Osteoarthritis - symptoms and treatment

Osteoarthritis(arthrosis) is a disease of the joints characterized by degenerative changes in the cartilage that cover the bone, in other words, its destruction.

The majority of the joints affected are the knee, hip, shoulder, and first metatarsophalangeal. Damage to other joints is less common and often secondary. In recent years, deformities caused by osteoarthritis have doubled.

Like any disease, osteoarthritis also has risk factors for its development, which are actively studied today, and the list grows every year. The main ones are considered to be:

• age;
• descent;
• metabolic disorders;
• weight gain;
• osteoporosis;
• inadequate and irregular nutrition;
• endocrine disorders;
• menopause;
• frequent hypothermia;
• trauma;
• arthritis (inflammation of the joints);
• foci of infection or chronic inflammation (e. g. , chronic tonsillitis).
• Vena varicose veins.

If you notice similar symptoms, consult your doctor. Do not self -medicate - it is dangerous to your health!

Symptoms of Osteoarthritis

Common symptoms of arthrosis include:

1. pain during exercise;
2. limitation of movement in the joints;
3. a feeling of stiffness in the morning, a feeling of "crunch";
4. pain after a long rest (called "starting").

Joint pain is rarely acute, more often painful or dull, and usually stops at rest. Symptoms are often wavy and can come and go without trying to treat. They can be mild, moderate or severe. Complaints in osteoarthritis may remain more or less the same for many years, but over time it progresses and the condition gets worse. Minor and moderate symptoms can be controlled to the same degree, but the course of a severe illness can lead to chronic pain, an inability to perform daily household activities, requiring disability, up to disability.

Pathogenesis of osteoarthritis

The main nutrient medium for the joints is synovial fluid. It also plays a role as a lubricating agent between articular surfaces. A large and major role in the development of osteoarthritis is given to metabolic processes in the joint and in its structure. In the early stages, when biochemical disturbances develop in the synovial fluid, its nature diminishes, which triggers a destructive mechanism. The first to be affected is the synovial membrane of the joint, which plays an important role as a membrane and is a kind of filter for the most important cartilage nutrient - hyaluronic acid, preventing it from leaving its main workplace - the joint cavity. The saturation nature of the joint fluid determines its circulation, which cannot be without the constant movement of the joint itself. Hence the famous phrase "movement is life". The constant circulation of synovial fluid in the joint cavity is the key to full metabolism in it. With a lack of nutrients, the cartilage becomes thinner, the formation of new cells stops, the articular surface becomes uneven, rough, with areas of defects. The link between lower leg vein disease (e. g. , varicose veins) and the development of metabolic disorders in the joints, especially the knee, is known. The bone structure beneath the cartilage responds to the process with a compensatory mechanism - it thickens, becomes rougher and widens the area of coverage, resulting in the formation of exostoses and osteophytes, which are the main reasons for joint limitations and deformities. Synovial fluid is saturated with inflammatory cells and decay elements, the joint capsule in response to this thickens, becomes rough and loses elasticity, soft tissues completely become dry (dehydration occurs), therefore complaints of morning stiffness, "pain begins". The pathological process at the last stage provokes the body to turn on the last compensatory mechanism - immobilization. At rest and in the so -called physiological position, pain is minimal, the ligament apparatus is straightened to the maximum. In this position, the joint tends to improve itself, and it succeeds in the rapid formation of rougher exostoses, which "fix" the joint, and the patient loses the ability to move it fully. The muscles of such limbs undergo hypotrophy, becoming weaker and smaller. Such changes are already considered irreversible.

Classification and stage of development of osteoarthritis

The disease is divided into 2 major groups: primary (or idiopathic) and secondary. The first group develops as a result of either an unclear cause, or as a result of age -related changes. The latter are characterized by obvious causes and develop as a result of their pathological processes (for example, against the background of tuberculosis, osteochondritis dissecans, subchondral necrosis, etc. ).

Regardless of the cause that is a factor in the development of osteoarthritis, there are 4 stages of its development:

• Stage 1: the hard structure of the joint is not involved in the process of destruction, there are initial changes in its soft structure and in the composition of the joint fluid (which is a nutrient medium and reduces joint friction), there is a lack of nutrients in the joints.
• Stage 2: accompanied by the "beginning" of the mechanism of destruction of the solid structure of the joint, the formation of edge solids (exostoses, osteophytes) is formed. Moderate complaints about changes in range of motion.
• Stage 3: accompanied by narrowing of the articular lumen, significant destruction of the loaded surface with the formation of osteochondral deformities, significant limitation of movement, a feeling of constant "crunch" during movement, initial changes in the axis of the limb.
• Stage 4: severe, in which movement is clearly limited in the joint until its complete absence (ankylosis), a significant inflammatory process, its deformation, the formation of bone defects (due to the complete absence of cartilage cover).

