Arthrosis (deforming arthrosis, folk name - deposition of salts) is a chronic disease of joints degenerative -dystrophic, in which the destruction of articular cartilage, joint capsules, and deformation of the bone itself occurs.
It should be noted that arthrosis is a whole group of joint diseases that have different origin and close development mechanisms.Most often there are arthrosis of large joints:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coksartrosis),
- as well as arthrosis of the shoulder joint.
These are the most severe types of arthrosis.
Arthrosis of small joints is less common.Most often there are deforming arthrosis of the interfalancing joints of the hands, as well as the metacarpophalangeal joints of the thumbs.Patients note the pain in the interfalancing joints, a decrease in their mobility, the appearance near the joints of the seals (nodules of Geberden and Bushar).This type of arthrosis is more common in old age.Often occurs arthrosis of the joints of the foot.
Polyrthrosis, or generalized arthrosis, is characterized by damage to several joints at once.
Arthrosis The joints of the spine - spondylarthrosis - belongs to the group of diseases of the spine, although it has a similar mechanism of development with other arthrosis.
The main clinical symptom of arthrosis is the pain in the joint, a decrease in its mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree of destructive changes in the joint.
The causes of arthrosis
Arthrosis It is customary to divide into primary and secondary.Primary (idiopathic) arthrosis is a consequence of a violation of recovery processes and increased degeneration in the cartilage tissue of the joint without any deviations in the work of the whole organism.Secondary arthrosis occurs as a result of other pathological processes in the body, or in the joint already damaged by any external effect, with partial destruction of the articular surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in older patients, it is far from always possible to draw a clear border between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, factors contributing to the occurrence and development are well known.
The following types of causes that contribute to the development of primary and secondary deforming arthrosis can be distinguished.
The causes of primary arthrosis are hereditary factors
The following hereditary disorders have been identified, which can cause the development of primary arthrosis:
- genetic disorders in the composition of the cartilage tissue of the joint, leading to its accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermobile of joints, dysplasia, flat feet and others), which are the cause of trauma of certain sections of cartilage tissue of the joint, and, as a result, the appearance of arthrosis.
It was also noted that deforming arthrosis of the inter -phalanx joints of the upper extremities is found mainly in women and is inherited by the female line.
The causes of secondary arthrosis
Secondary arthrosis is a consequence of joint damage.These damage can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various joint injuries, intra -articular bone fractures, as a result of which the joint structure is disturbed.The same result is caused by constant microtraumatization of the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).Also, obesity leads to overload and trauma.
Another factor that has a negative effect on the joints (primarily on hip) is incorrect posture.
The structure of the joint can also disrupt surgical intervention. - Joint diseases.Arthrosis may be a result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Violations of metabolism, diseases of the endocrine system, deficiency of minerals in the body.Various disorders of the metabolism, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage, synovial fluid, which leads to a violation of recovery processes and the gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency In postmenopause, women lead to changes in the tissues of the joints and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins), as well as Hypodynamia They cause circulatory disturbances in periarticular tissues, poor blood supply to the joint tissues and, as a result, dystrophic changes.
The mechanism of development of arthrosis
Development arthrosis It begins with the destruction of the cartilage.It is believed that at the beginning there is a violation of blood circulation in the capillaries of the corneal layer of the periosteum.Since the nutrition of the cartilage occurs due to the intake of nutrients from intra -articular fluid and adjacent bone tissue, the circulatory disruption leads to the fact that the cartilage gradually loses elasticity, becomes thinner, cracks appear on it, the smoothness of the articular surfaces is disturbed, the amount of synovial fluid in the joint is reduced.As a result, it appears Pain and crunch during movements.The width of the joint gap gradually decreases, bone are formed along the edges of the articular surfaces Osteophyta spikes.
Ultimately, the joint is deformed, the amplitude of movements in it decreases.Thus develops involutionary arthrosis associated with the aging of the body.The development of this form of arthrosis usually occurs gradually, over the years.
Other forms of arthrosis of large joints, for example, post -traumatic, post -infectious, metabolic, intoxication have several other development mechanisms, but as a result we get similar changes in the joint.
Symptoms of arthrosis of the joints.Stages and degree of arthrosis
"Classical" is the classification of arthrosis on the basis of clinical and radiological features.In accordance with it, three stages of the development of the disease are distinguished.It corresponds to the classification by the degree of maintenance of disability, which distinguishes 3 degrees of arthrosis:
- I degree of arthrosis - the disease does not prevent the work, although it complicates it,
- II degree of arthrosis - the disease prevents the performance of work,
- III degree of arthrosis - loss of working capacity.
Let us consider in more detail the clinical symptoms and signs of arthrosis at each of these stages
Arthrosis of the 1st degree (initial stage of arthrosis)
In the initial stage of the disease in the morning, after rest, stiffness, difficulty movement in the joints, which gradually passes some time after the start of movement.Perhaps some restriction of mobility in the joint.Periodically, “starting” pains appear (pain at the beginning of movement after a long stay at rest).With sharp movements, the joint crunches, but there is no pain during movement.The pain at this stage of arthrosis appears only with a significant and prolonged load, and subsides after rest.There is no pain alone and at low loads.At this stage of the disease, patients rarely see a doctor.
