Arthrosis (Deforming arthrosis, folkloric name -deposition of salts) is a chronic disease -dgenerative disease disease, in which the destruction of joint cartilage, joint capsules and the deformation of the bone itself.
It should be noted that arthrosis is an entire group of joint diseases that have different mechanisms of origin and development.Most of the time, there is arthrosis of large joints:
- Deformed arthrosis of knee joint (gonarthrosis),
- Deformed arthrosis of hip joint (cOKSARROSIS),
- as well as arthrosis of the shoulder joint.
These are the most serious arthrosis types.
Small joint arthrosis is less common.Most of the time, there is a deforming arthrosis of the interphalantic joints of the hands, as well as the metacarpofolangic joints of the thumbs.Patients observe pain in interphalândia joints, a decrease in mobility, the appearance close to the joints of the seals (geberden and bushar nodules).This type of arthrosis is more common in old age.Generally occurs arthrosis of the joints of the foot.
Polyrtrosis, or generalized arthrosis, is characterized by damage to various joints at the same time.
Arthrosis The articulations of the spine - spondylartrosis - belong to the spinal disease group, although it has a similar development mechanism with another arthrosis.
The main clinical symptom of arthrosis is joint pain, a decrease in 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 a violation of recovery processes and increased degeneration in articulation cartilage without deviations in the work of the entire body.Secondary arthrosis occurs as a result of other pathological processes in the body, or in the joint already damaged by any external effect, with partial destruction of joint surfaces.
Most of the time, traumatic arthrosis is diagnosed in young patients.And in older patients, it is always far from being possible to draw a clear edge between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, the factors that contribute to occurrence and development are well known.
The following types of causes that contribute to the development of primary and secondary deformation arthrosis can 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 composition of the articulation cartilage tissue, leading to its accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermobile joints, dysplasia, flat feet and others), which are the cause of trauma of certain sections of the articulation cartilage tissue and, as a result, the appearance of arthrosis.
It was also observed that the deformed arthrosis of the interfalanx joints of the upper ends is found mainly in women and is inherited by the female line.
The causes of secondary arthrosis
Secondary arthrosis is a consequence of joint damage.These damage can be caused by several factors.
- Mechanical damage to the joints.This group of factors includes various joint lesions, intra -articular bone fractures, as a result of which the joint structure is disturbed.The same result is caused by constant microtraumization of the joints as a result of excessive, static and dynamic constant cargo (eg athletes).In addition, obesity leads to overload and trauma.
Another factor that has a negative effect on the joints (especially on the hip) is the incorrect posture.
The joint structure can also interrupt surgical intervention. - Joint diseases.Arthrosis may be the result of inflammatory joint diseases (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Violations of metabolism, endocrine system diseases, body mineral deficiency.Several metabolism disorders, lack of calcium, phosphorus and other minerals, vitamins and elements traces cause changes in bone and cartilage composition, synovial fluid, which leads to a violation of recovery processes and the gradual destruction of composition.
- Autoimmune Diseases(gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency In the postmenopausal, women lead to changes in joint tissues and their gradual destruction.
- Vascular diseases (atherosclerosis of the lower extremity vessels, obliterating endarteryitis, varicose veins), as well as Hypodinamia They cause circulatory disorders in periarticular tissues, weak blood supply for joint tissues and, as a result, dystrophic changes.
The Arthrosis Development Mechanism
Development arthrosis It begins with the destruction of the cartilage.It is believed that in the beginning there is a violation of blood circulation in the capillaries of the periosteum corneal layer.Because cartilage nutrition occurs due to intra -articular fluid intake and adjacent bone tissue, circulatory interruption leads to the fact that cartilage gradually loses elasticity, it becomes thinner, cracks look, the softness of joint surfaces is disturbed.As a result, it seems Pain and crisp.The width of the joint gap gradually decreases, bones are formed along the edges of the joint surfaces Osteophyta peaks.
Finally, the joint is deformed, the amplitude of the movements decreases in it.Thus, it develops involving arthrosis associated with body aging.Development of this form of arthrosis usually occurs gradually over the years.
Other forms of large joint arthrosis, for example, post -traumatic poisoning, postinfectious, metabolic, have several other development mechanisms, but as a result, we get similar changes in the joint.
Joint arthrosis symptoms.Stages and degree of arthrosis
"Classic" is the classification of arthrosis based on clinical and radiological characteristics.According to him, three stages of disease development are distinguished.Corresponds to the classification by the degree of maintenance of the deficiency, which distinguishes 3 degrees of arthrosis:
- I degree of arthrosis - the disease does not prevent work, although complicating it,
- II degree of arthrosis - the disease prevents work performance,
- III degree of arthrosis - loss of work capacity.
Let's consider in more detail the clinical symptoms and signs of arthrosis in each of these stages
1st degree arthrosis (initial stage of arthrosis)
In the early stages of the disease in the morning, after rest, stiffness, difficulty in difficulty in the joints, which gradually spends some time after the beginning of the movement.Perhaps some restriction on mobility in the joint.Periodically, "beginner" pains appear (pain at the beginning of the movement after a long stay at rest).With clear movements, joint flexions, but there is no pain during movement.Pain in this phase of arthrosis appears only with a significant and prolonged load and disappears after rest.There is no pain alone and in low loads.At this stage of the disease, patients rarely consult a doctor.
