Gonarthrosis of the knee joint

Causes, symptoms, diagnosis and treatment of knee arthritis

Arthritis is a disease of inflammatory joints. According to statistics, every hundredth person in our country is ill with arthritis.

arthritis of the knee joint photo

Etiology

Various factors can be the reasons for the development of such a serious pathological process with its complications, among which scientists consider the genetic predisposition to be the main catalyst( this primarily concerns women).

The second factor is injuries associated with excessive stress on the joints. In third place - hypothermia. In addition, arthritis can develop as a complication after a sore throat, or a viral infection. This phenomenon is especially frequent in childhood.

Arthritis affects all joints, but the hip and knees, small joints of the hands, the elbows, the ankles are the most vulnerable. In the absence of treatment, joint deformity and immobility inevitably develop.

The disease is not limited to the age range, but middle-aged women are diagnosed with this diagnosis a little more often than the representatives of the strong half. Exceptions are infectious reactive arthritis, which is diagnosed mainly in men aged 20-40 years( more than 85% of patients with reactive arthritis are carriers of HLA-B27 antigen).

It is worth mentioning in detail rheumatoid arthritis( RA), which is an autoimmune disease with an unclear etiology. The disease belongs to the common pathologies - about 1% of the population suffers. Very rarely there are cases of self-healing, in 75% of patients there is a persistent remission;In 2% of patients, the disease leads to disability.

In this disease, the inner surface of the joints( cartilage, ligaments, bones) is destroyed and replaced by scar tissue. The rate of development of rheumatoid arthritis varies from several months to several years. The features of the clinical picture of a particular type of joint inflammation allow you to suspect the disease and prescribe the necessary examinations to confirm the diagnosis. According to ICD-10, RA is classified seropositive( code M05), seronegative( code M06), youthful( code MO8)

Arthritis in children

Some types of arthritis affect only children and adolescents, so they should be singled out in a separate row.

Juvenile rheumatoid arthritis( ICD-10 code M08) affects children after bacterial and viral infections. Inflammation, as a rule, one knee or other large joint. The child has pain in any movement, in the area of ​​the joint edema. Children limp, with difficulty get up in the morning. In the absence of treatment, the deformity of the joints gradually develops, which is impossible to correct.

Reactive children's arthritis( ICD-10 code MO2) manifests itself two weeks after the transferred intestinal infection. If the process develops in the knee joint, then the external signs are clearly visible: the skin turns red, a puffiness is visible under the patella, without pronounced borders. The child often rises a fever, which decreases from antipyretic drugs, but it retains tenderness in the knee area.

arthritis of the knee in a child

In addition to infectious, reactive, rheumatoid arthritis, the disease of allergic nature is often diagnosed in children. The disease begins in a child suddenly - immediately after getting allergens into the blood. Joints swell quickly, dyspnea appears, hives. Quincke's edema may develop, bronchial spasm. With the elimination of an allergic reaction, signs of arthritis pass.

Symptoms of the disease

Arthritis of the knee joint can develop as an independent disease, and be a complication after trauma and illness.

The knee joint, affected by arthritis, swells, pain appears when it moves. The skin in the joint region changes color( turns red or becomes "parchment"), but this is not a reliable sign of the inflammatory process.

The main reason for the appearance of swelling and a visually noticeable increase in the patella is the accumulation of fluid inside the joint. Excessive pressure on the walls of the joint tissue causes severe pain. The volume of fluid with time steadily increases, so the pain becomes more intense.

In addition, in the joint, uric acid crystals are deposited, which look like thin needle-like spines. They injure small vessels, which is the basis for the development of associated infections.

Arthritis of the knee is difficult not only because of the intense pain syndrome, but also due to impaired functioning of functional systems. Cardiovascular and endocrine systems are particularly affected. There is shortness of breath, tachycardia, subfebrile condition, sweating, circulatory disorders in the limbs, insomnia and other nonspecific signs.

The degree of disruption of the

function Symptoms vary depending on the degree of disruption of the function, stage and etiology of the disease:

The first degree is characterized by mild pain syndrome, there is little limitation of movements with knee rotations, during ascent or during squats.

The second degree - the pain intensifies, the restriction of motor activity is such that it leads to a decrease in working capacity and limited self-service.

With the third degree - the impossibility of self-service, a significant loss of mobility in the joint( joints).

