Arthrosis (Deformation of arthrosis, folk name - delayed salts) is a chronic disease of the joints degenerative - distilrophic, with the destruction of the articular cartilage, the capsules of the joints and the deformity of the bone.
It should be noted that arthrosis is a whole group of joint diseases that have different origin and close mechanisms of development.Most often there is arthrosis of large joints:
- Deformation of knee joint arthrosis (gonarthrosis),
- Deformation of arthrosis of the hip joint (coxarthrosis),
- as well as arthrosis of the shoulder joint.
These are the most severe types of arthrosis.
Small joint arthrosis is less common.Most often there is a deformation of arthrosis of the interacting joints of the hands, as well as metacarpophalangeal joints of the thumbs.Patients note the pain in the interfalancing joints, a decrease in their mobility, the appearance near the joints of the seals (nodes of gaberdon and bouchard).This type of arthrosis is more common in the elderly.Often occurs arthrosis of the joints of the foot.
Polisrosis or generalized arthrosis is characterized by damage to several joints at a time.
Arthrosis Spinal joints - spondylartrosis - belong to the group of diseases of the spine, although there is a similar mechanism of development with other arthrosis.
The main clinical symptom of arthrosis is joint pain, reducing its mobility.Specific symptoms are determined by the stage of arthrosis and depend on the degree of destructive changes in the joint.
The causes of arthrosis
Arthrosis It is customary to divide into primary and secondary.Primary (idiopathic) arthrosis is a consequence of disruption of the processes of recovery and increased degeneration in the cartilage tissue of the joint without any abnormalities in the functioning of the whole organism.Secondary arthrosis occurs as a result of other pathological processes in the body or in the joint, which is already damaged by some external effect, with partial destruction of the joint surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in older patients, it is far from always possible to make a clear boundary between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, the factors contributing to the occurrence and development are well known.
The following types of causes that contribute to the development of primary and secondary deforming arthrosis may be distinguished.
The causes of primary arthrosis are hereditary factors
The following hereditary disorders have been identified, which can cause the development of primary arthrosis:
- Genetic disorders in the cartilage tissue of the joint, which leads to its accelerated destruction;
- Congenital defects in the musculoskeletal system (hypermobile of joints, dysplasia, flat legs, etc.), which are the cause of trauma to certain areas of cartilage tissue of the joint and as a result of the appearance of arthrosis.
It has also been noted that deformation of arthrosis of the inter -phalax joints of the upper limbs is found mainly in women and is inherited from the female line.
The causes of secondary arthrosis
Secondary arthrosis is a consequence of joint damage.These damage can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various injuries to the joints, intraiortic bone fractures, resulting in the joint structure.The same result is caused by constant microtraumatization of the joints as a result of excessive constant loads, static and dynamic (eg in athletes).Also, obesity leads to overload and trauma.
Another factor that has a negative effect on the joints (mainly on the hip joint) is an incorrect stand.
The structure of the joint can also disrupt surgery. - Joint diseases.Arthrosis may be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of the bone tissue, etc.).
- Disorders of metabolism, diseases of the endocrine system, deficiency of minerals in the body.Various disorders of metabolism, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in bones and cartilage composition, synovial fluid, leading to disruption of the processes of restoration and gradual destruction of the composition.
- Autoimmune diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency In the aftermenopause, women lead to changes in the tissues of the joints and their gradual destruction.
- Vascular disease (atherosclerosis of the vessels of the lower limbs, pouring endarterite, varicose veins), and Hypodynamia They cause circulatory disorders in the periarticular tissues, poor blood supply to joint tissues and as a result of this dystrophic changes.
The mechanism of development of arthrosis
Development arthrosis It begins with the destruction of cartilage.It is believed that in the beginning there is a disorder of the circulation in the capillaries of the stratum layer of the periosteum.As the nutrition of cartilage occurs due to the intake of nutrients of internal -articular fluid and adjacent bone tissue, the blood disorder leads to the fact that the cartilage gradually loses elasticity, becomes sharper, the cracks appear on it, the smoothness of the joints is worm.As a result, it appears Pain and crunch during movementsSThe width of the gap of the joint gradually decreases, the bones are formed at the edges of the joint surfaces Osteophyte spikesS
In the end, the joint is deformed, the amplitude of the movements in it decreases.Thus develops involuntary arthrosis associated with aging of the body.The development of this form of arthrosis usually happens gradually over the years.
Other forms of arthrosis of large joints, for example, post -traumatic, after -infectious, metabolic, intoxication, have several other mechanisms for development, but as a result we obtain similar changes in the joint.
Symptoms of arthrosis of the joints.Stages and degree of arthrosis
"Classical" is the classification of arthrosis based on clinical and radiological characteristics.In accordance with it, there are three stages of disease development.It corresponds to the classification by the degree of maintenance of the damage, which distinguishes 3 degrees of arthrosis:
- I degree of arthrosis - the disease does not prevent work, although it complicates it,
- II degree of arthrosis - the disease prevents work from working
- III degree of arthrosis - loss of working ability.
