Arthrosis (arthrosis deformans, popular name - salt deposition) is a chronic disease of the joints of a degenerative-dystrophic nature, in which the destruction of articular cartilage, the joint capsule, and deformation of the bone itself occur.
It should be noted that arthrosis is a whole group of joint diseases that have different origins and similar development mechanisms.The most common arthrosis of large joints is:
- deforming arthrosis of the knee joint (gonarthrosis),
- deforming arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
These are the most severe types of arthrosis.
Arthrosis of small joints is less common.More common are deforming arthrosis of the interphalangeal joints of the hands, as well as metacarpophalangeal joints of the thumbs.Patients note pain in the interphalangeal joints, a decrease in their mobility, and the appearance of seals near the joints (Heberden's and Bouchard's nodes).This type of arthrosis is more common in old age.Arthrosis of the foot joints is common.
Polyarthrosis, or generalized arthrosis, is characterized by damage to several joints at once.
Arthrosis joints of the spine - spondyloarthrosis - belongs to the group of diseases of the spine, although it has a development mechanism similar to other arthrosis.
The main clinical symptom of arthrosis is joint pain and decreased mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree of destructive changes in the joint.
Causes of arthrosis
Arthrosis It is customary to divide it into primary and secondary.Primary (idiopathic) arthrosis is a consequence of disruption of the restoration processes and increased degeneration in the cartilage tissue of the joint without any deviations in the functioning of the whole organism.Secondary arthrosis occurs as a result of other pathological processes in the body, or in a joint already damaged by some external influence, with partial destruction of the articular surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in older patients it is not always possible to draw a clear line between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, the factors contributing to its occurrence and development are well known.
The following types of reasons can be identified that contribute to the development of primary and secondary deforming arthrosis.
Causes of primary arthrosis - hereditary factors
The following hereditary disorders have been identified that can cause the development of primary arthrosis:
- genetic disorders in the composition of the cartilage tissue of the joint, leading to its accelerated destruction;
- congenital defects of the musculoskeletal system (hypermobility of joints, dysplasia, flat feet and others), which cause trauma to certain areas of the cartilage tissue of the joint, and, as a consequence, the appearance of arthrosis.
It is also noted that deforming arthrosis of the interphalangeal joints of the upper extremities occurs predominantly in women and is inherited through the female line.
Causes of secondary arthrosis
Secondary arthrosis is a consequence of damage to the joint.These damages can be caused by various factors.
- Mechanical damage to joints.This group of factors includes various joint injuries, intra-articular bone fractures, as a result of which the structure of the joint is disrupted.The same result is caused by constant microtrauma of the joints as a result of excessive constant loads, both static and dynamic (for example, in athletes).Obesity also leads to overload and injury to joints.
Another factor that has a negative impact on the joints (primarily the hip joints) is incorrect posture.
The structure of the joint can also be disrupted by surgery. - Joint diseases.Arthrosis can be a consequence of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Metabolic disorders, endocrine system diseases, mineral deficiency in the body.Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and microelements cause changes in the composition of bone and cartilage tissue, synovial fluid, which leads to disruption of recovery processes and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in postmenopausal women lead to changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, varicose veins), as well as physical inactivity cause circulatory disorders in the periarticular tissues, poor blood supply to the joint tissues and, as a result, degenerative changes.
The mechanism of arthrosis development
Development arthrosis begins with the destruction of cartilage.It is believed that at the beginning there is a circulatory disorder in the capillaries of the subcartilaginous layer of the periosteum.Since the nutrition of cartilage occurs due to the supply of nutrients from the intra-articular fluid and adjacent bone tissue, poor circulation leads to the fact that the cartilage gradually loses its elasticity, becomes thinner, cracks appear on it, the smoothness of the articular surfaces is disrupted, and the amount of synovial fluid that ensures gliding in the joint decreases.As a result, it appears pain and crunching when moving.The width of the joint space gradually decreases, and bones form along the edges of the articular surfaces. osteophyte spines.
Ultimately, the joint becomes deformed and the range of motion in it decreases.This is how involutive arthrosis develops, associated with the aging of the body.The development of this form of arthrosis usually occurs gradually over many years.
Other forms of arthrosis of large joints, for example, post-traumatic, post-infectious, metabolic, intoxication, have slightly different development mechanisms, but as a result we get similar changes in the joint.
Symptoms of joint arthrosis.Stages and degrees of arthrosis
The classification of arthrosis based on clinical and radiological signs is considered “classical”.In accordance with it, three stages of disease development are distinguished.It corresponds to a classification according to the degree of preservation of working capacity, distinguishing 3 degrees of arthrosis:
- I degree of arthrosis - the disease does not interfere with the performance of work, although it makes it difficult,
- II degree of arthrosis - the disease interferes with work performance,
- III degree of arthrosis - loss of ability to work.
Let us consider in more detail the clinical symptoms and signs of arthrosis at each of the indicated stages.
