Joint arthrosis (also in the literature, you can find the names "deforming arthrosis", "osteoarthritis" or "osteoarthritis") is a chronic degenerative process of joint tissues, in which, due to dystrophic processes, over timecartilage The coverage of the joint surfaces is destroyed, in addition, degenerative processes can cover the joint capsule and the bone tissue itself, causing bone deformation.
Types of joint arthrosis
In general, the term "arthrosis" is used to refer to a very large group of diseases of different joints, the mechanism of development of such pathologies may differ to some extent. Most of the time, you can find arthrosis of large joints, this group of diseases includes:
- gonarthrosis - a deforming lesion of the knee joint;
- coxarthrosis - a pathology of the hip joint;
- arthrosis of the shoulder joint;
- arthrosis of the elbow joint, etc.
Less frequently, osteoarthritis of small joints develops: hands (most often interphalangeal and metacarpophalangeal) and feet. In addition, spondyloarthrosis is distinguished - a dystrophic lesion of the intervertebral joints, which is referred to as diseases of the spine, despite the development mechanism similar to other types of arthrosis. In case the pathology spreads to several joints, we can speak of generalized arthrosis, or - polyarthrosis.
In medicine, it is customary to distinguish two main types of joint arthrosis, depending on the mechanism of their development. Primary arthrosis (also called idiopathic) is a condition that develops mainly in the tissues of the joint, outside of any deviations in the systemic work of the body. Primary arthrosis is characterized by an increase in the degenerative processes in the cartilaginous tissue simultaneously with the violation of its restoration.
Secondary arthrosis is the result of an injury to the joint due to trauma (traumatic arthrosis). In addition, certain pathological processes in the body, in particular, disorders of mineral metabolism and others, can lead to the development of secondary arthrosis.
At a young age, as a rule, traumatic arthrosis is detected. In elderly patients, in some cases, it is not possible to distinguish between primary and secondary joint damage - so closely related are many pathological processes in the body.
Why does arthrosis develop?
Although there is still no consensus on the exact cause of the development of osteoarthritis, the factors that contribute to pathological changes in the tissues of the joint are known to scientists. The main reason for the development of idiopathic joint arthrosis is a variety of factors of a hereditary and genetic nature. First, this group includes congenital characteristics of the composition of the joint tissues, which contribute to more intense than normal destruction of the cartilage and its very slow recovery. In addition, hereditary factors can include a variety of birth defects and deformities of the osteoarticular system (dysplasia of the joints, their excessive mobility, deformities of the spine, feet, hands, etc. ), due to which an excessive or non-physiological load error isplaced on certain joints. , because the articular surfaces can develop incorrectly, deform and the cartilage that covers them - collapse;
The following reasons can lead to the development of secondary arthrosis of the joints:
- the mechanical damage to the joints is the result of certain mechanical influences that lead to a violation of the anatomical integrity of the structures that form the joint. The group of mechanical injuries includes injuries, surgical interventions, excessive physical activity and sports;
- joint diseases - first, pathologies of an inflammatory nature;
- metabolic disorders that lead to changes in the composition of the cartilage that covers the articular surfaces, due to which it becomes more vulnerable, decomposes more quickly and recovers more slowly;
- some diseases of the endocrine glands, which can also result in metabolic disorders;
- a series of autoimmune pathologies in which the cells of the immune system attack the body's own tissues, in this case, the tissues of the joints, causing destruction;
- vascular pathologies, the result of which is an insufficient supply of blood to the tissues and the development of dystrophic processes in them.
How does joint arthrosis develop?
It is believed that the first destructive process of the joint in joint arthrosis is the defeat of the cartilage. It starts with a violation of the microcirculation in the capillaries of the periosteum, located under the cartilage that covers the articular surface of the bone. Normally, the nutrients in the cartilage tissue come from both the joint fluid and the adjacent bone tissue. When blood circulation is disturbed in the vessels of the periosteum, cartilage nutrition is disturbed. Gradually, the cartilaginous tissue loses its natural elasticity, becomes thinner, its surface becomes uneven, micro-cracks and tubers may appear, impairing the sliding of the joint surfaces between them. The composition of the synovial fluid inevitably changes.
