Symptoms and diagnosis of osteoarthritis
Osteoarthritis is a serious not only medical, but also social and economic problem, as it is a frequent cause of loss of working capacity and development of disability. Unfortunately, at the first stage of the development of the disease, when it is possible to stop the pathological process, the diagnosis is rarely established, because there are no characteristic symptoms.
Often this lesion of the joints is hidden, without any signs, or on the nonspecific symptoms of osteoarthrosis, many people simply do not pay attention, because they are perceived as ordinary physical fatigue. Therefore it is important to know exactly how osteoarthritis is manifested in order to suspect the disease and contact a doctor for specialized care.
Common signs of osteoarthrosis
Osteoarthritis is a chronic degenerative-dystrophic disease of the joints of the body, which is characterized by damage and destruction of the cartilaginous tissue and underlying bone with the gradual development of persistent deformations of affected joints. The disease develops slowly. All joints of the body may suffer, but most often those that are subject to maximum loads( hip, knee, ankle, small joints of hands and feet) are affected. Depending on which joints are affected, the clinical picture will also differ.
Joint pain - the main sign of osteoarthritis
Common signs of osteoarthritis:
- pain in the affected area;
- sensation of crunching in the joint with its active and passive movements;
- short-term stiffness in the limbs in the morning;
- rapid muscle fatigue;
- periodic occurrence of synovitis;
- gradual limitation of mobility;
- development of deformation and deflection of affected joints.
Pain syndrome has some characteristics. At the beginning of the illness, pain or discomfort( not all patients characterize them as pain) arise after heavy physical labor and at the end of the day, disappear after rest, even without the use of medication. As osteoarthritis progresses, the pain becomes permanent and does not go away after rest. Often the patient can not fall asleep, tormented by pain. First, pain relievers and anti-inflammatory drugs are good, but over time their effect is weakened and the pain becomes unbearable.
A characteristic symptom is "starting" pain, when painful sensations occur at the patient's first steps and decrease with each successive meter passed. But, if the load is large, the pain appears again.
Also often there is acute pain, which is caused by blockade of the joint. The fact is that in a degenerative process, loose bodies( fragments of osteophytes, particles of articular cartilage) enter the articular cavity and during movement they can get between the articular surfaces and block the articulation. The pain in this case( this condition is often called the "joint mouse") is very sharp and intense, accompanied by complete immobility of the sick person. But in a certain position of the leg, the pain passes as quickly as it appeared.
Deformation of the foot at various degrees of osteoarthritis
Osteoarthritis is usually chronic, with no clear exacerbations and remissions. Gradually the pain syndrome, deformity and stiffness in the aching joint progresses. If the provoking factors( overfatigue, infection, trauma, etc.) act, the disease becomes aggravated by the development of reactive synovitis with signs of inflammation.
Symptoms of hip osteoarthrosis
Coxarthrosis, or osteoarthrosis of the hip joint, is the most severe form of the disease, occurring in 40% of all localizations of arthrosis lesions. Patients complain of pain in the affected joint, which is accompanied by lameness. There is also pain in the intact knee joint, in the lower back, which is associated with a pathological spasm of skeletal muscles.
With time, the pain increases, there is a "duck" gait, limiting bending, extension, lead and hip reduction. Rapidly developing atrophy of the hip muscles, flexing the hip contracture is formed and the supporting function of the limb is lost, which requires the replacement of the destroyed hip joint with an artificial endoprosthesis.
Pain in the hip - a dangerous sign
Symptoms of knee osteoarthritis
Most often, women are sick. Defeat, as a rule, is two-sided. Patients complain of pain at the end of the day, inability to climb and fall on the stairs. Often there is a feeling of "podkashivaniya" feet. First, the flexion in the knee joint is limited, and then the extension. During the movement, there is a crunch in the knee.
Over time, muscle atrophy at the knee joint, deformation( O or X-shaped legs) begins to form. Also, patients complain of instability and hypermobility of the knee joint. Periodically arises blockade of articulation and reactive synovitis.
Symptoms of osteoarthritis of interphalangeal joints
Most often, this variant of the disease occurs in women during the menopausal period. Clinically characterized by the formation of nodular outgrowths in the area of distal interphalangeal joints( nodes of Geberden).As a result, the joint is deformed and its function is impaired. Sometimes bony growths develop in the area of proximal interphalangeal joints( Bušar's nodes).
Diagnosis of osteoarthritis is based on clinical data and some additional methods of investigation. There are no specific laboratory signs of pathology, but laboratory tests are routinely performed to exclude similar pathologies.
The main diagnostic method is radiological. On the radiographs, narrowing of the joint gap, the presence of osteophytes, osteosclerosis, cystic formations in the joint part of the bone are revealed.
Radiography is the main method for diagnosis of osteoarthritis
. Additional methods use ultrasound, thermography to determine inflammatory changes, MRI and CT.
Differential diagnosis of
Differentiate osteoarthritis with several articular pathologies:
- rheumatoid arthritis,
- reactive arthritis,
- psoriatic arthritis,
- gouty arthritis,
- pyrophosphate arthropathy.
Often it is necessary to carry out differential diagnostics of osteoarthritis with rheumatoid arthritis, especially when the small joints of the hands are affected. Unlike osteoarthritis, rheumatoid arthritis begins with severe inflammatory joint changes( pain, swelling, redness, increased local temperature, impaired function).Almost always the small joints of the hands and feet are affected. There is a morning stiffness in the joints, rheumatoid nodules are formed. There may be violations of the internal organs, which is not the case with osteoarthritis.You can also read: Osteoarthrosis of the hip joints of the 2nd degree
In the blood, rheumatoid factor, an increase in ESR is detected. On roentgenograms, osteoporosis is noticed instead of osteosclerosis, the presence of usur( edge defects of bones).
