Since childhood we have got used to running, jumping, boys love to climb football and play, girls on ropes and much more.And the active lifestyle enters the human mind in such a way that the person over the years when the muscle has been pulled on a muscle is not even attentive-"Think about how often Kolenko violates."Here in today's article we will speak and why the knee can hurt and whether this is always the usual result of the sharp movement.
What is osteoarthritis?
Arthrosis -A group of diseases of the musculoskeletal system of different origins, but with similar biological, morphological and clinical manifestations.The basis of its development is the degenerative lesion of all components of the joint, mainly of the cartilage, the slim bone, the synovial membrane, the ligaments, the capsules and the periartic muscles, with the formation of a marginal osteophyte and a clear or hidden synovitis.Because with this disease, pathological changes capture both cartilage and bone tissue.
Osteoarthritis is often called Osteoarthrosisand sometimes Arthrosis.
Statistics (epidemiology)
Osteoarthritis is up to 80% of the cases under all diseases of the joints.
The disease mainly develops in medium and old age.At a young age, after injuries to joints, inflammation processes and with congenital pathology of the musculoskeletal system of the musculoskeletal system, can occur.
In most people over 65 and almost 95%over 70 years, x beam signs of osteoarthritis are found.
Women suffer from osteoarthritis almost twice than men.The incidence rate increases during postmenopause.
A major role in the development of osteoarthritis is played by hereditary factors.It was found that the frequency of developing the disease in families of patients with osteoarthritis is twice higher than in the entire population, and the development of osteoarthritis in people with innate defects of the musculoskeletal system increases by 7 to 8 times.
Arthrosis - ICD
- MKB-10: M15-M19, M47
- MKB-9: 715
- MKB-9-km: 715.3
Symptoms of arthrosis (clinical picture)
The clinical manifestations of the disease and its severe slopes from the localization of the pathological process, the patient's state of health and the image of his life.
The first signs of osteoarthritis
Osteoarthritis often begins gradually, imperceptible to the patient.
The first symptom of the disease is usually a short -term minor joint pain (arthralgia) that bears the greatest stress.These are the joints of the lower extremities of the knee, hip, plus phalanx joints of the first thumb of the foot.The carpal pattern connection of the dumb of the brush is affected more often from the joints of the upper extremity, the interphalic joints.
Osteoarthritis usually begins with the lesion of a joint, but after a while, other joints are involved in the process.
The main symptoms of osteoarthritis
In arthrosis, patients complain about pain, crispness, restriction of movements in the joint, swelling and joint deformation.
Regardless of this, it is worth living through the nature of pain.Mechanical and initially pain is possible with osteoarthritis.Mechanical pain occurs in the load of the affected joint.Such pain mainly disturb in the evening in peace, disappear after several hours of break.The appearance of this type of pain is associated with a gradual increase in bone pressure during physical exertion.The pressure causes bone rays and the irritation of painful bone tissue.
The pain appears at the beginning of the walk, then it stops quickly and reappears during the physical exertion.Pain start can occur with the friction of the joint surfaces of the affected joint.Small particles of the necrotic cartilage fall on the cartilage surfaces.In the first steps, these particles are pressed into the cavity of the joint bags and the pain stops.
With osteoarthritis, the pain with periarthritis and tendource (inflammation of the soft periartic tissue, band apparatus and joint pocket) can be associated.This pain only occurs in movements in which the affected tendons and in certain positions of the joint take part during the movements.
Pathological changes usually begin with large joints that are exposed to great physical efforts during the day.At the beginning of the disease, the pain occurs as a result of the inconsistency of the possibilities of the microcirculation channel with the needs of joint fabrics.To reduce the pain, patients slowly take the first steps and then accelerate walking.Pain can run after half to two hours or work in a standing position.This is a signal to change the load, the short -term break or the type of work.
In the later stages of the disease, arthralgia can occur with minimal stress on the joint and remain alone for a long time.This is due to the fact that rude changes in the joint tissue, the destruction of the articular cartilage and secondary synovitis are formed in the later stages.With the development of massive, coarse changes in the bone -chesis tissue, his individual fragments can be separated and fall into the joint column, cause sharp pain.This phenomenon is called the symptom of the joint mouse.
