Osteoarthritis is a chronic disease in which the connective tissue structure of the musculoskeletal system is destroyed. The disease is characterized by a progressive course, in which cartilage tissue is gradually destroyed. This condition can be diagnosed in many people over 65 years of age, because one of the factors contributing to this condition is the natural aging process in the body.
Disease description
After trauma, endocrine and inflammatory diseases, excessive body overload or vice versa, lack of exercise can cause the development of degenerative malnutrition diseases. The main signs of arthritis: joint pain with edema, and limited mobility.
To diagnose the disease, they turned to X-rays, arthroscopy, CT and MRI and other instrumental techniques. In the first and second stages of arthritis treatment, conservative methods are used-medication, physical therapy, massage and physical therapy exercises. If an irreversible and destructive change occurs in the joint tissue, surgery-arthrodesis or artificial repair is required.
Pathogenesis
Osteoarthritis is characterized by significant changes in the structure of connective tissue. Deformation and erosion will form on the cartilage. As collagen fibers and proteoglycans are destroyed, the proteins (5-10%) and glycosaminoglycans (90-95%) in collagen and proteoglycans are destroyed.
As a result, the stability of the collagen network is reduced, metalloproteinases are released, and all forms of proteins in the extracellular matrix are destroyed. The acceleration of destruction is caused by the fact that the biosynthesis of collagenase and matrix lysosin is increased.Generally, when enzymes are present in the body in normal amounts, they control the levels of cytokines (small peptide information molecules). If arthritis develops, the concentration of this protein decreases because of the large release of enzymes that affect cartilage.
As a result, the structurally deformed proteoglycans absorbed water and they could not be retained. Therefore, too much fluid will penetrate into the collagen fibers and begin to "swell", resulting in a loss of strength and elasticity.
The qualitative and quantitative composition of synovial fluid is also constantly changing. In the context of arthritis, a decrease in the concentration of hyaluronic acid therein was observed. The transportation of nutrients and oxygen to the hyaline cartilage tissue stops in the volume required for its recovery. In the cartilage, softened lesions are formed, followed by cracks, and specific necrotic growth. Then the bare head began to show up, and minor injuries appeared in the background shifted relative to each other.
What caused the development of the disease
It is not clear why it developed into primary (idiopathic) arthritis. The development of this disease is not affected by any factors, so doctors believe that the cause of this problem lies in the tendency of premature cartilage destruction on the genetic level. The formation of secondary arthritis is a complication of other joint diseases or is based on injury.
The existence of the following content may cause the formation of degenerative dystrophy pathology:
- In the form of fracture, dislocation, meniscus injury, partial rupture or complete separation from the bones of muscle and ligament tissue, the form of tendon destroys the joint tissue or is located near the connective tissue structure;
- The development of congenital hyperplasia in the joints; Endocrine system gland dysfunction, metabolic disorder;
- Rheumatism or rheumatic fever;
- Polyarthritis, rheumatoid, reactive, metabolic, gouty or psoriatic arthritis;
- Septic arthritis, which is caused by streptococcus, epidermis or Staphylococcus aureus;
- Tuberculosis, brucellosis, chlamydia, gonorrhea, syphilis in any location;
- Degenerative dystrophic pathology, such as anatomical osteochondrosis.
The increased mobility of joint tissue observed in the background of the production of special collagen fibers in the human body may contribute to the formation of arthritis.A similar phenomenon is observed in 10% of people living on the earth, which is not considered a disease.Although there is a weakness in the tendon-ligament system in the context of excessive exercise, people are vulnerable to sprains, ligament breaks, and dislocations due to this weakness, especially in the ankle joint.
In some cases, hematopoietic problems (for example, the presence of hemophilia) can lead to the development of arthritis. Against the background of thrombosis (bleeding into the joint cavity), the blood supply to the cartilage tissue deteriorates, so the blood supply begins to collapse.
Among the predisposing factors, it is worth noting that in old age, the frequent load of joint tissue exceeds its strength, excessive weight, surgery, and hypothermia.
People at risk include menopausal women, citizens living in adverse environmental conditions or exposed to toxic chemicals. If the vitamin and mineral content in the diet is insufficient, the hyaluronic cartilage tissue will gradually be destroyed.
Symptoms
Arthritis is very dangerous because the first stage of formation is asymptomatic. The clinical manifestations of the disease occur over time, and the main symptoms appear with the obvious destruction of cartilage.First, the patient will experience mild pain syndrome without a clear location.It happens after fatigue-lifting heavy objects and doing physical exercises.
In some cases, a person notices signs of creaking and rattling when the joints bend or stretch. The patient noticed that it is sometimes difficult to move around. Although in the early stages of arthritis, fluidity problems only appear in the morning and disappear quickly.
