Osteoarthritis: symptoms and treatment

Osteoarthritis(Osteoarthritis) is a joint disease characterized by degenerative changes in the cartilage that covers the bone, that is, its destruction.

The vast majority of joints affected are the knee, hip, shoulder, and first metatarsophalangeal. Damage to other joints is much less common and is often secondary. In recent years, disability caused by osteoarthritis has doubled.

Like any disease, osteoarthritis also has risk factors for its development, which are actively studied today, and the list is expanding every year. The main ones are considered to be:

• age;
• inheritance;
• metabolic disorders;
• increased body weight;
• osteoporosis;
• improper and irregular nutrition;
• endocrine disorders;
• menopause;
• frequent hypothermia;
• trauma;
• arthritis (inflammation of the joint);
• foci of infection or chronic inflammation (for example, chronic tonsillitis).
• Varicose veins

If you find similar symptoms, see your doctor. Do not self-medicate, it is dangerous for your health!

Symptoms of Osteoarthritis

Common symptoms of osteoarthritis include:

1. pain during exertion;
2. limitation of movement in the joint;
3. stiff feeling in the morning, "cracking" feeling;
4. pain after a long rest (the so-called "start").

Joint pain is rarely sharp, more often aching or dull, and usually stops during rest. Symptoms are usually wavy and can come and go without trying to treat them. They can be mild, moderate, or severe. Complaints of osteoarthritis can stay roughly the same for many years, but over time they progress and the condition worsens. Mild and moderate symptoms can be controlled to the same level, but the severe course of the disease can lead to chronic pain, inability to perform daily household activities, leading to disability, even disability.

Pathogenesis of osteoarthritis

The main nutritive medium of the jointit is the synovium. liquid. It also plays the role of a lubricating agent between the joint surfaces. A huge and leading role in the development of osteoarthritis is assigned to the metabolic processes in the joint and its structures. At the initial stage, when biochemical disorders develop in the synovial fluid, its properties decrease, which triggers the mechanism of destruction. The first to impact is the synovial membrane of the joint, which plays an important role as a membrane and is a kind of filter for the most important nutrient in cartilage, hyaluronic acid, preventing it from leaving its main place of work, the joint cavity. . The saturation of the properties of the joint fluid determines its circulation, which cannot be without a regular movement of the joint itself. Hence the well-known phrase "movement is life". The constant circulation of synovial fluid in the joint cavity is the key to a complete metabolism in it. With a lack of nutrients, the cartilage becomes thinner, the formation of new cells stops, the joint surface becomes uneven, rough, with areas of defects. The relationship between diseases of the veins of the lower extremities (for example, varicose veins) is knownand the development of metabolic disorders in the joints, mainly of the knee. The bone structure under the cartilage responds to the process with a compensatory mechanism: it thickens, thickens and expands the coverage area, resulting in the formation of exostoses and osteophytes, which is the main reason for the limitations and deformities of the joint. The synovial fluid is saturated with inflammatory cells and decay elements, the joint capsule in response to this thickens, becomes rough and loses elasticity, the soft tissues literally dry out (dehydration occurs), hence the complaints of morning stiffness, "initial pains". The pathological process in the later stages causes the body to turn on the last compensatory mechanism: immobilization. At rest and in the so-called physiological position, the pain is minimal, the ligamentous apparatus is straightened to the maximum. In this position, the joint tends to fixate on its own, leading to the rapid formation of thicker exostoses, which "fixate" the joint and the patient loses the ability to fully move it. The muscles of this limb are hypotrophied, they become weaker and smaller. These changes are already considered irreversible.

Classification and stages of development of osteoarthritis.

The disease is divided into 2 large groups: primary (or idiopathic) and secondary. The first group develops as a result of an unclear reason or as a result of age-related changes. The second is characterized by clear causes and develops as a result of its pathological process (for example, in the context of tuberculosis, dissecting osteochondritis, subchondral necrosis, etc. )

Regardless of the reasons that were a factor in the development of osteoarthritis, there are 4 stages of its development:

• Stage 1: the hard structures of the joint are not involved in the destruction process, there are initial changes in their soft structures and in the composition of the joint fluid (which is a nutrient medium and reduces friction of the joint), there is malnutrition of the joint.
• Stage 2 - accompanied by the "initiation" of the mechanism of destruction of the solid structures of the joint, solid edge formations are formed (exostoses, osteophytes). Moderate complaints of changes in range of motion.
• Stage 3: accompanied by a narrowing of the joint lumen, pronounced destruction of the loaded surface with the formation of osteochondral defects, pronounced limitation of movements, a constant sensation of "cracking" during movement, initial changes in the axis of the limb .
• Stage 4 - severe, in which movements are clearly limited in the joint until its complete absence (ankylosis), a pronounced inflammatory process, its deformation, the formation of bone defects (as a result of the complete absence of cartilaginous covering).

Complications of Osteoarthritis

Without treatment, any disease causes complications, and osteoarthritis is no exception. If this is the primary form, the main complications include:

• damage to the soft structures of the joint (degenerative tears of the menisci, tears of the ligaments, etc. );
• chronic inflammatory process;
• ankylosis (total absence of movement in the joint);
• joint deformation.

