Arthrosis (arthrosis deformans, popular name - salt deposition) is a chronic disease of the joints of a degenerative-dystrophic nature, in which the destruction of articular 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 large joint arthrosis is:
- Deformed arthrosis of the knee joint (gonarthrosis),
- Deformed arthrosis of the hip joint (coxarthrosis),
- and arthrosis of the shoulder joint.
This is the most severe type of arthrosis.
Arthrosis of small joints is less common.More common is the arthrosis deformation of the interphalangeal joint of the hand, as well as the metacarpophalangeal joint of the thumb.Patients note pain in the interphalangeal joints, a decrease in their mobility, and the appearance of seals near the joints (Heberden and Bouchard nodes).This type of arthrosis is more common in old age.Arthritis of the foot joints is common.
Polyarthrosis, or general arthrosis, is characterized by damage to several joints at once.
Arthrosis spinal joint - spondyloarthrosis - belongs to the group of spinal diseases, although it has a development mechanism similar to other arthrosis.
The main clinical symptoms of arthrosis are joint pain and decreased 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 the result of disruption of the recovery process and increased degeneration in the joint cartilage tissue without any deviation in the overall functioning of the organism.Secondary arthrosis occurs as a result of other pathological processes in the body, or in joints that have already been damaged by some external influence, with partial destruction of the articular surface.
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 determined, the factors that contribute to its occurrence and development are known.
The following types of reasons can be identified that contribute to the development of primary and secondary deforming arthrosis.
The cause of primary arthrosis - hereditary factors
The following hereditary disorders have been identified that can lead to the development of primary arthrosis:
- genetic disorders in the composition of joint cartilage tissue, which leads to its accelerated destruction;
- congenital defects of the musculoskeletal system (joint hypermobility, dysplasia, flat feet and others), which cause trauma to certain areas of joint cartilage tissue, and, as a result, the appearance of arthrosis.
It is also noted that deforming arthrosis of the upper interphalangeal joint occurs mainly in women and is inherited through the female line.
Causes of secondary arthrosis
Secondary arthrosis is the result of damage to the joint.This damage can be caused by various factors.
- Mechanical damage to the joint.This group of factors includes various joint injuries, intra-articular fractures, as a result of which the joint structure is disturbed.The same result is caused by continuous microtrauma of the joint due to excessive continuous load, both static and dynamic (for example, in athletes).Obesity also leads to overload and injury to the joints.
Another factor that has a negative effect on the joints (especially the hip joints) is incorrect posture.
Joint structures can also be disrupted by surgery. - Joint disease.Arthrosis can be the result of inflammatory joint diseases (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, lack of minerals in the body.Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone tissue and cartilage, synovial fluid, which leads to disruption of the recovery process and gradual destruction of the composition.
- Autoimmune disease(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in menopausal women leads to changes in joint tissue and their gradual destruction.
- Vascular disease (atherosclerosis of the vessels in the lower part of the legs, obliterating endarteritis, varicose veins), as well as physical inactivity causing circulatory disorders in the periarticular tissue, poor blood supply to the joint tissue and, as a result, degenerative changes.
Mechanisms of arthrosis development
Development arthrosis starting with the destruction of cartilage.It is believed that initially there is a blood circulation disorder in the capillaries of the subcartilaginous layer of the periosteum.Since cartilage nutrition occurs due to the supply of nutrients from the intra-articular fluid and 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 articular surface is disturbed, and the amount of synovial fluid that ensures gliding in the joint decreases.As a result, it appears pain and throbbing when moving.The width of the joint space gradually decreases, and bone is formed along the edge of the articular surface. osteophyte spine.
Eventually, the joint becomes deformed and the range of motion in it is reduced.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, after trauma, after infection, metabolic, intoxication, have slightly different mechanisms of development, but as a result we get the same changes in the joints.
Symptoms of joint arthrosis.Stages and degrees of arthrosis
Classification of arthrosis based on clinical and radiological signs is considered "classic".Accordingly, three stages of disease development are distinguished.It corresponds to the classification according to the degree of preservation of working capacity, distinguishing 3 degrees of arthrosis:
- I stage of arthrosis - this disease does not interfere with work performance, although it makes it difficult,
- Stage II arthrosis - this disease interferes with work performance,
- Stage III arthrosis - loss of ability to work.
Let's consider in more detail the clinical symptoms and signs of arthrosis at each indicated stage.
