Osteoarthritis - symptoms and treatment

Osteoarthritis(osteoarthritis) 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, hips, shoulders, and first metatarsophalangeal. Injury to other joints is much less common and is often secondary. In recent years, the disability caused by osteoarthritis has doubled.

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

• age;
• inheritance;
• metabolic disorders;
• body weight gain;
• osteoporosis;
• inadequate and irregular nutrition;
• 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 exercise;
2. restriction of movement in the joints;
3. feeling of stiffness in the morning, feeling of "chewing";
4. pain after a long rest (the so-called "onset").

Joint pain is rarely acute, more often aching or dull, and usually stops during rest. Symptoms are often wavy and can come and go without trying to be treated. They can be mild, moderate or severe. Complaints in osteoarthritis may remain roughly 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 severe course of the disease can lead to chronic pain, inability to perform daily household activities, leading to disability, up to disability.

Pathogenesis of osteoarthritis

The main nutrient for the joint is synovial fluid. It also plays the role of a lubricating agent between articular surfaces. A major and major role in the development of osteoarthritis is assigned to metabolic processes in the joints and its structures. In the initial stage, when biochemical disorders develop in the synovial fluid, its properties decrease, which triggers the mechanism of destruction. The first to be hit is the synovial membrane of the wrist, 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 the main workplace - the cavity ofkey. . 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 expression "movement is life". The constant circulation of synovial fluid in the ankle cavity is the key to a complete metabolism in it. With a lack of nutrients, the cartilage becomes thinner, the formation of new cells stops, the articular surface becomes uneven, rough, with areas of defects. The relationship between diseases of the veins of the lower extremities (for example, varicose veins) and the development of metabolic disorders in the joints, mainly of the knee, is well known. The bony structure under the cartilage responds to the process with a compensatory mechanism - it thickens, becomes thicker and expands the coverage area, resulting in the formation of exostoses and osteophytes, which is the main reason for the limitations and deformations of the joint. The synovial fluid is saturated with inflammatory cells and decay elements, the joint capsule in response to this thickens, becomes hard and loses elasticity, the soft tissues literally dry out (dehydration occurs), hence the complaints of morning stiffness, "painbeginners ". The pathological process in the final stages provokes the body to activate the last compensatory mechanism - immobilization. At rest and in the so-called physiological position, the pain is minimal, the ligament apparatus is maximally directed. In this position the joint tends to be fixed and succeeds in the rapid formation of more severe exostoses, which "fix" the joint and the patient loses the ability to move it completely. The muscles of such a limb are hypotrophied, becoming weaker and smaller. Such changes are already considered irreversible.

Classification and developmental stages of osteoarthritis

The disease is divided into 2 major groups: primary (or idiopathic) and secondary. The first group develops either as a result of an unclear reason, or as a result of age-related changes. The second is characterized by clear causes and develops as a result of their pathological process (for example, against the background of tuberculosis, osteochondritis disecans, subchondral necrosis, etc. )

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

• Stage 1: strong joint structures are not involved in the destruction process, there are initial changes in its soft structures and in the composition of the joint fluid (which is a nutrient and reduces the friction of the joint), there is a malnutrition of the joint.
• Stage 2: accompanied by the "beginning" of the mechanism of destruction of solid structures of the joint, solid edge formations are formed (exostosis, osteophytes). Moderate complaints about changes in range of motion.
• Stage 3: accompanied by a narrowing of the articular lumen, marked destruction of the surface charged with the formation of osteochondral defects, pronounced restriction of movements, a constant feeling of "chewing" during movement, initial changes in the axis of the limbs.
• Stage 4: severe, in which movements are clearly limited in the joint until its complete absence (ankylosis), a pronounced inflammatory process, its deformation, the formation of bone defects (as a result of complete lack of coveragecartilage).

Complications of osteoarthritis

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

• damage to soft joint structures (degenerative meniscus rupture, ligament rupture, etc. );
• chronic inflammatory processes;
• ankylosis (complete lack of movement in the joints);
• ankle deformity.

