Osteoarthritis: symptoms of the disease, causes, methods of treatment

Osteoarthritis is a chronic disease in which the connective tissue structure of the musculoskeletal system is damaged. The disease is characterized by a progressive course, against which the cartilage tissue is gradually destroyed. This pathology is diagnosed in many people over the age of 65, as one of the factors contributing to the formation of this condition is the natural aging process in the body.

Description of the disease

Post-trauma, endocrine and inflammatory disease, excessive physical overload or vice versa, inaction can provoke the development of degenerative-dystrophic disease. The main signs of osteoarthritis: pain in the joint with swelling and limited activity in it.

To diagnose the disease, they resort to the help of instrumental techniques - X-ray, arthroscopy, CT and MRI. In the treatment of osteoarthritis in stages 1 and 2, conservative methods are used - medication, physiotherapy, massage and physiotherapy exercises. If irreversible destructive changes in the joint tissue have occurred, surgery is required - arthrodesis or endoprosthesis.

Pathogenesis

Osteoarthritis is characterized by marked changes in the structure of connective tissue. The formation of deforming erosions occurs on cartilage, which destroys collagen fibers and proteoglycans, which contain proteins (5-10%) and glycosaminoglycans (90-95%).

As a result, the stability of the collagen network decreases, metalloproteinase is released and all forms of protein in the extracellular matrix are destroyed. Acceleration of degradation is due to the fact that the biosynthesis of collagenases and stromelysin is increased.

As a rule, when enzymes are present in the body in normal amounts, they keep the level of cytokines - small peptide information molecules - under control. If the osteoarthritis progresses, the concentration of this protein decreases, due to which the enzymes that affect the cartilage are released in large quantities.

As a result, distorted structure proteoglycans absorb water that they cannot retain. For this reason, excess fluid penetrates the collagen fiber, which begins to "swell", leading to a loss of strength and elasticity.

The qualitative and quantitative composition of the joint fluid also changes for the worse. Against the background of osteoarthritis, a decrease in the concentration of hyaluronic acid is observed in it. The transport of nutrients and oxygen to the hyaline cartilage tissue stops in the volume needed for its recovery. In cartilage, soft foci form, followed by the formation of cracks, specific necrotic growths. Then the bare heads begin to be exposed, against the background of the displacement relative to each other, microtrauma appears.

What provokes the development of the disease

Why no primary (idiopathic) osteoarthritis is diagnosed. Such a disease develops without the influence of any factors, so doctors believe that the cause of such a problem lies in the tendency at the genetic level to premature destructive processes in cartilage. The formation of secondary osteoarthritis occurs as a complication of other joint diseases or against the background of injury.

The presence of the following can provoke the formation of degenerative-dystrophic pathology:

• damage to joint tissue or located near the structure of connective tissue in the form of fracture, dislocation, trauma to the meniscus, partial rupture or complete separation from the bone of muscle and ligament tissue, tendons;
• congenital dysplastic disorder in joint development;
• disorders in the function of the glands of the endocrine system, metabolic disorders;
• rheumatism or rheumatic fever;
polyarthritis, rheumatoid, reactive, metabolic, gouty or psoriatic arthritis;
• purulent arthritis, the cause of which lies in the effects of streptococci, epidermal or Staphylococcus aureus;
• tuberculosis in any place, brucellosis, chlamydia, gonorrhea, syphilis;
• degenerative-dystrophic pathologies, for example, osteochondritis disecan.

Increased mobility of joint tissue, which is observed against the background of the production of special collagen fibers in the body, can contribute to the formation of osteoarthritis.A similar phenomenon is observed in 10% of people living on the planet, it is not considered a disease.Although against the background of hypermobility there is a weakness in the tendon-ligament system, due to which a person is prone to injury, especially in the ankle joint, in the form of sprains and tears of ligament tissue, dislocations.

In some cases, problems with haematopoietic function (eg the presence of haemophilia) can lead to osteoarthritis. Against the background of hemarthrosis (bleeding in the joint cavity), the blood supply to the cartilage tissue deteriorates, due to which it begins to disintegrate.

Among the predisposing factors it is worth noting the presence of old age, frequent loads on the joint tissue, exceeding the limits of its strength, overweight, undergoing surgery, hypothermia.

The risk group includes women during menopause, citizens living in adverse environmental conditions or in contact with toxic chemicals. If the diet does not contain enough vitamins and minerals, conditions appear for the gradual destruction of hyaluronic cartilage tissue.

Symptoms

Osteoarthritis is dangerous because the first stage of formation is asymptomatic. The manifestation of the clinical picture of the disease occurs over time, the primary symptoms appear with significant destruction of cartilage.Initially, the patient experiences mild pain syndrome without clear localization.Occurs after physical activity - lifting heavy objects, sports training.

In some cases, the first sign that a person notices the appearance of crunches and clicks during flexion or extension of the joints. The patient notices that it is sometimes difficult to move. Although in the early stages of osteoarthritis, mobility problems appear only in the morning and pass quickly.

With the further development of the pathology, the painful sensations begin to bother at night, due to which the sleep function is disturbed, and chronic fatigue also appears. When the disease progresses to grade 2, the intensity of pain increases against the background of changes in weather conditions, exacerbations of chronic diseases, acute respiratory viral infections.