Arthrosis degree 1 (early stage of arthrosis)
In the early stages of the disease, in the morning, after resting, there is stiffness and difficulty moving in the joints, which gradually disappears some time after the start of movement.There may be some limitation of movement in the joint."Starting" pain (pain when starting to move after a long period of rest) appears periodically.With sudden movement the joint crunches, but there is no pain when moving.Pain at this stage of arthrosis only appears with significant and prolonged stress, and subsides after rest.At rest and with light exercise there is no pain.At this stage of the disease, patients rarely see a doctor.
On x-rays with stage 1 arthrosis, no special changes in the joints are visible;sometimes small osteophytes may appear on the edge of the joint, the joint space is slightly narrowed.
Arthrosis 2 degree (second stage of arthrosis)
With the further development of arthrosis, the pain becomes more pronounced and becomes acute.A clear reflection on the joint appears with any movement, there is a significant limitation of movement in the joint (contraction), shortening of the function of the limb, disturbances in the biomechanics of movement, but the mobility of the joint is still preserved.At this stage, there is a significant increase in initial pain, they become acute and last longer.Under the influence of daily physical activity, constant fatigue appears, a feeling of pressure on the affected joint, and the so-called "mechanical pain" occurs, due to a decrease in the shock absorbing ability of the cartilage tissue of the joint.
The destruction of the joints is quite noticeable, the joints have begun to partially change shape.
Radiographs show significant osteophytes, narrowing of the joint space by 2-3 times compared to the norm, subchondral bone sclerosis and the formation of cystic cavities in the epiphyseal zone are observed.
Arthrosis of the 2nd degree is characterized by a decrease in the ability to work and the inability to perform certain types of work.
3rd degree arthrosis (third stage of arthrosis)
Arthrosis Stage 3 is the stage of severe and advanced disease.At this stage the following points are observed:
- significant joint deformation (due to bone growth and fluid accumulation in the joint cavity);
- sharp restriction of movement, so as to maintain rocking movements only;
- sharp pain not only when moving, but also in complete rest - constant pain associated with reflex spasms of nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- joint sensitivity to weather changes.
- the muscles around the knee spasm and atrophy;
The axis of the limb is deformed, varus or valgus curvature of the foot can be seen (ie, in the form of the letter "O" or "X").
On radiographs with grade 3 arthrosis, almost complete loss of the joint space, significant deformation of the articular surface, and various extensive marginal osteophytes are observed.Articular mice and paraarticular tissue calcification can be detected.
In grade 3, the disease has progressed very far, and often it is already 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 difficulty for the patient;
- a loud buzzing sound during any movement, clearly audible to others;
- joint deformation is severe, movement is limited to only a small amplitude or even impossible;
The photographs show destruction of intra-articular structures (ligaments and meniscus), as well as complete erosion of cartilage and signs of sclerosis (replacement of functional organs and structures with connective tissue).
Arthrosis 4 degrees
The state of complete destruction of joints with arthrosisWhen the joint stops working completely, it is often classified as a separate 4th degree arthrosis.There is a so-called "joint block" - an acute pain syndrome in which limited movement of the affected joint is impossible.The fourth stage of arthrosis is accompanied by unbearable pain in the joints, which cannot be relieved even with strong painkillers and intensive physiotherapy.Complete ankylosis (joint fusion) or neoarthrosis (formation of false joints between displaced bone ends) is possible.Free movement in both cases is almost impossible.
Photographs show gross sclerosis on the articulating surface with clear cystic effusion, fusion of connective bone in the joint space area.Progression of the disease to this stage almost always means disability, which can only be prevented by the implantation of an artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis in the early stages of the disease
It is better to start treating arthrosis as early as possible, when the first signs appear - creaking in the joints, difficulty moving.At this stage, drugs are useful - chondroprotectors that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physical therapy, proper nutrition, and preventative measures are important.It should be noted that the prevention of arthrosis is very important to prevent the aggravation of the disease.
Treatment of arthrosis 2 - 3 degrees
Although it is no longer possible to completely cure grade 2-3 arthrosis, the process of its development can be significantly slowed down.Treatment of arthrosis at this stage involves the following steps:
- relieve or reduce pain
- relieve inflammation in the joints.
- improves the recovery of cartilage tissue and slows down the degenerative process in it.
In the acute period, the treatment of arthrosis begins with pain relief.For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular corticosteroid injections are possible.It is necessary to reduce the load on the joints;you cannot walk or stand for long periods of time, or lift heavy objects.
After relieving the acute pain syndrome, the main task is to ensure, as far as possible, the activation of the recovery process in the joint itself and the periarticular tissue: improving blood circulation, improving metabolism, eliminating the inflammatory process.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of 4th degree arthrosis
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.Endoprosthesis significantly improves joint mobility and allows patients to continue an active life, at least without pain.