Complications of osteoarthritis

Without treatment, any disease causes complications, and arthrosis is no exception. If this is the main form, then the main complications include:

• damage to the soft structures of the joints (degenerative tears of menisci, rupture of ligaments, etc. );
• chronic inflammatory processes;
• ankylosis (complete absence of movement in the joints);
• change the shape of the joint.

If this is a secondary form, then the complication depends on the process that led to the development of arthrosis. For example, it can cause osteoporosis, a chronic disease characterized by progressive disorders of bone metabolism. As a result, bones become brittle, their nutrition is disrupted, as a result, osteoarthritis is complicated by the threat of intra-articular fractures. Therefore, it is very important to see a doctor on time. As a famous surgeon wrote: "The future belongs to preventive medicine. "

Diagnosis of osteoarthritis

The diagnosis of arthrosis usually begins with a doctor (usually an orthopedic traumatologist) of first -line medical care (polyclinic), where clinical examinations are performed and examination data (CT, MRI, radiographs, etc. ) are interpreted to determine the extent and type of osteoarthritis. . . Diagnosis and diagnosis are usually easy. If the diagnosis is unclear or the doctor suggests a secondary development of the disease, then for clarification the patient is referred to another specialist doctor (for example, a rheumatologist). It is very difficult to determine the degree of arthrosis without examination results. Disease history, methods and treatment trials are also important for diagnosis and determination of treatment tactics, as physicians often face the difficult task of differential diagnosis (e. g. , symptoms of arthrosis and arthritis often coincide).

Osteoarthritis Treatment

early life osteoarthritis can receive conservative treatment, by providing an integrated approach. Treatment takes a long time and pursues the main goal: either to stop the process of destruction at the stage where treatment is started, or to slow down this process. The complex includes drug and non-drug treatments, which include courses of exercise therapy (physiotherapy and gymnastics exercises), physiotherapy (usually phonophoresis and magnetotherapy), swimming, anti-inflammatory therapy (either ingestion or topical in gel or cream form), chondroprotective therapy(taking medications based on cartilage components) and intra-articular injections (these can be both homeopathic remedies and hyaluronic acid preparations). Chondroprotectors are still used by orthopedic traumatologists, they are prescribed by an internal course, but the results of recent scientific studies in Western countries negate the positive effect compared to the placebo effect. With severe symptoms and severe stages, conservative treatment becomes ineffective, which puts surgical treatment in the first place. Given the symptoms, it can be a minimally invasive treatment - arthroscopy and endoprosthetics. With arthroscopy (endoscopy of the joint), it is cleaned under video optical control, exostoses (if possible) and damage to the soft structure are removed, which is often observed at such a stage. Recently, however, the benefits of this type of intervention for osteoarthritis have been increasingly questioned, as it does not have the desired effect in chronic pain, and in some cases it can cause significant harm if done poorly.

Endoprosthetics is a difficult and technically difficult operation, the goal of which is to create a completely new artificial joint. Requires clear instructions and risk identification in the presence of contraindications. Today, endoprostheses for the knee, hip and shoulder joints are successfully used. Further outpatient supervision by physicians reduces the risks and conditions of recovery, improving the quality and efficiency of operations performed.

Prediction. Prophylaxis

Prognosis depends on timely visits to a traumatologist-orthopedic specialist and the beginning of a complex of treatment. In terms of eliminating morphological changes in osteoarthritis, the prognosis is unfavorable, as it is impossible to fully restore the cartilage structure of the joint. In old age, the course of the disease is more severe than in young people. However, with timely access to a doctor and compliance with all recommendations, it is possible to eliminate all complaints and restore full motor function of the joints.

Precautions:

1. Regular physical activity.It is a misconception that physical activity can "consume" the joints. Increased - yes, but unusual and modest. According to the latest data, any activity aimed at strengthening and maintaining muscle mass, improving coordination, supporting the motor function of the joints and their blood supply. Any physical activity allows you to achieve a constant circulation of joint fluid, which is a major source of nutrition for the joints and their structure. It is known that people who use public transportation every day and have foot traffic are less likely to get osteoarthritis.
2. Adequate weight control and reduction.The increased mass increases the load on the joints of the lower legs and spine. Therefore, any protocol for the rehabilitation and conservative treatment of osteoarthritis includes a course of LFT (physiotherapy and gymnastics training).
3. Correction and elimination of congenital defects.An important role is played by flat feet, which for many years lead to violations of the axis of the foot, which requires an increase in unbalanced load on certain parts of the joints and spine, changing its shape.
4. Good diet.It allows you to create conditions for full enrichment of the joints with nutrients. Therefore, the rejection of a large number of foods, frequent diet, irregular diet poor in nutrients (fast food, etc. ) can be a "trigger" for the development of osteoarthritis.
5. Timely elimination of concomitant diseases.The now -forgotten medical examination makes it possible to identify and eliminate the disease in a timely manner at an early stage. Concomitant diseases can be the main cause of the development and progression of arthrosis (for example, diseases of the endocrine system, gastrointestinal tract, chronic focus of infection or inflammation).