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Arthrosis

Arthrosis of the ankle joint

Arthrosis is a whole group of dystrophic-depth diseases of the articular apparatus with various etiology, but a similar clinical picture of pathological changes.The hyaline cartilage of the joint, then the drunken bone tissue, the joint capsule and the ligamentous apparatus, are exposed to destruction and deformation.The disease is chronic progressive and without proper treatment can significantly limit the patient's motor activity.

The diagnosis and treatment of pathology is engaged in an arthrologist, rheumatologist, surgeon, orthopedist.



General information

Arthrosis is diagnosed in approximately 1/5 of the population of the planet, but the disease is more characteristic of elderly.This proves the statistics of its spread among different ages:

  • Youth up to 40 years-no more than 6-7 %;
  • Mature faces after 45 years-up to 20-25%;
  • After 70 years - up to 80%.

The disease affects the tissues that are under a constant load: small joints of the hands and plus of the legs, hip and knee joints, areas in the cervical and thoracic parts of the spine, a little less often ankle and shoulder joint.

Note! The defeat of the interfalancing joints of the hands in women occurs 10 times more often than in men.

In many Western countries, the term “arthrosis” is not used, replacing it with the concept of “arthritis”.Such a substitution is quite justified, since inflammatory processes in most cases precede arthrosis or accompany it.In domestic medicine, the terms “arthrosis” and “arthritis” essentially mean the same disease, but with different etiology of the process.Additionally, the concepts of osteoarthritis, osteoarthrosis, deforming osteoarthrosis are used to designate the pathology.

Note! The difference between arthritis and arthrosis lies in the cause of the disease.In the first case, these are inflammatory processes (suffix -it means inflammation), in the second -metabolic disorders (protein, mineral). 

The mechanism of development and the causes of arthrosis

The main cause of arthrosis is a violation of equilibrium in the processes of anabolism and catabolism of cartilage and bone tissues.If the processes of synthesis prevail normally, then during arthrose changes, destruction processes go faster.As a result, rapid aging and degeneration of tissue structures is observed.They begin to collapse first at the cellular level, then at the organ-tone.The first destructive changes appear:

  • clouding of cartilage;
  • superficial storageness;
  • microcracks and tears;
  • The focal and general thinning of the cartilage layer.

The cartilage loses natural elasticity and density and is no longer able to serve as a shock absorber during movements.The mutual correspondence of the shape of the joint surfaces is disturbed, which leads to deformation of the connection.This exacerbates the development of pathological changes and triggers a number of irreversible processes.In exchange for the lost cartilage, bone tissue begins to grow with the formation of spikes and outgrowths, which fetter movements and subsequently can lead to severe disability of the patient.

Reasons for this scenario:

  • Violations of mineral metabolism are able to lead to gouty changes in the joints, osteoporosis, etc.
  • The disadvantage of tissue nutrition is venous stagnation and poor microcirculation slows down blood supply and lymphatic drainage.The mineral composition of the bone is depleted, it becomes osteoporous and loses the ability to self -heal.The phenomenon is characteristic of a lack of movement, with vascular pathologies, hormonal failures.
  • Inflammatory processes - a consequence of acute infectious diseases, hypothermia of the body, impaired hormonal background.
  • Autoimmune reactions are chronic foci of inflammation, nervous stress, endocrine pathologies and other causes can provoke aggression of the body's immune system against its own cells, including articular tissues.The most common autoimmune lesions with rheumatoid arthritis, scleroderma, and red lupus.
  • Increased joint wear - a mismatch between functionality and the load laid slows down the synthesis processes and accelerates destruction.The phenomenon is characteristic of athletes, dancers, people with overweight, as well as for everyone who is engaged in heavy physical labor or is associated with long static loads (standing work).
  • Injuries - bruises, dislocations, fractures, penetrating wounds, tears - violate the structure of tissues and give impetus to the beginning of the deformation.
  • Genetically determined pathologies - connective tissue dysplasia, a violation of collagen synthesis initially form an unstable, low -functional joint.

