Arthrosis (osteoarthrosis, deforming arthrosis) is a process of slow degeneration and destruction of joint cartilage. The articular ends of the bones become deformed and grow, and the periarticular tissues become inflamed. The general diagnosis of "arthrosis" means a group of diseases with similar symptoms but different origins. The joint - the affected area - consists of articular surfaces covered with cartilaginous tissue, a cavity with synovial fluid, a synovial membrane and a joint capsule. With advanced disease, he loses mobility and the patient feels pain due to inflammatory processes.
Causes
Joint arthrosis develops due to the discrepancy between the amount of stress and the body's capabilities. Lack of nutrients, excess body weight, intense physical work and even playing sports can cause this.
Factors influencing the development of the disease:
- genetics, hereditary predisposition;
- age over 40 years;
- obesity, overweight;
- sedentary work, passive lifestyle;
- hard work, work that involves constant physical activity;
- inflammatory diseases;
- congenital joint pathologies (dysplasia);
- injuries, wounds;
- malfunctions in the body (poor blood circulation, imbalance of hormones, microelements).
The disease can be primary or secondary. The causes of primary osteoarthritis are not yet well understood. Doctors believe that it develops in the presence of genetic factors (predisposition) and unfavorable external conditions.
Secondary arthrosis occurs against the background of inflammatory diseases, dysplasia and as a result of injuries, including professional ones.
Representatives of liberal professions and athletes have a greater chance of developing the disease. Representatives of the arts are also at risk: dancers (mainly ballerinas), pianists. Arthrosis of the wrist and finger joints most often affects people whose work involves fine motor skills: mechanics, mechanics and pianists. The "professional" arthrosis of porters is localized in the knees, collarbones and elbows. Drivers, painters and miners suffer from elbow and shoulder joints. The weak point of ballerinas is the ankle. Athletes are also more likely to suffer injuries to the ankle and other joints in the arms and legs, depending on the type of sporting activity. For example, a tennis player is at high risk of developing shoulder and elbow joint diseases.
Pathogenesis
Structural changes in cartilage occur due to an imbalance between tissue degradation and repair. Collagen and proteoglycans are gradually "eliminated" from the body, new nutrients are not supplied. Cartilage tissue loses elasticity, becomes soft and cannot withstand stress.
Regardless of the location and root cause, the disease develops in the same way. Gradually, the cartilage is completely destroyed, the ends of the bone "crunch" against each other. The patient feels pain, the intensity of which increases depending on the stage. The mobility of the joint gradually decreases, the patient has limited movements.
p>Classification
Orthopedists use the classification formulated by the professor in 1961:
- Stage I. The bone becomes denser, the joint space is slightly narrowed. Discomfort during physical activity, which disappears after rest;
- Stage II. The joint space is noticeably narrowed, the bone edges grow and the connective tissue becomes denser. The pain becomes constant, the muscles become hypertrophied, the joint becomes much less mobile, specific symptoms appear at the site;
- Stage III. The joint space is practically absent, bone growths are extensive and destruction of the bone under the cartilage is likely. The joint is completely deformed and immobile. Sharp or constant pain is possible depending on the type and location of the disease;
Depending on the location and form of the disease, symptoms, speed of development and treatment methods vary.
Forms
The disease is characterized by a chronic form, but can also occur acutely.
When the disease spreads to multiple joints (e. g. fingers), it is called generalized.
Anatomical shapes:
- deformation (osteoarthrosis). Leads to bone growth;
- uncovered. Destroys discs and intervertebral tissue in the cervical region;
- post traumatic. Develops as a result of trauma, injury;
- rheumatoid. Autoimmune disease, inflammation of connective tissue. It may be a consequence of previous arthritis;
- psoriatic. It develops against the background of psoriatic arthritis.
Locations
Osteoarthritis is a disease that affects joints throughout the body.
Column. The causes can be autoimmune diseases, back diseases, increased stress, injuries, lack of microelements, hormonal imbalance.
Locations:
- coccyx;
- Lumbar region;
- thoracic spine;
- cervical region
Legs. Knees and ankles are more susceptible to osteoarthritis. The reasons are injuries, excess weight, incorrect and excessive loads. Location types:
- gonarthrosis - knees;
- patellofemoral - femur and patella;
- ankle;
- talonavicular joint;
- feet and toes.