Infectious arthritis is characterized by the following symptoms:
- acute onset and rapid development of symptoms;
- pronounced pain syndrome and exudative manifestations;
- inflammatory changes in blood;
- high efficiency antibacterial therapy.
Gouty arthritis is characterized by acute attacks of articular syndrome with severe inflammatory symptoms and acute pain. Most often affects the first metatarsophalangeal joint of the foot. In the blood, an increase in uric acid, an increase in ESR, a characteristic symptom in the radiography.
When making a conclusion, it should be noted that in each case, you need to be careful about your health and when you have any suspicious signs you need to seek specialized medical help. Since the detection of osteoarthritis at an early stage can slow or completely stop the pathological process.
Symptoms and treatment of disease osteoarthritis
Osteoarthritis is a chronic joint disease, in which primary degeneration of the cartilaginous tissue of the joint is observed, which leads to its deformation. At an early stage of the disease, the articular cartilage softens, the surface becomes torn, with small cracks and slits, which under the action of mechanical loads lose integrity, and the subchondral bone covered by them is exposed, cysts( osteophytes) appear on it, the bone thickens. Bony processes osteophytes, popularly known as spurs, sprout into joints, to the attachment points of ligaments.
All these internal degenerative processes lead to severe pain when moving the joint, which without adequate treatment can lead to disability of the patient. Rheumatologists claim that the cause of osteoarthritis can be:
- excessive mechanical load of healthy cartilage;
- reduced the resistance of cartilage to physiological load.
Osteoarthritis is more affected by older people, after 50 years this disease is diagnosed in 27%, after 60 years - in 98%.Osteoarthritis is common in both men and women. But women are more prone to this disease during menopause. In women, interphalangeal joints of the big toes and toes are more often damaged, but for men - hip joints.
The clinical form of osteoarthrosis and the causes of
The form of osteoarthritis can be:
- primary( idiopathic) - occurs due to genetic predisposition and occurs in young people;
- secondary( acquired) - this type of osteoarthritis is acquired throughout life, due to injuries, bruises, complications of other diseases.
Common clinical forms of osteoarthritis:
- gonarthrosis - knee osteoarthritis, most common in women, damaging one joint;
- coxarthrosis is a form of osteoarthritis in which the hip joint is damaged, this form becomes the most common cause of disability among men;
- osteochondrosis - affection of cartilaginous intervertebral discs;
- spondylarthrosis is a form of the disease in which degenerative changes occur in the body of adjacent spines;
- Polyostearthrosis is a common form of the disease that damages multiple peripheral and intervertebral joints.
Osteoarthritis: causes of
- chronic joint disease;
- features the mineral composition of water or food in a certain region;
- is not normalized physical activity;
- infringement of a blood supply of a joint;
- is overweight;
- age over 50;
- is a professional sporting activity;
- bad habits( smoking, drug addiction, alcoholism);
- is a disease of the endocrine system.
Disease osteoarthritis does not carry a mortal danger to the patient, but in the absence of timely diagnosis and treatment can lead to disability and loss of ability to work.
Osteoarthrosis: Diagnosis and Clinic
Most often at the initial stage of osteoarthrosis, the disease can be asymptomatic, before the pain in the joint after the load, is perceived as fatigue. Often the pain occurs when moving or in a certain static stress. After a rest or a warm compress the pain subsides and for a while stops worrying the patient. If during this period, do not conduct examinations and treatment, then later the pain will arise in the middle of the night, and in the daytime. Sometimes patients complain of pain, which fetters movement and subsides after 15-20 minutes of motor activity.
The synovial membrane of the joint is subjected to constant irritation, as a result of which an extra amount of lubricant is produced in the joint, which is accompanied by a swelling of the joint and an increase in its size. With active movement, you can hear crunching, clicking and rubbing the bones. In women during menopause, when there is a change in the hormonal background, often there is a nodular form of osteoarthritis. The knot form of osteoarthritis arises as a result of inflammation of the nodules of Geberden or Bushard on the І and ІІІ fingers of the hand. The clinic of this form of the disease manifests itself as follows: the articular surface of the joints is covered with dense, painful palpation of bone knots( osteophytes) the size of a pea.
When the knee and hip joints are affected, the clinic is significantly different. So, with osteoarthritis of the knee joint ligaments stretch, and the joint itself loses its stability, whereas in the hip joint, mobility is impaired. The unifying symptom is severe pain.
Special attention should be paid to the clinic of osteoarthrosis of the spine, in which the main symptom is a constant back pain. The first symptoms of this disease manifested minor pain in the lower back after physical exertion, stiffness in the spine usually passes after an overnight rest. However, the fading of pain does not mean the diminution of the degenerative process. Bone at this time grows and begins to squeeze the nerves and blood vessels, causing numbness of the limbs, a violation of sensitivity, eyesight, blood circulation of the brain, the work of the gastrointestinal tract is disrupted.
Diagnosis of osteoarthritis
Diagnosis of osteoarthritis and osteoporosis can only be performed by a highly qualified physician who will inspect the patient and prescribe the necessary set of additional research methods:
- general and biochemical analyzes of blood, urine and synovial fluid;
- radiography of the damaged joint in several projections;
- magnetic resonance and computed tomography;
- if necessary, consultation of narrow specialists: anesthesiologist, endoprosthesis.
Specialists distinguish three clinical and coronary forms of the disease:
I form-characterized by a slight restriction of mobility in the joint, a radiologic image will show small proliferation of bone tissue along the edges of the joint cavity;
ІІ form - restriction of joint mobility, atrophy of nearby muscles, the picture shows a significant growth of bone tissue and narrowing of the joint gap;
ІІІ form - deformation of the joint with significant changes in the radiographic image, complete disappearance of the joint gap, extensive marginal proliferation of bone tissue.
