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Arthrosis

Arthrosis, the symptom of which is joint pain

Arthrosis – what is it in simple words?

Arthrosis is a chronic pathology in which gradual destruction of the cartilage plate occurs. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) develop. The articular capsule reacts to the events that occur, and reactive vasculitis develops.






About the disease and possible complications

The incidence of pathology depends on age. The first signs of arthrosis usually appear no earlier than 30-35 years, and by the age of 70, about 90% of the population suffers from this pathology. Arthrosis does not show any gender differences. The only exception is degenerative damage to the joints between the carpal phalanges. This form of the disease is 10 times more common in women compared to men. Arthrosis most often affects the large joints of the legs and arms.

The pathological process begins with the interstitial substance of cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by balancing the processes of anabolism and catabolism. If the process of cartilage tissue breakdown dominates its synthesis, then conditions are created for the development of osteoarthritis. This explains in simple terms what arthrosis is.

Most often, the first signs of the disease develop in places of greatest mechanical load, with limited areas of softening of the cartilage plate appearing. As the pathological process progresses, the cartilage fragments and cracks, and local deposition of calcium salts is possible. Under the cartilaginous defects, the underlying bone is exposed; separated fragments of cartilage enter the articular cavity and can lead to the so-called "jamming" (symptoms of a "joint mouse").

Damage to the cartilage lining the articular processes of the bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, when moving, the articular surfaces experience non-physiological load. In response to this, compensatory resynthesis processes are stimulated in bone tissue. The bone becomes denser (subchondral osteosclerosis develops), and irregularly shaped marginal growths (osteophytes) appear, which further changes the discrepancy between the articular surfaces. Developing pathological changes gradually limit the range of motion in the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead fragments of cartilage and bone activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, such long-term inflammation is accompanied by sclerosis of the periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthrosis is pain, which over time is accompanied by limited mobility in the joint. The limitation of mobility is first of a compensatory functional nature, and then due to organic changes. Additional imaging diagnostic methods (radiography, ultrasound scanning, computed tomography or magnetic resonance imaging) help establish the correct diagnosis.

Depending on the stage and degree of arthrosis, treatment can be carried out using conservative or surgical methods. An orthopedic traumatologist will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of arthrosis

There are 2 types of arthrosis:

  1. The primary variant is a consequence of a violation of the relationship between the processes of synthesis and degeneration in cartilage tissue and is accompanied by a disorder of the function of chondrocytes - the main cells of cartilage.
  2. The secondary variant occurs in a previously modified joint when the normal relationship (congruence) of the articular surfaces is disrupted, followed by a redistribution of the load on them and with a concentration of pressure in certain areas.

Symptoms of joint arthrosis

The main symptom of joint arthrosis is pain. It has certain distinctive features that allow for the primary diagnosis of the disease.

  1. Mechanical pain, caused by the loss of shock-absorbing characteristics of cartilage. Painful sensations occur during physical activity and are relieved during rest.
  2. Night pain.Caused by stagnation of venous blood and increased pressure of blood flowing inside the bone.
  3. Starting pain.It is short-lived and appears in the morning when a person gets out of bed (the patient says that he needs to "disperse"). These pains are caused by the deposition of detritus on the cartilaginous plates; during movement, these fragments are pushed into the articular inversions, so the unpleasant sensations stop.
  4. Meteor dependence.The pain may intensify when weather conditions change (increased atmospheric pressure, cold weather, excess humidity).
  5. Blockade pain.These are sudden painful sensations that are associated with pinching of a bone or cartilage fragment between the articular surfaces. Against the background of the "blockade", the slightest movements in the joint stop.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person is bothered by joint stiffness. Signs of the inflammatory process are objectively determined - swelling and a local rise in skin temperature.

Osteoarthritis usually begins slowly with the onset of pain in one affected joint. At first, the pain only bothers you during physical activity, but later it appears even at rest and during night sleep. Over time, pain is also felt in the joints of the opposite side, which is associated with a compensatory increase in load. An important distinguishing feature of arthrosis is its frequency, when short periods of exacerbation are followed by periods of remission. The progression of the pathological process is indicated by a shortening of the inter-relapse period and the development of adverse consequences in the form of contractures and a sharp limitation of mobility in the joint.