Some reasons are closely echoing with each other and form a complex pathological complex.

Attention! Hormonal deviations play a particularly important role in violations of bone tissue metabolism.A failure in the thyroid gland, menopause, taking contraceptives, corticosteroids - all this is a direct road to osteoporous and arthrose changes in the skeleton.

Classification of changes

In the systematics of arthrosis, several defining criteria are used: causes and etiology, localization, area of coverage.

By etiology:

  • Primary arthrosis - develop independently, with damage to completely healthy joints, without the participation of previous pathologies;
  • Secondary ones-are formed against the background of a disease (gout, psoriasis, rheumatism), as well as in the presence of existing articular deformations or injuries.

By the degree of coverage:

  • Local forms-with damage to a limited number of joints: monoarthrosis-1 joint, oligoarthritis-2-3;
  • Generalized forms are various types of polyarthrosis, when 3 large structures and more are involved in the pathological process.

According to the localization of the process, the names of the arthrosis of each joint separately are given:

  • Coksartrosis - disables the hip connection;
  • spondylarthrosis - affects intervertebral discs, mainly cervical, chest and lumbar;
  • gonarthrosis - with impaired work of the knee joint;one of the most common species;
  • Cruzartrosis - with the involvement in the pathological process of the ankle.

Arthrosis can be quickly or slowly progressive, compensated or decompensated.

The main symptoms and signs

Arthrosis is a complex disease.Conventionally, it can be divided into several pathologies united among themselves:

  • chondritis and chondrosis - inflammatory and degenerative lesion of cartilage tissue;
  • Osteoporosis is also osteoporosis - a pathological process in bone structures;
  • synovitis - the involvement of the lining shell of the joint capsule;
  • Bursit - general inflammation of the joint bag;
  • Reactive damage to the soft tissues in the adjacent area - affects the muscles, ligaments, fiber.
Stock and pain in arthrosis of the joints of the hands

Depending on the stage, degree and shape, they are observed simultaneously or selectively.With this in mind, a complex of symptomatic changes is formed.Among them:

  • Pokhrutzhazing is a symptom of a violation of mineral metabolism and the first sign of the disease.It can occur at any age.
  • Stock - intensively manifested in the morning.It is short -term and can be expressed by the effect of jamming of the joint.
  • Limiting mobility - reducing the amplitude of movements in the commission of active or passive actions.
  • Pain-has a different manifestation, starting from unpleasant and aching, which, after intense loads, acquires a background character, and ending with acute sharp-when performing movements.The so -called “starting pains” are especially characteristic, which manifest after a long period of rest and last until the joint is completely developed.
  • Swollenness - with inflammation of the soft tissues, synovitis, bursitis.
  • Deformation - is observed with complete degeneration of cartilage and lack of a shock -absorbing factor.

Note! The nodules of Bushara and Geberden is a characteristic sign of deforming arthrosis of the hands.They are bone growths with processes of osteophytes.

Stages and degree of arthrosis

In terms of intensity of arthrose changes, 4 stages of the disease are distinguished:

  • 1st stage - with slight re -flooding of cartilage (violation of structure and functionality in collagen fibers).In the X -ray, the picture is practically not visible.
  • Stage 2 - stinging of cartilage fabric in the lumen of the joint is up to 50%.It is covered with cracks, a slight pain appears in the area of the damaged compound.Osteophytic complexes appear on the X -ray;The joint gap slightly reduces its size.
  • Stage 3 - the lesion of the cartilage almost reaches the bone base, the joint gap is sharply reduced.
  • 4 stages - cartilage is completely damaged, which leads to partial or complete degeneration of the synovial fluid, abrasion of bone tissues about each other and deformation of the compound.In some areas, sclerosis changes develop.The extreme manifestation of arthrosis is the fusion of articular tissues with the ossification of structures and a complete loss of mobility.