Types of arthritis

Several forms of arthritis are distinguished by the nature of their origin in medicine:

  • reactive - a complication resulting from untreated( untreated) infections;
  • rheumatoid - is a consequence of rheumatic diseases;
  • acute - develops after bruises, fractures, strong physical exertion;
  • infectious - is caused by viruses or a fungal infection falling into a joint with a blood stream, or through an unsterile surgical instrument, often leads to the development of purulent inflammation of the knee joint;
  • Reiter syndrome is a type of reactive arthritis;
  • arthritis with Bechterew's disease, gout( infrequent phenomenon);
  • psoriatic arthritis( occurs in 10-40% of patients with psoriasis)
arthritis of the knee

Reiter's syndrome( according to ICD-10 code 02.3) can develop in two forms - sporadic( causative agent - S. Trachomatis) and epidemic( shigella, Yersinia, Salmonella).

The clinical picture differs from other varieties of arthritis, as concomitant signs of the disease are mucosal lesions of the oral cavity, prostatitis( in men), vaginitis and cervicitis( in women).A common sign is inflammation of the eyes( conjunctivitis, iridocyclitis), which is manifested in the reddening of the sclera, the appearance of purulent discharge, the swelling of the eyelids.

Differential diagnosis of

Arthritis of the knee joint should be differentiated from other pathological processes, the most common of which are arthrosis and bursitis. Bursitis, which is an inflammation in the synovial bag, an experienced specialist will easily distinguish from arthritis at the first reception.

First, with bursitis the mobility of the knee is slightly limited, and secondly, the area of ​​articular inflammation has clear contours. When palpation, the doctor quickly determines the boundaries of the inflammatory focus. With regard to arthrosis, the differentiation is more difficult, because these diseases, which have absolutely different etiologies, have a lot of similar signs.

Arthrosis is a degenerative process in the cartilaginous and bone tissue that occurs when metabolic disorders are not associated with the inflammatory component. The main group of patients are elderly people( by the age of 60 most people are diagnosed with dystrophic changes in the joint area).

Arthritis is always an inflammation that, over time, with the progression of the disease( in autoimmune nature), spreads to the entire body. That's why there are many concomitant signs in autoimmune arthritis - it's fever, subfebrile temperature, and headache, and general malaise. With rheumatoid arthritis, the cardiovascular system is seriously affected.

To diagnose arthritis of the knee joint( gonarthritis), it is necessary to conduct multidirectional diagnostic tests. In some cases, doctors diagnose arthrosis-arthritis of the knee joint , when differential diagnosis is performed between arthrosis and arthritis, usually in the initial stages of pathologies.

Knee joint arthritis differential diagnosis table

Characteristic Arthritis Osteoarthritis
Etiology Inflammation Degenerative changes in the joint
Age group No limits( any age) Generally over 50-60 years
Process nature Acute or chronic Always chronic
Disease beginning Acute,sudden Gradual( months, years develop)
Symptoms of is usually pronounced
changes in cartilage and bone tissue Pain intensity Strengthbut is expressed from the very beginning of the disease First expressed moderately, gradually builds up
Puffiness Pronounced edema from the very beginning of the disease Edema appears on attachment of inflammation
Redness of the joint Yes, but it may not be Yes, but in the late stages of reddening,not to be
Symptoms of intoxication Observed in the case of the autoimmune nature of the disease No
Symptoms of "joint stinging" No Yes
Laboratory testing methods Youthe changes Do not reveal specific deviations
Instrumental research methods Radiography, additional methods( MRI) Radiography, MRI
Treatment Complex( inpatient + ambulatory + sanatorium) Complex( inpatient + ambulatory + sanatorium Antibiotics( purulent,reactive arthritis), NSAIDs, corticosteroids, cytostatics, vitamin preparations, blockade with SCS Symptomatic therapy, chondroprotectors, blockade with SCS
LFK, sanatorias, physiotherapy, massage Shown during remission Shown

Diagnosis of knee arthritis

Arthritis of the knee joint can be diagnosed at home if you carefully examine the symptoms of the disease. Regardless of the etiology, there are symptoms such as swelling, redness in the joint area, general malaise, external signs of deformation of the joint tissue.

Heatgram for knee arthritis

However, one should not wonder how to treat arthritis of the knee joint alone, especially using questionable prescriptions for folk medicine. This can lead to irreversible consequences. The decision on how to treat knee arthritis is taken only after a comprehensive examination.

Doctors must determine the nature of the disease in order to prescribe adequate treatment. The direction for laboratory and instrumental research is given by traumatologists, orthopedists, surgeons, rheumatologists. The scheme of therapy is developed by the specialized specialist( it can be the phthisiatrician, dermatologist-venereologist, cardiologist and other doctors).

