Arthrosis (deforming arthrosis, popular name - deposition of salts) is a chronic disease of the joints of a degenerative-dystrophic nature, in which destruction of the joint cartilage, joint capsule and deformation of the bone itself occurs.
It should be noted that arthrosis is a whole group of joint diseases that have different origins and similar mechanisms of development.The most common arthrosis of the large joints is:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
These are the most severe types of arthrosis.
Arthrosis of the small joints is less common.More common are the deforming arthrosis of the interphalangeal joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients note pain in the interphalangeal joints, a decrease in their mobility and the appearance of seals near the joints (Heberden's and Bouchard's nodes).This type of arthrosis occurs more often in old age.Osteoarthritis of the joints of the feet is common.
Polyarthrosis or generalized arthrosis is characterized by damage to several joints at the same time.
Arthrosis joints of the spine - spondyloarthrosis - belongs to the group of diseases of the spine, although it has a mechanism of development similar to other arthrosis.
The main clinical symptom of arthrosis is joint pain and reduced mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree of destructive changes in the joint.
Causes of arthrosis
Arthrosis It is customary to divide it into primary and secondary.Primary (idiopathic) arthrosis is a consequence of disruption of the recovery processes and increased degeneration in the cartilage tissue of the joint without any deviations in the functioning of the whole organism.Secondary arthrosis occurs as a result of other pathological processes in the body or in a joint already damaged by external impact with partial destruction of the joint surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in older patients, it is not always possible to draw a clear line between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be established, the factors that contribute to its occurrence and development are well known.
The following types of causes can be identified that contribute to the development of primary and secondary deforming arthrosis.
Causes of primary arthrosis - hereditary factors
The following hereditary diseases have been identified that can cause the development of primary arthrosis:
- genetic disorders in the composition of the cartilage tissue of the joint, leading to its accelerated destruction;
- congenital defects of the locomotor apparatus (hypermobility of the joints, dysplasia, flat feet and others), which cause trauma to certain areas of the cartilage tissue of the joint and, as a result, the appearance of arthrosis.
It is also noted that the deforming arthrosis of the interphalangeal joints of the upper limbs occurs mainly in women and is inherited through the female line.
Causes of secondary arthrosis
Secondary arthrosis is a consequence of damage to the joint.These damages can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various joint injuries, intra-articular bone fractures, as a result of which the structure of the joint is disturbed.The same result is caused by constant microtrauma of the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).Obesity also leads to joint overload and damage.
Another factor that has a negative impact on the joints (mainly the hips) is incorrect posture.
The structure of the joint can also be disrupted by surgery. - Diseases of the joints.Arthrosis can be a consequence of inflammatory joint diseases (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, mineral deficiency in the body.Various metabolic disorders, the lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone and cartilage tissue, synovial fluid, which leads to the disruption of restorative processes and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in menopausal women lead to changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins), as well as physical inactivity cause blood circulation disorders in periarticular tissues, poor blood supply to joint tissues and, as a result, degenerative changes.
The mechanism of development of arthrosis
development arthrosis begins with the destruction of cartilage.It is believed that at the beginning there is a violation of blood circulation in the capillaries of the subcartilaginous layer of the periosteum.Since the nutrition of the cartilage is due to the supply of nutrients from the intra-articular fluid and the adjacent bone tissue, poor circulation leads to the fact that the cartilage gradually loses its elasticity, becomes thinner, cracks appear on it, the smoothness of the joint surfaces is disturbed, and the amount of synovial fluid that provides sliding in the joint decreases.As a result, it appears pain and crunch on movement.The width of the joint gap gradually decreases and bones form along the edges of the joint surfaces. osteophytic spines.
Eventually, the joint becomes deformed and the range of motion in it decreases.This is how involutive arthrosis develops, associated with the aging of the body.The development of this form of arthrosis usually occurs gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication, have slightly different mechanisms of development, but as a result we get similar changes in the joint.
Symptoms of arthrosis of the joints.Stages and degrees of arthrosis
The classification of arthrosis based on clinical and radiological signs is considered "classic".In accordance with it, three stages of disease development are distinguished.Corresponds to a classification according to the degree of preservation of work ability, distinguishing 3 degrees of arthrosis:
- I degree of arthrosis - the disease does not interfere with the performance of work, although it makes it difficult,
- II degree of arthrosis - the disease interferes with work,
- III degree of arthrosis - loss of working capacity.
Let's take a closer look at the clinical symptoms and signs of arthrosis at each of the indicated stages.
Arthrosis 1st degree (initial stage of arthrosis)
In the initial stage of the disease, in the morning, after rest, there is stiffness and difficulty in movement in the joints, which gradually disappears some time after the start of movement.There may be some limitation of joint mobility."Start-up" pain (pain when starting to move after a long period of rest) appears periodically.It becomes creaky with sudden movements, but there is no pain when moving.The pain at this stage of arthrosis occurs only with significant and prolonged stress and subsides after rest.There is no pain at rest and with light exercise.At this stage of the disease, patients rarely visit a doctor.