With the further development of pathology, at night, the feeling of pain begins to be troubled, and chronic fatigue will occur due to disturbed sleep function. When the disease progresses to level 2, the intensity of pain will increase as the weather conditions change, chronic diseases increase and acute respiratory virus infections.
Physical activity is significantly reduced. The thinning of cartilage tissue and the patient's deliberate restriction of movement to prevent pain restricts mobility. This increases the load on the tissue of the opposing joint, which helps its further destruction.
Arthropathy also has other specific characteristics:
- Pain that causes skeletal muscle spasm and muscle contracture (restricted passive movement of joints);
- In the process of constant movement, cru shrinking, clicking, and cracking in the joint tissue are actually produced during each displacement of the bones relative to each other;
- Painful muscle cramps often occur; Joint deformation, resulting in impaired posture and gait; In the context of Grade 3 arthritis,
- deforms significantly up to the curvature of the joint, where joint activity is significantly reduced or there is no movement at all.
If arthritis of the knee, ankle or hip joint progresses to stage 3, the person must use crutches or crutches when moving.
If you don't start treatment in time, the disease will start to worsen, and relapse will disturb you regularly. In addition, as time goes by, the chances of getting worse will increase. The stiffness in the morning does not go away for a long time, and gradually becomes permanent.
When examining a person with stage 1 arthritis, the doctor only noticed mild edema of the joint tissue and fully retained motor function. The second stage of the disease is manifested by soreness and mild deformity on palpation. Bone thickening is formed near the synovial cavity.
Arthropathy is characterized by the formation of synovitis-inflammation of the synovial membrane of the hip, ankle, knee or shoulder joint. The main symptom of this disease is the formation of a circular seal near the joint, and when you press it, you can feel the way the fluid moves. With acute synovitis, the body temperature may rise to 37-38 degrees, headaches, and digestive problems may occur.
Diagnostic measures
The disease was diagnosed based on research results through instrumental methods, clinical features, recall data and patient complaints. In this case, clinical studies of blood and urine are not very helpful-if the cause of arthritis is not metabolic problems, then all indicators remain within the normal range.
If synovitis develops, the red blood cell sedimentation rate increases (up to 30 mm / h), and the white blood cells and fibrinogen in the blood increase.This indicates that there is acute or chronic inflammation in the body.Biochemical and immunological parameters change with secondary arthritis.
On the X-ray image, the joint disease looks like this:
- In the initial stage, there are no radiological signs.
- In the first stage, the pathological manifestations are blurry and uneven narrowing of the joint cavity. The edges of the bone plates flatten slightly, forming the initial osteophytes (sometimes absent).
- In the second stage, the image shows an image in the form of a significantly narrowed cavity in the joint, which exceeds the standard value by 2-3 times. Osteophytes formed in large numbers, and the formation of subchondral bone sclerosis was noted. Enlightenment of cyst-like appearance in the attachment.
- In the third stage, this image shows obvious subchondral osteopetrosis and large marginal osteophytes. The joint space is significantly narrowed.
- In the fourth stage, thick blocky osteophytes are formed, the joint space is almost completely fused, and the bone appendages that form the joint are deformed and compressed.
If the doctor has any doubts about the diagnosis after examining the X-ray images, he will prescribe a computed tomography scan for the patient. In order to assess the condition of the connective tissue located near the joint, MRI is required. The use of contrast agents allows you to dynamically track the blood supply of the tissues to determine the degree of inflammation of synovitis.
Treatment of arthritis
Currently, arthritis cannot be cured completely because there is no pharmacological effect to restore cartilage tissue.The main goal of treatment is to prevent the further development of the disease and keep the joints moving.The treatment of arthritis is long-term and complex, involving the use of local and systemic drugs.
The patient should not overload the joints; it is necessary to use orthopedic equipment (orthotics, elastic bandages) to restrict movement. People who are overweight will have to adjust their diet to lose weight over time and start dieting.
When stable relief is achieved, the patient needs to perform therapeutic gymnastics daily. First of all, you must play this sport under the supervision of an expert. In the future, you will need to do gymnastics at home. In addition to physical therapy, you can also register for the swimming pool, do yoga or ride a bicycle.
To relieve pain, drugs belonging to different pharmacological categories are prescribed:
- Non-steroidal anti-inflammatory drugs in tablets, ointments, and intravenous injections.
- Inject anesthetics into the joint cavity and add glucocorticoids.
- Muscle relaxants can relieve muscle spasms and contractures.
In addition, the treatment plan for joint disease includes the use of B vitamins, sedatives (if necessary)-antidepressants and tranquilizers. The cartilage protector must be appointed on a long-term basis.The methods of this group help to partially restore cartilage.
In order to increase the clinical activity of joint tissues, it is necessary to perform physical therapy procedures-laser therapy, magnetic therapy, UHF.
Any pain in the joint area should be used as a basis for immediate medical attention. Treatments performed in the early stages of arthritis development can prevent destructive processes in cartilage to prevent disability and disability.