The first stage for determining the disease( according to the ICD 10) - visual examination, collection of anamnesis.

The second stage - laboratory blood tests( inflammation observed an increase in ESR, leukocytosis, a marker of inflammation of CRP, other specific reactions).

The third stage is radiography. In the presence of arthritis, there is a curvature of the joint surface, bone ankylosis.

The fourth stage is MRI, ultrasound( it is prescribed for the differentiation of arthritis from arthrosis, Bechterew's disease and bursitis).With erased signs, which occur during a slow chronic process, additional hardware joint examinations can be prescribed - tomography of the joint tissue, CT, pneumoartrography.

At the same stage, the joint is punctured and the synovial fluid is taken for laboratory examination( if there is evidence, a biopsy).

The biological material( general blood and urine tests) is examined in determining the type and degree of reactive arthritis( ICD-10 code), an urogenital and ophthalmological examination is performed, a test for the presence of HLA-B27, ECG, thymol test, sialic assay, determination of ALT,AST, seeding of biological fluids.

Treatment of reactive arthritis, according to ICD-10, is carried out in two directions: therapy with the use of antibacterial agents and the removal of joint syndrome( pain, stiffness).

Despite not leading the role of radiography in the diagnosis of arthritis, it must be remembered that in the early stages of the disease, pathological changes in the pictures are not always visible. Arthrography is of informative value for physicians when examining large joints, and for polyarthritis this method of diagnosis is not effective. Serological reactions are used to identify the causative agent of an infectious nature of arthritis.

Treatment of

Treatment of arthritis is a long process and requires not only the implementation of the doctor's recommendations regarding drug therapy, but also the completion of rehabilitation courses.

Diet for arthritis of the knee joint must be strictly observed. Excludes food rich in carbohydrates, smoked meat, fatty meat, legumes. When translating into dietary nutrition and using individual therapy, there is a positive effect. In general, the treatment of arthritis of the knee joint provides the following directions:

  • medications( tablets, injections, ointments, gels);
  • physiotherapy procedures;
  • exercise therapy;
  • massage;
  • methods of operative surgery( injections into the joint cavity).

From medicines prescribe NSAIDs, cytostatics, hormones, antibiotics, etc. A set of drugs directly depends on the type and etiology of arthritis. Table 2 shows the treatment regimens of rheumatoid arthritis.

The drug Principle of action Schemes of prescription Possible side effects
Preparations of quinoline series( delagil - tablets of 0.25 g) Stabilization of lysosomal membranes, inhibition of phagocytosis and chemotaxis of neutrophils, inhibition of cytokine synthesis. Initial stage of RA. 2 tab.per day for the first 2-4 weeks, then 1 table.a day is long. Dyspeptic phenomena, pruritus, dizziness, leukopenia, retinal lesions.
Sulfanilamide preparations( sulfasalazine, salazopyridazine) - 500 mg tablets Depression of the synthesis of prostaglandins and leukotrienes, inhibition of antibody synthesis and RF. Seronegative clinical-immunological variant of RA. 500 mg / day with a gradual increase in dose to 2-3 grams per day. Stabilization of lysosomal membranes, inhibition of phagocytosis and chemotaxis of neutrophils, inhibition of cytokine synthesis.
Gold preparations( taudedon) Inhibition of the functional activity of macrophages and neutrophils, inhibition of production of immunoglobulins and RF. Predominantly articular form of RA regardless of the activity of the disease. Tauredon - 10, 20 mg / day,
auranofin - 6 mg / day, maintenance dose - 3 mg / day.
Skin rash, stomatitis, peripheral edema, proteinuria, myelosuppression.
D-penicillamine( capsules of 150 and 300 mg);(tablets of 250 mg) Suppression of collagen synthesis, inhibition of T-helper type I and B-lymphocyte activity, destruction of CEC High clinical and laboratory activity of RA Initial dose of 250 mg / day with gradual increase up to 500-1000 mg / day;maintenance dose - 150-250 mg / day
Skin rash, dyspepsia, cholestatic hepatitis, myelosuppression
Methotrexate( 2.5 mg tablets, 5 mg ampoules) Folate antagonist;suppresses the proliferation of T- and B-lymphocytes, the production of antibodies and pathogenic immune complexes. RA with systemic manifestations, high activity of RA, low efficiency of other basic means. 7.5-25 mg per week orally. Myelosuppression, liver damage( fibrosis), lungs( infiltrates, fibrosis), activation of foci of chronic infection.
Azathioprine, Imran( 50 mg tablets) Inhibition of proliferative activity of T and B lymphocytes. RA with systemic manifestations. 150 mg / day, maintenance dose - 50 mg / day. Myelosuppression, activation of foci of chronic infection.
Cyclophosphamide( ampoules of 200 mg), endoxane - 50 mg tablets Alkylating cytotoxic;forms alkyl radicals with DNA, RNA and proteins, violating their function;has an antiproliferative effect. RA with systemic manifestations( vasculitis, nephropathy). 200 mg IM 2-3 times a week until the total dose of 6-8 g per course;combined pulse therapy;endoxan in a dose of 100-150 mg / day, maintaining a dose of 50 mg / day. Hemorrhagic cystitis, myelosuppression, activation of foci of infection.
Chlorbutin( leukeran) - tablets of 2 and 5 mg Alkylating cytotoxic;forms alkyl radicals with DNA, RNA and proteins, violating their function;has an antiproliferative effect High activity of RA with systemic manifestations, generalized lymphadenopathy, splenomegaly. 6-8 mg / day, maintenance dose - 2-4 mg / day. Myelosuppression.

