Osteoarthritis is the most common disease of the joints. According to experts, 6, 43% of the population of our country suffers from this. Men and women suffer from osteoarthritis equally often, although men are slightly more prevalent in young patients and women in the elderly. An exception to the general picture is arthrosis of the interphalangeal joints, which develops 10 times more often in women than in men.
With age, the frequency increases dramatically. Thus, according to studies, osteoarthritis is manifested in 2% of people under the age of 45, in 30% of people between the ages of 45 and 64, and in 65-85% of people over the age of 65. Osteoarthritis of the knee, hip, shoulder and ankle joints is of great clinical importance due to its negative impact on patients ’standard of living and ability to work.
ᲛReasons
In some cases, the disease occurs for no apparent reason, such arthrosis is called idiopathic or primary.
There is also secondary arthrosis - developed as a result of some pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, ligament rupture, dislocations, etc. ).
- Dysplasia (congenital disorders of joint development).
- Degenerative-dystrophic processes (Perthes disease, osteochondritis dissection).
- Diseases and conditions in which joint mobility and weakness of the ligament apparatus are noted.
- Hemophilia (arthrosis develops as a result of frequent hemarthrosis).
Risk factors for developing osteoarthritis include:
- Older age.
- Excess weight
- Excessive load on joints or a specific joint.
- Joint surgeries,
- Hereditary predisposition (presence of arthrosis in close relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervix or lumbar spine (shoulder arthritis, lumbar-femoral muscle syndrome).
- Recurrent microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease that, regardless of the specific causes of its origin, is based on disruption of the normal formation and repair of cartilage cells.
Usually, the articular cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, provides the necessary shock absorption and, consequently, reduces the load on the surrounding structures (bones, ligaments, muscles and capsules). During arthrosis, the cartilage becomes rougher, the articular surfaces begin to "bundle" with each other in motion. The cartilage disintegrates more and more. Locations: Communication cysts form in the central zone near the joint cavity, around which ossification zones also form due to intra-articular fluid pressure.
Pain syndrome
Pain is the most persistent symptom of osteoarthritis. The most obvious signs of pain in osteoarthritis are the connection with physical activity and weather, night pains, initial pain, and sudden sharp pain with joint blockage. During prolonged exercise (walking, jogging, standing) the pain intensifies and decreases during rest. The cause of nocturnal pain during osteoarthritis is venous edema as well as an increase in intraosseous arterial pressure. The pain is exacerbated by unfavorable weather factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of osteoarthritis is the initial pain - pain that appears during the first movements after a state of rest and disappears while maintaining motor activity.
Symptoms
Arthrosis develops gradually, gradually. Initially patients experience mild, short-term pain without a clear localization that is exacerbated by physical exertion. In some cases, the first symptom is a convulsive movement. Many patients with osteoarthritis report discomfort in the joint and transient stiffness during the first movements after a period of rest. The clinical picture is further complemented by night and weather pains. Over time the pain becomes more and more pronounced, noticeable restriction of movement. Due to the increased load on the opposite side the joint starts to ache.
Periods of exacerbation alternate with remissions. Exacerbation of osteoarthritis often occurs against the background of increased stress. Because of the pain, the muscles of the limbs reflexively spasm, muscle contractions may form. Joint cramps are becoming more and more constant. Muscle cramps and discomfort in the muscles and joints occur at rest. Due to the growing deformity of the joint and severe pain syndrome, lameness occurs. In the later stages of arthrosis, the deformity is even more pronounced, the joint is bent, the movements in it are significantly limited or absent. Support is difficult, a patient with osteoarthritis should use a cane or crutches when moving.
Diagnosis
Diagnosis is made on the basis of the characteristic clinical signs of arthrosis and radiographic picture. X-ray of the diseased joint (usually in two projections): with gonarthrosis - X-ray of the knee joint, with coxarthrosis - X-ray of the hip joint, etc. Sh. X-ray picture of arthrosis consists of marks. Dystrophic changes in the articular cartilage and surrounding bone. The joint gap narrows, the bone site deforms and flattens, cystic formations, subchondral osteosclerosis, and osteophytes appear. In some cases, arthrosis shows signs of joint instability: curvature of the limb axis, subluxation.
According to the radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of arthrosis (Kelgren-Lawrence classification):
- Stage 1 (suspected arthrosis) - Suspicion of narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild arthrosis) - Suspicion of narrowing of the joint space, clearly defined osteophytes.
- Stage 3 (moderate arthrosis) - clear narrowing of the joint space, obvious osteophytes, possible bone deformities.
- Stage 4 (severe arthrosis) - marked narrowing of the joint space, large osteophytes, pronounced bone deformities, and osteosclerosis.
Sometimes an x-ray is not enough to accurately assess the condition of the joint. Bone CT is done to examine the bone structures, to assess the condition of the soft tissues - MRI of the joint.
Treatment
The main goal of treatment of patients with osteoarthritis is to prevent further destruction of the cartilage and to maintain joint function.
During remission, a patient with osteoarthritis is referred for physiotherapy. The set of exercises depends on the stage of arthrosis.
In the exacerbation phase of osteoarthritis, medical treatment includes the appointment of nonsteroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Prolonged use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation, and eliminate muscle spasm, a patient with osteoarthritis is referred to physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet radiation are prescribed, in the remission phase - electrophoresis with dimexid, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermia, thermal procedures (ozaforite, sea buckthorn, ozone, radish). Electrical stimulation is performed to strengthen the muscles.
Arthroplasty is performed in case of destruction of joint surfaces with pronounced joint dysfunction.