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 with the same frequency, however, among young patients there is a slight predominance of men and among the elderly, women. An exception to the general picture is osteoarthritis of the interphalangeal joints, which develops in women 10 times more often than in men.
With age, the incidence increases dramatically. So, according to studies, osteoarthritis is detected in 2% of people under 45 years of age, in 30% of people between 45 and 64 years of age, and in 65-85% of people aged 65 and over. Osteoarthritis of the knee, hip, shoulder and ankle joints is of the highest clinical importance due to its negative impact on the standard of living and the work capacity of patients.
Causes
In some cases, the disease occurs for no apparent reason, such arthrosis is called idiopathic or primary.
There is also a secondary osteoarthritis, developed as a result of some pathological process. The most common causes of secondary osteoarthritis are:
- Injuries (fractures, meniscus injuries, ligament tears, dislocations, etc. ).
- Dysplasia (congenital developmental disorders of the joints).
- Degenerative-dystrophic processes (Perthes disease, dissecting osteochondritis).
- 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 the development of osteoarthritis include:
- Advanced age.
- Over weight
- Excessive stress on the joints or a specific joint.
- Surgical interventions on the joint,
- Hereditary predisposition (presence of osteoarthritis in relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders in the cervical or lumbar spine (shoulder arthritis, lumbar-iliac muscle syndrome).
- Repetitive microtrauma of the joint.
Pathogenesis
Osteoarthritis is a polyetiological disease, which, regardless of the specific causes of its occurrence, is based on a violation of the normal formation and restoration of cartilage tissue cells.
Normally, the articular cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, provides the necessary shock absorption and thus reduces the load on adjacent structures (bones, ligaments, muscles and capsule). With osteoarthritis, the cartilage becomes rough, the joint surfaces begin to "stick" to each other during movement. The cartilage becomes more and more loose. Small pieces separate from it, fall into the joint cavity and move freely in the joint fluid, injuring the synovial membrane. Small foci of calcification appear in the superficial areas of the cartilage. Areas of ossification appear in the deep layers. In the central area, cysts are formed that communicate with the joint cavity, around which, due to the pressure of the intra-articular fluid, areas of ossification are also formed.
Pain syndrome
Pain is the most constant symptom of osteoarthritis. The most striking signs of pain in osteoarthritis are the connection with physical activity and with the weather, night pains, initial pain and sudden sharp pains in combination with the blockage of the joints. With prolonged effort (walking, running, standing), the pain intensifies and at rest disappears. The cause of night pain in osteoarthritis is venous congestion, as well as an increase in intraosseous blood pressure. The pains are aggravated by unfavorable climatic factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of osteoarthritis is the initial pain, pain that occurs during the first movements after a state of rest and disappears while maintaining motor activity.
Symptoms
Osteoarthritis develops gradually, gradually. Initially, patients are concerned with brief, mild pain without clear localization, aggravated by physical exertion. In some cases, the first symptom is a cracking noise when moving. Many patients with osteoarthritis report a feeling of discomfort in the joint and temporary stiffness during the first movements after a period of rest. Subsequently, the clinical picture is complemented by nocturnal and meteorological pain. Over time, the pain becomes more and more pronounced, there is a noticeable restriction of movement. Due to the increased load, the joint on the opposite side begins to ache.
Periods of exacerbations alternate with remissions. Exacerbations of osteoarthritis often occur in a context of increased stress. Due to pain, the muscles of the extremities undergo reflex spasms and muscle contractures can form. The creaking in the joint becomes more and more constant. At rest, muscle cramps and discomfort in muscles and joints appear. Due to the increasing deformation of the joint and severe pain syndrome, lameness occurs. In the later stages of osteoarthritis, the deformity becomes even more pronounced, the joint is bent, movements in it are significantly limited or absent. Support is difficult; When moving, a patient with osteoarthritis has to use a cane or crutches.
Diagnosis
The diagnosis is made on the basis of the characteristic clinical signs and the X-ray image of osteoarthritis. X-rays of the diseased joint are taken (usually in two projections): with gonarthrosis - X-ray of the knee joint, with coxarthrosis - X-ray of the hip joint, etc. The radiographic image of osteoarthritis consists of signs of dystrophic changes in the area of the articular cartilage and adjacent bone. The articular gap narrows, the bone site is deformed and flattened, cystic formations, subchondral osteosclerosis, and osteophytes are revealed. In some cases, with arthrosis, signs of joint instability are found: curvature of the limb axis, subluxation.
Taking into account the radiological signs, specialists in the field of orthopedics and traumatology distinguish the following stages of osteoarthritis (Kellgren-Lawrence classification):
- Stage 1 (doubtful osteoarthritis): suspected narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild osteoarthritis) - a suspected narrowing of the joint space, the osteophytes are clearly defined.
- Stage 3 (moderate osteoarthritis) - a clear narrowing of the joint space, there are 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 study bone structures, a joint CT scan is performed to assess the state of soft tissues - MRI of the joint.
Treatment
The main goal of treating patients with osteoarthritis is to prevent further destruction of cartilage and preserve joint function.
During the remission period, a patient with osteoarthritis is sent to physical therapy. The set of exercises depends on the stage of osteoarthritis.
Drug treatment in the exacerbation phase of osteoarthritis includes the appointment of non-steroidal 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 eliminate muscle spasms, a patient with osteoarthritis is referred for physical therapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet irradiation 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. Electrical stimulation is done to strengthen the muscles.
In case of destruction of articular surfaces with pronounced dysfunction of the joint, an arthroplasty is performed.