Deformation is remarkable during the examination of the joints.In addition, in the case of osteoarthritis, a thickening of periacal soft tissues, hypotrophy of the regional muscles, displacement of the axis of the limbs is present.The thickening of the interphalangeal joints with bone growth and the seal of the periartic substances is referred to as the knot by Gerberden.
The pain when feeling that the joint in the joint column has been located, the places of binding the joint capsule, but this symptom of the disease is not always.The swelling and pain of the joint are determined by secondary synovitis.
Violations of the common function in the early stages of osteoarthritis manifest itself by restricting the amplitude of the movements.This is due to the lesion of periosematic tissues and synovitis.
In the later stages of the disease, the clinical manifestations of contract rain develop differently based on the severity.The functions of the knee and hip joints are mostly impaired.
Arthrosis symptoms depending on the localization of the pathology
Arthrosis with damage to the knee joints - symptoms
The lesion of the knee joints with osteoarthritis is referred to as gonarthrosis.Primary gonarthrosis develops for women in menopause.The reasons for the secondary level are most common injuries to the knee joint and a violation of the statics with the curvature of the spine, flat feet.The patients complain about pain in the knee joint that occurs during the movements, especially when they go up the stairs.The pain is located at the front or within the knee joint.The movements in the connection are limited: first bend and later expansion.A crunch often appears when moving.With the development of reactive synovitis, the pain increases at rest and worries during the movements.The swelling of the joint, pain during the palpations, redness (hyperemia) and an increase in skin temperature are determined.Over time, a deformation of the knee joints occurs due to bone growth.
Osteoarthritis with damage to the hip liners - symptoms
The lesion of the hip joints is referred to as coksart rose.This is the heaviest form of osteoarthritis.The causes of the disease can be a congenital dysplasia of the hip joints, injuries, menopause.The patients have pain in the joints in a standing position during the movements.The restriction of movements in the joint gradually increases (first internal and external rotation, later flexion).There is lameness associated with the shortening of the limb.With bilateral damage, ducks are typical.The atrophy of the muscles of the thighs and buttocks develop.There is no swelling of the joints with a cotese.Palpation meters determines the limited pain in the thigh head.
The joint functions are preserved in the early stages of arthrosis.With the further development of the disease, it is temporarily restricted, and then the ability to work is completely lost, the patient loses the ability of self -sufficiency, needs outside help.
The causes of osteoarthritis
The arthrosis is based on the primary degeneration of the articular cartilage with the accompanying destructive changes in the bones that form the joint.Such a degeneration takes place by an imbalance between mechanical loads on the articular surface of the cartilage and the possibility of compensation for this load.
In the development of degenerative changes in the articular cartilage, several factors can participate at the same time:
- Functional overloads, including professionals, household and sport, cause cartilage -Mycotrauma;
- Joint injuries;
- Infectious and not specific inflammation of the joint;
- Common dysplasia, which leads to a comparison of the common surfaces;
- Violation of the statics of the body due to the curvature of the spine (kyphosis, scoliosis, pathological lordosis, etc.), flat feet;
- Chronic hemarthrosis:
- Diseases with metabolic disorders (gout, obesity, chondrocalcinosis);
- Osteodistrophy or pedget disease;
- Osteomyelitis;
- Pathology of the peripheral nervous system with loss of sensitivity;
- Endocrine pathology (acromegaly, diabetes, amenorrhea, hyperthyroidism);
- Hereditary tendency.
The risk factors for osteoarthritis are older age, female gender, obesity.
Development mechanism
The metabolic disorders in the cartilage are based on quantitative and qualitative changes in the main substance of cartilage.The main substance consists of protoglycanes that offer collagen stability.The development of osteoarthritis is accompanied with inadequate formation or increased destruction of the components of the cartilage.
With arthrosis in cartilage tissue, the content of hyaluronic acid, chondroitine and keratin decreases.In addition, changed protoglycans lose the ability to keep water.It is absorbed by a collagen that swells, which leads to a decrease in cartilage resistance.
When chondrocytes are damaged, they produce collagen and proteoglycanes that are not characteristic of normal cartilage tissue.These changed substances cause the loss of biochemical cartilage qualities.
