Osteoarthritis is a chronic disease of the joints associated with degenerative-dystrophic changes in their structures, with predominant damage to the cartilaginous tissue.The disease progresses slowly and is asymptomatic in the early stages.The cartilage and bone tissue of the joint, its capsule and periarticular bursa are gradually destroyed, and subsequently the surrounding muscles, ligaments and subcutaneous tissue are involved in the pathological process.
According to the WHO, one in ten people suffers from this disease and the risk of developing it increases significantly in people over 50 years of age.The knee and hip joints are most affected.The cause of osteoarthritis is the inability of the joint to support the load on it.In response to traumatic effects, inflammation develops, which leads to pathological processes in the tissues of the joint.
Patients with joint osteoarthritis require complex treatment, without which the disease leads to reduced work capacity and quality of life, limitation of sporting and professional activities and, ultimately, disability.
Classification of osteoarthritis
Based on the cause of occurrence, the disease is divided into:
- primary arthrosis - occurs due to the fact that the cells of the cartilage tissue of the joint are destroyed faster than new ones are formed.Most often this is associated with age-related changes and is not a consequence of any specific pathological process in the body;
- secondary arthrosis - arises against the background of a specific disease or as a result of joint damage.
Based on location, osteoarthritis is divided into localized (affecting less than 3 joints) and generalized (affecting more than 3 joints).The latter is also called polyarthrosis.
Causes of osteoarthritis
This disease ranks first in the world among the causes of pain and impairment of activity.Despite the fact that age-related changes are considered the main cause, they are often diagnosed in young patients.Women are more prone to osteoarthritis than men, although around the age of 70 this difference becomes almost imperceptible.
Osteoarthritis of the hip, knee, ankle and shoulder joints has the greatest negative impact on patients' quality of life and work capacity.Less common are arthrosis of the elbow and temporomandibular joints, as well as the hands, feet and spine.
Predisposing factors include:
- old age;
- genetic predisposition;
- intense physical activity associated with sports or professional activities or, conversely, with a sedentary lifestyle, which disrupts the normal nutrition of tissues, especially large joints;
- joint injuries (fractures, fissures, dislocations);
- wear inappropriate shoes;
- systemic diseases (metabolic disorders, endocrine diseases, neuropathies, gastrointestinal diseases, bleeding disorders);
- poor nutrition;
- overweight.
Women are more likely to suffer from this disease because they are more susceptible to hormonal imbalances.
Symptoms and degrees of osteoarthritis
The main clinical sign of osteoarthritis is pain.In the initial stages it may be absent, mild or intermittent.As the disease progresses, the pain becomes more noticeable, can occur during exercise and, in advanced stages, can be uncomfortable even at rest.
Secondary manifestations of the disease depend on the location of the process.Most often, these are limited mobility in the affected area (especially after prolonged sleep or rest), deformation, swelling and redness in the joint area, clicking and crepitus during movement, sleep disturbances due to pain and inability to find a comfortable body position, changes in gait and coordination, muscle spasms.
It is important to emphasize that the pathological process of one joint can move to neighboring joints due to inadequate load distribution or movement restrictions.
According to the severity of the injury, the following are distinguished:
- 1st degree arthrosis - it is asymptomatic or the signs are not expressed, the patient remains able to work and the diagnosis is difficult;
- 2nd degree osteoarthritis – accompanied by severe symptoms, the patient's quality of life decreases, the diagnosis reveals obvious disorders;
- 3rd degree arthrosis - characterized by an increase in clinical signs, joint deformation is noted externally and diagnostic methods reveal severe intra-articular disorders;
- 4th degree arthrosis - leads to partial or total disability;Disorders are found in all structures of the joint, muscles and surrounding ligaments.
Diagnosis of osteoarthritis
The orthopedic traumatologist makes the primary diagnosis based on the patient's data about his lifestyle and work activities, the nature and duration of complaints, the dynamics of symptoms, the presence of arthrosis in family members, as well as carrying out examinations and prescribing examinations or consultations with related specialists (endocrinologist, hematologist, nutritionist, gastroenterologist).
Laboratory tests include a general blood test with white blood cell count, hemoglobin level and ESR.These indicators indicate inflammation in the body, which is necessarily present in arthrosis.Biochemical parameters measure the level of rheumatoid factor and C-reactive protein.If certain pathologies are suspected, other laboratory blood parameters are checked.The analysis of synovial fluid also has diagnostic value, which reveals cells and pathological inclusions, allows you to confirm the diagnosis or differentiate another disease.
Instrumental and visual methods for diagnosing arthrosis help not only detect pathology, but also determine the stage of the disease and the degree of involvement of surrounding tissues.The most effective of them are:
- radiography - carried out mainly in two projections, it is used to detect narrowing of the joint space and the formation of bone protuberances (osteophytes) at the site of damaged cartilage;
- magnetic resonance imaging and computed tomography - prescribed in the early stages, when small changes are not yet noticeable on x-rays;
- Ultrasound - used in addition to these methods and helps to identify the accumulation of excess fluid in the joint cavity (for example, Baker's cyst in gonarthrosis), assess the condition of the surrounding tissues and measure the thickness of the articular cartilage;
- scintigraphy – involves the intravenous administration of a radioactive drug that accumulates in tissues with inflammatory processes, and such areas of accumulation are displayed on the images, thanks to this it is possible to identify arthrosis in the early stages and carry out differential diagnosis;
- arthroscopy - allows you to examine the joint from the inside, introducing a microcamera into the joint cavity through a small incision, thus, it is possible to collect detailed data on the pathological processes and ongoing injuries, as well as perform a biopsy of the affected area;
- histological examination of the synovial membrane - reveals an altered proportion of healthy cells and the presence of pathological inclusions in the joint, allowing differential diagnosis.
Differential diagnosis makes it possible to distinguish arthritis from other diseases with a similar clinical picture, which include:
- various arthritis (ankylosing, reactive, rheumatoid, psoriatic, infectious);
- gout and pseudogout;
- diseases of muscles and ligaments (fibromyalgia, polymyalgia rheumatica);
- arthropathy (diabetic, paraneoplastic);
- congenital diseases (hypoplasia of the femoral head).
Osteoarthritis treatment
Despite the widespread prevalence of the disease and well-studied methods, there is no treatment for osteoarthritis.Therapeutic approaches aim to eliminate pain, alleviate inflammation, restore joint function and prevent complications.
The choice of therapy depends on the cause, location and degree of osteoarthritis:
- drug therapy in the form of tablets for arthrosis (analgesics and non-steroidal anti-inflammatory drugs, corticosteroids, chondroprotectors), intra-articular or periarticular injections of these groups of drugs, as well as the use of ointments and gels;
- physiotherapy during remission (medicated electrophoresis, galvanization, acupuncture, electrical stimulation, shock wave therapy, massage, magnetic and laser therapy, cryotherapy);
- therapeutic exercises for arthrosis are prescribed individually, sessions are carried out under the supervision of a specialist;
- in advanced cases, surgical intervention is performed (partial or complete joint replacement, suturing or removing a torn meniscus, removing bone growths and Baker's cysts).
Osteoarthritis prevention
It is recommended to control the load on the joints, maintain a healthy lifestyle, practice therapeutic exercises, monitor weight and adhere to an adequate diet.
An orthopedic traumatologist will help select knee braces, an orthosis or a bandage for patients with arthrosis to fix the affected joint, reduce the load on it and prevent injuries.
Preventive examinations and timely consultation with a doctor when joint discomfort occurs allow you to identify the problem at an early stage and avoid serious complications and disability.