In Image X -Raio with arthrosis of the 1st degree of special changes in the joint is not visible, sometimes small osteophytes along the edges of the joint can be visible, the joint gap is slightly narrow.
2 degrees arthrosis (second stage of arthrosis)
With the additional development of arthrosis, pain becomes more significant, acquires an acute character.A distinct articulation crisis appears with any movements, there is a remarkable restriction on joint mobility (contracture), functional shortening of the limb, impaired biomechanics of movements, but joint mobility is still preserved.This stage is characterized by a remarkable strengthening of initial pain, they become acute and longer.Under the influence of daytime physical activity, constant fatigue appears, a sense of pressure on the affected joints, the “mechanical pain” of sound arise by a decrease in shock absorption skills from the articulation cartilage tissues.
The destruction in the joint is already quite significant, the joints are already partially deformed.
In radiographs, perceptible osteophytes are visible, the narrowing of the joint gap is 2-3 times compared to the norm, there are sclerosis of the subcondral bone and the formation of cystic cavities in the epiphyseal zone.
Second degree arthrosis is characterized by a decrease in work capacity, the inability to do certain types of work.
3 degrees arthrosis (third stage of arthrosis)
Arthrosis 3 degrees are a serious and neglected stage of the disease.At this stage, there are:
- Significant joint deformation (due to bone growth and fluid accumulation in the joint cavity);
- a marked restriction of movements, until the preservation of only balance movements;
- Stronged pain not only when moving, but also in a complete rest of rest - constant pain associated with reflex cramps of the nearby muscles, as well as with the development of reactive synovitis;
- joint inflammation,
- Articulation sensitivity for climate change.
- The muscles around the knee are unpleasant and atrophied;
The limb axis is deformed, visibly varus or Valgus curvature of the legs (ie, in the form of the letter "o" or "x").
About radiographs with 3rd degree arthrosis, almost complete disappearance of the joint gap, severe deformation of joint surfaces, vast multiple regional osteophytes are observed.The articular mice and the calcification of the tissues for aarticular can be determined.
In 3 degrees, the disease has been far away, is often the cause of persistent disability.It is manifested as follows:
- The pain becomes constant and painful: walking, and especially the descent and climb the stairs - a difficult test for the patient;
- High crispness in any movements, well for others;
- Joint deformation is strongly expressed, movements are limited only by a small amplitude or even impossible;
The figures show the destruction of intra -articular structures (ligaments and meniscus), as well as the complete abrasion of cartilage and signs of sclerosis (replacement of functional organs and connective tissue structures).
4th degree arthrosis
The state of complete destruction of the articulation arthrosis, when the articulation to function completely is often distinguished in a separate degree of arthrosis from 4. There is such a "joint block" so -called - an acute pain syndrome, in which the limited movement in a sick joint is impossible.The fourth degree of arthrosis is accompanied by unbearable joint pain, which is not removed even by powerful medications and intensive physical therapy.Complete ankylosis (joint fusion) or neoarthrosis (the formation of a false joint between the displaced ends of the bones) is possible.The independent movement in both cases is almost impossible.
In figures, rough sclerosis of pronounced cystic lit surfaces, the fusion of connection bones in the joint gap is visible.The development of the disease at this stage almost always means disability, which can only be avoided by the implantation of artificial artificial prosthesis.
Treatment of arthrosis
Treatment of arthrosis at the early stage of the disease
It is better to start treating arthrosis as early as possible, with the appearance of the first signs - joint crispness, difficulty in motion.At this stage, the medicines are useful - -Chondrotectors that improve the structure of the cartilage, as well as the vitamin mineral complexes.
Medical Physical Education, Proper Nutrition and Preventive Measures are important.It should be noted that arthrosis prevention is also of great importance to prevent the exacerbation of the disease.
Arthrosis Treatment 2 - 3 degrees
Although it is already impossible to completely cure the arthrosis of 2-3 degrees, however, the process of its development can be visibly inhibited.The treatment of arthrosis at this stage involves the following stages:
- Removal or reduction of pain syndrome
- Remove inflammation in the joint.
- Improve cartilage restoration and reduce degenerative processes.
In the acute period, the treatment of arthrosis begins with the elimination of pain.For this, non -hormonal anti -inflammatory drugs (NSAIDs) are used painkillers.The intra -articular injections of corticosteroids are possible.It is necessary to reduce the load at the joint, you cannot walk or stay for a long time, raise heavy objects.
After removing acute pain syndrome, the main task is to ensure, as far as possible, the activation of recovery processes in joint and periarticular tissues: improvement of blood circulation, increased metabolism, eliminating inflammatory processes.They are prescribed by chondroprotectors, vasodilators, as well as therapeutic exercises and physiotherapy.
Treatment of Arthrosis 4 degrees
At this stage of the disease, the joint is almost completely destroyed.In this case, an output remains - the operation and replacement of the sick joint with an endoprosthesis.Endoprosthesis significantly improves joint mobility, allows the patient to resume active life at least getting rid of pain.