When the doctor diagnosed with osteoporosis and the cause of the disease is established, the most important period comes - the treatment of the disease. It is worth noting that only qualified medical care, treatment in a hospital or under the strict medical control can lead to a full recovery at an early stage of the disease. Osteoarthritis is treated in a comprehensive manner and includes:
- drug therapy;
- physiotherapy procedures;
- complex exercises exercise therapy.
Drug therapy primarily includes preparations of anti-inflammatory, analgesic, actions, chondroprotectors. All these drugs help to remove a strong pain syndrome, eliminate swelling and inflammation, and also have a cartilage-protective effect. If necessary, the doctor can recommend the use of hormonal drugs that can stop the degenerative processes in the joint.
Physiotherapy procedures( electrophoresis, UHF, ozokerite applications, medical baths and mud) relieve swelling, inflammation, joint pain, improve blood circulation in the joint, stimulate metabolic processes.
Complex LFK and massage can improve metabolic processes in the tissues of joints and nearby muscles, partially restore mobility in the joint, reduce spasm and pain during movement.
In case of ineffectiveness of conservative treatment, an orthopedic doctor may raise the issue of performing an operation on a damaged joint. Endoprosthetics is a radical method of treatment of osteoarthritis, which in most cases gives a chance to prolong life and preserve its quality. Today, it is possible to perform minimally invasive surgical interventions, in which the circumferential ligaments and muscles are practically not injured, thereby shortening the period of postoperative recovery. Most often, with osteoarthritis, these types of surgical intervention are recommended:
- arthroscopy is a minimally invasive surgical procedure that allows the cartilage to be removed without damaging nearby tissues;
- endoprosthetics - replacement of a damaged joint with an implant( partial or complete).
Sanatorium treatment and prevention of osteoarthrosis
After the treatment, the patient needs a course of restorative procedures. The attending physician will prescribe a course of rehabilitation procedures, which can be done at specialized sanatoriums.
Osteoarthritis, osteoporosis, like other diseases, is easier to prevent than after a long and debilitating treatment. Therefore, throughout life it is necessary to follow several simple rules:
- to keep track of your weight;
- engage in gentle sports( walking, swimming);
- to eat natural vitaminized food;
- avoid excessive physical exertion.
Remember that when the first symptoms occur, you should not self-medicate, but you should consult a doctor for qualified medical care.
Osteoarthrosis - Wikipedia
The term "osteoarthritis" unites a group of diseases of different etiology, but with similar biological, morphological and clinical outcomes, in which not only the articular cartilage but also the entire joint is involved in the pathological process, including the subchondral bone, ligaments, capsule, synovial membrane and periarticular muscles.
The main clinical symptoms of osteoarthritis are joint pain and deformity, leading to functional failure.
At the heart of degenerative dystrophic changes in arthrosis is primary damage to the cartilage followed by an inflammatory reaction, so often arthrosis is called arthrosis-arthritis .Osteoarthritis is always associated with deformation of the bone tissue, and therefore it is also called osteoarthritis or deforming arthrosis .
Terminological definitions - osteoarthritis, arthrosis, osteoarthritis, deforming arthrosis - are currently listed as synonyms in the X International Classification of Diseases.
Most often, the term "osteoarthrosis" is used to refer to a chronic progressive disease of synovial joints.
Isolate localized( with lesion of one joint) and generalized forms of osteoarthritis( polyostearosis ).Some common types of osteoarthritis have been given separate names. In particular, the term "gonarthrosis"( from other-Greek.γόνυ-knee) is used to denote arthrosis of the knee joint, "coxarthrosis"( from the Latin coxa - thigh) - to denote arthrosis of the hip joint.Years of life adjusted for the incapacity for work for osteoarthritis per 100 000 population in 2004.no data ≤ 200 200-220 220-240 240-260 260-280 280-300 300-320 320-340 340-360 360-380 380-400 ≥ 400 Frequency and severity of joint disease in osteoarthritis
Osteoarthritis is the most common form of lesionjoints and one of the main causes of disability, causing a deterioration in quality of life and significant financial costs, especially in the elderly.
There is osteoarthritis everywhere. In the US, he suffers from 21 million people( about 7% of the population).A large-scale study in 7 cities of the former USSR revealed a manifest( accompanied by clinical symptoms) osteoarthritis in 6.43% of the examined( 41,348 people over 15 years old).
In general, the prevalence and incidence of osteoarthritis varies widely in different countries of the world. For example, the prevalence of osteoarthritis in Ukraine is 2515.7 per 100 thousand population, the incidence is 497.0 per 100 thousand population. As established by population studies, these rates are slightly lower than in the US, and significantly higher than in the UK.
The incidence of osteoarthritis increases dramatically with age, reaching a third of the population in the elderly and senile ages. Among patients with osteoarthritis at a young age, men predominate, and in the elderly, women. In the US, osteoarthritis occurs in 2% of the population under the age of 45, 30% at the age of 45-64 years and 63-85% older than 65 years.
At the same time in Sweden, the manifest osteoarthritis of peripheral joints was found only in 5.8% of the population aged 50-70 years.
Most often, osteoarthritis affects the joints of the hand, the first metatarsophalangeal joint of the foot, the joints of the cervical and lumbar spine, knee and hip joints. However, the severity of the disability of the musculoskeletal system is dominated by the hip, knee and ankle joints, as well as the shoulder joint.
ThiologyBasic etiological factors of osteoarthrosis
Osteoarthritis is a consequence of mechanical and biological causes that disrupt the formation of cells of articular cartilage and subchondral bone. It can be initiated by many causes, including hereditary, evolutionary, metabolic and traumatic.
Osteoarthritis affects all joint tissues. The disease is manifested by morphological, biochemical, molecular and biomechanical changes in cells and matrix that lead to softening, deflation, ulceration and decrease in the thickness of articular cartilage, as well as to osteosclerosis with sharp thickening and densification of the cortical layer of the subchondral bone, osteophyte formation and development of subchondral cysts.
