Arthrosis 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 arthrosis equally often, however, among young patients there is little male dominance, and among the elderly - women. The exception to the general picture is arthrosis of the interphalangeal joint, which develops in women 10 times more often than in men.
With age, the incidence increases dramatically. So, according to studies, arthrosis is detected in 2% of people under the age of 45, in 30% of people from 45 to 64 years and in 65-85% in people aged 65 and over. Arthrosis of the knee, hip, shoulder and ankle joints is of the greatest clinical importance because of its negative impact on the living standards and work capacity of patients.
cause
In some cases, the disease occurs for no apparent reason, the arthrosis is called idiopathic or primary.
There is also secondary arthrosis - developed as a result of some pathological process. The most common causes of secondary arthrosis are:
- Injuries (fractures, meniscus injuries, ruptured ligaments, dislocations, etc. ).
- Dysplasia (congenital joint developmental disorder).
- Degenerative-dystrophic processes (Perthes disease, osteochondritis dissecans).
- Diseases and conditions in which there is increased mobility of the joints and weakness of the ligament apparatus.
- Hemophilia (arthrosis develops as a result of frequent hemarthrosis).
Risk factors for the development of arthrosis include:
- Old age.
- Overweight
- Excessive pressure on certain joints or joints.
- Surgical intervention on the joints,
- Hereditary predisposition (presence of arthrosis in the immediate family).
- Endocrine imbalances in menopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (shoulder arthritis, lumbar-iliac muscle syndrome).
- Recurrent microtrauma of the joints.
Pathogenesis
Arthrosis is a polyetiological disease, which, regardless of the specific cause of its occurrence, is based on a violation of the normal formation and restoration of cartilaginous tissue cells.
Usually, articular cartilage is smooth and elastic. This allows the articular surfaces to move relatively independently of each other, providing the necessary shock absorption and, thus, reducing the load on adjacent structures (bones, ligaments, muscles and capsules). With arthrosis, the cartilage becomes rough, the articular surfaces begin to "cling" to each other during movement. The cartilage is getting looser. Small pieces are separated from it, which fall into the joint cavity and move freely in the joint fluid, injuring the synovium. In the superficial zone of prone, small foci of calcification appear. In the inner layer, ossification areas appear. In the central zone, a cyst is formed, communicating with the joint cavity, around it, due to the pressure of the intra-articular fluid, the ossification zone is also formed.
Pain syndrome
Pain is the most persistent symptom of arthrosis. The most obvious pain symptoms in arthrosis are contact with physical activity and with weather, night pain, onset pain and sudden onset of pain in combination with joint restriction. With prolonged effort (walking, running, standing), the pain intensifies, and during rest they subside. The cause of night pain in arthrosis is venous congestion, as well as an increase in intraosseous blood pressure. The pain is exacerbated by adverse weather factors: high humidity, low temperatures and high atmospheric pressure.
The most characteristic sign of arthrosis is the onset of pain - pain that occurs during the first movement after a state of rest and disappears while maintaining motor activity.
symptoms
Arthrosis develops gradually, gradually. Initially, patients are concerned about mild, short -term pain with no obvious localization, exacerbated by physical exertion. In some cases, the first symptom is throbbing when moving. Many patients with arthrosis report discomfort in the joints and temporary stiffness during the first movement after the rest period. Thereafter, the clinical picture is complemented by night pain and weather. Over time, the pain becomes more and more pronounced, there is a significant restriction of movement. Due to the increased load, the joints on the opposite side begin to ache.
The period of exacerbation alternates with remission. Exacerbation of arthrosis often occurs against the background of increased pressure. Due to the pain, the limb muscles reflexively spasm, muscle contractions can form. Meditation on the joints becomes more and more constant. During rest, muscle cramps and discomfort in muscles and joints appear. Due to the increasing deformation of the joints and severe pain syndrome, lameness occurs. In the final stages of arthrosis, the deformation becomes more pronounced, the joints are bent, movement in them is very limited or absent. Support is tough; when moving, patients with arthrosis should use a cane or crutches.
Diagnostics
Diagnosis is made based on characteristic clinical signs and X-ray pictures of arthrosis. X-rays are taken from diseased joints (usually in two projections): with gonarthrosis-X-rays of the knee joint, with coxarthrosis-X-rays of the hip joint, etc. X-ray pictures of arthrosis consist of signs of dystrophic changes in areas of articular cartilage and adjacent bones. Joint gaps are narrowed, bone sites are deformed and flattened, cyst formation, subchondral osteosclerosis and osteophytes are revealed. In some cases, with arthrosis, signs of joint instability are found: axial curvature of the limb, subluxation.
Taking into account radiological signs, specialists in orthopedics and traumatology distinguish the following stages of arthrosis (Kellgren-Lawrence classification):
- Stage 1 (dubious arthrosis) - suspicion of narrowing of the joint space, osteophytes are absent or present in small amounts.
- Stage 2 (mild arthrosis) - suspicion of narrowing of the joint space, osteophytes are clearly defined.
- Stage 3 (moderate arthrosis) - obvious narrowing of the joint space, there are obvious osteophytes, possible bone defects.
- Stage 4 (severe arthrosis) - significant narrowing of the joint space, large osteophytes, significant bone defects and osteosclerosis.
Sometimes X-rays are not enough to accurately assess the condition of the joint. To study the bone structure, CT of the joint is performed, to assess the condition of the soft tissue - MRI of the joint.
Treatment
The main goal of treating patients with arthrosis is to prevent further cartilage destruction and to preserve joint function.
During the remission period, patients with arthrosis are sent to physical therapy. The set of exercises depends on the stage of arthrosis.
Drug treatment in the exacerbation phase of arthrosis includes the appointment of nonsteroidal anti-inflammatory drugs, sometimes combined with sedatives and muscle relaxants.
Long -term use of arthrosis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation and eliminate muscle spasms, patients with arthrosis are referred for physiotherapy. 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, inductothermy, thermal procedures (ozokerite, paraffin), sulfide, radon and sea baths. Electrical stimulation is done to strengthen the muscles.
In the event of destruction of the articular surface with obvious joint dysfunction, arthroplasty is performed.