Arthrosis is a chronic pathology that affects the connective tissue structures of the musculoskeletal system.The disease is characterized by a progressive course with gradual destruction of cartilage tissue.Arthrosis is detected in most patients after 65 years of age, since one of the reasons for its development is the natural aging of the body.
The occurrence of degenerative-dystrophic pathology is caused by previous injuries, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, a sedentary lifestyle.The leading symptoms of arthrosis are joint pain, swelling, and limitation of movement.
To diagnose pathology, instrumental studies are performed - radiography, arthroscopy, MRI, CT.Arthrosis of 1st and 2nd severity is treated conservatively with a course of medications, physiotherapeutic and massage procedures, and exercise therapy.In case of irreversible destructive changes in the joints, surgical intervention is indicated - arthrodesis, endoprosthetics.
Pathogenetic mechanisms
With arthrosis, pronounced changes occur in the internal connective tissue structures.Deforming erosions form on cartilage tissues, which causes the destruction of collagen fibers, as well as proteoglycans consisting of protein (5–10%) and glycosaminoglycans (90–95%).As a result, the collagen network loses stability and metalloproteinases begin to be released, destroying all types of extracellular matrix proteins.Destruction is accelerated by increasing the biosynthesis of collagenases and stromelysin.Typically, the normal quantitative values of enzymes are controlled by cytokines - small peptide information molecules.But as arthrosis progresses, the concentration of these proteins decreases, which provokes the release of a large number of enzymes that damage cartilage tissue.
Proteoglycans with an altered structure begin to absorb water molecules that they are unable to retain.Therefore, excess fluid enters the collagen fibers.They “swell” and lose strength and elasticity.Negative changes also occur in the qualitative and quantitative composition of synovial fluid.With arthrosis, the concentration of hyaluron in it decreases.The hyaline cartilages no longer receive sufficient nutrients and oxygen for their regeneration.Foci of softening form in the cartilaginous tissues, and then cracks and specific necrotic growths appear.The bone heads become exposed and begin to undergo microtrauma when displaced relative to each other.
Causes and provoking factors
The reasons for the development of primary (idiopathic) arthrosis have not yet been established.It occurs in the absence of any provoking factors, therefore theories are put forward about a hereditary predisposition to premature destruction of cartilage.Secondary arthrosis develops as a consequence of other joint pathologies or previous injuries.What can cause degenerative-dystrophic disease:
- injury to a joint or nearby connective tissue structures - fracture, dislocation, damage to the meniscus, partial rupture of muscles, ligaments, tendons or their complete separation from the bone base;
- congenital dysplastic disorder of joint development;
- disruption of the functioning of the endocrine glands, disorder of metabolic processes;
- rheumatism, or rheumatic fever;
- rheumatoid, reactive, metabolic, psoriatic or gouty arthritis, polyarthritis;
- purulent arthritis caused by streptococci, epidermal or Staphylococcus aureus;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative disease, for example, osteochondritis dissecans.
Hypermobility of the joints, caused by the production of special collagen, predisposes to the development of arthrosis.This condition is detected in 10% of the planet's inhabitants and is not considered a pathology.But hypermobility is accompanied by weakness of the tendon-ligamentous apparatus, which leads to frequent injuries, especially to the ankle joint (sprains and ruptures of ligaments, dislocations).
Osteoarthritis is sometimes caused by hematopoietic disorders, such as hemophilia.Hemarthrosis, or hemorrhage into the joint cavity, provokes deterioration of cartilage trophism and its destruction.
Predisposing factors include old age, frequent loads on joints that exceed their strength limits, excess weight, surgical interventions, and hypothermia.
The risk group includes women during menopause, people living in unfavorable environmental conditions or in contact with toxic chemical compounds.If there is a deficiency in the diet of foods with vitamins and microelements, the prerequisites are created for the gradual destruction of hyaline cartilage.
Clinical picture
The danger of arthrosis lies in the absence of symptoms at the first stage of its development.The pathology clinically manifests itself gradually, the first signs appear against the background of significant destruction of cartilage tissue.Initially, a person feels a slight pain that does not have a clear localization.It appears after physical activity - weight lifting, sports training.Sometimes the first clinical manifestation is a crunching or clicking sound when bending or extending the joint.A person begins to notice that some movements are difficult.However, at the initial stage of arthrosis, stiffness occurs in the morning and soon disappears.