Hands. Injuries to the hands and fingers are more common and in most cases are associated with professional activities, injuries, age-related and hormonal changes. In addition, the disease is localized in the shoulder, wrist and elbow joints.
Stem. Location on the trunk is less common compared to arthrosis of the extremities. Injuries are associated with professional activity, sedentary lifestyle (stagnation).
Location types:
- clavicle. When moving, "clicks" and pain are felt. At risk are athletes involved in weightlifting and military personnel due to possible injuries;
- hip joints (coxarthrosis). The disease manifests itself as pain in the groin area.
Cabeça>. Sometimes dental problems, autonomic disorders, and even hearing loss are caused by damage to the temporomandibular joint. Swelling disrupts the symmetry of the face, can affect the ear and cause headaches.
Symptoms
Symptoms of the disease depend on its location. Common manifestations for all types are:
- pain in the affected area. In the initial stages - during movement, work, in the later stages - at rest;
- inflammation, swelling. Periarticular tissues swell, the skin turns red;
- "clicks", crunching. When moving, characteristic sounds are heard;
- difficulty moving. As the disease progresses, the mobility of the affected area becomes impaired;
- reaction to cold. Many types of osteoarthritis are characterized by exacerbations in rainy and cold weather.
Exacerbations of the disease are associated with general weakening of health. Due to viral diseases and increased stress, it takes an acute form and develops many times faster. During an exacerbation, symptoms, especially pain, become more pronounced. It is difficult for the patient to move, to the point of completely losing mobility, and to carry out their usual work.
Possible complications
The main danger is the loss of joint mobility, its deformation beyond the possibility of recovery. Due to the displacement of the axis, the posture is disturbed and the figure loses symmetry. Possible increase in pressure in internal organs, their displacement, compression. Concomitant diseases and failures in the body's systems appear. For example, with arthrosis of the coccyx in women, gynecological complications are possible, and arthrosis of the temporomandibular joint or cervical spine causes disorders in the autonomic system: dizziness, sleep disturbances. A patient with osteoarthritis may become disabled.
Diagnosis
To make a diagnosis, a comprehensive examination is carried out:
- take anamnesis;
- radiography in different projections;
- magnetic resonance imaging and computed tomography to exclude tumors and obtain a three-dimensional image;
- blood and urine tests to exclude concomitant diseases and assess general health.
Depending on the cause of the disease, the patient is referred to a rheumatologist, traumatologist, surgeon or orthopedist.
Treatment
Stage I of the disease is best treated. Patients with stage II can expect long-term relief from bone destruction. Stage III usually requires surgical intervention.
Conservative (non-surgical) treatment:
- physiotherapy, use of orthoses, canes, crutches to reduce the load. Elimination of accompanying and aggravating factors (e. g. weight loss, stress, change of activity);
- taking nonsteroidal anti-inflammatory drugs. Selective COX-2 inhibitors are the most effective. Chondroprotectors and atypical antidepressants are prescribed as auxiliary agents;
- intra-articular injections of glucocorticoid hormones to reduce severe pain and inflammation.
Surgical methods:
- arthroscopy - internal examination of the joint and removal of cartilage fragments;
- arthroplasty - implantation of artificial cartilage;
- osteotomy - removal or dissection of bone tissue;
- chondroplasty - cartilage restoration;
- arthrodesis – artificial immobilization of a joint (usually the ankle);
- endoprosthetics - removal and replacement of damaged joints with artificial ones.
Cardinal treatment makes it possible to stop the disease even at a late stage. It is possible to restore mobility in isolated cases (after replacement with an artificial one). However, this method is effective in combating pain. After surgery, recovery is necessary through physiotherapeutic and medication methods.
Prognosis and prevention
After starting treatment for osteoarthritis in stages I and II, a lasting improvement occurs: pain and inflammation disappear. In this case, complete relief of the disease or its long-term preservation is possible.
In the treatment of stage III osteoarthritis, improvements do not occur immediately. In some cases, pain relief is only possible after surgery. Often the joint remains immobilized or deformed. Patients with severe forms of arthrosis of the hip and knee joints receive group I or II disability.
It has been proven that there is no effective prevention against osteoarthritis. Weight control, a balanced diet and moderate exercise help reduce the risk of developing the disease. An examination at the first signs of osteoarthritis (especially after injuries and infectious diseases) and careful health care will make it possible to identify the disease at an early stage.