With movements in the joint, pain, crushing, clicks start to disturb. Over time, the pathology progresses, the range of motion in the joint decreases, the joint gap becomes narrower, the cartilage on the protruding parts of the joint surfaces may become thinner until it disappears completely, and osteophytes form at the edges of the joint surfaces.
The described mechanism is mainly characteristic of senile arthrosis, which develops gradually over time. The mechanism of development of other forms of arthrosis - for example, post-traumatic, post-operative, post-infectious, associated with metabolic disorders - may be slightly different, but in general, changes in the joint with such pathologies will be identical to arthrosissenile.
The degree of arthrosis and its manifestations
The specific manifestations of the pathological process, its severity, depend largely on how intense the destructive process in the joint is, how much tissue is involved in it. However, there are two main clinical symptoms characteristic of osteoarthritis at any stage. First of all, it is a pain in the joints. In addition, the decrease in joint mobility is worrying.
In our country, it is customary to distinguish the degrees of arthrosis according to the clinical and radiological classification adopted in 1961.
1 degree joint arthrosis- the initial stage of the development of the pathological process.Its main symptom is stiff joint movements in the morning, after resting. As soon as the patient starts to move, the stiffness disappears. In the joints, there may be some impairment of mobility, small pains can disturb after resting, during the first movements. Cracks in the joints are frequently observed. However, there is no pronounced pain after performing normal movements, the pain may appear only with a clearly excessive load on the joint and, after resting, it disappears on its own.
X-ray examination of the affected joint does not show any marked changes in anatomical structures; in some cases, there may be a slight narrowing of the joint space or the presence of small, single bone growths along the edges of the joint surface.
Due to the absence of evident pain and movement disorders in the joint, patients rarely seek medical help at this stage of the disease's development.
2 degree of arthrosis - disease progression.It manifests itself by the appearance of intense and acute pain, as well as a distinct crack, cracking in the joint during the movements in it. The range of motion in the joint is significantly limited, so if we are talking about the defeat of a large joint, the development of a functional shortening of the limb is possible. Pains bother you in the morning, upon waking up, as in the first phase of arthrosis, but on the contrary, they are more intense, more prolonged, often gradually turning into daytime pains. The latter are formed during the day, when mechanical work on the joint gradually decreases the ability to amortize the cartilage. At this stage, there is quite significant destruction of the joint, deformations of the bones that form it. The joint's meteorosensitivity can be worrying: the appearance or significant intensification of pain in it when the climate changes, which is associated with a decrease in the compensatory properties of joint tissues and its ability to regulate intra-articular pressure during atmospheric pressure fluctuations.
The X-ray examination shows a significant narrowing of the joint gap, a significant number of bone growths. Bone tissue in the pericartilaginous zone is sclerotic due to pronounced dystrophic processes; cystic cavities can form in it.
At this stage of the disease, the patient's work capacity decreases, he is unable to perform a series of tasks due to severe pain during the movements of the affected joint or its contracture.
Arthrosis of the 3rd degree joints corresponds to the advanced stage of the pathological process.The pain is constantly disturbing - both during movement and in a state of complete rest, which is associated with a number of factors: inflammation of the joint tissues, deformation of the joint surfaces, surrounding muscle spasm. The range of movements is strongly limited, in some cases they are generally impossible. The movement in the affected joint is accompanied by a loud crack, audible not only for the patient, but also for those around him. The joint at this stage is significantly deformed, the liquid accumulates in the joint capsule due to the intense inflammatory process. Severe meteosensitivity develops: intensification of pain due to climatic changes. The muscles in the area of the large joints are spasmodic, due to lack of mobility, atrophy may develop. In the 3rd degree arthrosis of the knee joints, the curvature of the legs is noted - varus (in the form of the letter "O") or valgus (in the form of the letter "X").