Clinically, osteoarthritis is manifested by arthralgia, pain and movement limitation, recurrent synovitis, local inflammation in various joint tissues.
Primary and secondary osteoarthrosis
Osteoarthritis is primary and secondary.
If the cause of the development of the disease is not established, then such an arthrosis is usually called primary, or idiopathic( from other.-Greek.ἴδιος - a peculiar, special, unusual and πάθος - disease).
The main causes of
Osteoarthritis is a multifactorial poly-disease. The three main causes of the degenerative-dystrophic process in the joint: trauma, dysplasia and inflammation.
Injury of the joint is the most common cause of arthrosis. In the second place is dysplasia of the joint - congenital features that are accompanied by poor biomechanics of the joint.
Inflammation also often leads to damage to joint tissues and the development of secondary arthrosis. Most often this is the result of autoimmune diseases( for example, rheumatoid arthritis), less often - the infectious process( for example, acute purulent inflammation of the joint caused by staphylococcus or another specific infection( in gonorrhea, syphilis, tick-borne encephalitis)).it is also a very common complication in chronic hemarthrosis( Hemophilia).
Risk factors for
Risk factors for primary osteoarthritis are: hereditary predisposition, overweight, elderly age, specific occupations. In addition, the incidence of osteoarthritis depends on sex and race / ethnicity.
Genetic factors include: hereditary disorders and mutations of type II collagen, other hereditary diseases of bones and joints, congenital disorders of joint development( dysplasia).
Non-genetic( non-hereditary) multiple factors, such as:
- age, osteoporosis, affect the development and progression of osteoarthrosis;
- metabolic disorders in the body;
- deficiency in the body of microelements;
- developmental disorders( dysplasia) and acquired diseases of bones and joints;
- neurodystrophic manifestations of the pathological process in the lumbosacral( lumbosacral muscle syndrome), or in the cervical spine( shoulder-scapular periarthritis);
The following risk factors for osteoarthritis are environmental factors:
- action of chemical toxins;
- joint injury, repeated microtrauma;
- operations on joints( eg, meniscectomy);
- occupation and physical activity at work.
Stages of the diseaseStages of arthrosis
Regardless of the cause, there are 3 stages of arthrosis. At the first or the initial stage of arthrosis there are no pronounced morphological disturbances of the joint tissues. The changes refer only to the function of the synovial membrane, to the biochemical composition of the synovial fluid, which, through diffusion, nourishes the cartilage and menisci of the joint. The joint loses its ability to withstand the usual load for it, and the joint overload is accompanied by inflammation and pain syndrome.
In the second stage of the disease, we see the beginning destruction of articular cartilage and meniscus. Bone reacts to the load of the articular area with edge growths - osteophytes.
The second stage inevitably passes into the third stage of severe arthrosis. Its signs are pronounced bone deformation of the joint support site, which changes the axis of the limb. Insolvency, shortening of ligaments of the joint leads to pathological mobility of the joint or in combination with the stiffness of the joint bag - to a sharp restriction of natural movements - contractures. Chronic inflammation and chronic pain syndrome usually accompany 2 and 3 stage.
In the initial stage of the disease, the muscles that perform movements in the joint are weakened, but, in general, are not changed. In the second stage there is a violation of muscle function due to violation of reflex neuro-trophic regulation. In the third stage of the disease, joint loading and motor activity are severely disrupted, due to contractures and limb axis disorders, the amplitude of muscle contraction changes, normal attachment points of the muscular-tendon complex change.then it is accompanied by a shortening or stretching of the muscle, a decrease in the ability to fully reduce. Trophic disorders in the joint disease affect not only the muscles, but all limb tissues.
The pathogenesis of this disease is caused by a disruption of the function and structure of the cartilage of the joint. Articular cartilage is a highly specialized tissue consisting of a matrix and chondrocytes immersed in it. Matrix contains two main macromolecules, glycosamines( proteoglycans) and collagen. The high concentration of proteoglycans in the cartilage keeps the collagen network energized, thereby promoting a uniform distribution of the load that affects the cartilage, and ensuring the restoration of the shape after the termination of the load. With the loss of even a small amount of glycosamin, the resistance of the cartilage matrix to physical stress is reduced, and the surface of the cartilage becomes sensitive to damage. In the earliest stages of arthrosis, the cartilage becomes thicker than normal, but with progression it becomes thinner. The cartilage becomes soft and friable, on it there are deep ulcers, usually only in the most loaded part of the joint.
Normally, with periodic loads, such as walking, the cartilage plate deforms and returns to its original form, performing the function of a peculiar pump that provides for the expulsion of the decomposition products and the "absorption" of nutrients and building material. Compression and restoration of the form under loading is the main condition for the regeneration of damaged cartilaginous tissue. However, excessive or prolonged loading of the joint adversely affects the function of the articular cartilage and increases the flow of arthrosis.
The supply of cartilage and meniscus joint is carried out only at the expense of synovial fluid. The "health" of the sliding and damping structures of the joint depends on the quantity and quality of the fluid secreted by the synovial membrane.
Synovial membrane performs an important function of filtering the building material of cartilage - hyaluronic acid, it protects the elution of the latter from the joint cavity. Violation of the biochemical composition of synovial fluid in case of trauma or inflammation of the joint actually leads to the development of a disease called osteoarthritis.
The efficiency of the circulation and diffusion of the synovial fluid is directly related to movement in the joint and joint loading. Movement in the joint is necessary for the metabolism in the cartilage. In itself, prolonged restriction of movements in the joint leads to a deterioration in the supply of cartilage.
