Arthrosis of the joints (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 time, the cartilage covering the articular surfaces is destroyed, in addition, degenerative processes cancover the joint capsule and the actual bone tissue, causing bone deformation.
Types of arthrosis of the joints
In general, the term "arthrosis" is used to refer to a fairly large group of diseases of different joints, the mechanism of development of such pathologies may differ to some extent. Most often, you can encounter 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 often, arthrosis of small joints develops: hands (more 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 the event that the pathology has spread to several joints, we can say about generalized arthrosis, or polyarthrosis.
In medicine, it is customary to distinguish two main types of arthrosis of the joints, depending on the mechanism of its development. Primary arthrosis (also called idiopathic) is a pathology that develops primarily 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 degenerative processes in the cartilaginous tissue simultaneously with a violation of its restoration.
Secondary arthrosis is the result of 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?
Despite the fact that there is still no consensus on the exact cause of the development of arthrosis, 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 arthrosis of the joints is a variety of factors of a hereditary and genetic nature. First of all, this group includes congenital features of the composition of the joint tissues, which contribute to more intensive than normal destruction of cartilage and its too slow recovery. In addition, hereditary factors can include a variety of congenital 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 is placed on certain joints. , why the articular surfaces may develop incorrectly, deform, and the cartilage covering them - collapse;
The following reasons can lead to the development of secondary arthrosis of the joints:
- mechanical damage to the joints is the result of certain mechanical influences leading to a violation of the anatomical integrity of the structures forming the joint. The group of mechanical injuries includes injuries, surgical interventions, excessive physical activity and sports;
- joint diseases - first of all, pathologies of an inflammatory nature;
- metabolic disorders leading to changes in the composition of the cartilage covering the articular surfaces, due to which it becomes more vulnerable, breaks down faster and recovers more slowly;
- some diseases of the endocrine glands, which can also result in metabolic disorders;
- a number 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, provoking destruction;
- vascular pathologies, the result of which is insufficient blood supply to tissues and the development of dystrophic processes in them.
How does arthrosis of the joints develop?
It is believed that the first destructive process in the joint in arthrosis of the joints is the defeat of the cartilage. It begins with a violation of microcirculation in the capillaries of the periosteum, located under the cartilage covering the articular surface of the bone. Normally, nutrients in the cartilage tissue come both from the articular fluid and from the adjacent bone tissue. When blood circulation is disturbed in the vessels of the periosteum, the nutrition of the cartilage is disturbed. Gradually, the cartilaginous tissue loses its natural elasticity, becomes thinner, its surface becomes uneven, microcracks and tubercles may appear on it, disrupting the sliding of the articular surfaces relative to each other. The composition of the synovial fluid inevitably changes.
With movements in the joint, pain, crunching, clicks begin 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 articular surfaces can become thinner until it disappears completely, and osteophytes form on the edges of the articular surfaces.
The described mechanism is characteristic primarily of senile arthrosis, which develops gradually over time. The mechanism of development of other forms of arthrosis - for example, post-traumatic, postoperative, post-infectious, associated with metabolic disorders - may be slightly different, but in general, changes in the joint with such pathologies will be identical to senile arthrosis.
The degree of arthrosis and its manifestations
The specific manifestations of the pathological process, their severity largely depend on how intense the destructive process in the joint is, how much tissue is involved in it. Nevertheless, there are two main clinical symptoms characteristic of arthrosis at any stage. First of all, it is joint pain. In addition, the decrease in joint mobility is of concern.
In our country, it is customary to distinguish the degrees of arthrosis in accordance with the clinical and radiological classification adopted in 1961.
Arthrosis of the joints 1 degree- the initial stage of the development of the pathological process.Its main symptom is stiff joint movements in the morning, after rest. Once the patient starts to move, the stiffness goes away. In the joints, there may be some impairment of mobility, minor pains may disturb after being at rest, during the first movements. Cracking in the joints is often noted. However, there is no pronounced pain after performing normal movements, pain can appear only with a clearly excessive load on the joint, and after rest it goes away on its own.
X-ray examination of the affected joint does not show pronounced changes in the anatomical structures; in some cases, there may be a slight narrowing of the joint space or the presence of single, small-sized bone growths along the edges of the articular surface.
Due to the absence of obvious pain and movement disorders in the joint, patients rarely seek medical help at this stage of the development of the disease.
