Osteoarthritis is a chronic disease of the joints associated with degenerative-dystrophic changes in their structures with predominantly damage to cartilaginous tissue.The disease progresses slowly and is asymptomatic in the initial stages.The cartilage and bone tissue of the joint, its capsule and periarticular bursa are gradually destroyed, and subsequently the surrounding muscles, ligaments and subcutaneous tissue take part in the pathological process.
According to the WHO, one in ten people suffers from this disease and the risk of developing it increases significantly in people over 50 years of age.The knee and hip joints are the most affected.The cause of osteoarthritis is the inability of the joint to cope with the load it supports.In response to traumatic effects, inflammation develops, which leads to pathological processes in the tissues of the joint.
Patients with osteoarthritis of the joints require complex treatment, without which the disease leads to a decrease in the ability to work and quality of life, limitation of sports and professional activities and, ultimately, to disability.
Osteoarthritis classification
Depending on the cause of appearance, the disease is divided into:
- Primary osteoarthritis - arises due to the fact that the cells of the cartilaginous tissue of the joint are destroyed faster than new ones are formed.In most cases, this is associated with age-related changes and is not a consequence of any specific pathological process in the body;
- Secondary osteoarthritis: appears in the context of a specific disease or as a result of a joint injury.
Depending on its location, osteoarthritis is divided into localized (affecting less than 3 joints) and generalized (affecting more than 3 joints).The latter is also called polyarthrosis.
Causes of osteoarthritis
This disease ranks first in the world among the causes of pain and impairment of activity.Although age-related changes are considered the main cause, it is often diagnosed in young patients.Women are more prone to osteoarthritis than men, although closer to age 70 this difference becomes almost imperceptible.
Osteoarthritis of the hip, knee, ankle and shoulder joints has the greatest negative impact on patients' quality of life and work ability.Less common are osteoarthritis of the elbow and temporomandibular joints, as well as the hands, feet and spine.
Predisposing factors include:
- old age;
- genetic predisposition;
- intense physical activity associated with sports or professional activities or, on the contrary, a sedentary lifestyle, which disrupts the normal nutrition of tissues, especially in large joints;
- joint injuries (fractures, cracks, dislocations);
- wearing inappropriate shoes;
- systemic diseases (metabolic disorders, endocrine diseases, neuropathies, gastrointestinal diseases, bleeding disorders);
- poor nutrition;
- overweight.
Women are more likely to suffer from this disease because they are more susceptible to hormonal imbalances.
Symptoms and degrees of osteoarthritis.
The main clinical sign of osteoarthritis is pain.In the early stages it may be absent, mild or intermittent.As the disease progresses, the pain becomes more noticeable, it can occur during exercise and in advanced stages it can be bothersome even at rest.
Secondary manifestations of the disease depend on the location of the process.In most cases, these are limited mobility in the affected area (especially after sleeping or a long rest), deformation, swelling and redness in the joint area, creaking and crackling when moving, sleep disturbances due to pain and the inability to find a comfortable position for the body, changes in gait and coordination, muscle spasms.
It is worth noting that the pathological process in one joint can move to neighboring ones due to improper distribution of load or movement restrictions.
Depending on the severity of the injury, they are distinguished:
- arthrosis of 1 degree - is asymptomatic or the signs are not expressed, the patient remains able to work and the diagnosis is difficult;
- Second degree osteoarthritis: accompanied by severe symptoms, the patient's quality of life decreases, the diagnosis reveals obvious disorders;
- third degree arthrosis - characterized by an increase in clinical signs, deformation of the joints is externally noted, and diagnostic methods reveal severe intra-articular disorders;
- fourth degree osteoarthritis - leads to partial or total disability;Disorders are found in all joint structures, surrounding muscles and ligaments.
Diagnosis of osteoarthritis.
An orthopedic traumatologist makes a primary diagnosis based on the patient's data on his lifestyle and work activities, the nature and duration of complaints, the dynamics of symptoms, the presence of arthrosis in relatives, and also conducts an examination and prescribes tests or consultations with related specialists (endocrinologist, hematologist, nutritionist, gastroenterologist).
Laboratory tests include a general blood test with leukocyte count, hemoglobin level and ESR.These indicators indicate inflammation in the body, which is necessarily present in osteoarthritis.Biochemical parameters measure the level of rheumatoid factor and C-reactive protein.If certain pathologies are suspected, other laboratory blood parameters are monitored.The analysis of the synovial fluid also has diagnostic value, which reveals cells and pathological inclusions, allowing us to confirm the diagnosis or differentiate another disease.
Instrumental and visual methods for diagnosing osteoarthritis help not only to detect pathology, but also to determine the stage of the disease and the degree of involvement of the surrounding tissues.The most effective of them are:
- x-ray - performed mainly in two projections, used to detect narrowing of the joint space and the formation of bone growths (osteophytes) in the place of damaged cartilage;
- MRI and CT scan - prescribed in the early stages, when minor changes are not yet noticeable on X-rays;
- Ultrasound - used in addition to these methods and helps to identify the accumulation of excess fluid in the joint cavity (for example, a Baker's cyst in gonarthrosis), evaluate the condition of the surrounding tissues and measure the thickness of the articular cartilage;
- scintigraphy – involves the intravenous administration of a radioactive drug that accumulates in tissues with inflammatory processes, and these areas of accumulation are shown on the images, thanks to this it is possible to identify osteoarthritis in the early stages and make a differential diagnosis;
- arthroscopy - allows you to examine the joint from the inside by introducing a microcamera into the joint cavity through a small incision, as a result, it is possible to collect detailed data on ongoing pathological processes and lesions, as well as take a biopsy of the affected area;
- Histological examination of the synovial membrane reveals an altered proportion of healthy cells and the presence of pathological inclusions in the joint, allowing differential diagnosis.
Differential diagnosis allows arthritis to be distinguished from other diseases with a similar clinical picture, including:
- various arthritis (ankylosing, reactive, rheumatoid, psoriatic, infectious);
- gout and pseudogout;
- diseases of muscles and ligaments (fibromyalgia, polymyalgia rheumatica);
- arthropathy (diabetic, paraneoplastic);
- Congenital diseases (hypoplasia of the femoral head).
Osteoarthritis treatment
Despite the widespread prevalence of the disease and well-studied methods, there is no treatment for osteoarthritis.Therapeutic approaches aim to eliminate pain, relieve inflammation, restore joint function, and prevent complications.
The choice of treatment depends on the cause, location and degree of osteoarthritis:
- drug therapy in the form of tablets for osteoarthritis (non-steroidal analgesics and anti-inflammatory drugs, corticosteroids, chondroprotectors), intra-articular or peri-articular injections of these groups of drugs, as well as the use of ointments and gels;
- physiotherapy during remission (medicinal electrophoresis, galvanization, acupuncture, electrical stimulation, shock wave therapy, massage, magnetic and laser therapy, cryotherapy);
- therapeutic exercises for osteoarthritis are prescribed individually, sessions are carried out under the supervision of a specialist;
- in advanced cases, surgical intervention is performed (partial or complete joint replacement, suturing or removal of a torn meniscus, removal of bone growths and Baker's cysts).
Osteoarthritis prevention
It is recommended to control the load on the joints, maintain a healthy lifestyle, perform therapeutic exercises, control weight and follow proper nutrition.
An orthopedic traumatologist will help select knee pads, an orthosis or a bandage for patients with osteoarthritis to repair the affected joint, reduce the load on it and prevent injuries.
Preventive examinations and timely consultation with a doctor when discomfort occurs in the joints make it possible to identify the problem at an early stage and avoid serious complications and disability.