The bone-arthritis, chronic pathology which affects the connective tissue structures of the musculoskeletal device. The disease is characterized by progressive course with the gradual destruction of the cartilage. Arthrosis is diagnosed in most patients 65 years and is one of the reasons that the development that is the natural aging process.
The appearance of degenerative-dystrophic pathology, the result of previous trauma, endocrine, or inflammatory diseases, excessive physical exertion or, on the contrary, a sedentary lifestyle. Leading symptom of osteoarthritis is pain, swelling of joints, limitation of movement.
Diagnose pathology leads the instrumental studies — x-rays, arthroscopy, MRI, CT. Arthritis 1 2 severity of treatment-conservative, of course, drugs, physical therapy, massage, physiotherapy treatment. When irreversible destructive changes in the joints, surgery — arthrodesis, arthroplasty.
Pathogenetic mechanisms
Osteoarthritis occurs in pronounced changes in the internal connective tissue structures. The cartilaginous tissue formed deformed erosion, which causes destruction of the collagen fibers, and proteoglycans, which a protein (5-10%), and glycosaminoglycans (90-95%). The result of the collagen network loses its stability, begin to appear metalloproteinases, that destroy all types of extracellular matrix proteins. Decomposition is accelerated by increasing the biosynthesis collage collagens, and stromelysin. Generally, normal values of the enzyme are controlled by cytokines are small peptide information molecules. But with the progression of osteoarthritis, the concentration of these proteins is reduced, which is due to the release of a large number of enzymes damaging cartilage.
Proteoglycans of the changed structure begins to absorb the water molecules that they can't keep. Therefore, the excess fluid enters the collagen fibers. These are the "good", you lose strength, flexibility. Qualitative and quantitative composition of synovial fluid is also experiencing negative changes. Osteoarthritis is a decrease in the concentration of the hyaluronic acid. The üvegporc terminated, it is sufficient if the regeneration process is the amount of nutrients, oxygen. The cartilaginous tissue formed foci of softening, and cracks, individual necrotic growths. Bone head's bare, you begin to micro traumatic the relative offset to each other.
Causes and predisposing factors
The cause of primary (idiopathic) osteoarthritis has not yet been established. This happens, when the absence of any precipitating factors, therefore, presented the theory of hereditary predisposition to early cartilage breakdown. Secondary arthritis develops as a consequence of other diseases, arthritis or previous injuries. What can cause degenerative diseases:
- damage to the joint or nearby soft tissue structures — fracture, dislocation, injuries to the meniscus, a partial tear in the muscles, ligaments, tendons, or the total detachment from bone base;
- congenital dysplastic malformation, articulation;
- violation of the endocrine glands, diseases, metabolism processes;
- rheumatism, or rheumatic fever;
- rheumatoid, reactive, metabolic, arthritis, or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococcus or Staphylococcus epidermidis staphylococcus bacteria;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative disease, such as dissection Legg.
The development of osteoarthritis can hypermobility of the joints due to the production of a particular collagen. This condition is diagnosed in 10% of the planet, and is not considered a pathology. But the hypermobility is accompanied by weakness of the tendinous-ligamentous apparatus, which leads to the common injuries, special ankle (sprains, torn ligaments, sprains).
Cause arthritis sometimes the disorders of hematopoiesis, such as hemophilia. Hemarthrosis, or bleeding into the cavity of the joint, provoking deterioration in the nutrition of cartilage, and the destruction.
The predisposing factors in the elderly is a common stress to the joints, which exceed the limit values of the strength, weight gain, surgery, and hypothermia.
The risk group includes women with menopause, people living in adverse environmental conditions, or contact the toxic chemical compounds. Deficiency in the diet of the foods, vitamins, minerals, creating conditions for the gradual deterioration of the üvegporc.
The clinical picture
The danger of osteoarthritis is that there is no symptoms, the first stage of the development. Pathology is clinically manifested gradually, the first signs arise against significant destruction of the cartilage tissue. First, the people feel mild pain without clear localization. It seems, after the physical exertion — lifting weights, sports training. Sometimes the first clinical manifestation of a crunch, clicks when bending, or better the community. People began to notice that certain movements are difficult. However, in the initial phase of osteoarthritis is stiffness occurs in the morning hours, and soon disappears.
