-articular tissues.
In the 3 degrees of the disease went away, very often it is already is the reason for the support of the disability. It manifests itself as follows:
- the pain becomes constant and painful to walk, especially down and up the stairs - a hard test for the patient;
- a strong creaking at any movement, very audible to others;
- the deformation of the joints strongly expressed, the movements are limited to only a small amplitude, or even impossible;
In the photo you see to the destruction of structures, intra-articular (cruciate ligaments and menisci), and complete wear of the cartilage and signs of multiple sclerosis (replacement of the functioning of the organs and structures of the connective tissue).
Arthritis grade 4
The state of complete destruction of the joint during osteoarthritis, when the joint is completely stops working often highlight a - 4 the degree of osteoarthritis. You look at the so-called "joint lock" - acute pain syndrome, which is impossible even for the limited motion in a diseased joint. The fourth degree of osteoarthritis accompanied by unbearable pain in the joints, which are not removed even with powerful pain-relieving drugs and physiotherapy intensive care. Can complete ankylosis (the remodeling of the joint) or newartriot (education false articulation between the displaced ends of the bones). Auto-movement in both cases is almost impossible.
In the photo you can see rough sclerosis soslanovna surfaces with severe cystic the age of enlightenment, the coalescence accessing the bones in the region of the joint space. The development of the disease before this stage, almost always means a disability, to prevent the artificial plant of a knee replacement.
The treatment of osteoarthritis
The treatment of the arthrosis in the initial stage of the disease
Start to deal with arthritis as better before, when the first signs of the - creaking of the joints, difficulty moving. In this phase, are useful drugs - chondroprotectors, improve the structure of cartilage tissue, and also vitamins and minerals.
Important is the therapeutic exercise, the correct diet, but also preventive measures. It should be noted that the prevention of osteoarthritis is of great importance, and to prevent the worsening of the disease.
The treatment of osteoarthritis of 2 - 3 degrees
Even if totally heal arthrosis of 2-3 degrees is impossible, however, the development process can be significantly slow. The treatment of osteoarthritis in this phase involves the following steps:
- removing or reducing the pain
- remove the inflammation in the joints.
- to improve the recovery of cartilage tissue and slow down the degenerative processes in it.
In the acute phase the treatment of osteoarthritis begin with eliminating the pain. For this reason, we used non-hormonal anti-inflammatory drugs (NSAIDS), painkillers. Are possible intra-articular injections of corticosteroids. It is necessary to reduce the work load in the municipality, do not have time to walk or stand, lift heavy objects.
After removal of acute pain main task is to ensure, to the extent possible, the activation of recovery processes in the knee and periarticular tissues: improvement of blood circulation, increase the metabolism, and the resolution of inflammatory processes. Are assigned chondroprotectors, vasodilator drugs, and medical gymnastics and physiotherapy.
The treatment of osteoarthritis 4 can
In this stage of the disease is common almost completely destroyed. In this case, it remains a way out - the operation, and the replacement of a patient's joint endoprosthesis. Systems greatly improves the mobility of joints, allows the patient to resume an active life, as a minimum, to get rid of the pain.