Let's look at clinical symptoms and signs of arthrosis more in detail at each of these stages
First degree arthrosis (initial stage of arthrosis)
In the initial stage of the disease in the morning, after rest, stiffness, movement of difficulty in the joints, which gradually passes some time after the start of the movement.Maybe some restriction of mobility in the joint.Periodically, "start -up" pain (pain at the beginning of movement after a long stay at rest).With sharp movements, the joints of the crunch, but there is no pain during movement.The pain at this stage of arthrosis occurs only at significant and prolonged load and disappears after rest.There is no pain alone at low loads.At this stage of the disease, patients rarely see a doctor.
In X -ray picture with arthrosis of the first degree of special changes in the joint is not visible, sometimes small osteophytes can be seen at the edges of the joint, the joint is slightly narrowed.
2 -degree arthrosis (second stage of arthrosis)
With the more increasing development of arthrosis, the pain becomes more significant, acute.A different crisis in the joint occurs in all movements, there is a noticeable limitation of mobility in the joint (contracture), the functional shortening of the limb, impaired biomechanics of the movements, but the joint mobility is still preserved.This stage is characterized by a noticeable strengthening of the initial pain, they become acute and longer.Under the influence of physical activity during the day, constant fatigue, a feeling of pressure in the affected joints occurs, so "mechanical pain" arises caused by a decrease in the abilities of the shock abbey of the cartilage tissues of the joint.
The destruction in the joint is already quite significant, the joints are already partially deformed.
The radiographs show noticeable osteophytes, the narrowing of the gap of the joints is 2-3 times compared to normal, there are sclerosis of the subchondral bone and the formation of cystic cavities in the pineal area.
Grade 2 arthrosis is characterized by a decrease in working ability, the inability to perform certain types of work.
3 -degree arthrosis (third stage of arthrosis)
Arthrosis 3 degrees are a severe, neglected stage of the disease.At this stage there is:
- significant deformity of the joint (due to bone growth and the accumulation of fluid in the joint cavity);
- a sharp restriction of movements, to the preservation of only swinging movements;
- Acute pain not only in the movement, but also in a state of complete rest - constant pain associated with reflex spasms of the nearby muscles, as well as the development of reactive synovitis;
- Inflammation of the joints,
- Sensitivity of joints to change of time.
- The muscles around the knee are nasty and atrophied;
The axis of the limbs is deformed, noticeably varus or valgus curvature of the legs (that is, in the form of the letter "O" or "X").
In radiographs with arthrosis of the 3rd degree, almost complete disappearance of the joint precipice, severe deformity of the joint surfaces is observed, and huge numerous regional osteophytes are observed.The joint mice and the calcification of paradicular tissues can be determined.
At 3 degrees, the disease has reached a very far away, often this is already a cause of constant damage.It manifests as follows:
- The pain becomes constant and painful: walking and especially descending and climbing the stairs - a difficult test for the patient;
- Strong crunch in any movement well heard to others;
- The deformity of the joints is severely pronounced, the movements are limited only by a small amplitude or even impossible;
The photos show the destruction of internal -articular structures (ligaments and meniscus), as well as the complete abrasion of cartilage and signs of sclerosis (replacement of functioning organs and connective tissue structures).
4th degree arthrosis
The state of complete destruction of the joint arthrosisWhen the joint completely stops functioning, it is often distinguished into a separate - 4 degrees of arthrosis.There is a so -called "joint blockade" - a syndrome of acute pain, in which even limited movement in the sick becomes impossible.The fourth degree of arthrosis is accompanied by unbearable joint pain, which is not even eliminated by powerful drugs and intense physiotherapy.Complete ankylosis (joint merger) or neoarthrosis is possible (the formation of a fake occurs between the displaced bone ends).Independent movement in both cases is almost impossible.
The photos show rough sclerosis on the Sattime surfaces with a pronounced cystic enlightenment, the merger of the binding bones into the joint gap.The development of the disease to this stage almost always means damage, which can only be prevented by implanting the artificial joint prosthesis.
Arthrosis
Treatment of arthrosis in the initial stage of the disease
It is better to start treating arthrosis as early as possible, with the appearance of the first signs -crunching in the joints, difficulty in movement.At this stage, drugs are useful -hondroprotectors that improve the structure of cartilage, as well as vitamin mineral complexes.
Medical physical education, proper nutrition, and preventive measures are important.It should be noted that prevention of arthrosis is also of great importance in preventing the disease from exacerbating.
Treatment of arthrosis 2 - 3 degrees
Although it is already impossible to completely cure arthrosis at 2-3 degrees, however, the process of its development can be noticeably inhibited.The treatment of arthrosis at this stage includes the following stages:
- eliminating or reducing pain syndrome
- Remove inflammation in the joint.
- Improve cartilage recovery and slow down the degenerative processes in it.
In the acute period, the treatment of arthrosis begins with the elimination of pain.For this, non -hormonal anti -inflammatory drugs (NSAIDs) are used, analgesics are used.Intraiorticular injections of corticosteroids are possible.You need to reduce your joint load, you cannot walk or stand for a long time, lift heavy objects.
After removing the acute pain syndrome, the main task is to guarantee, as far as possible, activate the processes of recovery in joints and periarticular tissues: improvement of blood circulation, increased metabolism, elimination of inflammatory processes.Chondroprotectors, vasodilating drugs, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of arthrosis 4 degrees
At this stage of the disease, the joint is almost completely destroyed.In this case, one outcome remains - the surgery and the replacement of the patient joint with an endoprosthesis.The endoprosthesis significantly improves joint mobility, allows the patient to resume active life, at least to get rid of pain.