Arthrosis ,
Keep in mind that arthrosis is a group of joint diseases that have different origin and close development mechanisms.Usually there is a large joint arthrosis:
- Reduces arthrosis of the knee joint (gonarthrosis),
- Reduces arthrosis of the hip joint (coksartrosis),
- as well as shoulder joint arthrosis.
This is the worst type of arthrosis.
Small joint arthrosis is less common.Often there is a deformation of arthrosis of the interforancing joints, as well as the thumb metacarpophalangeal joints.Patients note pain in the interforancing joints, decreases in their mobility, appearance near the seal joints (Geberden and Bushar nodules).This type of arthrosis is more common in old age.Frequent arthrosis of the joints.
Polyrthrosis, or general arthrosis, is characterized by damage to several joints at once.
Arthrosis The spinal joints - spondylarthrosis - belong to a group of spinal diseases, though they have the same developmental mechanism as other arthrosis.
The main clinical symptoms of arthrosis are pain in the joints, decreases in its mobility.Specific symptoms are determined by the level of arthrosis and depend on the degree of destructive change in the joints.
The cause of arthrosis
Arthrosis It is customary to divide into primary and secondary.The main arthrosis (idiopathic) is the result of a violation of the recovery process and increased degeneration in the cartilage of the joints without any deviation in the work of the whole organism.Secondary arthrosis occurs as a result of other pathological processes in the body, or in the joints that are damaged by any external effects, with the destruction of some of the articular surfaces.
Often, traumatic arthrosis is diagnosed in young patients.And in older patients, it is far from always possible to draw a clear border between primary and secondary arthrosis.
Although the actual cause of arthrosis cannot be determined, the factors contributing to events and development are known.
The following types of causes contributing to the development of primary and secondary deformation arthrosis can be distinguished.
The main cause of arthrosis is a hereditary factor
The following hereditary disruption has been identified, which can lead to the development of major arthrosis:
- genetic disorders in the composition of cartilage joints, leading to accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermobile joints, displacements, flat feet and others), which are the cause of the trauma of several parts of the cartilage of the joints, and, consequently, the appearance of arthrosis.
It is also noted that the deformation of arthrosis from the joints between the upper leg found primarily in women and inherited by the female line.
The cause of secondary arthrosis
Secondary arthrosis is a result of joint damage.This damage can be caused by a variety of factors.
- Mechanical damage to the joints.This group of factors includes a variety of joint injuries, -articular intra fractures, resulting in disrupted joint structure.The same result is due to the continuous microtraumatization of the joints due to excessive constant load, both static and dynamic (for example, in athletes).Also, obesity leads to load and trauma.
Another factor that has a negative effect on the joints (especially on the hip) is the wrong posture.
The structure of the joints can also interfere with surgical intervention. - A common disease.Arthrosis may be caused by joint inflammation (acute and chronic arthritis, synovitis, major aseptic necrosis of bone tissue, etc.)))
- Violation of metabolism, endocrine system disease, mineral deficiency in the body.Various metabolic disorders, calcium deficiency, phosphorus and other minerals, vitamins and trace elements cause changes in bone and cartilage composition, synovial fluid, leading to a gradual impairment and destruction of the composition.
- Autoimmune disease(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormone disruption, estrogen deficiency In postmenopause, women lead to changes in joint tissue and their gradual destruction.
- Vascular disease (atherosclerosis of the vessel -on the lower part of the foot, eliminating endarteritis, varicose veins), as well as Hypodynamia They cause disruption of blood circulation in periartic tissue, poor blood supply to the joint tissue and, consequently, dystrophic changes.
The mechanism of development of arthrosis
Development arthrosis It starts with the destruction of cartilage.It is believed that there was initially a violation of blood circulation in the capillaries of the cornea of the periosteum.Because cartilage nutrition occurs due to the intake of nutrients from intra -articular fluid and adjacent bone tissue, blood circulation disorders lead to the fact that the cartilage gradually loses elasticity, becomes thinner, cracks appear on it, the smoothness of the articular surface is disrupted, the amount of innoval fluid in the reduced joints.As a result, it seems Pain and problems during movement.The width of the joints gradually decreases, the bone formed along the edges of the articular surface Osteophyta spikes.
Finally, the joints are defective, the amplitude of the movement is reduced.Therefore, develop arthrosis related to body aging.The development of this form of arthrosis usually occurs gradually, for years.
Other forms of arthrosis from large joints, for example, post -traumatic, post -Infectious, metabolic, intoxication have several other development mechanisms, but as a result we get the same changes in the joints.
Symptoms of joint arthrosis.Level and level of arthrosis
"Classical" is a classification of arthrosis based on clinical and radiological features.In line with it, the three stages of the development of the disease are distinguished.It matches the classification with the level of defect maintenance, which distinguishes 3 degrees arthrosis:
- I The level of arthrosis - the disease does not hinder work, even if it complicates it,
- II The level of arthrosis - the disease prevents work performance,
- III Arthrosis degree - loss of work capacity.