In arthrosis, the equilibrium between the formation of a new building material for the restoration of cartilage and its destruction is disturbed. The cartilage of a firm, elastic structure turns into a dry, thin with a rough surface. The underlying bone becomes thicker and grows apart from the cartilage, which limits movement and causes deformity of the joints. The joint capsule thickens - is fibrotic, and also inflames. The joint is filled with an inflammatory fluid that stretches the capsule and ligaments of the joint. Pain, and later deformation of articular surfaces with arthrosis leads to joint stiffness and joint contractures. Morning and starting pain, as well as stiffness in the joint in patients with deforming arthrosis itself is due to the low elasticity of the cartilage and the need for starting movements to restore sufficient elasticity of the cartilage.it creates a feeling of pain and stiffness.
In inflammation, the joint assumes a resting position or a physiological position. In this position, the maximal spreading of the ligaments and the capsule of the joint is ensured. In this position, the pain in the joint is minimal. A major influence on the course of the pathological process is the condition of the so-called muscle corset of the joint, that is, a system of muscles that not only moves in the joint but also stabilizes the joint, absorbing powerful inertial impulses during movement. Thus, the internal broad muscle in the quadriceps femur protects the knee from lateral instability at the moment of landing on the heel while walking, and the middle gluteal muscle on the side of the support leg limits the pelvic inclination at the time of transfer, which protects the hip joint from overload.
Outcome of the diseaseOutcome of arthrosis of the knee and hip joint
The outcome of arthrosis is the complete destruction of the joint with the formation of ankylosis - complete immobility of the joint or neoarthrosis with unnatural mobility.then it is accompanied by a severe disability of the limb. Recently, without waiting for the outcome of the disease, more and more often special operations are used to replace the joint with a prosthesis - joint replacement. The figure depicts the varus deformity of the knee typical for the terminal stage of knee arthrosis in combination with lateral pathological instability of the knee joint. Osteoarthritis of the block-shaped or globular joint, such as the hip joint, ends with ankylosing. In this case, the closure of the joint usually occurs in the nonphysiological( vicious) position of the limb. In this case, we see the hip in the position of flexion and reduction, in which the leg is shortened, and the limb axis and biomechanics of the locomotor system are significantly impaired.
Clinical course and diagnosis
If at the onset of the disease the pain occurs only periodically, after considerable physical exertion, and quickly passes at rest, then as the disease progresses, the intensity of pain increases, it does not disappear after rest and appears at night.
In the context of evidence-based medicine, a number of standard tests have been developed to evaluate osteoarthritis. To assess joint pain and morning stiffness, a ten-point visual analogue scale is used. To characterize gonarthrosis and coxarthrosis, the Leken index is widely used.
Disease of osteoarthritis
Osteoarthrosis is a disease of the joints of the limbs and joints of the spine, which is based on dystrophic changes in the cartilaginous cover with its gradual destruction.
At later stages, pathological changes are added in the synovium and the joint capsule adjacent to the cartilage of bone tissue, as well as in the periarticular muscles. As a result, there are pains in the joints and a restriction of mobility, deformations develop and the functions of the limbs and spine are disturbed. The most commonly affected knee, elbow, hip and shoulder joints, as well as the joints of the foot, hand and spine.
Currently, intensive and multifaceted studies are under way on the problems of joint diseases, which is determined by the frequency of suffering and its steady progression, which leads to a gradual loss of the ability of the joints to function normally. For example, 10-12% of the population suffers from a disease like osteoarthritis. With age, the frequency of the disease increases and after 70 years it reaches 97%.Women suffer from this disease 2 times more often than men. Let us consider in more detail the nature of osteoarthritis.
Osteoarthrosis is a chronic and progressive joint disease in which metabolic( metabolic) and articular cartilage are disturbed, leading to destruction of the articular surface( degeneration and destruction of cartilage), structural changes in the subchondral bone, the appearance of osteophytes, to apparent or latent moderate effusionin the joint( synovitis).
Osteoarthritis initially affects the articular cartilage. Externally, the cartilage loses its normal shine, its surface becomes rough, the elasticity decreases. Gradually it becomes thinner, sometimes disappears, bareing the bone.
The process of cartilage destruction is more rapid in the areas of articular surfaces experiencing overload. Simultaneously with the destruction, the regeneration process takes place, which leads to the appearance of sprouting( osteophytes) in the less loaded parts of the joint( usually along the edges of the joint surfaces), which change the shape of the joint, deform it.
Therefore, later stages of the disease are often called deforming arthrosis.
However, in spite of the fact that the bony growths increase the area of contact of the articular surfaces, the inferiority of this additional support does not allow to significantly reduce the burden on the affected parts of the joint, and deformation leads to deterioration of its biomechanics and limitation of mobility. The synovial membrane coarsens as a result of the development of the fibrous process, periodically becomes inflamed when the joint is traumatized.
Subchondral areas of the bone can become denser, sometimes foci of destruction are formed. Bone ankylosis( complete fusion of the articular ends of bones with loss of mobility) does not happen, in spite of pronounced deformation and a significant limitation of the amplitude of movements in the joint.
In most cases, dystrophic changes in the joint develop slowly and gradually. The immediate causes that initiate the onset of the disease are not known. There are factors that dramatically accelerate the destruction of cartilage not only in the elderly, but also in young people. Incomplete or incorrect development of the joint, the so-called dysplasia and anomalies, lead to an overload of individual joint sites and the appearance of osteoarthritis even in adolescence. Injury of the joint also accelerates the process of cartilage destruction and causes posttraumatic osteoarthritis.
Clinical picture with osteoarthritis( as osteoarthritis manifests itself)
Osteoarthrosis affects, as a rule, one or two large joints, rarely more. With the localization of the disease in the spine, joints of cervical and lumbar vertebral motor segments suffer more often. As it is customary to say, salts are deposited in the joints. Initially, the patient appears only pain in the joint after physical exertion, sometimes - a crunch when moving. Gradually, the intensity of pain increases, the crunch becomes rougher, and periodically there is tight mobility in one direction of movement.
