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Osteoarthritis Symptoms and Treatment

arthrosis(Arthrosis) is a joint disease that is characterized by degenerative changes in the cartilage covering the bone, i. e. its destruction.

Joint changes in osteoarthritis (left) and normal cartilage (right)

The vast majority of the joints affected are the knee, hip, shoulder, and the first metatarsal bone. Damage to other joints is much less common and often secondary. In recent years, the disability caused by osteoarthritis has doubled.

Like any disease, osteoarthritis has risk factors for its development, which are actively studied today and the list is expanded every year. The most important are:

  • Age;
  • Inheritance;
  • Metabolic disorders;
  • increased body weight;
  • Osteoporosis;
  • insufficient and irregular diet;
  • endocrine disorders;
  • Menopause;
  • frequent hypothermia;
  • Trauma;
  • Arthritis (inflammation of the joint);
  • Focuses of chronic infection or inflammation (e. g. chronic tonsillitis).
  • Varicose veins.

If you experience similar symptoms, contact your doctor. No self-medication - that is dangerous to health!

Osteoarthritis symptoms

Common symptoms of osteoarthritis are:

  1. Pain on exertion;
  2. Restriction of movement in the joint;
  3. Feeling of stiffness in the morning, feeling of "crunching";
  4. Pain after a long pause (the so-called "starting").

Joint pain is rarely acute, more often painful or dull, and usually stops at rest. Symptoms are often wavy and can come and go without attempting treatment. They can be easy, moderate, or difficult. Osteoarthritis symptoms can remain roughly the same for many years, but over time they progress and the condition worsens. Mild and moderate symptoms can be combated in the same way, but the severe course of the disease can lead to chronic pain, inability to do everyday household chores that result in a handicap, or even handicap.

Pathogenesis of osteoarthritis

Of theThe most important nutrient medium for the joint is the synovial fluid. It also plays the role of a lubricant between the articular surfaces. A large and important role in the development of osteoarthritis is ascribed to the metabolic processes in the joint and in its structures. At the initial stage, when biochemical disorders develop in the synovial fluid, its properties decrease, which triggers the mechanism of destruction. The first thing that hits is the synovial membrane of the joint, which plays an important role as a membrane and a kind of filter for the most important nutrient in cartilage - hyaluronic acid - and prevents it from leaving its main place of work - the joint cavity. The saturation of the properties of the synovial fluid determines its circulation, which can not be without regular movement of the joint itself. Hence the well-known phrase "movement is life". The constant circulation of synovial fluid in the joint cavity is the key to a full metabolism in it. If there is a lack of nutrients, the cartilage becomes thinner, the formation of new cells stops, the joint surface becomes uneven, rough, with flaws. The relationship between diseases of the veins of the lower extremities (e. g. varicose veins) and the emergence ofMetabolic disorders in the joints, especially the knee, are known. The bone structure under the cartilage responds to the process with a compensatory mechanism - it thickens, becomes coarser and expands the area of coverage, which leads to the formation of exostoses and osteophytes, which are the main reason for the limitations and deformities of the joint. The joint fluid is saturated with inflammatory cells and putrefactive elements, the joint capsule thickens, becomes rough and loses its elasticity, soft tissues literally become dry (dehydration), hence the complaints of morning stiffness, "initial pain". The pathological process in the latter stages provokes the body to turn on the last compensatory mechanism - immobilization. At rest and in the so-called physiological position, the pain is minimal, the ligaments are maximally straightened. In this position, the joint tends to fix itself and quickly succeeds in forming gross exostoses that "fix" the joint and the patient loses the ability to move it completely. The muscles of such an extremity are hypotrophied, become weaker and smaller, and such changes are already considered irreversible.

Classification and stages of development of osteoarthritis

The disease is divided into 2 broad groups: primary (or idiopathic) and secondary. The first group develops either because of an unclear reason or because of age-related changes. The second is characterized by clear causes and develops due to its pathological process (for example, against the background of tuberculosis, osteochondritis dissecans, subchondral necrosis, etc. )

Regardless of the reasons that played a role in the development of osteoarthritis, there are 4 stages of development:

Developmental stages of osteoarthritis
  • Stage 1: the hard structures of the joint are not involved in the process of destruction, there are first changes in its soft structures and in the composition of the synovial fluid (which is a nutrient medium and reduces the friction of the joint), there is malnutrition of the joint.
  • Stage 2: Accompanied by the "start" of the destruction mechanism of the firm structures of the joint, firm marginal formations (exostoses, osteophytes) are formed. Moderate complaints about changes in range of motion.
  • Stage 3: accompanied by a narrowing of the joint lumen, pronounced destruction of the loaded surface with the formation of osteochondral defects, pronounced restriction of movement, constant "crunching" during movement, initial changes in the limb axis.
  • Stage 4: difficult, in which the movements in the joint to the point of complete absence (ankylosis), a pronounced inflammatory process, its deformation, the formation of bone defects (due to the complete absence of the cartilage cover) are clearly restricted.