X-ray images reveal an almost complete absence of the joint space, the joint surfaces are significantly deformed and large bone growths are located at their edges. Intra-articular structures (menisci, ligaments) are destroyed, bone tissue is sclerotic. The tissues around the joint are calcified, articular rats can appear in the joint cavity - fragments of bone tissue.
With third degree arthrosis of the joints, there is a persistent decrease in the patient's ability to work, his disability.
4 degree of arthrosis - the stage of complete destruction of the affected joint.Its "blockage" develops - the impossibility of even the slightest movements due to severe pain. Pain cannot be relieved even with powerful, non-narcotic painkillers; they are not relieved by physical therapy procedures. With the defeat of the knee joints, the patient loses the ability to move independently. Intense inflammation in the tissues of the joint can cause the joint to fuse (ankylosis) or the formation of false joints (neoarthrosis).
Radiography shows the strongest sclerosis of the bones that form the joint, its fusion, a large number of osteophytes and intense calcification of the joint tissues.
How is arthrosis treated?
The scope of therapeutic measures for the treatment of joint arthrosis depends on the stage of the disease and the prevalence of the pathological process. The pattern is simple: the sooner osteoarthritis treatment is started, the more effective it will be. Therefore, it is very important to consult the doctor in a timely manner, at the first signs of discomfort in the joint area, the slightest morning stiffness or the appearance of cracking during movements. In the early stages of the pathological process, it is effective to take vitamin-mineral and chondroprotective complexes - drugs that improve the metabolism in cartilage tissue and its structure. For example, a drug whose active ingredient is crystalline glucosamine sulfate - a natural component of healthy cartilage. It stimulates the production of proteoglycans and at the same time inhibits the processes of destruction of cartilage tissue.
A good complement to the measures listed for the treatment of osteoarthritis will be the physiotherapy exercises, the physiotherapy techniques, it is important to have a good diet with a sufficient amount of proteins and fats in the diet. Timely therapeutic and prophylactic measures allow not only to eliminate pain and discomfort, but also to prevent disease progression, the transition from pathology to more severe stages.
Second-degree and more severe arthrosis cannot be completely cured. In these phases, the treatment of arthrosis is reduced to the elimination or reduction of pain, as well as the suppression of inflammation in the tissues of the joint. For pain relief, non-steroidal anti-inflammatory drugs and non-narcotic analgesics are used, in the form of local agents (ointments, gels with anesthetic and anti-inflammatory effects), in addition to systemic medications. An important role is played in relieving the load on the diseased joint, which reduces the mechanical damage to the joint surfaces.
After the elimination of acute pain, an important task is to normalize the metabolic processes in the cartilaginous tissue, to slow down the destructive processes in it, for which the use of chondroprotectors is also recommended. In addition, drugs that stimulate tissue microcirculation have been shown to be good. In the remission phase of arthrosis (in the absence of severe pain), physiotherapy exercises, physiotherapy are useful, which will reduce the likelihood of another exacerbation and reduce the need for pain relievers and NSAIDs.
The list of physical therapy measures in the treatment of joint arthrosis includes electrophoresis, exposure to ultrasound, radiation and magnetic therapy. The most important condition for the effectiveness of such measures is to carry out the physiotherapeutic treatment of arthrosis only in the period outside the exacerbation of the disease, otherwise, there is a high probability of activation of the inflammatory process and increased pain.
How to treat arthrosis in the fourth stage of the disease? The articular tissues at this stage are practically destroyed, the only effective solution is surgical intervention, during which the injured joint is replaced by a special endoprosthesis. Such an operation does not always allow to fully restore the range of motion of the joint, however, after the end of the recovery period, the patient can return to active life, work, get rid of pain.
Arthrosis, whose symptoms and treatment are described in this article, is a serious condition that can lead to disability, significantly reducing quality of life. The timely treatment initiated can significantly slow the progression of the disease, prevent the development of serious complications and maintain the patient's activity and ability to work.