In the late stage of the disease the joint is deformed , it sharply limits mobility, the pains become intense, the supporting function of the limb is significantly reduced. The patient moves only with the help of an additional support - a cane or crutches( with the defeat of the joints of the lower extremities).The function may suffer even more, since with arthrosis in the joint cavity sometimes there are different bodies( pieces of cartilage, bones, enlarged villi of the synovial membrane).Such bodies( "articular mice") can be trapped between the articulating surfaces of the joint, causing severe pain and limiting mobility.
Some sources state that a disease such as osteoarthritis does not respond to treatment. Unfortunately, in part this is so. Let's see why the destruction of articular cartilage in osteoarthritis does not imply its restoration.
Regeneration( restoration) in articular cartilage has the character of "incomplete or perverted regeneration".In case of superficial damage, due to the absence of cambial cells( progenitor cells) in the articular cartilage, the defect is not filled with tissue. In case of damage penetrating through the cartilage into the subchondral bone tissue, biologically active substances and stem mesenchymal cells ( connective tissue precursors) migrate to the defect area, which activate the processes of cartilage repair. Therefore, only in certain conditions, when the size of the defect, the age of the patient, the specificity of the joint load, and also with the timely stage complex treatment allow the progenitor cells to differentiate into cartilage cells, and the defect is replaced by hyaline cartilage.
In general, the defects of articular cartilage are filled with a fibrous tissue that does not have those unique characteristics that hyaline cartilage possesses - elasticity, elasticity in combination with a harmonious strength.
Stages of the disease
Three stages are distinguished in the development of the disease.
In the first stage of the , patients complain of pain arising in the joint under load and passing at rest.
Palpation of the joint area is usually painless, but it causes discomfort, especially during the exacerbation of the disease. Mobility in the joint is limited only slightly, only the volume of those movements that have the smallest amplitude decreases. Even at this stage the patient spares the affected joint, which results in the development of mild atrophy( a decrease in the volume and smoothness of the contours) of the periarticular muscles and limb muscles. The function of the joint almost does not suffer, which prevents active activity only for persons engaged in manual labor.
In the second stage of the the pain in the joint acquires a permanent character, at rest decreases, but completely, as a rule, does not pass. Palpation causes painful sensations not only in the projection of the joint space, but also in the periarticular( paraartricular) zones. Mobility in the joint is limited significantly( up to half the amplitude of movements), although it remains in the amount sufficient for self-service and relatively normal life.
In the joint, contractures develop( limitations in the amplitude of movements), which are mostly of a near-articular nature and can be corrected with conservative treatment, without surgery. There is a pronounced atrophy of muscles that move in the affected joint. The function of the joint is severely affected, which particularly restricts the ability of the people engaged in manual labor, which sometimes results in a change in the profession or disability;there are difficulties in the work activity of intellectuals.
In the third stage of the , patients complain of constant, severe pain, the intensity of which increases with movements. Palpation of the joint and the periarticular region is sharply painful. Mobility in the joint is severely limited, remaining in an insignificant amount, sometimes only in the form of weak swinging movements. Developing persistent contractures, which are mainly a consequence of intra-articular changes. With osteoarthritis, there is never ankylosis( complete immobility) of the joint. Atrophy of the periarticular muscles is expressed. The function of the joint is often lost completely, which forces the patients to use the means of unloading( cane, crutches, walkers).
The most common forms of osteoarthrosis
The joints bearing the greatest static load( knee, hip, small foot joints) and dynamic load( shoulder joint, hand joints) are most often affected by osteoarthritis. Clinical manifestations of osteoarthritis are different, depending on the localization of the lesion.
Gonarthrosis - osteoarthritis of the knee joint. The most common osteoarthrosis of the internal part of the knee( medial typhi-femoral articulation) and osteoarthrosis between the articular surface of the patella and the joint surface of the femur( patellofemoral joint).
Biomechanics of the knee joint is well studied. Normally, the load axis passes through the center of the tibiofemoral section( Figure 1.3.1).
Fig.1.3.1 Diagram of the joints( joints) of the knee: 1-femur;2-patella;3-tibia;4-fibula;5-medial tibiofemoral articulation;6-lateral tibiofemoral articulation;7-patellofemoral joint
However, during movements the load on this department is 2-3 times that of the body, and when flexing the knee joint, the load on the patellofemoral part is 7-8 times greater than the body weight. Often this explains the high incidence of osteoarthritis of these parts of the knee joint.
Osteoarthritis most often affects people of young age, more often men, with isolated lesions of one, less than two knee joints, who have had a knee injury in the past or a joint operation( removal of the meniscus).
Another large group of patients with osteoarthritis is made up of middle-aged and elderly people, mostly women( many of them are overweight) who have osteoarthritis at the same time and other localization.
The most important symptoms of gonarthrosis are joint pain in walking, standing and climbing stairs;crunching in the joints during movements;local tenderness in palpation, mainly along the inner part of the joint space;painful restriction of flexion, and later extension of the joint;marginal bony growths;atrophy of the quadriceps muscle of the thigh.
Periodically, if osteoarthritis of the knee is affected, signs of inflammation are found. This changes the nature of the pain: pain increases, there is "starting" pain, pain at rest, morning stiffness in the joint lasting up to half an hour. In the joint area there is a slight swelling, a local increase in skin temperature. Due to the possible presence in the joint of the "articular mouse", the symptoms of "blockade" of the joint may appear - acute pain in the joint, which deprives the patient of the opportunity to make any movement.
For osteoarthritis, the varus deformity of the lower extremity( venu varus) is characteristic, reflecting the lesion of the internal part of the joint( Figure 1.3.2, a).