Due to the fact that the treatment regimens indicated in the table are not always effective, several combinations of basic drugs are used in practice, among which the most common combinations are methotrexate with sulfasalazine, methotrexate and delagil. Currently, the most promising is the treatment regimen, in which methotrexate is combined with anticytokines.

In medical practice, there are often cases of lack of treatment effect( for example, with reactive arthritis, inflammation is not eliminated even when taking antibiotics in combination with NSAIDs), when patients remain active disease and rapid progression of joint deformities.

Conclusion on the need to change the program of therapy doctors do if the patient was treated for six months using at least three basic drugs. The evidence of the ineffectiveness of therapy is the negative dynamics of laboratory studies, the preservation of the focus of inflammation. In this case, an alternative solution is needed on how to treat arthritis of the knee joint. Medical statistics confirm the positive dynamics in the use of pulse therapy with the use of hormonal drugs( methylprednisolone intravenously, isotonic solution for three days - repeated three courses in one month).Caution is prescribed methylprednisolone in combination with cyclophosphamide because of the high toxicity of the drugs.

New methods of

A new trend in the treatment of rheumatoid arthritis is therapy, which involves the use of so-called biological agents( biologic agents).The action of the drugs is based on the inhibition of the synthesis of cytokines( TNF-α and IL-1β).

The fact that 60% of patients with active rheumatoid articular syndrome, even at the third degree of the disease, shows a decrease( or absence) of the progression of joint changes on the background of maintenance therapy with remicade. However, the use of this form of treatment is justified in the event that the basic therapy did not give the expected effect.

The importance of the drugs of a number of NSAIDs, which were previously actively used in the treatment of arthritis of the knee joint, decreased somewhat, because other treatment programs with higher efficacy appeared.

Non-steroidal anti-inflammatory drugs( Movalis, Diclofenac - in tablets and as injections) continue to be prescribed for the diagnosis of arthritis, since these medications have a pronounced anti-inflammatory effect and contribute to overall improvement in the patient's condition.

However, it has been reliably established that non-steroidal anti-inflammatory drugs do not have a significant effect on the course of the autoimmune disease, as evidenced by the radiograph data and laboratory studies. However, the nonspecific process is well treatable with NSAID drugs.

Rehabilitation programs

Massage, exercise therapy, mud therapy - all these methods are applicable only if the doctor rheumatologist has determined that the inflammatory process is localized by drug therapy, and the remission has come. Special exercises and therapeutic massage are aimed at restoring mobility of the knee joint.

While performing rotational movements, pain may occur, but this is quite normal, as the tissue lost its elasticity during the progression of the disease. All training and massage sessions should be under the supervision of a doctor - this will help to avoid accidental injuries that occur when physical efforts or loads are exceeded.

Balneological therapy is a very effective procedure in the complex program of arthritis treatment of the knee joint. However, this direction of rehabilitation is indicated for those patients who do not have serious diseases of the cardiovascular system, neoplasms of malignant nature, and previously there were no heart attacks or strokes. All procedures using therapeutic biological components are appointed with great care.

Since there are many varieties of arthritis and articular pathologies, it is necessary to consult a doctor when the first signs of the disease appear. The sooner the causes that cause the inflammatory process are identified, the more likely it is to cure the disease completely.