Let's consider in more detail clinical symptoms and signs of arthrosis at each stage
Arthrosis in the first stage (early stage of arthrosis)
In the early stages of the disease in the morning, after rest, stiffness, movement of difficulty in the joints, which gradually passed some time after the onset of movement.Probably some mobility restrictions in the joints.Periodically, the pain "begins" appears (pain at the beginning of the movement after a long rest).With sharp movements, crunches together, but there is no pain during movement.The pain at this level of arthrosis only appears with a significant and prolonged burden, and decreases after rest.No pain only and at low load.At the stage of this disease, patients rarely see doctors.
In picture X -ray with the first stage arthrosis of the special change in the joints is invisible, sometimes the small osteophytes along the edge of the joints are visible, the articular gap is slightly narrow.
2 degree arthrosis (second stage of arthrosis)
With further development of arthrosis, the pain becomes more important, acquiring acute character.Different deficiencies in the joints appear with any movement, there are significant mobility restrictions in the joints (contractions), functional shortening of the limbs, biomechanical movement of movement, but joint movement is still preserved.This level is characterized by the strengthening of significant start pain, they become acute and longer.Under the influence of daytime physical activity, persistent fatigue appears, feelings of pressure on the affected joints, "mechanical pain" caused by decreased in shock -absorption of cartilage tissue.
The destruction of the joints is quite important, the joints are partially defective.
In radiography, significant osteophytes are visible, the narrowing of the joint gap is 2-3 times compared to the norm, subcondral bone sclerosis and the formation of the cyst cavity in the epiphyseal zone are observed.
Arthrosis of the 2nd degree is characterized by a decrease in work capacity, inability to perform certain types of work.
Arthrosis 3 degrees (third stage of arthrosis)
Arthrosis 3 degrees is a severe and neglected stage of illness.At this stage, there are:
- significant deformation of the joints (due to bone growth and fluid accumulation in the joint cavity);
- Sharp movement restrictions, so the preservation is just a shaking movement;
- Sharp pain is not only when moving, but also in complete rest - persistent pain associated with nearby muscle reflex spasms, as well as the development of reactive synovitis;
- inflammation together,
- Joint sensitivity to weather change.
- The muscles around the knees are evil and atrophied;
The body's axis is defective, it appears to be varus or leg valgus (that is, in the form of "o" or "x").
On radiography with the 3rd degree arthrosis, the almost complete gap is joint, severe articular surface deformation, a wide range of regional osteophytes is observed.Articular mice and paraarticular tissue calcification can be determined.
In 3 degrees, the disease has become very far, it is often the cause of a persistent defect.It is shown as follows:
- Pain becomes fixed and painful: walking, and especially descent and climbing stairs - difficult tests for patients;
- Strong crunch in any movement, good with others;
- Joint modification is highly stated, movement is only limited by small or even impossible amplitude;
The pictures show the destruction of the intra -articular structure (ligaments and meniscus), as well as complete abrasion of cartilage and signs of sclerosis (replacement of organs and structure of connective tissue function).
Arthrosis of the 4th degree
A state of complete destruction together arthrosis, when the joints stop fully functioning often distinguished into 4 degrees of separate arthrosis.There is a "blockade" - acute pain syndrome, where limited movement in the joints is impossible.The fourth stage of arthrosis is accompanied by unbearable joint pain, which is not released even by strong medication and intensive physiotherapy.Full ankylosis (joint combination) or neoartrosis (formation of false joints between bone -transferred ends) is possible.Free movement in both cases is almost impossible.
In the images, the rough sclerosis of the Simtime surface with clear cyst light, the combination of the connecting bone in the joint gap can be seen.The development of disease to this stage almost always means defects, which can only be prevented by artificial prosthesis implantation.
Arthrosis treatment
Treatment of arthrosis in the early stages of the disease
It is best to start treating arthrosis as early as possible, with the appearance of the first signs - crisis in the joints, difficulty in movement.At this stage, medications are useful -chondroprotectors that improve cartilage structure, as well as the vitamin -mineral complex.
Physical education of medicine, proper nutrition, and preventive measures are important.It should be noted that the prevention of arthrosis is also very important in preventing disease improvement.
Arthrosis treatment 2 - 3 degrees
Although it is impossible to cure arthrosis completely 2-3 degrees, however, its development process can be prevented.Arthrosis treatment at this stage involves the following stages:
- removal or reducing the pain syndrome
- Remove inflammation in the joints.
- Improve the recovery of cartilage and slow down the degenerative process in it.
During the acute period, the treatment of arthrosis begins with the elimination of pain.For this, anti -non -hormone drugs (NSAIDs), analgesics are used.Intra -articular corticosteroid injection is possible.It is necessary to reduce the load on the joints, you cannot walk or stand for a long time, lifting heavy objects.
After removing acute pain syndrome, the main task is to ensure, as far as possible, activation of the recovery process in joint tissue and periarartic: increased blood circulation, increased metabolism, elimination of inflammation.Chondroprotectors, vasodilating drugs, as well as therapeutic training and physiotherapy are prescribed.
4 -degree arthrosis treatment
At the stage of the disease, the joints are almost completely destroyed.In this case, one out remains - surgery and replacing diseased joints with endoprosthesis.Endoprosthesis significantly improves joint movement, allowing patients to continue active life, at least, eliminating pain.