Osteoarthritis - Symptoms and Treatment

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

The overwhelming majority of affected joints are knees, hips, shoulders and first metatarsophalangeal. Damage to other joints is much less common and usually minor. In recent years, the deficiency caused by osteoarthritis has doubled.

Like any disease, osteoarthritis also has risk factors for its development, which are now actively studied, and the list expands each year. The main ones are considered:

• was;
• heredity;
• metabolic disorders;
• increased body weight;
• osteoporosis;
• inadequate and irregular nutrition;
• endocrine disorders;
• menopause;
• frequent hypothermia;
• trauma;
• arthritis (joint inflammation);
• foci of infection or chronic inflammation (eg, chronic tonsillitis).
• Varicose veins.

If you experience similar symptoms, see your doctor. Don't self-medicate - it's dangerous for your health!

Osteoarthritis Symptoms

Common symptoms of osteoarthritis include:

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

Joint pain is rarely acute, more often painful or dull, and usually subsides during rest. Symptoms are usually wavy and can come and go without trying to treat. They can be mild, moderate or severe. Osteoarthritis complaints may remain approximately the same for many years, but over time they progress and the condition worsens. Mild and moderate symptoms can be controlled at the same level, but the severe course of the disease can lead to chronic pain, inability to carry out daily household activities, which leads to incapacity, even incapacity.

Pathogenesis of Osteoarthritis

The main nutrient medium forthe joint is the fluid synovial membrane. It also plays the role of a lubricating agent between joint surfaces. A huge and important role in the development of osteoarthritis is attributed to metabolic processes in the joint and its structures. In the initial stage, when biochemical disturbances occur in the synovial fluid, its properties diminish, which triggers the destruction mechanism. The first to target 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 occur without the 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 complete metabolism. With a lack of nutrients, the cartilage becomes thinner, the formation of new cells stops, the joint surface becomes irregular, rough, with areas of defects. The relationship between diseases of the veins of the lower extremities (eg, varicose veins) and the development of metabolic disorders in the joints, particularly the knee, is known. The bone structure under the cartilage responds to the process with a compensatory mechanism - it thickens, becomes coarser and expands the coverage area, resulting in the formation of exostosis and osteophytes, mainly responsible for the limitations and deformities of the joint. The synovial fluid is saturated with inflammatory cells and decomposition 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, "pain initials". The pathological process in the last stages causes the body to switch on the last compensatory mechanism - immobilization. At rest and in the so-called physiological position, pain is minimal, the ligament apparatus is maximally straightened. In this position, the joint tends to become fixed, and coarser exostoses rapidly form, which "fix" the joint, and the patient loses the ability to move it fully. The muscles of such a limb are atrophied, become weaker and smaller. Such changes are already considered irreversible.

Classification and stages of development of osteoarthritis

The disease is divided into 2 major groups: primary (or idiopathic) and secondary. The first group develops as a result of an obscure 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 (eg in the context of tuberculosis, osteochondritis dissecans, subchondral necrosis, etc. )

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

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

Complications of Osteoarthritis

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

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

If it is a secondary form, complications depend on the process that caused the arthrosis to develop. For example, it can lead to osteoporosis, a chronic disease characterized by a progressive disorder of bone metabolism. As a result, bones become fragile, 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. "

Osteoarthritis Diagnosis

The diagnosis of osteoarthritis usually starts with a physician (usually an orthopedic traumatologist) in the first-line medical care (polyclinic), where a clinical examination is performed and the examination data (CT scan, MRI, X-rays, etc. ) is interpreted to determine the degree and type of osteoarthritis. . . Diagnosis and diagnosis are usually straightforward. If the diagnosis is not clear or if the physician suggests a secondary development of the disease, for clarification the patient is referred to physicians in other specialties (eg, a rheumatologist). It is very difficult to determine the degree of osteoarthritis without the test results. The history of the disease, methods, and treatment attempts are also important for diagnosing and determining treatment tactics, as the physician is often faced with the difficult task of differential diagnosis (eg, the symptoms of arthrosis and arthritis often coincide).

Osteoarthritis treatment

About the early stages of osteoarthritis amenable to conservative treatment, from an integrated approach. The treatment is time-consuming and aims at the main objective: either to interrupt the destruction process at the stage in which the treatment was started, or to delay this process. The complex includes drug and non-drug treatment, which includes courses of exercise therapy (physiotherapy and gymnastics exercises), physiotherapy (generally phonophoresis and magnetotherapy), swimming, anti-inflammatory therapy (by ingestion or topically in the form of gel or cream), therapy chondroprotective (taking medicines based on cartilage components) and intra-articular injections (can be homeopathic medicines and hyaluronic acid preparations). Chondroprotectors are still used by orthopedic traumatologists, 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 stages, conservative treatment becomes ineffective, putting surgical treatment first. Given the indications, it can be a minimally invasive treatment - arthroscopy and endoprosthesis. With arthroscopy (joint endoscopy), it is sanitized under video-optic control, exostoses (if possible) and damage to soft structures is removed, which is often observed in these phases. 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 poorly performed.

The endoprosthesis is a technically difficult and difficult operation, the aim of which is to create an entirely 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 successfully. Outpatient supervision by a physician reduces the risks and terms of rehabilitation, improves the quality and efficiency of the operation performed.

Forecast. Prophylaxis

The forecast depends on a timely visit to an orthopedist-traumatologist and the start of a complex of treatment. In terms of eliminating the morphological changes in osteoarthritis, the prognosis is poor, as it is impossible to completely restore the cartilage structure of the joint. In old age, the course of the disease is more serious than in young people. However, with timely access to a physician and compliance with all recommendations, it is possible to eliminate all complaints and restore the full motor function of the joint.

Preventive measures:

1. Regular physical activity.It is a mistake to think that physical activity can "wear out" a joint. Increased - yes, but not regular and moderate. According to the most recent 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 the regular circulation of the joint fluid, which is the main source of nutrition for the joint and its structures. It is known that people who use public transport every day and pass by pedestrians are 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 rehabilitation and conservative treatment of osteoarthritis includes a course of LFT (physiotherapy and gymnastics exercises).
3. Correction and elimination of congenital deformities.An important role is played by the flat feet, which over the years lead to a violation of the axis of the legs, which leads to a disproportionate increase in load on certain parts of the joints and spine, deforming them.
4. Good nutrition.Allows you to create conditions for the total enrichment of the joint with nutrients. Therefore, the rejection of a large number of foods, frequent diets, irregular nutrition of foods low in substances (fast food, etc. ) can become a "trigger" for the development of osteoarthritis.
5. Timely elimination of concomitant illnesses.Medical examinations, now forgotten, made it possible to timely identify and eliminate diseases at an early stage. Concomitant diseases can be a significant cause of the development and progression of arthrosis (eg, diseases of the endocrine system, gastrointestinal tract, chronic foci of infection or inflammation).