Do not try to create a therapy scheme yourself, especially taking medication. This is not only inefficient, but also dangerous. Medical methods used in recent years in the treatment of arthritis of different etiologies are highly effective, which is a strong argument for using the methods of treatment offered by official medicine.

Sources:

  1. Rheumatology: national leadership Ed. E.L.Nasonova, V.A.Nason.
  2. Rheumatoid arthritis EN Dormidontov, NI Korshunov, BN Friesen.
  3. Arthritis and motor activity. Gordon N.F.

SpinaZdorov.ru

Knee joint gonarthrosis

Gonarthrosis is a deforming arthrosis of the knee joint, a degenerative-dystrophic disease in which the hyaline cartilage covering the articular surfaces of the tibia and femur is affected and gradually degrades. In the late stages of the pathology, when the cartilage tissue is completely destroyed, the bone tissue begins to suffer, the disease acquires the character of osteoarthritis. The bone becomes denser, cystic cavities are formed, osteophytes grow at the edges of the joint, which causes the loss of joint function and disability.

Gonarthrosis is in the first place in terms of prevalence among all arthroses. Mostly middle-aged and elderly people, mostly women, are ill. But gonarthrosis of the knee joint can also occur in young people. In such cases, it is often a secondary process and develops after the trauma of the knee joint( posttraumatic gonarthrosis).

Gonarthrosis develops gradually over many years. The main signs of the disease: pain in the knees, the integration of their mobility and the periodic development of synovitis( accumulation of fluid inside the articulation).At first, the symptoms of arthrosis are almost invisible, but as the joint deteriorates, it becomes more intense and negatively affects the quality of human life.

Osteoarthritis of the knee joint
This is how the knee joint affected by arthrosis

Reasons and types of knee joint gonarthrosis

As a rule, it is impossible to single out one cause that led to the development of gonarthrosis. In most cases, there are 2-3 or more risk factors for the development of the disease.

The main groups of reasons:

  1. Increased load on the components of the joint. This situation is observed in athletes, in people engaged in heavy physical labor, as well as in patients suffering from obesity.
  2. Knee injury, congenital or acquired deformities of the musculoskeletal system. In such situations, the load on the joint is distributed unevenly and some areas of the cartilage are under increased pressure, which causes their destruction. An example of such deformations may be flatfoot, kyphosis, scoliosis, incorrect fusion of bones after fractures, etc.
  3. Disturbance of the metabolism of cartilaginous tissue and its ability to self renewal. This situation leads to a shortage of substances in the body, necessary for the regeneration of hyaline cartilage, metabolic and endocrine disorders, a decrease in microcirculation in the tissues of the articulation.
  4. Disturbance of secretion of synovial fluid in the knee joint. As you know, the synovial fluid, which is produced by the synovial membrane of the joint, provides smooth movements, reduces the frictional force, and also nourishes the cartilage, which does not have its own vessels. If, for some reason, the synovia becomes smaller, degenerative changes develop in the cartilage, it cracks and collapses.

There are many more risk factors for gonarthrosis. Their definition is very important not only for treatment, but also for prevention. Having got rid of such negative influence, it is possible to completely stop the development of arthrosis and preserve the full function of the lower limb.

Depending on the cause, two types of gonarthrosis are distinguished:

  • Primary - diagnose when the true cause remains unknown. At risk are women, elderly people, patients with obesity, with metabolic and endocrine diseases.
  • Secondary - set when there is a clear connection between arthrosis and its causative factor. For example, after a joint injury or surgery.

As a rule, the primary gonarthrosis is always bilateral, and the secondary one affects only one knee.

According to ICD-10( international classification of diseases 10 revision), gonarthrosis has a code M17.

Professional athletes
Reinforced knee load may cause development of gonarthrosis

Degenerative gonarthrosis levels

Gonarthrosis is a chronic and slowly progressive disease. Symptoms, prognosis and tactics of treatment depend on the degree of pathological changes in the joint. There are three clinical stages of the disease:

  • Arthrosis of the 1st degree is characterized by the appearance of pain or discomfort after an increased stress on the joints, at the end of the working day. After rest, all signs disappear on their own. The amplitude of the movements is not disturbed, there is no deformation of the joint.
  • Gonarthrosis of the 2nd degree. At this stage, pathology is diagnosed in most people, because it constantly makes itself felt. Patients complain of pain in the joint even after minor loads. Rest does not give the desired relief, and you have to take various painkillers. There is a limitation of the amplitude of movements in the knee, begins muscle atrophy, you can see the initial stage of limb deformation. Knee Osteoarthritis of the 3rd stage. The pain bothers the person round the clock, for its occurrence it is not necessary even to load a joint. Anesthetics do not help anymore. The mobility of the knee is partially or completely lost, its deformations develop, which is often the cause of disability. Treatment in this case is only surgical.