If it is a secondary form, the complications depend on the process that caused the development of osteoarthritis. For example, it can cause osteoporosis, a chronic disease characterized by a progressive disorder of bone metabolism. As a result, the bones become brittle, their nutrition is disturbed, as a result, osteoarthritis is complicated by the threat of intra-articular fractures. Therefore, it is very important to consult a doctor in a timely manner. As the eminent surgeon wrote: "The future belongs to preventive medicine. "

Diagnosis of osteoarthritis

Diagnosis of osteoarthritis often begins with a doctor (usually an orthopedic traumatologist) from first-line medical care (polyclinic), where a clinical examination is performed and examination data (CT scan, MRI, X-rays, etc. ) are interpreted. . ) to determine the degree and type of osteoarthritis. . . Diagnosis and diagnosis are usually straightforward. If the diagnosis is unclear or the doctor suggests a secondary development of the disease, then, to clarify, the patient is referred to doctors of other specialties (for example, a rheumatologist). It is very difficult to determine the degree of osteoarthritis without the results of the examination. The history of the disease, the methods and the attempts at treatment are also important for the diagnosis and the determination of the treatment tactics, since the doctor is often faced with the difficult task of differential diagnosis (for example, the symptoms of osteoarthritis and arthritis often coincide).

Treatment of osteoarthritis

On the early stages of osteoarthritis amenable to conservative treatment they provided an integrated approach. Treatment is time consuming and pursues the main goal: to stop the destruction process at the stage when the treatment was started or to slow down this process. The complex includes pharmacological and non-pharmacological treatment, which includes courses of exercise therapy (physical therapy and gymnastics exercises), physical therapy (usually phonophoresis and magnetotherapy), swimming, anti-inflammatory therapy (either by ingestion or topically in the form of gels or cream) . , chondroprotective therapy (taking medicines based on cartilage components) and intra-articular injections (these can be both homeopathic medicines and hyaluronic acid preparations). Orthopedic traumatologists still use chondroprotectors, they are prescribed by internal courses, but the results of recent scientific studies in Western countries refute the positive effect compared to the placebo effect. With severe symptoms and severe stages, conservative treatment becomes ineffective, putting surgical treatment first. Given the indications, it can be a minimally invasive treatment: arthroscopy and endoprosthesis. With arthroscopy (endoscopy of the joint), it is disinfected under the control of video optics, exostoses are removed (if possible) and damage to soft structures, which is often observed at such stages. Recently, however, the benefits of this type of intervention for osteoarthritis have been increasingly questioned, as it does not have the desired effect on chronic pain, and in some cases it can cause significant harm if done wrong.

Endoprosthesis is a technically difficult and difficult operation, the purpose of which is to create a completely new artificial joint. It requires clear indications and identification of risks in the presence of contraindications. Today, endoprostheses for the knee, hip and shoulder joints are used with success. Additional outpatient supervision by a doctor reduces the risks and terms of rehabilitation, improves the quality and efficiency of the operation performed.

Forecast. Prophylaxis

The prediction depends on a timely visit to a traumatologist-orthopedist and the beginning of a complex of treatment. In terms of eliminating morphological changes in osteoarthritis, the prognosis is unfavorable, since it is impossible to completely restore the cartilaginous structure of the joint. In old age, the course of the disease is more severe than in young people. However, with timely access to a doctor and compliance with all recommendations, it is possible to eliminate all complaints and restore full motor function of the joint.

Precautionary measures:

1. Regular physical activityIt is a mistake to think that physical activity can "wear out" a joint. Increase: yes, but not regular and moderate. According to the latest data, any activity aimed at strengthening and maintaining muscle mass, improving coordination, supports the motor function of the joints and their blood supply. Any physical activity allows you to achieve a regular circulation of joint fluid, which is the main source of nutrition for the joint and its structures. People who use public transportation every day and have foot traffic are known to be less likely to develop osteoarthritis.
2. Control of body weight and its adequate reduction.The increase in mass increases the load on the joints of the lower extremities and the spine. Therefore, any protocol for the rehabilitation and conservative treatment of osteoarthritis includes a course in LFT (physical therapy and gymnastics exercises).
3. Correction and elimination of congenital deformities.Flat feet play an important role, which over the years leads to a violation of the axis of the legs, which implies a disproportionate increase in load on certain parts of the joints and the spine, deforming them.
4. Good nutrition.It allows you to create the conditions for the complete enrichment of the joint with nutrients. Therefore, the rejection of a large amount of food, frequent diets, irregular nutrition of foods poor in substances (fast food, etc. ) can become a "trigger" for the development of osteoarthritis.
5. Timely elimination of concomitant diseases.The now-forgotten medical examinations made it possible to identify and eliminate diseases at an early stage. Concomitant diseases can be an important cause of the development and progression of osteoarthritis (for example, diseases of the endocrine system, gastrointestinal tract, chronic foci of infection or inflammation).