Osteoarthritis is the most common joint disease. According to experts, 6. 43% of the population of our country suffers from it. Men and women suffer from osteoarthritis equally often, however, in young patients, men easily predominate, and in older women - women. An exception to the overall picture is osteoarthritis of the interphalangeal joints, which occurs 10 times more frequently in women than in men.
The incidence increases dramatically with age. According to studies, osteoarthritis is found in 2% of people under 45 years of age, in 30% of people between 45 and 64 years of age and in 65-85% in people aged 65 and over. Osteoarthritis of the knee, hip, shoulder and ankle is of the utmost clinical importance because of its negative impact on the standard of living and the ability to work of patients.
causes
In some cases, the disease occurs for no apparent reason, such osteoarthritis is called idiopathic or primary.
There is also secondary osteoarthritis that developed as a result of a pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, torn ligaments, dislocations, etc. ).
- Dysplasia (congenital joint development disorders).
- Degenerative-dystrophic processes (Perthes disease, osteochondritis dissecans).
- Diseases and conditions in which there is increased mobility of the joints and weakness of the ligamentous apparatus.
- Hemophilia (osteoarthritis develops as a result of frequent hemarthrosis).
Risk factors for developing osteoarthritis are:
- Older age.
- Obesity
- Excessive stress on the joints or a specific joint.
- Surgical interventions on the joint,
- Hereditary predisposition (the presence of osteoarthritis in the next of kin).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic diseases of the cervical or lumbar spine (shoulder arthritis, lumbar-pelvic muscle syndrome).
- Repeated microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease that, regardless of the specific causes of its occurrence, is based on a violation of the normal formation and restoration of cartilage cells.
Usually the articular cartilage is smooth and elastic. This enables the joint surfaces to move freely with respect to one another, provides the necessary shock absorption and thus reduces the stress on the adjacent structures (bones, ligaments, muscles and capsules). In osteoarthritis, the cartilage becomes rough, the joint surfaces begin to "stick" to one another during movement. The cartilage loses more and more. Small pieces of it are severed and fall into the joint cavity and move freely in the synovial fluid, injuring the synovium. Small foci of calcification appear in the superficial zones of the cartilage, ossification occurs in the deep layers, and cysts are formed in the central zone, communicating with the articular cavity, around which zones of ossification also form due to the pressure of the intra-articular fluid.
Pain syndrome
Pain is the most persistent symptom of osteoarthritis. The most noticeable signs of pain in osteoarthritis are the connection with physical activity and with the weather, night pain, onset of pain and sudden sharp pain in combination with a joint blockage. With prolonged exertion (walking, running, standing) the pain intensifies and it subsides when you are at rest. Night-time pain in osteoarthritis is caused by venous congestion and an increase in intraosseous blood pressure. The pain is aggravated by adverse weather factors: high humidity, low temperature and high air pressure.
The most characteristic sign of osteoarthritis is the onset of pain - pain that appears during the first movements after a state of rest and disappears with the maintenance of motor activity.
Symptoms
Osteoarthritis develops gradually, gradually. Initially, the patients fear slight, short-term pain without a clear localization, which is exacerbated by physical exertion. In some cases, the first symptom is a crunch when moving. Many patients with osteoarthritis report joint discomfort and temporary stiffness during the first movements after a period of rest. The clinical picture is then supplemented by night and weather pain. Over time, the pain becomes more and more severe and there is a noticeable restriction in movement. Due to the increased stress, the joint on the opposite side begins to hurt.
The phases of exacerbations alternate with remissions. Often exacerbations of osteoarthritis occur against the background of increased stress. Pain causes the muscles of the limbs to cramp reflexively, and muscle contractures can form. The crunch in the joint becomes more and more constant. Muscle cramps and discomfort in muscles and joints occur at rest. The increasing deformation of the joint and severe pain syndrome lead to lameness. In the later stages of osteoarthritis, the deformity becomes even more pronounced, the joint is bent, movements in it are significantly restricted or absent. Support is difficult and a patient with osteoarthritis has to use a cane or crutches when moving.
diagnosis
The diagnosis is made on the basis of the characteristic clinical symptoms and the x-ray of the osteoarthritis. The diseased joint is x-rayed (usually in two projections): for gonarthrosis - x-ray of the knee joint, for coxarthrosis - x-ray of the hip joint, etc. The x-ray of osteoarthritis consists of signs of dystrophic changes in the articular cartilage and the adjacent bone. The joint space is narrowed, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis and osteophytes become visible. In some cases, with osteoarthritis, signs of joint instability are noted: curvature of the limb axis, subluxation.
Taking into account the radiological signs, specialists in orthopedics and traumatology differentiate between the following stages of osteoarthritis (Kellgren-Lawrence classification):
- Stage 1 (doubtful osteoarthritis) - a narrowing of the joint space is suspected, osteophytes are absent or present in small numbers.
- Stage 2 (mild osteoarthritis) - suspected narrowing of the joint space, osteophytes are clearly defined.
- Stage 3 (moderate osteoarthritis) - a significant narrowing of the joint space, clearly pronounced osteophytes, bone deformities are possible.
- Stage 4 (severe osteoarthritis) - pronounced narrowing of the joint space, large osteophytes, pronounced bone deformities and osteosclerosis.
Sometimes x-rays are not enough to accurately assess the condition of the joint. To examine the bone structures, a CT scan of the joint is done to assess the condition of the soft tissues - MRI of the joint.
treatment
The main goal of treating patients with osteoarthritis is to prevent further cartilage destruction and to keep the joint working.
During remission, a patient with osteoarthritis is sent for physical therapy. The exercise set depends on the stage of osteoarthritis.
Drug treatment in the period of exacerbation of osteoarthritis includes the appointment of nonsteroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of osteoarthritis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation, and relieve muscle spasms, a patient with osteoarthritis is referred for physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet radiation are prescribed, in the remission phase - electrophoresis with dimexide, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermia, thermal procedures (ozokerite, paraffin), sulfide, radon and sea baths. Electrostimulation is carried out to strengthen the muscles.
If joint surfaces with pronounced dysfunction of the joint are destroyed, endoprosthetics are performed.