Osteoarthritis is the most common joint disease. According to experts, 6, 43% of the population of our country suffers from it. Men and women also often suffer from osteoarthritis, however, among young patients there is a slight predominance of men, and among older people - women. An exception to the general picture is osteoarthritis of the interphalangeal joints, which develops in women 10 times more often than in men.
With age, the incidence increases considerably. Thus, according to studies, osteoarthritis is detected in 2% of people under 45, 30% of people 45 to 64 and 65 to 85% of people 65 and over. Osteoarthritis of the knee, hip, shoulder and ankle joints is of the greatest clinical importance due to its negative impact on the standard of living and working capacity of patients.
Causes
In some cases, the disease occurs for no apparent reason, such arthrosis is called idiopathic or primary.
There is also secondary osteoarthritis - developed as a result of a pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, ligament ruptures, dislocations, etc. ).
- Dysplasia (congenital developmental disorders of the joints).
- Degenerative-dystrophic processes (Perthes disease, osteochondritis dissecans).
- Diseases and conditions characterized by increased mobility of the joints and weakness of the ligament apparatus.
- Hemophilia (osteoarthritis develops as a result of frequent hemarthrosis).
Risk factors for the development of osteoarthritis include:
- Age of the elderly.
- Overweight
- Excessive stress on the joints or a specific joint.
- Surgical interventions on the joint,
- Hereditary predisposition (presence of osteoarthritis in the next of kin).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (arthritis of the shoulder, lumbar iliac muscle syndrome).
- Repetitive microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease, which, regardless of the specific causes of its occurrence, is based on a violation of the normal formation and restoration of cells of cartilage tissue.
Normally, articular cartilage is smooth and elastic. This allows the joint surfaces to move freely relative to each other, provides the necessary shock absorption and thus reduces the load on adjacent structures (bones, ligaments, muscles and capsule). With osteoarthritis, the cartilage becomes rough, the joint surfaces begin to "cling" to each other during movement. The cartilage is losing more and more. Small pieces are separated from it, which fall into the joint cavity and move freely in the joint fluid, injuring the synovium. In the superficial areas of the cartilage, small foci of calcification appear. In the deep layers, areas of ossification appear. In the central zone, cysts are formed, communicating with the joint cavity, around which, due to the pressure of intra-articular fluid, areas of ossification are also formed.
Pain syndrome
Pain is the most constant symptom of osteoarthritis. The most striking signs of pain in osteoarthritis are the connection with physical activity and the weather, nighttime pain, onset pain, and sudden sharp pains associated with a joint blockage. With prolonged exertion (walking, running, standing) the pain intensifies and at rest it subsides. The cause of nocturnal pain in osteoarthritis is venous congestion, as well as an increase in intraosseous blood pressure. The pains are aggravated by unfavorable climatic factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of osteoarthritis is incipient pain - pain that occurs during the first movements after a state of rest and disappears while maintaining motor activity.
Symptoms
Osteoarthritis develops gradually, gradually. Initially, patients worry about slight short-term pain without clear localization, aggravated by physical exertion. In some cases, the first symptom is a cracking sound when moving. Many OA patients report a feeling of discomfort in the joint and transient stiffness during the first movements after a period of rest. Subsequently, the clinical picture is supplemented by nocturnal and meteorological pain. Over time, the pain becomes more and more pronounced, there is a noticeable restriction of movement. Due to the increased load, the joint on the opposite side begins to hurt.
Periods of exacerbations alternate with remissions. Exacerbations of osteoarthritis often occur against a background of increased stress. Due to the pain, reflex spasms of the muscles of the limbs, muscle contractures may form. The crackle in the joint becomes more and more constant. At rest, muscle cramps and muscle and joint discomfort appear. Due to the increasing deformation of the joint and severe pain syndrome, lameness occurs. In the later stages of osteoarthritis, the deformity becomes even more pronounced, the joint is bent, movements in it are significantly limited or absent. Support is difficult; to move around, an OA patient must use a cane or crutches.
Diagnostic
The diagnosis is made on the basis of the characteristic clinical signs and the radiographic image of osteoarthritis. X-rays are taken 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. The x-ray for osteoarthritis consists of signs of dystrophic changes in the area of joint cartilage and adjacent bone. The joint space is narrowed, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis and osteophytes are revealed. In some cases, with osteoarthritis, signs of joint instability are found: curvature of the axis of the limb, subluxation.
Taking into account the radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of osteoarthritis (Kellgren-Lawrence classification):
- Stage 1 (doubtful osteoarthritis) - suspected narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild osteoarthritis) - suspected joint space narrowing, osteophytes are clearly defined.
- Stage 3 (moderate osteoarthritis) - a sharp narrowing of the joint space, there are clearly pronounced osteophytes, bone deformities are possible.
- Stage 4 (severe osteoarthritis) - pronounced narrowing of the joint space, large osteophytes, pronounced bone deformities and osteosclerosis.
Sometimes x-rays are not enough to accurately assess the condition of the joint. To study bone structures, CT of the joint is done, to assess the condition of soft tissue - MRI of the joint.
Processing
The main goal of treating patients with osteoarthritis is to prevent further destruction of cartilage and to preserve joint function.
During the period of remission, a patient with osteoarthritis is sent for physiotherapy. The set of exercises depends on the stage of osteoarthritis.
Drug treatment in the phase of exacerbation of osteoarthritis includes the appointment of nonsteroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation and eliminate muscle spasms, a patient with osteoarthritis is referred for physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet irradiation are prescribed, in the remission phase - electrophoresis with dimexide, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermia, thermal procedures (ozokerite, paraffin), sulfide, radon and sea bathing. Electrical stimulation is done to strengthen the muscles.
In case of destruction of joint surfaces with pronounced dysfunction of the joint, arthroplasty is performed.