2 degree of arthrosis - the progression of the disease.It is manifested by the appearance of severe, acute pain, as well as a distinct crunch, clicking in the joint during movements in it. The range of motion in the joint is significantly limited, which is why, if we are talking about the defeat of a large joint, the development of a functional shortening of the limb is possible. Pain bothers in the morning, immediately after waking up, as in the first stage of arthrosis, but in contrast to it, they are more intense, longer, often they gradually turn into daytime pains. The latter are formed during the day, when mechanical work in the joint gradually decreases the amortization capacity of the cartilage. At this stage, there are quite significant destruction of the joint, deformations of the bones that form it. The meteosensitivity of the joint may be disturbing: the appearance or significant intensification of pain in it when the weather changes, which is associated with a decrease in the compensatory properties of the joint tissues and its ability to regulate intra-articular pressure during fluctuations in atmospheric pressure.
X-ray examination shows a significant narrowing of the joint gap, a significant number of bone growths. Bone tissue in the pericartilaginous zone is sclerosed due to pronounced dystrophic processes; cystic cavities can form in it.
At this stage of the disease, the patient's ability to work decreases; he cannot perform a number of works at all due to severe pain during movements in the affected joint or its contracture.
Arthrosis of the joints of the 3rd degree corresponds to the advanced stage of the pathological process.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 tissues of the joint, deformation of the articular surfaces, muscle spasm around it. The range of movements is sharply limited, in some cases they are generally impossible. Movement in the affected joint is accompanied by a loud crunch, audible not only to the patient, but also to those around him. The joint at this stage is significantly deformed, fluid accumulates in the joint capsule due to the intense inflammatory process. Severe meteosensitivity develops: pain intensification due to weather changes. Muscles in the area of large joints are spasmodic, due to lack of mobility, their atrophy may develop. With arthrosis of the 3rd degree of the knee joints, curvature of the legs can be 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 articular surfaces are significantly deformed, and large bone growths are located at their edges. Intra-articular structures (menisci, ligaments) are destroyed, bone tissue is sclerosed. The tissues around the joint are calcified, articular mice can appear in the joint cavity - fragments of bone tissue.
With arthrosis of the joints of the third degree, 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.His "blockade" develops - the impossibility of even the slightest movements due to severe pain. Pain cannot be stopped even with potent non-narcotic analgesics; they are not relieved by physiotherapy 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 provoke fusion of the joint (ankylosis) or the formation of false joints (neoarthrosis).
On the roentgenogram, one can see the strongest sclerosis of the bones forming the joint, their 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 arthrosis of the joints depends on the stage of the disease and the prevalence of the pathological process. There is a simple pattern: the earlier the treatment of arthrosis is started, the more effective it is. Therefore, it is very important to consult a doctor in a timely manner, at the first signs of discomfort in the joint area, at the slightest morning stiffness or the appearance of a crunch during movements. At the initial stages of the pathological process, it is effective to take vitamin-mineral complexes and chondroprotectors - 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 addition to the listed measures for treating arthrosis will be physiotherapy exercises, 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 the progression of the disease, the transition of pathology to more severe stages.
Arthrosis of the second and more severe degrees cannot be completely cured. At these stages, the treatment of arthrosis is reduced to the elimination or reduction of pain, as well as suppression of inflammation in the tissues of the joint. To relieve pain, non-steroidal anti-inflammatory drugs and non-narcotic analgesics are used, in the form of local agents (ointments, gels with anesthetic and anti-inflammatory effect), as well as systemic drugs. An important role is played by relieving the load on the diseased joint, which makes it possible to reduce mechanical damage to the articular surfaces.
After acute pain is eliminated, an important task is to normalize metabolic processes in cartilaginous tissue, slow down destructive processes in it, for which it is also recommended to take chondroprotective drugs. Also, drugs that stimulate tissue microcirculation have proven themselves well. In the remission stage 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 analgesics and NSAIDs.
The list of physiotherapeutic measures in the treatment of arthrosis of the joints includes electrophoresis, ultrasound exposure, radiation and magnetic therapy. The most important condition for the effectiveness of such measures is the carrying out of physiotherapeutic treatment of arthrosis only during the period outside the exacerbation of the disease, otherwise there is a high probability of activating the inflammatory process and increasing pain.
How to treat arthrosis at the fourth stage of the disease? The joint tissues are practically destroyed at this stage, the only effective solution is surgical intervention, during which the damaged joint is replaced with a special endoprosthesis. Not always, such an operation allows you to fully restore the range of motion in the joint, however, after the completion of the recovery period, the patient can return to active life, work, getting rid of pain.
Arthrosis, the symptoms and treatment of which are described in this article, is a serious pathology that can lead to disability, significantly reducing the quality of his life. Timely treatment begun can significantly slow down the progression of the disease, avoid the development of severe complications, and maintain the patient's activity and ability to work.