In some sources, the stage 1 and 2 is combined into one.

With the progress of symptoms, the motor activity of a person suffers.Given the violations of the functional performance of the joint, 4 degrees of possible development of pathology are distinguished:

  1. 0 degree - mobility and performance are preserved in full;
  2. 1 degree - the patient retains the ability to self -service and manifest social activity, but is not able to engage in labor activity;
  3. 2 degree - difficulties in the manifestation of social activity are added to a violation of labor activity;
  4. 3 degree - all types of activities are limited or completely impossible: labor, social and self -service;The patient needs constant care.

What are possible complications

By tightening with treatment, you can provoke a number of unpleasant consequences:

  • constant pain syndrome;
  • lameness;
  • vertebrates (with spondylarthrosis);
  • pronounced joint deformation;
  • Complete immobility with the ossification of structures.

What does the survey procedure include

For the diagnosis of arthrosis, a medical examination with the collection of an anamnesis is enough.To determine the degree of damage, an instrumental examination is carried out.The main ways to obtain a clear picture of the disease:

  • radiography;
  • CT, MRI;
  • ultrasonography;
  • scintigraphy;
  • Diagnostic arthroscopy with biopsy of cartilage tissue and synovial fluid.

In an acute inflammatory process, the doctor prescribes additional analyzes: a general blood test, rheumen, biochemistry (level of glucose, protein compounds, electrolytes).

Treatment

It is impossible to completely eliminate the disease.Timely treatment of arthrosis allows you to maintain the functionality of the joint, normal motor activity and prevent pain.To exclude complications, it should begin at the first stage.

Drug therapy Includes:

  • anti -inflammatory drugs, mainly NSAIDs;
  • intra -articular steroid blocks of pain and inflammation (with pronounced synovitis, bursitis);
  • proteolysis inhibitors - slow down and suspend the process of destruction of bone and cartilage;
  • antispasmodics - prevent muscle cramps;
  • angioprotectors and drugs to improve blood microcirculation in affected tissues;
  • chondroprotectors;
  • synthetic substitutes for synovial fluid;
  • Vitamin and mineral compositions.
Exercise therapy for the treatment of arthrosis of the joints

A complex of physiotherapy prescribed in parallel to enhance the effect of drugs.The main physiotherapy: 

  • magnetotherapy;
  • electrophoresis;
  • UHF;
  • mud;
  • baths;
  • massage;
  • Exercise therapy and kinesiotherapy using special simulators.



Surgery - The only way to treat in the later stages, when the cartilage tissue is completely destroyed.The following solutions to the problem are possible:

  • endoscopy - with a partial or complete replacement of the joint by an artificial analogue;
  • Arthroscopy - a minimally invasive operation to remove osteophytes or partial replacement of cartilage;
  • Arthrodesis - the closure of joint and fixing it in the most convenient position;The motionlessly connected joint surfaces grow over over time.

Forecast 

Arthrosis does not threaten the patient’s life, but the lack of treatment can significantly limit freedom of movement and worsen the quality of life.Timely and competent therapy in the early stages can restore the joint to a healthy state.In other cases, only a slowdown in the degeneration process is possible with the help of conservative treatment and compensation for lost functions due to prosthetics.

Prevention of the disease

A complete recovery is almost impossible, therefore, prevention should be paid to special attention.The main requirement is a healthy lifestyle and a full treatment of inflammatory processes:

  • Do not allow hypothermia and treat infectious diseases in a timely manner;
  • Avoid physical overload and long static loads;
  • maintain normal body weight;
  • Adhere to the right diet-the balanced composition of vitamins and minerals is very important for the health of the musculoskeletal system;
  • fully (if possible, until complete recovery), treat any damage to the joints;
  • Practice systematic physical exercises to stimulate blood circulation (bicycle, hiking, light jogging, Scandinavian walking).

If you are at risk (elderly age, poor heredity, physical overload) be sure to undergo a regular radiographic examination.