The disease progresses the pain I felt that night, which is not only a sleep disorder, but the appearance of the chronic fatigue. The intensity of the pain syndrome in the second stage increases with the change of weather, exacerbation of chronic disease, infection. Significantly reduced the range of motion. The reason for this is that the stiffness change of the blood thinning of the cartilage, or intentional restriction of people's movement seeks to avoid the pain. This leads to increased load on the opposite joint, which causes further damage. Osteoarthritis characteristics, as well as other special symptoms:
- pain provokes spasms of skeletal muscles, development of muscle contractures (restriction of passive movement, joint);
- the crisis in the joints, clicks, bounces the move to become permanent, you may have almost every displacement of the bones relative to each other;
- often there are painful muscle cramps;
- the joint is deformed, which leads to the diseases, posture, gait;
- in the third stage of the arthrosis deformation is expressed so vividly that the joint is bent, and the volume of movements in them significantly reduced or completely missing;
- the third degree osteoarthritis of the knee, ankle, hip joint motion while the patient uses a cane or crutches.
If not treated, the pathology progresses, and the course of remission alternative, the recurrence of the exacerbations increase the frequency of the time. Stiffness in the morning, now doesn't seem like a long time, it will be permanent.
Examine the patient with osteoarthritis of 1 degree, the doctor concluded that only a mild swelling of the joint complete safety of the range of motion. The pathology of 2 degrees palpation reveals pain, as well as the weakly expressed deformation. In the region of the joint space observed in the formation of bone nodules.
Osteoarthritis is characterized by the development of synovitis — inflammation of the synovial membrane of the hip, knee, ankle, shoulder joint. The leading symptom becomes rounded education seal the field joint, by pressing on which there is a displacement of the fluid (fluctuation). Acute synovitis may be accompanied by rise in temperature up to 37-38°C, headache, indigestion.
Diagnosis
The diagnosis is made up, based on the results of the instrumental examination, clinical features, anamnesis, complaints of patients. General analysis of blood and urine and did not contain any information — all values remain within normal limits, if the arthritis would not trigger the metabolic diseases. The development of synovitis increases the erythrocyte sedimentation rate (30 mm/hour) in the blood increases the level of white blood cells and the fibrinogen. This indicates that can occur in the body acute or chronic inflammatory process. Changes in the biochemical and immunological parameters may be secondary forms of osteoarthritis.
The most informative method of diagnostics of degenerative-dystrophic pathology, x — ray frontal and lateral projections.
| Stage osteoarthritis, in accordance to the classification of Kellgren-Lawrence (1957) | Radiological signs of pathology |
| Starting | In the absence of radiological signs of |
| First | Indistinct, irregular narrowing of the joint space. A little flattening of the edges of the bone plates, the initial formation of joints or lack thereof |
| Second | Marked narrowing of the joint space greater than the norm by 2-3 times, the formation of numerous joint, subchondral osteosclerosis. The appearance kistevidnyj enlightenment, the growth |
| Third | The appearance of expressed subchondral osteosclerosis very marginal joints, significant narrowing of the joint space |
| Fourth | The formation of rough severe pain in the joints, the almost complete fusion of the joint space, the deformation or compression, the growth of the bones forming the joint |
If after studying x-ray images to the doctor, my doubts are setting in the diagnosis, prescribe a CT scan. You'll appreciate the state be located around the joint connective tissue structures MRI. Using contrast in dynamics, to assess the blood flow to the tissue, the stage of the inflammatory process in the development of synovitis.
The main methods of therapy
Osteoarthritis is still an incurable disease, since there is no pharmaceutical drug on the regeneration of cartilage. The main task of the treatment becomes the prevention of the progression of the diseases, preservation of joint mobility. The treatment is long and complex, using both local and systemic drug treatment. Patients should avoid serious stress on the joint, if necessary, to limit the range of motion orthopedic devices such as braces, elastic bandage. The patients with the excess weight, you need to make adjustments to your diet, gradual weight loss, diet.
After achieving sustained remission, patients can be seen daily physical therapy. The first training carried out under the guidance of the therapist, the patient performs the exercises at home. Physical therapy may be supplemented with swimming, yoga, Cycling.
Reduces the severity of pain in the medicine in various clinical pharmacological groups:
- non-steroidal anti-inflammatory drugs, in the form of ointments, tablets, solutions for parenteral application of the active ingredients;
- injection of the common solutions anesthetics in combination with corticosteroids;
- muscle relaxants, to eliminate the muscle spasms and restrictive contractures.
The therapy program contains the B-vitamins, tranquilizers, if necessary, tranquilizers, antidepressants Also appointed chondroprotectors long course get. This is the only group of drugs, the ability to partially restore the cartilage.
Enhance the clinical activity physiotherapy — laser therapy, magnetic field, UHF-therapy.
Joint pain should be the signal for immediate treatment to the doctor. Therapy carried out at the initial stage of osteoarthritis, it will help to stop the destruction of the cartilage, loss of data, in order to avoid the health, or disability.