Fig.1.3.2.Deformation of the knee joint: a-varus deformation( genu varus);b-valgus deformation( genu valgus);in-flexion contracture of the knee joint
When the joint is affected in all departments accompanied by a synovitis, a valgus deformation( venu valgus) is observed( Figure 1.3.2, b).Fixed flexion contracture, when the knee can not fully unbend and is constantly under a certain angle, is noted in osteoarthritis complicated by synovitis( Figure 1.3.2, c).
Swelling and effusion in the knee joint are determined by the smoothness of the contours of the knee joint. With the synovitis, ballotation of the patella and fluid fluctuations in the joint are noted.
Gonarthrosis is characterized by soreness and restriction of movements in the knee joint, sometimes the instability of the joint is determined.
The course of gonarthrosis is prolonged, chronic, progressive, with a slow increase in symptoms, often without pronounced exacerbations. Periodically, there may be a spontaneous decrease in the severity of symptoms. Osteoarthrosis of the knee joint proceeds with periods of exacerbation, which are usually accompanied by the appearance of effusion into the joint cavity and can last for a long time( days, months).In some cases, the course of the disease worsens for several weeks or months, which may be due to joint instability. Sometimes sudden, almost instant pain in the knee joint can mean the development of aseptic necrosis of the joint end of the femur, which is a rare but severe complication of osteoarthritis.
Coxarthrosis - osteoarthrosis of the hip joint. The disease usually affects people aged 40-60 years. The main predisposing factors are congenital dysplasia of the hip joint, Perthes' disease. Unilateral joint damage is more common than bilateral. About 60% of patients with coxarthrosis are men, 40% are women.
The hip joint is located most deeply under the soft tissues( subcutaneous fatty tissue, muscle mass), so the effusion to the joint, swelling and tenderness during palpation can be detected extremely rarely. Soreness is noted often when palpation in the inguinal ligament. Sometimes the first signs of this disease are difficulty and restriction of movements in the joint, so it is very important to know the normal amplitude of movements in the joint.
Mobility in the hip joint is examined in the prone position. Extension in the joint is performed in the patient's position on the side, normally it is 20 °, and it is very important that the pelvis and spine do not participate in movement. The angle of flexion, equal to the norm of 115 °, is determined by maximally attracting the limb bent in the knee joint to the abdomen in the supine position on the back, with the immobility of the pelvic bones. The amplitude of the abduction and reduction of the leg in the hip joint is 45 ° and 40 °, respectively. One of the earliest signs of hip joint damage is the restriction and soreness of rotational movements, which are examined with the lower limb bent at right angles in the knee and hip joints. Normally, the external and internal rotation is 45 °.
The main symptom of coxarthrosis is pain when walking and resting on the leg in the thigh, buttock, groin, sometimes the pain irradiates( transfers pain impulse) to the knee joint, which greatly complicates the diagnosis. The functional capacity of the patient decreases: it is difficult, bending over, putting on socks, shoes, lifting something from the floor. In the most severe cases, you can hear crepitation when moving in the joint.
The soreness on the outer surface of the joint can be caused by the inflammation of the bag of the large trochanter and the ischial tuberosity, and also in the places of attachment of the muscles and tendons to the large trochanter( enthesopathy).In later stages of coxarthrosis, lameness occurs due to the shortening of the leg due to the movement of the femoral head, and in bilateral lameness, the lameness has a characteristic kind of swaying from side to side: "duck walk".Develops atrophy of the muscles of the thigh and buttocks, there is a coxalgic gait, the so-called Trendelenburg sign: when trying to lean on the affected leg, the pelvis also falls.
The study compares the length of the limbs( from the anterior superior iliac bone to the inner ankle).At their same length, but with a visible shortening of one of the extremities, one can suspect a "skewed" pelvis, which is associated with changes in the spine. At varying lengths, changes in the hip are likely( a violation of the anatomical relationship between the femoral head and the acetabulum).
Coxarthrosis - the most severe form of osteoarthritis, has a chronic, progressive course. With a rapidly progressing course for several years, rapid disability occurs, in most cases, patients need surgical treatment - hip joint endoprosthetics.
Osteoarthrosis of the first metatarsophalangeal foot joint is the third most frequent after gonarthrosis and coxarthrosis and often accompanies them. The development of the disease leads to a violation of the static-dynamic function of the foot due to an incorrect redistribution of the body weight load.
Due to the progression of osteoarthritis, a specific deformity of the foot is formed, the first finger digs outward, it seems to float on the 2nd toe of the foot, which hammers bends. Externally, this manifests itself in the form of "protrusion" along the inner surface of the foot of the 1st metatarsophalangeal joint, which periodically inflames and leads first to discomfort, and then to severe pain and impossibility to wear shoes on the heel or too narrow.
Periarthrosis humeroscapular. The pain that occurs in the shoulder joint is characterized by the fact that it is felt not in the area of the joint itself, but in the upper part of the arm, below the shoulder joint at the width of the palm. Intensive pain extends lower on the shoulder, and also upwards, into the neck area. Pain often begins gradually, without an obvious provoking factor. It is variable in intensity, but usually has a progressive nature, often awakens the patient at night and significantly affects the performance of everyday movements.
Pain in the shoulder joint is not always a manifestation of osteoarthritis or joint capsule damage, often the osteochondrosis of the cervicothoracic spine, which is a frequent companion of the humeroparous periarthrosis, often manifests itself. When palpation in the shoulder region, soreness is detected in the projection of the joint space, sometimes crepitation during movement, felt under the fingers.
The patient is asked to perform two "difficult" active movements during the examination in connection with the violation of the function of the shoulder joint: lay both hands behind the head( assessing the withdrawal, external rotation and flexion in the shoulder joint, as well as the function of the supraspinatus, subacute and small round muscles)hands behind the back( internal rotation, withdrawal and extension in the shoulder joint, as well as the function of the subscapular muscle are evaluated).An "arch of soreness" is evaluated - a straightened arm is withdrawn slowly from the trunk and is also slowly lowered( Figure 1.3.3).