Physical activity decreases significantly. Mobility is hampered by thinning of the cartilage tissue and deliberate restriction of the patient's movement in an attempt to prevent pain. This increases the load on the tissue of the opposite joint, which contributes to its further destruction.

Osteoarthritis is characterized by other specific features:

1. pain that provokes the appearance of spasm in the skeletal muscles and the formation of muscle contracture (limited passive motor function of the joint);
2. crunching in the joint tissue, clicks, cracking during movement with a constant character, occurring during virtually any displacement of the bones relative to each other;
3. frequent painful muscle cramps;
4. deformation of the joints, which leads to impaired posture and gait;
5. pronounced deformity to the curvature of the joints with a significant reduction or complete absence of motor activity in them against the background of grade 3 osteoarthritis

If osteoarthritis of the knee, ankle or hip has developed to stage 3, one should use a cane or crutches when moving.

If you do not start treatment on time, the disease begins to progress, relapses begin to bother you regularly, and exacerbations appear more often over time. The stiffness in the morning does not disappear for a long time, it gradually becomes permanent.

When examining a person with stage 1 osteoarthritis, the doctor notices only a slight swelling of the joint tissue with complete preservation of motor function. Stage 2 of the disease is manifested by pain and slight deformity on palpation. Bone thickenings form near the synovial cavity.

Osteoarthritis is characterized by the formation of synovitis - inflammation of the synovium in the hip, ankle, knee or shoulder joint. The main symptom of this disease is the development of a rounded seal near the joint, when you press it, you can feel how the liquid contents move. In acute synovitis, the temperature may rise to 37-38 degrees, headaches and digestive problems may occur.

Diagnostic measures

The disease is diagnosed based on the results of the study through instrumental methods, clinical features, anamnestic data, patient complaints. In this case, the clinical examination of blood and urine is not very informative - all indicators remain within normal limits, if the cause of osteoarthritis does not lie in metabolic problems.

If synovitis develops, the erythrocyte sedimentation rate increases (up to 30 mm / h), leukocytes and fibrinogen increase in blood flow.This indicates the presence of acute or chronic inflammation in the body.Biochemical and immunological parameters change with arthrosis of the secondary form.

The most informative way to detect degenerative-dystrophic diseases is the X-ray in 2 projections (lateral and straight).

On the X-ray image, the arthrosis is visualized as follows:

• There are no radiological signs at the initial stage.
• In the first stage, the pathology is visualized as a vague, uneven narrowing of the joint cavity. The edges of the bone plates are slightly flattened, initial osteophytes are formed (sometimes missing).
• In the second stage, the image shows an image in the form of a pronounced narrowing of the cavity in the joint, which exceeds the norm by 2-3 times. Osteophytes are formed in large numbers, the formation of subchondral osteosclerosis is noted. Cyst-like enlightenments appear in the appendages.
• In the third stage, the image shows pronounced subchondral osteosclerosis and large marginal osteophytes. The joint space is significantly narrowed.
• In the fourth stage, coarse massive osteophytes are formed, the joint space is almost completely fused, the bone appendages forming the joint are deformed and compacted.

If the doctor has doubts about the diagnosis after X-ray examination, the patient is prescribed a computed tomography scan. To assess the condition of the connective tissue located near the joint, MRI is performed. The use of a contrast agent allows you to track in dynamics how the tissues are supplied with blood, to determine the degree of inflammation in synovitis.

Treatment of osteoarthritis

It is currently impossible to completely cure osteoarthritis because there are no pharmacological agents that repair cartilage tissue.The main goal of treatment is to prevent further development of the disease, to keep the joints mobile.Osteoarthritis therapy is long-term, complex, and involves the use of topical and systemic medications.

Patients should not overload the joints; it will be necessary to limit motor activity with the help of orthopedic devices - orthoses, elastic bandage. Overweight people will need to adjust their diet to lose weight over time and start a diet.

When stable remission is achieved, the patient should perform therapeutic gymnastic exercises every day. At first you will have to do it under the supervision of a specialist, and in the future you will have to do gymnastics at home. In addition to physical therapy, you can sign up for a swimming pool, do yoga or go cycling.

To reduce the intensity of pain, the use of drugs belonging to different pharmacological groups is prescribed:

1. Non-steroidal anti-inflammatory drugs in tablets, ointments, solutions for intravenous injection.
2. Intra-articular injections of anesthetics with the addition of glucocorticosteroids.
3. Muscle relaxants to relieve muscle spasms and contractures.

Also, the treatment regimen for osteoarthritis includes the use of B vitamins, sedatives, if necessary - antidepressants and tranquilizers. It is mandatory to appoint chondroprotectors in the form of a long course.Funds from this group contribute to the partial recovery of cartilage.

In order to increase the clinical activity of the joint tissue, it is necessary to perform physiotherapeutic procedures - laser therapy, magnetic therapy, UHF.

Any painful manifestations in the area of ​​the joints should be the basis for an immediate visit to the doctor. The treatment carried out in the early stages of the development of osteoarthritis makes it possible to stop the destructive processes in the cartilage, to prevent damage and injury.