Osteoarthritis - symptoms and treatment

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

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

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

• Age;
• heredity;
• metabolic disorders;
• increased body weight;
• osteoporosis;
• inadequate and irregular diet;
• endocrine disorders;
• menopause;
• frequent hypothermia;
• trauma;
• arthritis (inflammation of the joint);
• foci of chronic infection or inflammation (for example, chronic tonsillitis).
• Varicose veins.

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

Symptoms of osteoarthritis

Common symptoms of osteoarthritis include:

1. pain during exertion;
2. restriction of movement in the joint;
3. feeling stiff in the morning, feeling "crunchy";
4. pain after a long rest (so-called "start").

Joint pain is rarely acute, more often painful or dull, and usually stops during rest. Symptoms are often wavy and can come and go without attempting treatment. They can be mild, moderate or severe. The problems with osteoarthritis can remain approximately the same for many years, but over time they progress and the condition worsens. Minor and moderate symptoms can be controlled at the same level, but the more severe course of the disease can lead to chronic pain, inability to perform daily household chores, which leads to disability, all the way to disability.

Pathogenesis of osteoarthritis

The main nutrient medium for the joint is synovial fluid. It also plays the role of a lubricant between the joint surfaces. A huge and large role in the development of osteoarthritis is attributed to metabolic processes in the joint and its structures. In the initial phase, when biochemical disorders develop in the synovial fluid, its properties decrease, which triggers the mechanism of destruction. The first to strike 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 nutrient of cartilage - hyaluronic acid, preventing it from leaving its main place of work - the joint cavity. . The saturation of the properties of the joint fluid determines its circulation, which cannot be without regular movement of the joint itself. Hence the well-known phrase "movement is life". Constant circulation of synovial fluid in the joint cavity is the key to full metabolism in it. With a lack of nutrients, cartilage becomes thinner, the formation of new cells stops, the joint surface becomes uneven, rough, with areas of defectsThere is a known link between lower extremity vein disease (for example, varicose veins) and the development of metabolic disorders in the joints, mainly the knees. osteophytes, which is the main reason for the limitation and deformity of the joint. Synovial fluid is saturated with inflammatory cells and decay elements, the joint capsule in response to it thickens, becomes rough and loses elasticity, soft tissues literally dry out (dehydration occurs), hence the discomfort. morning stiffness, "initial pains. " Pathological process in the latterstages provokes the body to engage the last compensatory mechanism - immobilization. At rest and in the so-called physiological position, the pain is minimal, the ligament apparatus is maximally corrected. In this position, the joint tends to fix itself, and rapidly forms coarser exostoses that "fix" the joint, and the patient loses the ability to move it completely. The muscles of such a limb are hypotrophied, become weaker and smaller.

Classification and stages 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 reason, or as a result of age changes. Others are characterized by clear causes and develop as a result of their pathological process (for example, on the background of tuberculosis, osteochondritis dissecans, subchondral necrosis, etc. )

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

• Stage 1: hard structures of the joint are not involved in the process of destruction, there are initial changes in its soft structures and in the composition of the joint fluid (which is a nutrient medium and reduces joint friction), there is malnutrition of the joint.
• Phase 2: followed by the "beginning" of the mechanism of destruction of solid joint structures, marginal solid formations (exostoses, osteophytes) are formed. Moderate complaints of changes in range of motion.
• Stage 3: accompanied by narrowing of the joint lumen, marked destruction of the loaded surface with the formation of osteochondral defects, pronounced restriction of movement, constant feeling of "crunching" during movement, initial changes in the axis of the extremities.
• Stage 4: severe, in which movements in the joint are clearly limited to its complete absence (ankylosis), pronounced inflammatory process, its deformation, formation of bone defects (as a result of complete absence of cartilage cover).

Complications of osteoarthritis

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

• damage to the soft structures of the joint (degenerative cracks of the meniscus, rupture of ligaments, etc. );
• chronic inflammatory process;
• ankylosis (complete lack of movement in the joint);
• joint deformation.