Fig.1.3.3 Diagram of the "arch of pain"
With this composite movement, the first 90 ° is performed by retraction in the shoulder joint, the next 70 ° - due to the rotation of the shoulder blade and the remaining 20 ° - also due to movement in the shoulder joint. Therefore, painfulness in one or another part of the arc, described by the hand in this movement, can be distinguished from the damage of the shoulder joint from other causes that cause pain in the shoulder region( for example, from damage to the rotator cuff of the shoulder).
The main distinguishing symptom of shoulder joint damage is the restriction of the outer rotation of the shoulder( normal 45 °) and the possibility of removing the straightened upper limb to the side. Also assess the instability of the joint.
Osteoarthritis of the hand joints is formed with age or independent of it with excessive physical stress on the hand. It manifests itself in the form of pain, restriction of the function of the fingers and specific deformities of the fingers. In 90% of patients, the process is localized in the distal interphalangeal joints. The process in the joints begins gradually, gradually progressing, hitting the articular cartilage. In the future, there are sprouting of newly formed coarse-fibrous tissue. In the distal interphalangeal joint( the joint between the nail and the middle phalanx of the finger) they are called the Geberden nodes, in the proximal interphalangeal joint( the joint between the main and middle phalanges of the finger) - the knots of Bouchard.
Often, such manifestations are symmetrical on both hands, spread to different joints, accompanied by muscle atrophy, do not give an effusion to the joint, and do not cause acute suffering.
Prevention of osteoarthritis
It is known that human health depends not only and not so much on the skill of the doctor, but on the correct way of life. And maybe the main task of a doctor is to teach his patient that.
The disease is characterized by chronic course and periodic exacerbations. Therefore, measures aimed at preventing exacerbations and slowing the progression of the disease are secondary prevention. It is necessary to pay special attention to the diet and the motor regime. Thus, during an exacerbation of osteoarthritis, the affected joint needs rest, but with a reduction in the pain syndrome, the motor mode should be expanded, and the strength and duration of movements should not be excessive.
In case of arthrosis of the joint, the increased physical load promotes the further destruction of the cartilage, so therapeutic exercises should be gentle, easy, in a position that facilitates movement. It is recommended to unload the sick joint( use a cane, and sometimes crutches), do not walk for long distances, avoid long standing on the legs, stay in a bent position. Do not try to "break salt" in the joints - this leads only to the traumatization of cartilage and inflammation of the periarticular tissues, and consequently, to the further progression of the disease.
Orthopedic regimen is one of the main means for joint diseases, without its observance, other therapeutic measures may be less effective. With prolonged walking, even in the absence of pain syndrome, unloading of the joint( cane, crutches, soft and comfortable footwear) is necessary. When using a cane, remember that the handle of the cane should be at the level of the large trochanter of the femur. The angle of flexion of the arm in the elbow joint should be about 45 °.The cane is taken in the hand from the side of the healthy joint. Incorrectly selected cane can cause functional overload of the muscles of the upper limb and spine.
Wrongly selected by the bones lead to squeezing the soft tissues of the shoulder( brachial plexus) and the development of "crutch" plexites. With a pronounced inflammatory process in the joint, a bed rest is recommended with a gradual, accurate activation of the limb after the pain subsides.
Osteoarthritis occurs more often and progresses faster in persons who are overweight, which means an increased strain on the joints of the limbs and the spine. Reducing the body weight in obese patients with osteoarthrosis of the joints of the lower extremities is an important component of the success of treatment along with drug therapy. Clinical studies have shown that with a decrease in body weight, even by 3-6 kg, the severity of symptoms decreases by 30%.Patients with osteoarthritis are recommended diet food.
It is necessary to exclude animal fats, digestible carbohydrates( sugar, chocolate, confectionery, white bread), fatty milk and kefir, cream, condensed milk, fatty and bold cheeses, mayonnaise, pork, mutton, duck and goose meat. It is necessary to use vegetable oil containing polyunsaturated fatty acids( corn, olive, sunflower, cotton), lean meats( veal, chicken, turkey, rabbit), fish( including fatty varieties), vegetables( except potatoes, its consumptionshould be limited) and fruits, skim milk and kefir, low-fat cheeses.
It is recommended to eat a balanced diet with caloric restriction due to fat and carbohydrates, but rich in proteins and vitamins. When exacerbating osteoarthritis, it is desirable to limit carbohydrates, salt and alcohol. In complex therapy, dietary supplements containing chondroitin sulfate and glucosamine sulfate can be recommended.
Medical treatment of osteoarthrosis
Treatment of osteoarthritis today presents an actual and serious problem, even though the list of used medications has recently been significantly enlarged. First of all, this is due to the fact that most drugs used in osteoarthritis have only symptomatic effect. Until the ability of any drug to radically change the course of the disease and completely heal the joint has not been proven.
To the tasks of treatment of osteoarthritis, the following can be attributed:
decrease in the severity of the symptoms of the disease;
improving the functional activity of the limb and the patient as a whole;
slows the progression of osteoarthritis.
Based on data on the main links of structural and metabolic disturbances in the joint tissues, it is possible to single out the main principles of drug treatment of osteoarthritis.
The first principle of is the correction of intraarticular disorders( normalization of the supply of cartilage cells - chondrocytes, suspension or delay of the processes of cartilage and bone tissue destruction, normalization of articular fluid production, protective, protective action, preventing cartilage damage).
The second principle - relief of pain syndrome ( fight against inflammation in the joint, normalization of the tone of the periarticular muscles).
The third principle - improvement of intraosseous and regional blood flow.
The fourth principle - stimulation of metabolic( metabolic) processes in the body .