On an X-ray with arthrosis of the 1st degree, no special changes in the joint are visible;sometimes small osteophytes can be seen on the edges of the joint, the joint gap is slightly narrowed.
Arthrosis 2 degree (second stage of arthrosis)
With the further development of arthrosis, the pain becomes more significant and becomes acute.With each movement, a distinct crunch appears in the joint, there is a noticeable limitation of joint mobility (contracture), functional shortening of the limb, disturbances in the biomechanics of movements, but joint mobility is still preserved.At this stage, there is a noticeable intensification of the initial pains, they become sharp and longer.Under the influence of daily physical activity, constant fatigue appears, a feeling of pressure in the affected joints, and the so-called "mechanical pain" caused by a decrease in the cushioning abilities of the cartilage tissues of the joint.
The destruction in the joint is already quite significant, the joints are already beginning to partially deform.
X-rays show noticeable osteophytes, narrowing of the joint space 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal area are observed.
Arthrosis of the 2nd degree is characterized by reduced working capacity and inability to perform certain types of work.
Arthrosis grade 3 (third stage of arthrosis)
Arthrosis Stage 3 is a severe, advanced stage of the disease.At this stage, the following is observed:
- significant deformation of the joint (due to bone growth and fluid accumulation in the joint cavity);
- sharp limitation of movements, to maintaining only rocking movements;
- sharp pain not only during movement, but also in a state of complete rest - constant pain associated with reflex spasm of the nearby muscles, as well as the development of reactive synovitis;
- inflammation of the joints,
- sensitivity of the joints to changes in time.
- the muscles around the knee are spasmodic and atrophied;
The axis of the limb is deformed, the varus or valgus curvature of the legs is noticeable (ie in the form of the letter "O" or "X").
On radiographs with arthrosis of the 3rd degree, almost complete disappearance of the joint gap, pronounced deformation of the joint surfaces and extensive multiple marginal osteophytes are observed.Joint mice and calcification of paraarticular tissues can be detected.
In stage 3, the disease is very advanced and is often the cause of permanent disability.It looks like this:
- the pain becomes constant and painful: walking and especially going up and down stairs is a difficult test for the patient;
- loud crunching sound during each movement, clearly audible to others;
- the deformation of the joint is severe, the movements are limited only to a small amplitude or even impossible;
Photographs show destruction of intra-articular structures (ligaments and menisci), as well as complete abrasion of cartilage and signs of sclerosis (replacement of functioning organs and structures with connective tissue).
Arthrosis 4 degrees
The state of complete destruction of the joint with arthrosisWhen the joint completely stops functioning, it is often classified as a separate 4th degree of osteoarthritis.There is the so-called "joint block" - a syndrome of acute pain, in which even limited movement in the affected joint is impossible.The fourth degree of arthrosis is accompanied by unbearable pain in the joints, which cannot be relieved even with strong painkillers and intensive physical therapy.Complete ankylosis (fusion of the joint) or neoarthrosis (formation of a false joint between the displaced ends of the bones) is possible.Independent movement in both cases is almost impossible.
The photos show gross sclerosis of the joint surfaces with pronounced cystic spaces, fusion of the connecting bones in the area of the joint gap.Progression of the disease to this stage almost always means damage that can only be prevented by implanting an artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis in the initial stage of the disease
It is better to start the treatment of arthrosis as early as possible, when the first signs appear - crunching in the joints, difficulty in movement.At this stage, drugs are useful - chondroprotectors, which improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physiotherapy, proper nutrition and preventive measures are important.It should be noted that the prevention of arthrosis is of great importance to prevent exacerbation of the disease.
Treatment of 2-3 degree arthrosis
Although it is no longer possible to completely cure arthrosis of the 2-3 degree, the process of its development can be significantly slowed down.Treatment of arthrosis at this stage includes the following steps:
- relieve or reduce pain
- relief of inflammation in the joint.
- improve the recovery of cartilage tissue and slow down its degenerative processes.
In the acute period, the treatment of arthrosis begins with pain relief.Non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used for this purpose.Intra-articular corticosteroid injections are possible.It is necessary to reduce the load on the joint;you should not walk or stand for a long time or lift heavy objects.
After alleviating the acute pain syndrome, the main task is to ensure, as far as possible, the activation of restorative processes in the joint itself and peri-articular tissues: improving blood circulation, increasing metabolism, eliminating inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic gymnastics and physiotherapy are prescribed.
Treatment of arthrosis grade 4
At this stage of the disease, the joint is almost completely destroyed.In this case, there is only one way out - surgery and replacement of the diseased joint with an endoprosthesis.The endoprosthesis significantly improves joint mobility and allows the patient to resume active life, at least without pain.