4 degrees of arthrosis does not happen, but there is a fourth X-ray degree of pathological changes in the joint, which coincides with the third, clinical stage.

Symptoms of the disease

At the initial stage of the disease, it is difficult to diagnose, as patients do not take the symptoms seriously and perceive them as ordinary fatigue. Most people can not even say that they are concerned about pain, most likely, unpleasant sensations in the knees after work or excessive load of joints, which completely and quickly disappear after rest.

A characteristic sign is pain during descent or ascent on stairs, as well as starting pain( occurs at the first steps after rest, then disappears).Outwardly, there are no changes. From time to time, patients may note some swelling( reactive synovitis).Also, most people complain of crepitation in the knee( crackling sounds with active and passive movements).

Pain in the knee joint
Pain in the knee joint is the first and the main sign of arthrosis

As arthrosis progresses, the pain becomes more intense, appears more often after minor loads. Independently does not pass, which often prevents a person from falling asleep. We have to take analgesics. Synovitis appears more often, have a more persistent current. Also a rough crunch develops during movements. The amplitude of movement decreases. It becomes difficult for a patient to perform familiar things, for example, to get off his knees. The knee joint begins to deform, it becomes wider, the shin bends( the beginning of the formation of O- or X-shaped deformation of the legs).

At the last stage the pain is intense and constant, it is not removed even by medications. Significantly difficult movements in the knee, especially flexion. The leg is in a forced position. The knee is enlarged in volume. There may be varus or valgus deformities of the legs.

Due to the described changes, gait and limb support function are disrupted. This leads to the fact that a person moves only with the help of an additional support( crutches, walking stick) or is not able to walk at all.

Diagnosis

At the 2nd and 3rd stage, it is not difficult to establish a diagnosis. You can do this at the first, but only if you suspect a disease. Diagnostic program includes:

  • examination by a doctor orthopedist or rheumatologist;
  • clarifying complaints and identifying risk factors;
  • objective examination of knee joints, determination of the amplitude of their movements;
  • X-ray examination;
  • joint ultrasound;
  • in severe for diagnostic cases resort to MRI or CT;
  • standard laboratory blood and urine tests.
Radiography of knee joints
Radiography is a valuable and informative method for diagnosing gonarthrosis

Conservative treatment

Knee arthrosis therapy consists of several methods, individually they are ineffective, but if you use the whole medical complex, then very soon you will start moving without pain.

Read more: Osteoarthritis of the knee joint How to cure arthrosis of the knee joint?

The main tasks of treatment of gonarthrosis:

  • relieve a person from pain;
  • to adjust the nutrition of cartilaginous tissue and accelerate its recovery;
  • improve microcirculation;
  • reduce pressure and pressure on diseased hyaline cartilage joints;
  • to develop a good muscular knee joint corset for protection and support;
  • to increase the mobility of the joint;
  • prevent deformation and ankylosis.

This can be done using the methods described below.

Medication treatment

Not essential, but allows you to quickly eliminate pain and signs of inflammation. Most often prescribe drugs from the group of NSAIDs( diclofenac, meloxicam, ibuprofen, ketoprofen, celecoxib, aceclofenac, etc.).These drugs are used for both systemic therapy( tablets, injections), and for topical treatment( ointments, gels, creams, patches).They quickly and effectively relieve the pain, but they are forbidden to take long courses, as severe adverse reactions may occur.

Chondroprotectors are on the second place. These medicines in their composition have chondroitin and glucosamine( the main structural elements of the cartilage).Thus, it is believed that chondroprotectors with long-term admission can stop the progression of the disease and contribute to the restoration of already destroyed cartilage. Among the most popular drugs worth noting: Arthra, Dona, Structum, Teraflex, Hondrolon, Alflutop. Treatment should start with a monthly course of intramuscular or intra-articular injections, and then switch to 3-4 months of maintenance therapy with tablets. Only in this case it is possible to achieve a positive result.

Don
Dona - modern and effective chondroprotector

The intra-articular injections are a popular method of treating gonarthrosis. Inside the knee can introduce chondroprotectors, as well as glucocorticoid anti-inflammatory drugs of long-term action( Diprospan, Kenalog).The pain passes even after 1 injection, the effect can last for several months.