Arthrosis 1st degree (initial stage of arthrosis)
In the initial stage of the disease, in the morning, after rest, there is stiffness and difficulty moving in the joints, which gradually disappears some time after the start of movement.There may be some limitation of mobility in the joint.“Starting” pain (pain when starting to move after a long period of rest) appears periodically.With sudden movements the joint crunches, but there is no pain when moving.Pain at this stage of arthrosis appears only with significant and prolonged stress, and subsides after rest.At rest and with light exertion there is no pain.At this stage of the disease, patients rarely see a doctor.
On an x-ray with arthrosis of the 1st degree, no special changes in the joint are visible; sometimes small osteophytes may be visible at the edges of the joint, the joint space is slightly narrowed.
Arthrosis 2 degrees (second stage of arthrosis)
With further development of arthrosis, the pain becomes more significant and becomes acute.A distinct crunch in the joint appears with any movement, there is a noticeable limitation of mobility in the joint (contracture), functional shortening of the limb, disturbances in the biomechanics of movements, but the mobility of the joint is still preserved.At this stage, there is a noticeable increase in the starting pains, they become acute and longer lasting.Under the influence of daily physical activity, constant fatigue appears, a feeling of pressure in the affected joints, and so-called “mechanical pain” occurs, caused by a decrease in the shock-absorbing abilities of the cartilage tissues of the joint.
The destruction in the joint is already quite significant, the joints are already beginning to partially deform.
Radiographs show noticeable osteophytes, a narrowing of the joint space by 2-3 times compared to the norm, sclerosis of the subchondral bone and the formation of cystic cavities in the epiphyseal zone are observed.
Arthrosis of the 2nd degree is characterized by decreased ability to work and the inability to perform certain types of work.
Arthrosis 3 degrees (third stage of arthrosis)
Arthrosis Stage 3 is a severe, advanced stage of the disease.At this stage the following are observed:
- significant deformation of the joint (due to bone growth and fluid accumulation in the joint cavity);
- sharp restriction of movements, up to maintaining only rocking movements;
- sharp pain not only when moving, but also in a state of complete rest - constant pain associated with reflex spasm of nearby muscles, as well as the development of reactive synovitis;
- inflammation of the joints,
- joint sensitivity to weather changes.
- the muscles around the knee are spasmed and atrophied;
The axis of the limb is deformed, varus or valgus curvature of the legs is noticeable (that is, in the shape of the letter “O” or “X”).
On radiographs with grade 3 arthrosis, an almost complete disappearance of the joint space, pronounced deformation of the articular surfaces, and extensive multiple marginal osteophytes are observed.Articular mice and calcification of paraarticular tissues can be detected.
In grade 3, the disease has progressed very far, and often it is already the cause of permanent disability.It appears as follows:
- the pain becomes constant and painful: walking, and especially going up and down stairs, is a difficult ordeal for the patient;
- a loud crunching sound during any movement, clearly audible to others;
- joint deformation is severe, movements are limited to only a small amplitude or even impossible;
The photographs show the destruction of intra-articular structures (ligaments and menisci), as well as complete abrasion of cartilage and signs of sclerosis (replacement of functioning organs and structures with connective tissue).
Arthrosis 4 degrees
The state of complete destruction of the joint with arthrosisWhen the joint completely ceases to function, it is often classified as a separate 4th degree of arthrosis.There is a so-called “joint block” - an acute pain syndrome in which even limited movement in the affected joint is impossible.The fourth degree of arthrosis is accompanied by unbearable pain in the joints, which cannot be relieved even with strong painkillers and intensive physiotherapy.Complete ankylosis (fusion of the joint) or neoarthrosis (formation of a false joint between the displaced ends of the bones) is possible.Independent movement in both cases is almost impossible.
The photographs show rough sclerosis of the articulating surfaces with pronounced cystic clearings, fusion of the connecting bones in the area of the joint space.The development of the disease to this stage almost always means disability, which can only be prevented by implantation of an artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis at the initial stage of the disease
It is better to start treating arthrosis as early as possible, when the first signs appear - crunching in the joints, difficulty moving.At this stage, medications are useful - chondroprotectors that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physical therapy, proper nutrition, and preventive measures are important.It should be noted that the prevention of arthrosis is of great importance to prevent exacerbation of the disease.
Treatment of arthrosis 2 - 3 degrees
Although it is no longer possible to completely cure grade 2-3 arthrosis, the process of its development can be significantly slowed down.Treatment of arthrosis at this stage involves the following steps:
- relieve or reduce pain
- relieve inflammation in the joint.
- improve the restoration of cartilage tissue and slow down degenerative processes in it.
In the acute period, treatment of arthrosis begins with pain relief.For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular corticosteroid injections are possible.It is necessary to reduce the load on the joint; you should not walk or stand for a long time, or lift heavy objects.
After relieving the acute pain syndrome, the main task becomes to ensure, as far as possible, the activation of restoration processes in the joint itself and periarticular tissues: improving blood circulation, increasing metabolism, eliminating inflammatory processes.Chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of arthrosis 4th degree
At this stage of the disease, the joint is almost completely destroyed.In this case, there is only one way out - surgery and replacement of the diseased joint with an endoprosthesis.The endoprosthesis significantly improves joint mobility and allows the patient to resume an active life, at least without pain.