Arthrosis

Arthrosis - what is it in simple words?

Arthrosis is a chronic pathology in which cartilage is gradually destroyed. Pathological changes affect the lower bone, which becomes more compact and marginal growths (osteophytes) develop. The joint capsule reacts to the events that occur and reactive vasculitis develops.

About the disease and possible complications

The frequency of pathology depends on age. The first signs of arthrosis usually appear no earlier than 30-35 years of age, and by the age of 70, about 90% of the population suffers from this pathology. Arthrosis does not show any gender differences. The only exception is degenerative joint damage between the carpal phalanges. This form of the disease is 10 times more common in women than in men. Arthrosis most often affects the large joints of the legs and hands.

The pathological process begins with the interstitial substance of the cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by balancing the processes of anabolism and catabolism. If the process of breakdown of cartilage tissue dominates its synthesis, then the conditions for the development of osteoarthritis are created. This simply explains what osteoarthritis is.

Most often, the first signs of the disease develop in places of the greatest mechanical load, with the appearance of limited areas of cartilage softening. As the pathological process progresses, cartilage fragments and cracks occur, and local deposition of calcium salts is possible. Beneath the cartilaginous defects, the underlying bone is revealed; separate cartilage fragments enter the joint cavity and can lead to the so-called

Damage to the cartilage lining the articular processes of the bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, during movement, the articular surfaces experience an unphysiological load. In response to this, compensatory resynthesis processes are stimulated in the bone tissue. The bone becomes denser (subchondral osteosclerosis develops), marginal outgrowths of irregular shape (osteophytes) appear, which further changes the discrepancy between the joint surfaces. The development of pathological changes gradually limits the range of motion in the joint and contributes to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead fragments of cartilage and bone activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, such long-term inflammation is accompanied by sclerosis of periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthrosis is pain, which is accompanied by limited mobility in the joint over time. Mobility limitation is first of a compensatory functional nature, and then of organic changes. Additional imaging diagnostic methods (radiography, ultrasound scan, computer tomography or magnetic resonance) help to establish the correct diagnosis.

Depending on the stage and degree of arthrosis, treatment can be carried out with conservative or surgical methods. An orthopedic traumatologist will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of arthrosis

There are 2 types of arthrosis:

1. The primary variant is a consequence of the violation of the relationship between the processes of synthesis and degeneration in the cartilage tissue and is accompanied by a disruption of the function of chondrocytes - the main cells of cartilage.
2. The secondary variant occurs in a previously modified joint when the normal relationship (congruence) of the joint surfaces is disturbed, followed by a redistribution of the load on them and with the concentration of pressure in certain areas.

Symptoms of arthrosis of the joints

The main symptom of arthrosis of the joints is pain. It has certain characteristic features that allow the primary diagnosis of the disease.

1. Mechanical pain, caused by the loss of the shock-absorbing characteristics of cartilage. Painful sensations occur during physical activity and are alleviated during rest.
2. Night pain.It is caused by stagnation of venous blood and increased pressure of the blood flowing inside the bone.
3. Initial pain.It is short-lived and occurs in the morning when a person gets out of bed (the patient says that he needs to "spread out"). These pains are caused by the deposition of detritus on the cartilage plates, when moving, these fragments are pushed into joint inversions, so that the unpleasant sensations stop.
4. Meteor Addiction.The pain can increase when weather conditions change (increased atmospheric pressure, cold weather, excess moisture).
5. Blockade pain.These are sudden painful sensations associated with the pinching of bone or cartilage fragments between joint surfaces. Against the background of "blockage", even the smallest movements in the joint stop.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, the person suffers from stiffness in the joints. The signs of the inflammatory process were objectively determined - swelling and a local increase in skin temperature.

Osteoarthritis usually begins slowly with the onset of pain in one affected joint. At first, the pain bothers you only during physical activity, and later it occurs even at rest and during night sleep. Over time, the pain is also felt in the joints of the opposite side, which is associated with a compensatory increase in load. An important characteristic of arthrosis is its frequency, when short periods of exacerbation are followed by periods of remission. The progression of the pathological process indicates a shortening of the intermediate relapse period and the development of adverse consequences in the form of contractures and severe limitation of joint mobility.