As the disease progresses, pain is also felt at night, causing not only sleep disturbance, but also the appearance of chronic fatigue.The severity of the pain syndrome at the second stage increases with changes in weather, exacerbation of chronic pathologies, and acute respiratory viral infections.The range of movements is noticeably reduced.The cause of stiffness is the thinning of the cartilage, as well as the person’s conscious restriction of movements in an attempt to avoid pain.This leads to increased load on the opposite joint, which provokes further damage.Arthrosis is also characterized by other specific symptoms:
- pain provokes spasms of skeletal muscles and the development of muscle contractures (limitation of passive movements in the joint);
- crunching in the joints, clicks, crackling noises when moving become constant, occurring with almost every displacement of the bones relative to each other;
- painful muscle cramps often occur;
- joints are deformed, which leads to disturbances in posture and gait;
- at the third stage of arthrosis, the deformation is so pronounced that the joints are bent, and the range of movements in them is significantly reduced or completely absent;
- with arthrosis of the third degree of the knee, ankle, hip joint, the patient uses a cane or crutches when moving.
In the absence of treatment, the pathology progresses, and during its course remissions are replaced by relapses, and the frequency of exacerbations is increasing all the time.Stiffness in movements in the morning now does not disappear for a long time, it becomes permanent.
When examining a patient with grade 1 arthrosis, the doctor notes only slight swelling of the joint and complete preservation of range of motion.In grade 2 pathology, palpation reveals pain and mild deformity.In the area of the joint space, the formation of bone thickenings is observed.
Arthrosis is characterized by the development of synovitis - inflammatory processes in the synovial membranes of the hip, knee, ankle, and shoulder joints.Their leading symptom is the formation of a rounded seal in the area of the joint, when pressure is applied to which the movement of fluid (fluctuation) is felt.Acute synovitis can be accompanied by a rise in temperature to 37-38 °C, headaches, and digestive disorders.
Diagnostics
The diagnosis is made based on the results of instrumental studies, features of the clinical picture, anamnesis, and patient complaints.A general blood and urine test is not very informative - all values remain within normal limits if arthrosis is not caused by metabolic pathology.With the development of synovitis, the erythrocyte sedimentation rate increases (30 mm/hour), and the level of leukocytes and fibrinogen in the blood increases.This indicates an acute or chronic inflammatory process occurring in the body.Changes in biochemical and immunological parameters occur in secondary forms of arthrosis.
The most informative method for diagnosing degenerative-dystrophic pathology is radiography in frontal and lateral projection.
| Stages of arthrosis according to the Kellgren-Lawrence classification (1957) | X-ray signs of pathology |
|---|---|
| Initial | No radiological signs |
| First | Indistinct, uneven narrowing of the joint space.Slight flattening of the edges of bone plates, formation of initial osteophytes or their absence |
| Second | Marked narrowing of the joint space, 2-3 times higher than normal, formation of a large number of osteophytes, subchondral osteosclerosis.The appearance of cystic clearings in the epiphyses |
| Third | The appearance of pronounced subchondral osteosclerosis and large marginal osteophytes, significant narrowing of the joint space |
| Fourth | Formation of coarse massive osteophytes, almost complete fusion of the joint space, deformation and compaction of the epiphyses of the bones forming the joint |
If, after studying the X-ray images, the doctor has doubts about making a diagnosis, a CT scan is prescribed.And to assess the condition of the connective tissue structures located near the joint, an MRI is performed.When using contrast, it is possible to dynamically assess the blood supply to tissues and establish the stage of the inflammatory process during the development of synovitis.
Basic methods of therapy
Arthrosis is still an incurable disease, since there are no pharmacological drugs for the regeneration of cartilage tissue.The main goal of therapy is to prevent the progression of pathology and maintain joint mobility.Treatment is long-term, complex, using both local and systemic medications.Patients should avoid severe stress on the joint and, if necessary, limit the range of motion with orthopedic devices - orthoses, elastic bandages.Overweight patients need to make adjustments to their diet to gradually reduce body weight and follow a diet.
After achieving stable remission, patients are shown daily physical therapy exercises.The first training sessions are carried out under the guidance of a physical therapy doctor, then the patient performs a set of exercises at home.Exercise therapy can be supplemented with swimming, yoga, and cycling.
To reduce the severity of pain, drugs of various clinical and pharmacological groups are prescribed:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active ingredients;
- injections into the joint of anesthetic solutions in combination with glucocorticosteroids;
- muscle relaxants to eliminate muscle spasms and restrictive contractures.
Therapeutic regimens include B vitamins, sedatives, and, if necessary, tranquilizers and antidepressants.Chondroprotectors are required for long-term use.This is the only group of drugs that have the ability to partially restore cartilage tissue.
To increase their clinical activity, physiotherapeutic procedures are carried out - laser therapy, magnetic fields, UHF therapy.
Any pain in the joints should be a signal for immediate consultation with a doctor.Therapy carried out at the initial stage of arthrosis will stop the destruction of cartilage and avoid loss of performance and disability.