Also today, the introduction of so-called liquid transplants of synovial fluid( Fermatron, Hyastat, Synvisc, Ostenil) is popular. These drugs are based on hyaluronic acid, which compensate for the synovial deficiency in the joint and promote the resumption of cartilage.

LFK

Therapeutic exercises are the most important element of arthrosis therapy. Without regular special physical exercises, it is almost impossible to achieve improvement. Complex exercise therapy is selected individually, depending on the stage of arthrosis, the age of a person, his physical fitness, the presence of concomitant diseases.

Simple and effective complex of exercise therapy for arthrosis of knee joints:

Other methods of

Other methods of conservative therapy are:

  1. Massage and physiotherapy. They are used during remission, when acute pain is absent. Allow to improve blood circulation in the tissues of articulation, which contributes to the regeneration of damaged structures.
  2. Orthopedic aids. To protect the joint and prevent the progression of arthrosis, you can use special knee pads for physical work or sports. They perfectly support the articulation and protect it from damage. At the last stage of gonarthrosis, a cane can be used to facilitate movement and reduce pain.
  3. Treatment with folk remedies. Folk methods of therapy are very popular among the population. There are not one dozen recipes that can help reduce pain, improve the mobility of knee joints. But we must not forget that such treatment should be used only as an additional one, and not replace all other methods. Also, before using any prescription, you need to consult a doctor about possible contraindications.

Surgical treatment

Operation with gonarthrosis is prescribed in the following cases:

  • inefficiency of conservative therapy;
  • constant pain, which can not be eliminated in other ways;
  • deformity or ankylosis of the joint;
  • loss of leg function;
  • patient desire.
Endoprosthetics of the knee joint
Before and after arthroplasty of the knee joint

There are 2 groups of operations that are performed with gonarthrosis:

  • organ preserving,
  • knee arthroplasty.

All modern organ-preserving surgeries are performed by arthroscopy. There are several options for surgery: arthrodesis, arthroscopic debridement, periarticular osteotomy. The surgeon chooses the necessary procedure depending on the individual characteristics of the patient.

Endoprosthetics is the most effective and widespread type of operation for gonarthrosis. Replacement of the destroyed joint with an artificial prosthesis( in some cases, and bilateral prosthesis) allows you to save the mobility feet and live a full life without pain. It is also important to know that success depends not only on the operation, but also on the correctness of the rehabilitation period. Sometimes only such cardinal measures can help a person to move again without pain.

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ICD 10. Class XIII( M00-M25) |

2 Shoulder Shoulder Elbow joint bone

3 Forearm, radial, wrist joint, ulna

4 Brush Wrist, Joints between these fingers, bones, metacarpals

5 gluteal pelvic hip joint, hip region and the area of ​​the sacrum-iliac, femoral joint, bone, pelvis

6 drumstick peroneal knee joint, bone, tibia

7 Ankle metatarsus, ankle soustaw, joint and tarsus, other joints, toes, toes

8 Other Head, neck, ribs, skull, trunk, spine

9 Localization, unspecified

Disturbances mainly affecting the peripheral joints( extremities)

INFECTIOUS ARTHROPATHIES( M00-M03)

Note This group covers arthropathies caused by microbiological agents The distinction is made according to the following types of etiological association: a) direct infection of the joint, in which microorganisms are invadedt synovial tissue and in the joints has also been observed microbial antigens;b) indirect infection, which can be of two types: "reactive arthropathy", when the microbial infection of the organism is established, but neither microorganisms nor antigens are detected in the joint;and "postinfection arthropathy", in which the microbial antigen is present, but the body's recovery is inconclusive and there is no evidence of local multiplication of the micro organism.

M00 Piogenic arthritis

M00.0 Staphylococcal arthritis and polyarthritis M00.1 Pneumococcal arthritis and polyarthritis M00.2 Other streptococcal arthritis and polyarthritis M00.8 Arthritis and polyarthritis caused by other specified bacterial pathogens If necessary, identify bacterial pathogensagent is used an additional code( B95 - B98 ). M00.9 Piogenic arthritis, unspecified. Infectious arthritis BDU

M01 * Direct infection of the joint in infectious and parasitic diseases classified elsewhere

Excluded: arthropathy in sarcoidosis( M14.8 *) postinfection and reactive arthropathy( M03 . - *)

M01.0 .* Meningococcal arthritis( A39.8 +)

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The main idea of ​​the RMES is that we created it for Russian girls and Russian boys. In the conditions of our time and our Russian mentality, in conditions of speaking in Russian and communication with Russian people. It was possible to take as a basis the works of Jeffries or Di Angelo( both from the States), but the methods that these respected people preach, without adaptation, still do not work. And after adaptation they become very similar to what we have reached ourselves.