Improper disorders are of great importance for the development of osteoarthritis.The destruction of protoglycans of the cartilage is accompanied by the occurrence of immune reactions of the cellular and humoral type.This in turn causes progressive fibrosis and sclerosis of the synovial membrane, pathological changes in the intra -articular synovial fluid and a violation of the cartilage.The inferior synovial shell supports the progression of degenerative changes in the articular cartilage.
An inherited factor has a certain value in the development of osteoarthritis.
Classification of arthrosis
Osteoarthritis is divided into two groups: primary and secondary.
In the distribution (primary osteoarthritis):
- Local (with damage to three joints)
- Frequent or generalized polyarthrosis (defeat of three joints or more).
Depending on the goal (secondary):
- A. Tabobel joint (Cokesartrose);
- A. the knee joint (gonart rose);
- A. the elbow joint;
- A. the shoulder joint;
- A. spine;
- A. Cervical duct department (uncoat thermal throsis);
- A. Hands;
- A. ankle joint (cruzart rose)
- A. Stop.
Through etiology:
- Post -Traumatic
- Metabolism-
- Because of the endocrine pathology.
Diagnosis of osteoarthritis
The variety of clinical manifestations and arthrosis variants makes it difficult to diagnose the disease in front of earlier.The falsehood of diagnosis is also associated with the lack of specific symptoms, the hidden occurrence of the disease.The definition of factors that contribute to the development of osteoarthritis is of great importance:
- Chronic shared trauma;
- Long -term execution of stereotypical movements;
- Physical activity on the joint for a certain time;
- Violation of salt or fat metabolism;
- Hereditary trucks of the movement apparatus system.
An X beam examination is of the most important importance in diagnosis of osteoarthritis.A consideration radiography of both knee joints is also carried out in a lateral position in a direct position, a curved position.The classic signs of osteoarthritis on the X -ray image are: narrowing of the joint column, the presence of osteophytes, subchondral bone clerosis and subchondral cysts.There are the following phases of radiological changes in osteoarthritis:
- 0 - There are no changes.
- I - Radiologically dubious signs.
- II - Minimal changes (slight narrowing of the common gap, side osteosclerosis, individual osteophytes).
- III - Moderate manifestations (moderate narrowing of the Charter, several osteophytes).
- IV- Expressed changes (the common gap is not visible, several rude osteophytes are determined), synovitis is often present.
No further tools are required in the presence of these symptoms.
In their absence or low severity, joints, MRI and scintigraphy are carried out.
Clinical tests of blood, urine and intra -articular synovial fluid are not included in the list of mandatory studies on the diagnosis of osteoarthritis.However, these tests are necessary to exclude such joint pathologies.
The most important clinical and diagnostic signs of osteoarthritis:
- Mechanical joint pain;
- Fatigue;
- A feeling of instability in the joints of the lower extremities;
- Damage to the joints of the first finger and finger and hands;
- The gradual beginning of the disease;
- slow progressive electricity;
- Joint deformation;
- Hypotrophy of regional muscles;
- recurring synovitis;
- Limitation of movements in the joint;
- X -Ray changes.
The arthrosis must be differentiated by damage to the joints by rheumatoid arthritis, infectious, metabolic and reactive arthritis.
In contrast to osteoarthritis, rheumatoid arthritis begins with inflammation of the small joints of the hands and feet.It is characterized by intensive pain of the inflammatory type, the morning stiffness of the joints, the presence of rheumatoid nodes.
Gothric arthritis is mainly found in men.A high local activity with acute paroxysmal pain in the first plus phalanx foot of the foot is characteristic.With gout, the presence of tofus is typical.There is "punch" on the X -ray.
Psoriatic arthritis is characterized by skin lesions, in particular the scalp, the spindle -shaped deformation of the fingers and a light raspberry color of the skin over the affected joints.
Infectious arthritis is characterized by an acute start, quick development and sharp pain, high temperature and the effectiveness of antibacterial therapy.
Treatment of osteoarthritis
Treatment for osteoarthritis should be long, complex.The basic principles of the treatment of osteoarthritis:
- Discharge of the joints (the correct type of mobility and mechanical loads, lectured go, reduction in body weight, exclusion from a longer standing, wearing weights, strengthening the muscle league apparatus using physiotherapy exercises, massage, electrical stimulation).
- Conservative correction of static disorders (use of orthopedic shoes, corsets, superiors).