In the X -ray picture with arthrosis of the 1st degree of special changes in the joint is not visible, sometimes small osteophytes along the edges of the joint may be visible, the articular gap is slightly narrowed.
2 degree arthrosis (second stage of arthrosis)
With the further development of arthrosis, the pain becomes more significant, acquires an acute character.A distinct crunch in the joint appears with any movements, there is a noticeable restriction of mobility in the joint (contracture), functional shortening of the limb, impaired biomechanics of movements, but the joint mobility is still preserved.This stage is characterized by a noticeable strengthening of starting pain, they become acute and longer.Under the influence of daytime physical activity, constant fatigue appears, a feeling of pressure in the affected joints, the so -called “mechanical pains” arise caused by a decrease in the shock -absorption abilities of cartilage tissues of the joint.
The destruction in the joint is already quite significant, the joints are already partially deformed.
On the radiographs, noticeable osteophytes are visible, the narrowing of the joint gap is 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal zone are observed.
Arthrosis of the 2nd degree is characterized by a decrease in working capacity, the inability to perform certain types of work.
Arthrosis of 3 degrees (third stage of arthrosis)
Arthrosis 3 degrees are a severe, neglected stage of the disease.At this stage, there are:
- significant deformation of the joint (due to the growth of bones and the accumulation of fluid in the joint cavity);
- a sharp restriction of movements, up to the preservation of only rocking movements;
- sharp pain not only when moving, but also in a state of complete rest - constant pain associated with reflex cramps of the nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- Sensitivity of the joints to the change in the weather.
- The muscles around the knee are nasty and atrophied;
The axis of the limbs is deformed, noticeably varus or valgus curvature of the legs (that is, in the form of the letter "o" or "x").
On radiographs with arthrosis of the 3rd degree, almost complete disappearance of the joint gap, severe deformation of the articular surfaces, vast multiple regional osteophytes are observed.The articular mice and calcification of paraarticular tissues can be determined.
In 3 degrees, the disease has gone very far, often it is already the cause of persistent disability.It is manifested as follows:
- The pain becomes constant and painful: walking, and especially the descent and climbing the stairs - a difficult test for the patient;
- loud crunch in any movements, well -heard to others;
- The deformation of the joints is strongly expressed, the movements are limited only by a small amplitude or even impossible;
The pictures show the destruction of intra -articular structures (ligaments and meniscus), as well as the complete abrasion of cartilage and signs of sclerosis (replacement of functioning organs and structures of connective tissue).
Arthrosis of the 4th degree
The state of complete destruction of the joint arthrosis, when the joint completely stops functioning is often distinguished into a separate - 4 degree of arthrosis.There is a so -called “joint blockade” - an acute pain syndrome, in which even limited movement in a sick joint is impossible.The fourth degree of arthrosis is accompanied by unbearable joint pain, which are not removed even by potent drugs and intensive physiotherapy.Full ankylosis (joint fusion) or neoartrosis (the formation of a false joint between the displaced ends of the bones) is possible.Independent movement in both cases is almost impossible.
In the pictures, rough sclerosis of the sattime surfaces with pronounced cystic enlightenment, the fusion of the connecting bones in the joint gap is visible.The development of the disease to this stage almost always means disability, which can only be prevented by implantation of the artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis at the initial stage of the disease
It is better to start treating arthrosis as early as possible, with the appearance of the first signs - crunch in the joints, difficulty in movement.At this stage, drugs are useful -chondroprotectors that improve the structure of cartilage, as well as vitamin -mineral complexes.
Medical physical education, proper nutrition, as well as preventive measures are important.It should be noted that the prevention of arthrosis is also of great importance to prevent exacerbation of the disease.
Treatment of arthrosis 2 - 3 degrees
Although it is already impossible to completely cure arthrosis of the 2-3 degrees, however, the process of its development can be noticeably inhibited.Treatment of arthrosis at this stage involves the following stages:
- removal or reduce pain syndrome
- Remove inflammation in the joint.
- Improve the restoration of cartilage and slow down the degenerative processes in it.
In the acute period, the treatment of arthrosis begins with the elimination of pain.For this, non -hormonal anti -inflammatory drugs (NSAIDs), analgesics are used.Intra -articular injections of corticosteroids are possible.It is necessary to reduce the load on the joint, you can not walk or stand for a long time, lift heavy objects.
After removing the acute pain syndrome, the main task is to ensure, as far as possible, the activation of recovery processes in the joint and periarticular tissues: improvement of blood circulation, increased metabolism, elimination of inflammatory processes.Chondroprotectors, vasodilating drugs, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of arthrosis 4 degree
At this stage of the disease, the joint is almost completely destroyed.In this case, one exit remains - the operation and replacing the diseased joint with an endoprosthesis.The endoprosthesis significantly improves the mobility of the joint, allows the patient to resume active life, at least, getting rid of pain.