If this is a secondary form, then the complications depend on the process that caused the development of osteoarthritis. For example, it can lead to osteoporosis, a chronic disease characterized by a progressive disorder of bone metabolism. As a result, the bones become brittle, their diet is disrupted, as a result, osteoarthritis is complicated by the threat of intra-articular fractures. That is why it is very important to see a doctor on time. As the eminent surgeon wrote, "The future belongs to preventive medicine. "

Diagnosis of osteoarthritis

The diagnosis of osteoarthritis often begins with a doctor (usually an orthopedic traumatologist) first-line medical care (polyclinic), where a clinical examination is performed and examination data (CT, MRI, X-rays, etc. ) are interpreted to determine the condition. degree and type of osteoarthritis. . . Diagnosis and diagnosis are usually simple. If the diagnosis is unclear or the doctor suggests a secondary development of the disease, then the patient is referred to doctors of other specialties (for example, a rheumatologist) for clarification. It is very difficult to determine the degree of arthrosis without examination results. Medical history, methods, and treatment attempts are also important for diagnosis and determination of treatment tactics, as the physician is often faced with the difficult task of differential diagnosis (e. g. , symptoms of osteoarthritis and arthritis often coincide).

Treatment of osteoarthritis

The initial stages of osteoarthritis are amenable to conservative treatment, provided an integrated approach. Treatment lasts a long time and has a 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 therapy, which includes courses of exercise therapy (physiotherapy and gymnastics), physiotherapy (usually phonophoresis and magnetotherapy), swimming, anti-inflammatory therapy (either for ingestion or topically in the form of gels or creams), chondroprotectivebase of cartilage components) and intra-articular injections (these can be both homeopathic medicines and hyaluronic acid preparations). Chondroprotectors are still used by orthopedic traumatologists, they are prescribed by internal courses, but the results of recent scientific studies in Western countries refute the positive effect compared to the placebo effect. With pronounced symptoms and difficult stages, conservative treatment becomes ineffective, which puts surgical treatment in the first place. Given the indications, it can also be a minimally invasive treatment - arthroscopy and endoprosthetics. Arthroscopy (joint endoscopy) repairs under the control of video optics, removes exostoses (if possible) and damage to soft structures, which is often observed in such phases. Recently, however, the benefit of this type of intervention for osteoarthritis has been increasingly questioned, as it does not have the desired effect in chronic pain, and in some cases can cause significant harm if performed poorly.

Endoprosthetics is a technically difficult and difficult operation whose purpose is to create an artificial, completely new joint. It requires clear indications and risk identification in the presence of contraindications. Today, endoprostheses are successfully used for the knee, hip and shoulder joints. Further outpatient supervision of doctors reduces the risks and deadlines for rehabilitation, improves the quality and efficiency of the performed procedure.

Forecast. Prophylaxis

Prediction depends on a timely visit to the traumatologist-orthopedist and the beginning of the treatment complex. As for the elimination of morphological changes in osteoarthritis, the prognosis is unfavorable, because it is impossible to completely restore the cartilaginous 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 the problems and restore full motor function of the joint.

Preventive measures:

1. Regular physical activity.It is a misconception that physical activity can "wear out" a joint. Increased - yes, but not regularly and moderately. According to the latest data, any activity aimed at strengthening and maintaining muscle mass, improving coordination, supports the motor function of the joints and their blood supply. Every physical activity allows you to achieve regular circulation of joint fluid, which is the main source of nutrition for the joint and its structures. It is known that people who use public transport every day and have pedestrian traffic are less likely to get osteoarthritis.
2. Weight control and its adequate reduction.Increased mass increases the load on the joints of the lower extremities and spine. Therefore, each protocol for the rehabilitation and conservative treatment of osteoarthritis includes an LFT course (physiotherapy exercises and gymnastics).
3. Correction and elimination of congenital deformities.Flat feet play an important role, which over the years leads to a violation of the axis of the legs, which implies an increased disproportionate load on certain parts of the joints and spine, deforming them.
4. Good nutrition.It allows you to create the conditions for complete enrichment of the joints with nutrients. Therefore, the rejection of a large number of foods, frequent diets, irregular feeding of poor food (fast food, etc. ) can become a "trigger" for the development of osteoarthritis.
5. Timely elimination of accompanying diseases.Now forgotten medical examinations have enabled the timely recognition and elimination of the disease at an early stage. Concomitant diseases can be a significant cause of the development and progression of arthrosis (for example, diseases of the endocrine system, gastrointestinal tract, chronic foci of infection or inflammation).