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 nutrition is disturbed, as a result, osteoarthritis is complicated by the threat of intra-articular fractures. Therefore, it is so important to consult a doctor in a timely manner. As the eminent surgeon wrote: "The future belongs to preventive medicine. "

Diagnosis of osteoarthritis

The diagnosis of osteoarthritis often begins with a first-line (polyclinic) primary care physician (usually an orthopedic traumatologist) where a clinical examination is performed and examination data (CT, MRI, radiography, etc. ) are interpreted to determine the extent. and type of osteoarthritis. . . Diagnosis and diagnosis are usually straightforward. If the diagnosis is unclear or the doctor suggests a secondary development of the disease, then for clarification the patient is referred to doctors of other specialties (for example, a rheumatologist). It is very difficult to determine the degree of osteoarthritis without examination results. Disease history, methods, and treatment efforts are also important in diagnosing and determining treatment tactics, as the physician often faces the difficult task of differential diagnosis (for example, the symptoms of osteoarthritis and arthritis often coincide).

Treatment of osteoarthritis

The initial stages of osteoarthritis suitable for conservative treatment, provided an integrated approach. Treatment takes a lot of time and pursues the main goal: either to stop the destruction process at the stage at which the treatment started, or to slow down this process. The complex includes drug and non-drug treatment, which includes courses of exercise therapy (physiotherapy and gymnastics exercises), physiotherapy (usually phonophoresis and magnetotherapy), swimming, anti-inflammatory therapy (whether swallowed or topically in gel form orcreams), chondroprotective therapy (taking cartilage-based drugs) 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 inpatient courses, but the results of recent scientific studies in western countries refute the positive effect compared to the placebo effect. With severe symptoms and severe stages, conservative treatment becomes ineffective, which puts surgical treatment first. Given the indications, it may also be minimally invasive treatment - arthroscopy and endoprosthetics. With the arthroscope (articulation endoscope), it is disinfected under the control of video optics, the exostoses are removed (if possible) and the soft structures are damaged, which is often observed in such stages. Recently, however, the benefits of this type of intervention for osteoarthritis have been increasingly questioned, as it does not have the desired effect on chronic pain and in some cases can cause significant harm if performed poorly.

Endoprosthetics is a technically difficult and arduous operation, the purpose of which is to create an artificial, completely new joint. Requires clear indications and identification of risks in the presence of contraindications. Today, endoprostheses for the knee, hip and shoulder joints are used successfully. Further outpatient supervision by the doctor reduces the risks and conditions of rehabilitation, improves the quality and efficiency of the performed surgery.

Forecast. Prophylaxis

The prognosis depends on a timely visit to a traumatologist-orthopedist and the start of a treatment complex. Regarding the elimination of morphological changes in osteoarthritis, the prognosis is unfavorable, as 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 the doctor and adherence to all recommendations, it is possible to eliminate all complaints and restore full motor function of the wrist.

Preventive measures:

1. Regular physical activity.It is a misconception that physical activity can "exhaust" a key. Adult - yes, but not regular and moderate. 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. Any physical activity allows you to achieve regular circulation of key fluid, which is the main source of nutrition for the joint and its structures. It is known that people who use public transportation daily and have foot traffic are less likely to develop osteoarthritis.
2. Body weight control and its adequate reduction.The added mass increases the load on the joints of the lower extremities and the spine. Therefore, any protocol for rehabilitation and conservative treatment of osteoarthritis includes an LFT course (physiotherapy exercises and gymnastics).
3. Correction and elimination of congenital deformities.An important role is played by flat feet, which over the years lead to a violation of the ankle, which leads to an increase in disproportionate load on certain parts of the joints and spine, deforming them.
4. Good nutrition.Allows you to create conditions for complete enrichment of the joint with nutrients. Therefore, the rejection of a large number of foods, frequent diets, irregular feeding of food poor in substances (fast food, etc. ) can become a "trigger" for the development of osteoarthritis.
5. Timely elimination of concomitant diseases.Already forgotten medical examinations made it possible to identify diseases in time and eliminate them at an early stage. Concomitant diseases can be an important cause of the development and progression of osteoarthritis (for example, diseases of the endocrine system, gastrointestinal tract, chronic foci of infection or inflammation).