Course of arthrosis during pregnancy

During pregnancy, arthrosis can occur in different ways. Usually, up to 12-13 weeks, an exacerbation of the pathological process may occur, associated with hormonal changes occurring in the woman’s body. The second and third trimesters are usually relatively stable. Pregnancy management is carried out by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint arthrosis

The main mechanism that triggers the destruction of cartilage is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthrosis is preceded by a period of metabolic disorders, which occurs hidden. This metabolic imbalance is characterized by damage to proteoglycans and their constituent components (chondroitin, glucosamine, keratan), which is accompanied by disintegration and breakdown of the cartilage matrix. Collagen fibers rupture in the cartilage plate, the supply of metabolites necessary for life is disrupted, and the water balance also changes (first the cartilage is hydrated, and then the number of water molecules sharply decreases, which further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. With arthrosis, a cytokine "boom" is also observed - released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of arthrosis can be varied:

  • "excess" weight, which increases the load on the joints;
  • wearing low-quality shoes;
  • concomitant diseases of the musculoskeletal system;
  • suffered joint injuries.

Signs and diagnosis of joint arthrosis

Based on clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are carried out.

  1. Radiography.At an early stage, X-ray signs of the disease are of little significance - these may be uneven narrowness of the joint space, slight compaction of the underlying bone and small cysts in this area. At a later stage, radiography is more informative - marginal bone growths appear, the shape of the articular surfaces changes, articular "mice" and areas of calcification in the capsule can be determined.
  2. Ultrasound of joints.Ultrasound scanning is more informative for detecting initial signs of arthrosis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate, and secondary reactions of the capsule, musculotendinous and ligamentous compartments can be visualized.
  3. Computed or nuclear magnetic tomography.This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilaginous plate, the subchondral region of the bone, and determine the volume of synovial fluid, incl. in articular inversions.

Expert opinion

Deforming arthrosis of the joints is one of the most common pathologies of the musculoskeletal system, which occurs in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. At first, these are short-term pains in one joint, to which a person often does not pay attention. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain is transformed into constant. In the absence of treatment, the disease continues to progress and is accompanied by severe degeneration of cartilage, which no longer responds to conservative therapy and to solve this problem only arthroplasty is required - a complex and expensive intervention to replace the destroyed joint with a full-fledged implant. However, targeted drug therapy and lifestyle modification can help significantly delay this operation or avoid it altogether. Therefore, if joint pain occurs, it is important to visit a doctor as soon as possible.

Treatment of arthrosis

According to clinical guidelines, the main goal of arthrosis treatment is to slow the progression of degenerative lesions of the cartilage plate. To achieve this, measures are taken that reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

Unloading the joint is achieved in the following ways:

  • loss of body weight (if it is excess);
  • performing physical therapy that excludes prolonged similar poses;
  • refusal to lift large loads or stay on your knees for long periods of time (relevant for some professions).

In the initial stages of the disease, in addition to physical therapy, swimming and cycling are useful. In the later stages, to unload the joint during an exacerbation, walking with an orthopedic cane or using crutches is recommended.

To relieve pain, incl. against the background of secondary synovitis, non-steroidal anti-inflammatory drugs are used, both local and systemic. Intra-articular injections of corticosteroids can be used for the same purpose.

To improve the anatomical and functional state of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help improve the metabolism of cartilage tissue, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progression of the pathological process and improve mobility in the joint.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

  • Joint puncture– indicated for severe reactive synovitis. It allows not only to remove the inflammatory fluid, but also to introduce corticosteroids that interrupt the pathological chain.
  • Arthroscopic operations, which involve introducing instruments into the joint cavity through small punctures and subsequent visualization under magnification. These interventions make it possible to wash the joint and its inversions, level the cartilaginous plate, remove necrotic areas, "polish" the articular surfaces, etc.
  • Endoprosthetics– is considered a radical operation, which is performed in case of an advanced pathological process. Typically used for arthrosis of the knee or hip joint.

Prevention of arthrosis

Prevention of arthrosis is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding work on the knees, dosed lifting of heavy objects and adherence to a physical activity regime.

Rehabilitation for arthrosis of the joints

Rehabilitation for arthrosis of the joints involves a set of procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and health-improving gymnastics are used.

Questions and answers

Which doctor treats arthrosis?

Diagnosis and treatment is carried out by a traumatologist-orthopedist.

Does radiography always allow the correct diagnosis to be made?

The severity of clinical signs of arthrosis does not always correlate with radiological changes. Often in practice there are cases when, with intense pain, radiography does not reveal significant changes, and vice versa, when a "bad" X-ray picture is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for arthrosis?

If arthrosis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to search for causes that can lead to disruption of the functional state of the joint (for example, damage to the menisci of the knee joint and intra-articular ligaments).