Section - Programming

No matter how good the finished products for stock trading or for other business processes, they will never be better than the package written specifically for you, your trading style and other needs that simply can not be taken into account in commercial packages. There may be section materials and will be useful for this. Simulation basics in Simulink

Simulink is an extension of the MATLAB software package. When simulating using Simulink, the principle of visual programming is implemented, according to which the user on the screen from the library of standard blocks creates a model of the device and performs calculations. Chapter 2 Bus selector block

Section - Math and finance

If we look directly at the depth of things we will see one interesting thing. At the basis of all sciences connected at least somehow sideways with the movement of money is mathematics. Without it, nowhere. Mathematical packages are not uncommon in financial offices. Mathematical modeling increasingly ceases to be an abstract area of ​​science and people associated with the flow of money increasingly understand this. Mathematics

The increase in the complexity of the solved problems for objective reasons leads to the complexity of algorithms and their implementations in the algorithmic languages ​​C, Pascal, Fortran, etc. Even more time is spent debugging the code. These reasons led to the creation of Computer Aided Design( CAD) systems, in which some algorithms are laid.

Section - Learning foreign languages ​​

Still, how not to twist, but in our country the path to innumerable riches began with a huge lag from the rest of the world. As a consequence, the main chapter of knowledge about this subject exists in foreign languages, and not Russian at all. This concerns the interfaces of analytical programs, books, magazines, numerous Internet forums. There's nothing to be done, this is reality. Therefore, you have to regret unlearned school lessons and start teaching them here and now. Actually, this section was created for this purpose. English for dealing

The English course for dealing involves two types of lessons: the first is the introduction and primary fixing of the grammar minimum for an interpreter;the second - work with the text. The last type of lesson is basic. Particular attention is paid to the primary fixation of reproductive vocabulary, the analysis of difficult grammatical structures and the development of a reading skill. English-Russian Stock Dictionary

Knowledge of English in the context of modern integration opens up new opportunities for free communication with business partners around the world, provides access to any information. And the information for the trader is his bread. In addition, without knowledge of the legal foundations of trading activities, neither the competent conduct of business in the international securities market nor the correct banking operations or the use of tax advantages of offshore zones are possible. Chapter 2 Price-volume relationship Coefficient Price / Volume

Section - Psychology

Here we come to an extremely important section. Without it, no business activity is simply impossible. Believe it or not, you want to check with your losses. I checked it with money. Well, I did not believe in any psychological training. It turned out not to believe in vain, I did not believe in a couple of pieces of evergreen bucks. I believed where I was going to go if I entered the market correctly, but then I began to create miracles. I had to listen to what is written in books, practically in all, dedicated to businesses. It turned out for me the following - psychological preparation is more important than preparation is purely technical, commercial. Yes, you are not mistaken and read it all correctly. Psychology is more important. I do not know how to convince those who have not tried to lose real money yet. But I think that those who tried this entertainment will not argue with me. Psychologists' advice

Motivation for a trader is of prime importance. In this section, you will be given ready-made autosuggestion schemes that help me with various actions on Forex. They take away fear, improve well-being, remove stress. Each block needs to be understood and applied when you feel the need for it. Psychology practical

The notion of the subject of psychology is very vague. Often, psychologists simply point to mental processes( thinking, memory, feelings, etc.) as a subject for their study. In other cases, it is said about a person, about a person as a subject of psychology. But both the first and the second approaches to the subject of psychology are clearly unsatisfactory, since the above-named is studied not only by psychology, but also by many other sciences. Age psychology

Let's agree right away: fairy tales are one thing, fairytale therapy is another. Those fairy tales that are used in real psychotherapeutic work, as a rule, do not fall on paper, and those of someone else's ear are incomprehensible( indistinct).Literary fairy tales can serve in therapy with prevention, training, illustration, model, development of contact, but not the main means. Dianetics was a bold journey into the dark realm of secrets to gather knowledge and to establish the truth. Prior to Dianetics, these goods belonged to the philosophy of either esoteric or monotonous schools, or were used by charlatans-in cassocks or without them-to lure and catch.

Section - Your reserves

A person very often does not represent all his capabilities. Or he does not know how to develop the qualities he needs. But in fact to actually improve memory or learn to read quickly is quite simple. It's all in your head-just as you think, so you live. Maybe you should try something in yourself for the better.

ros-med.info

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