Osteoarthritis complications

Without treatment, any disease causes complications and osteoarthritis is no exception. If this is the primary form, the main complications include:

  • Damage to the soft structures of the joint (degenerative tears of the meniscus, torn ligaments, etc. );
  • chronic inflammatory process;
  • ankylosis (complete freedom of movement in the joint);
  • Deformation of the joint.

If this is a secondary form, then the complications will depend on the process that caused the development of osteoarthritis. For example, it can lead to osteoporosis, a chronic disease characterized by a progressive disorder of bone metabolism. As a result, the bones become fragile, their nutrition is disrupted, as a result of which osteoarthritis is complicated by the risk of intra-articular fractures. That is why it is so important to see a doctor in a timely manner. As the respected surgeon wrote: "Preventive medicine is the future. "

Diagnosis of osteoarthritis

The diagnosis of osteoarthritis often begins with a doctor (usually an orthopedic traumatologist) in the medical first aid department (polyclinic), where a clinical examination is carried out and the examination data (CT, MRI, X-rays, etc. ) are interpreted to determine the degree and type of osteoarthritis. . . Diagnosis and diagnosis are usually straightforward. If the diagnosis is unclear or the doctor suggests a secondary development of the disease, the patient will be referred to doctors in other specialties (e. g. a rheumatologist) for evaluation. Without examination results, it is very difficult to determine the degree of osteoarthritis. The medical history, methods and treatment attempts are also important for the diagnosis and determination of the treatment tactics, since the doctor is often faced with the difficult task of differential diagnosis (e. g. the symptoms of osteoarthritis and arthritis often coincide).

Treatment of osteoarthritis

The early stages of osteoarthritis, which were amenable to conservative treatment, offered an integrated approach. Treatment lasts for a long time and has the main goal: either to stop or slow down the process of destruction at the stage of starting treatment. The complex includes drug and non-drug treatments that include exercise therapy (physical therapy exercises and gymnastics), physical therapy (usually phonophoresis and magnetotherapy), swimming, anti-inflammatory therapy (either ingested or topically in the form of gels or creams). , chondroprotective therapy (taking drugs based on cartilage components) and intra-articular injections (these can be both homeopathic drugs and hyaluronic acid preparations). Chondroprotectors are still used by orthopedic traumatologists, they are prescribed by internal courses, but the results of recent scientific studies in Western countries disprove the positive effect compared to the placebo effect. With severe symptoms and severe stages, conservative treatment becomes ineffective, as a result of which surgical treatment comes first. The indications can be either minimally invasive treatment - arthroscopy or endoprosthetics. In arthroscopy (endoscopy of the joint), under the control of video optics, it is disinfected, exostoses (if possible) and damage to soft structures are removed, which is often observed in such stages. Recently, however, the benefit of this type of intervention in osteoarthritis has been increasingly called into question, as it does not have the desired effect on chronic pain and can sometimes cause considerable damage if it is poorly performed.

Endoprosthetics is a technically difficult and difficult operation, the purpose of which is to create an artificial, completely new joint. Requires clear indications and the identification of risks in the presence of contraindications. Today endoprostheses for knee, hip and shoulder joints are used successfully. Further outpatient monitoring by a doctor reduces the risks and deadlines of rehabilitation, improves the quality and efficiency of the performed operation.

Forecast. prophylaxis

The prediction depends on a timely visit to a traumatologist-orthopedic surgeon and the beginning of a treatment complex. With regard to the elimination of morphological changes in osteoarthritis, the prognosis is unfavorable because the cartilage structure of the joint cannot be completely restored. The disease is more severe in old age than in young people. However, with timely access to a doctor and compliance with all recommendations, it is possible to eliminate all discomfort and restore full motor function of the joint.

Precautions:

  1. Regular physical activity.It is a misconception that physical activity can "wear out" a joint. Increased - yes, but not regularly and moderately. According to the latest data, every activity to strengthen and maintain muscle mass and improve coordination supports the motor function of the joints and theirsAny physical activity allows for a regular circulation of synovial fluid, which is the main source of nutrition for the joint and its structures. It is known that people who use public transport every day and have pedestrian traffic are less likely to develop osteoarthritis.
  2. Control of body weight and its appropriate reduction.The increased mass increases the load on the joints of the lower extremities and the spine. Therefore, every protocol for rehabilitation and conservative treatment of osteoarthritis includes an LFT (physical therapy exercises and gymnastics) course.
  3. Correction and elimination of congenital malformations.An important role is played by flat feet, which over the years lead to an injury to the axis of the leg, which leads to an increased disproportionate load on certain parts of the joints and the spine and deforms them.
  4. Good nutrition.It allows you to create conditions for the joint to be fully enriched with nutrients. Therefore, the rejection of a large number of foods, frequent diets, an irregular diet of low-substance foods (fast food, etc. ) can become a "trigger" for the development of osteoarthritis.
  5. Timely elimination of comorbidities.The medical examinations, which have been forgotten today, made it possible to detect diseases early and to eliminate them. Concomitant diseases can be a major cause of the development and progression of osteoarthritis (e. g. diseases of the endocrine system, gastrointestinal tract, chronic foci of infection or inflammation).