- The effects on the overall metabolism and blood circulation (the use of biostimulants, vasodilating medication, balneotherapy and physiotherapy courses twice a year).
- Elimination of reactive synovitis, anti -inflammatory therapy anti -inflammatory.
Patients with osteoarthritis show a diet with a restriction of salt, sugar, strong tea, coffee, smoked meat and sharp dishes.This improves the sensitivity of vascular and joint receptors, restores the tone of blood vessels, normalizing the exchange in chondrocytes.With osteoarthritis, it is necessary to drink enough liquid (at least 8 glasses of water per day).
The drug treatment of osteoarthritis includes the use of rapidly acting anti -inflammatory and painkillers (non -steroidal anti -inflammatory drugs), basic medication chondroprotectors.Not-?Non-selective and selective TSO-2 inhibitors are used by the NSAIDs.
NSAIDS are used as local therapy for the affected joints in the form of an ointment or a gel.
In the presence of reactive synovitis, tendinitis or tendovaginitis, if the treatment of NSAIDS is ineffective, corresponding intra -articular or intramuscular administration of corticosteroids.
Basic therapy with chondroprotectors (chondroitin, glucosamine, hyaluronic acid) is used to prevent the degeneration of the articular cartilage.
The treatment of chondroprotectors is given in the clinical and radiological stages of I-III arthrosis.
In addition to direct chondroprotectors, medication are used that stimulate the restoration of cartilage tissue (biogenic stimulants).These drugs are used during the remission in the absence of reactive synovitis.
In arthrosis, medication are also displayed that improve microcirculation.In the presence of varicose veins of the lower extremities, the correction of venous blood flow is required.
In patients with osteoarthritis, it is necessary to diagnose and treat osteoporosis in good time.
Physiotherapy of arthrosis
Physical treatment methods also relate to the basic therapy of osteoarthritis.Under their influence, metabolic processes, microcirculation of blood and tissue fluid are stimulated, the neurogumoral regulation is restored.
The treatment complex with osteoarthritis includes inductor, microwave therapy, pulsed currents, electrophoresis of medicines and magnetotherapy.In order to remove synovitis, the ultraviolet radiation of the area of the affected joints in erythema can use an electrical field with ultra -high frequency, electrophoresis with analgin, dimexid or hydrocortisone.
To prevent the progression of osteoarthritis, it is recommended to reduce the body weight, to avoid increased loads on the joints, to go in a suppressed area, to be increased humidity and hypothermia.An individual selection of shoes and superiors is important.
With gonarthrosis, regular physical exercises, swimming and cycling are shown to strengthen the muscles.Classes of heavier and light athletics, football are not recommended.
Therapeutic exercises are carried out differently in the seated position in the pool.Movements should not be intense, traumatic, their volume and the number of repetitions are gradually increased, which prevents overload.
The popular and effective methods for the treatment of arthrosis also include massage and kine therapy.
With significant changes in the joints by deformation, the restriction of mobility and surgical treatment is recommended.Arthroplasty, endoprosthetics, osteotomy are carried out.
The forecast of the disease
Primary arthrosis rarely leads to a complete disability.In the presence of reactive synovitis, patients are temporarily disabled, and sometimes they are forced to change the profession.With secondary coconry, the forecast is less favorable due to the rapidly progressive course of the disease with the development of a significant connection functions.In such cases, a disability can occur over several years of the disease.
Prevention of osteoarthritis
The primary prevention of osteoarthritis should begin in childhood.It is as follows:
- Prevention and treatment of scoliosis;
- Correction of flat feet with special superiors;
- Sports lessons courses to strengthen the muscles and ligaments;
- rational nutrition and prevention of metabolic disorders;
- Restriction of severe sports in childhood and youth;
- Change work at a table with you;
- The correct organization of workers and remains of employees at companies in which there is strong physical activity.
Secondary prevention provides measures that prevent the development of reactive reactive synovitis.This includes lectured walking, restriction of physical exertion, go with support and other measures that unload the joints.In the case of severe symptoms of arthrosis, it is necessary to constantly take basic medication.The general strengthening of the therapy, improving blood circulation and metabolism and the annual spa treatment is recommended.
Which doctor will he go to?
- rheumatologist
- Orthopedic surgeon