The course of arthrosis during pregnancy

During pregnancy, arthrosis can appear in different ways. Usually, up to 12-13 weeks, there may be a worsening of the pathological process, associated with hormonal changes that occur in a woman's body. The second and third trimesters are usually relatively stable. Pregnancy is managed by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of arthrosis of the joints

The main mechanism that triggers the destruction of cartilage is the violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthrosis is preceded by a period of metabolic disorders, which occurs hidden. This metabolic imbalance is characterized by damage to proteoglycans and their components (chondroitin, glucosamine, keratan), which is followed by disintegration and breakdown of the cartilage matrix. In the cartilage plate, collagen fibers break, the supply of metabolites necessary for life is disturbed, and the water balance changes (first the cartilage is hydrated, and then the number of water molecules suddenly decreases, which further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. In arthrosis, a "boom" of cytokines is also observed - released cytokines interfere with the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of arthrosis can be different:

• "excess" weight, which increases the load on the joints;
• wearing low-quality shoes;
• accompanying diseases of the musculoskeletal system;
• suffered wrist injuries.

Signs and diagnosis of arthrosis of the joints

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are conducted.

1. Radiography.In the early stage, X-ray signs of the disease are of little importance - they can be uneven narrowness of the joint space, slight compaction of the underlying bone and small cysts in this area. At a later stage, radiography is more informative - marginal bone growths appear, the shape of the joint surfaces changes, joint "mice" and areas of calcification in the capsule can be determined.
2. Ultrasound of joints.An ultrasound scan is more informative for detecting the initial signs of arthrosis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate, and secondary reactions of the capsule, musculotendinous and ligamentous compartments can be visualized.
3. Computer or nuclear magnetic tomography.This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the state of the cartilage plate, the subchondral region of the bone and determine the volume of synovial fluid, incl. in joint inversions.

Expert opinion

Deforming arthrosis of the joints is one of the most common pathologies of the musculoskeletal system, which occurs in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. At first, these are short-term pains in one joint, which the person often does not pay attention to. Gradually, the strength of the pain syndrome becomes more intense, while the periodic nature of the pain turns into a constant one. In the absence of treatment, the disease continues to progress and is accompanied by severe cartilage degeneration, which no longer responds to conservative therapy, and to solve this problem, only arthroplasty is needed - a complex and expensive intervention to replace the destroyed joint with a complete - original implant. However, targeted drug therapy and lifestyle modification can significantly delay this surgery or avoid it altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Treatment of arthrosis

According to clinical guidelines, the main goal of arthrosis treatment is to slow down the progression of degenerative lesions of the cartilage plate. In order to achieve this, measures are taken that reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

Joint relief is achieved in the following ways:

• weight loss (if excess);
• performing physical therapy that excludes prolonged similar poses;
• refusal to lift heavy loads or stay on the knees for a long period of time (relevant for some professions).

In the initial stages of the disease, in addition to physical therapy, swimming and cycling are useful. In the later stages, to relieve the joint during an exacerbation, walking with an orthopedic cane or using crutches is recommended.

For pain relief, incl. on the background of secondary synovitis, non-steroidal anti-inflammatory drugs, local and systemic, are used. Intra-articular corticosteroid injections can be used for the same purpose.

To improve the anatomical and functional state of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help improve cartilage tissue metabolism, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progression of the pathological process and improve joint mobility.

Operation

The possibilities of surgical treatment depend on the stage and activity of the pathological process.

• Wrist puncture– indicated for severe reactive synovitis. It allows not only the removal of inflammatory fluid, but also the introduction of corticosteroids that interrupt the pathological chain.
• Arthroscopic operations, which involve the introduction of instruments into the joint cavity through small punctures and subsequent visualization under magnification. With these procedures, it is possible to wash the joint and its inversions, flatten the cartilage plate, remove necrotic areas, "polish" joint surfaces, etc.
• Endoprosthetics- it is considered a radical operation, which is performed in the case of an advanced pathological process. It is usually used for arthrosis of the knee or hip joint.

Prevention of arthrosis

Prevention of arthrosis is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding work on the knees, dosed lifting of heavy objects and adherence to a physical activity regimen.

Rehabilitation in arthrosis of the joints

Rehabilitation for joint arthrosis includes a series of procedures that can improve the functional state of the joint and surrounding tissues. Physiotherapy, therapeutic massage and health gymnastics are used.

Questions and answers

Which doctor treats arthrosis?

Diagnosis and treatment is carried out by a traumatologist-orthopedic.

Does X-ray always make it possible to make an accurate diagnosis?

The severity of clinical signs of arthrosis does not always correlate with radiological changes. Often in practice there are cases when, with intense pain, radiography does not reveal significant changes, and vice versa, when a "bad" X-ray image is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for arthrosis?

If arthrosis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to look for causes that may lead to a disturbance in the functional state of the joint (eg damage to the meniscus of the knee joint and intra-articular ligaments).