Osteoarthritis is the most common joint disease. According to experts, 6. 43% of the country's population suffers from this. Men and women suffer from osteoarthritis equally often, but men are slightly more prevalent among young patients and slightly more prevalent among the elderly. The exception to the general picture is osteoarthritis of the interphalangeal joints, which develops 10 times more often in women than in men.
With age, the incidence increases dramatically. According to research, osteoarthritis is found in 2% of people under the age of 45, 30% of people aged 45-64, and 65-85% of people over 65. Osteoarthritis of the knee, hip, shoulder and ankle joints is of the greatest clinical importance as it has a negative impact on patients' quality of life and ability to work.
Reasons
In some cases, the disease occurs for no apparent reason, so osteoarthritis is called idiopathic or primary.
There is also secondary osteoarthritis - it developed as a result of some pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, broken ligaments, dislocations, etc. ).
- Dysplasia (congenital joint development disorders).
- Degenerative-dystrophic processes (Perthes disease, osteochondritis dissections).
- Diseases and conditions with increased joint mobility and weakness of the garden apparatus.
- Hemophilia (osteoarthritis often develops as a result of hemarthrosis).
Risk factors for the development of osteoarthritis include:
- Old age.
- Overweight
- Excessive stress on joints or a certain joint.
- Surgical interventions in the joint,
- Hereditary predisposition (presence of osteoarthritis in close relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar region (arthritis of the shoulder, lumbar-iliac muscle syndrome).
- Recurrent microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease based on a violation of the normal formation and regeneration of cartilage tissue cells, regardless of the specific causes.
Normally, articular cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, ensuring the necessary shock absorption, thereby reducing the load on adjacent structures (bones, ligaments, muscles and capsules). With osteoarthritis, the cartilage becomes rough, and the articular surfaces begin to "stick" to each other during movement. The cartilage is loosening more and more. It separates into small pieces, which fall into the joint cavity and move freely in the joint fluid, damaging the synovium. Small calcification foci are visible in the surface areas of the cartilage. Ossification areas are visible in the deeper layers. In the central zone, cysts are formed that contact the joint cavity, and ossification zones are formed around it due to the pressure of intraarticular fluid.
Pain syndrome
Pain is the most common symptom of osteoarthritis. The most striking signs of pain in osteoarthritis are sudden sharp pains associated with physical activity and contact with the air, night pains, onset pains, and joint blockage. With long-term strength (walking, running, standing) the pain increases, and at rest decreases. The cause of nocturnal pain in osteoarthritis is venous obstruction, as well as increased intraosseous blood pressure. The pain is exacerbated by unfavorable weather factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic symptom of osteoarthritis is the initial 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 are concerned about mild, short-term pain that is aggravated by physical force, without a clear localization. In some cases, the first symptom is wheezing when moving. Many patients with osteoarthritis experience discomfort and temporary stiffness in the joint during the first movements after a period of rest. Later, the clinical picture is completed with night and weather pains. Over time, the pain becomes more pronounced, there is a noticeable limitation in movement. Due to the increasing load, the joint on the opposite side begins to damage.
Periods of exacerbation are replaced by remissions. Exacerbation of osteoarthritis often occurs against the background of increasing stress. Due to the pain, the muscles of the extremities spasm reflexively, muscle contractures may occur. The crisis in the joint is becoming more stable. Muscle cramps and discomfort in the muscles and joints appear at rest. Lameness occurs due to increased joint deformation and severe pain syndrome. In the later stages of osteoarthritis, the deformity becomes more pronounced, the joint bends, and the movements inside are significantly limited or absent. Support is difficult, and a patient with osteoarthritis should use a cane or crutch when moving.
Diagnostics
The diagnosis is made on the basis of characteristic clinical signs and radiography of osteoarthritis. X-rays are taken of the patient's joint (usually in two projections): with gonarthrosis - radiography of the knee joint, with coxarthrosis - radiography of the thigh joint, etc. An X-ray of osteoarthritis consists of symptoms. dystrophic changes in the articular cartilage and adjacent bone region. The joint cavity narrows, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis and osteophytes are found. In some cases, signs of instability are found with osteoarthritis: curvature of the joint axis, subluxation.
Taking into account the radiological signs, specialists in orthopedics and traumatology distinguish the following stages of osteoarthritis (Kellgren-Lawrence classification):
- Stage 1 (suspected osteoarthritis) - suspected narrowing of the joint space, no or little osteophytes.
- Stage 2 (mild arthrosis) - suspicion of narrowing of the joint space, osteophytes are clearly identified.
- Stage 3 (moderate osteoarthritis) - a clear narrowing of the joint space, there are clearly expressed osteophytes, bone deformities are possible.
- Stage 4 (severe osteoarthritis) - open narrowing of the joint space, large osteophytes, open bone deformities and osteosclerosis.
Sometimes X-rays are not enough to accurately assess the condition of the joint. A CT scan of the joint is performed to study the bone structures, and an MRI of the joint is performed to assess the condition of the soft tissues.
Treatment
The main goal of treatment of patients with osteoarthritis is to prevent further destruction of cartilage and maintain joint function.
During remission, a patient with osteoarthritis is sent for physical therapy. The set of exercises depends on the stage of osteoarthritis.
In the acute phase of osteoarthritis, drug treatment involves the administration of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
A patient with osteoarthritis is referred to physiotherapy to relieve pain, reduce inflammation, improve microcirculation, and relieve muscle spasms. In the acute phase, laser therapy, magnetic fields and ultraviolet radiation, in remission - electrophoresis with dimexid, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermy, thermal procedures (ozokerite, paraffin and sulfide), radon, baths are prescribed. Electrical stimulation is performed to strengthen the muscles.
Arthroplasty is performed in case of destruction of joint surfaces with obvious joint dysfunction.