Osteoarthritis — chronic malocclusion that affects the connective tissue structure of the musculoskeletal system. For the disease characteristic and has a progressive course with progressive destruction of the cartilage tissues. Osteoarthritis is revealed in the majority of patients after 65 years, as well as one of the reasons of its development becomes the natural aging process.
The appearance of degenerative diseases-degenerative diseases malocclusion lead to injury, pre-existing endocrine and inflammatory diseases, excess of exercise, or, on the contrary, a sedentary life-style. The main symptoms of osteoarthritis are pain, the swelling, limitation of movement.
To diagnose malocclusions are held checkups — x-ray, arthroscopy, magnetic RESONANCE imaging, CT scan. Osteoarthritis of 1 and 2 degree of severity treated conservatively changes, taking medicines, physiotherapy, and massage, physical THERAPY. When irreversible changes and destructive joint indicated surgery, arthrodesis, and arthroplasty.
Pathogenetic mechanisms
With arthritis you experience expressed internal changes connective tissue structures. The cartilage tissues are formed, deformation of the erosion, which becomes the cause of the destruction of the collagen fibers and proteoglycans, formed by proteins (5-10%) and glycosaminoglycans (90-95%). As A result of the collagen mesh loses stability, begin to be released metalloproteinases, that destroy all types of extracellular matrix proteins. The destruction accelerated as a result of increased biosynthesis based on collagenase class and stromelysin. Usually normal quantitative values of enzymes that control cytokine — small peptide information molecules. But with the progression of osteoarthritis of the concentration of these proteins is reduced, which causes the release of large amounts of enzymes that affect the cartilage tissue.
Proteoglycans with modified structure, begin to absorb the water molecules, which are not able to retain. Then the excess of liquid enters in the fibers of collagen. Are "waves", they lose their strength and elasticity. In the qualitative and quantitative composition of the synovial fluid occur also decreases. With osteoarthritis it decreases the concentration of hyaluronic acid. In hyaline cartilage, they stop doing enough for their regeneration amount of nutrients and oxygen. In the cartilage tissue forming foci of softening, and then there are cracks, which are specific to necrotic growths. Bone of the head naked, they begin to microtraumatic when you move with respect to one another.
Causes and triggers
Development causes primary (idiopathic) osteoarthritis is not yet been established. It occurs in the absence of triggers, and advance theories on the hereditary predisposition to the premature destruction of the cartilage. Secondary osteoarthritis develops as a consequence of other diseases of the joints, or previous injuries. That may be the cause of degenerative diseases-degenerative disease:
- injury to the joint or in the vicinity of the connective tissue structures — fracture, dislocation, meniscus injury, a partial tear of the muscles, ligaments, tendons, or their total detachment from the bone marrow of the foundation;
- innate dysplastic violation of the development of the articulation;
- violation of the functioning of the endocrine glands, disorders of metabolic processes;
- rheumatism, or rheumatic fever;
- rheumatoid, jet, metabolic, psoriatic arthritis, or gouty arthritis, polyarthritis;
- arthritis, purulent, which is caused by streptococci, epidermal, or golden staphylococci;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, and syphilis;
- degenerative-degenerative disease, for example, osteocondrite dissecante.
For the development of osteoarthritis predisposes hypermobility of the joints, due to a special production of collagen. It was recorded in 10% of the inhabitants of the planet and is not considered to be a malocclusion. But hypermobility is accompanied by weakness the tendon of the device, which leads to frequent accidents, special ankle (sprains and strains to the ligaments, sprains).
The cause of the arthritis sometimes become blood disorders, e.g., hemophilia. Hemarthrosis, or bleeding into the cavity of the joint, causes degradation of the trophic cartilage and their destruction.
With the predisposing factors are advanced age, frequent load on the joints, in excess of the limits of their resistance, overweight, surgery, hypothermia.
At risk are women in menopause, people who live in situations of poor environmental or contact with toxic chemical compounds. When the deficiency in the diet of foods with vitamins and trace elements create the preconditions for a progressive degradation of the hyaline cartilage.
The clinical picture
The danger of osteoarthritis is the absence of symptoms in the early stage of its development. Malocclusion clinically manifests itself gradually, the first signs occur in a context of significant destruction of the cartilage tissues. Initially the person feels weak, the pain of not having a clear localization. Appears after exercise — lifting weights, sports training. Sometimes the first clinical manifestation becomes crunch, shots in flexion or extension of the knee. The man begins to notice that some of the movements are indicated with difficulty. However, in the initial phase of arthritis, the joint stiffness occurs in the early hours of the morning and immediately disappears.
As the disease progresses pain is felt during the night, causing not only a sleep disorder, but also the emergence of chronic fatigue. The severity of the pain in a second stage increases when the weather changes, worsening of chronic diseases, and SARS. Significantly reduced the volume of movements. The rigidity becomes thinning of the cartilage, but also aware of limitation of human movement in an attempt to avoid the appearance of headache. This leads to an increase of the load on the opposite side of the joint, which causes further damage. For osteoarthritis are also other specific symptoms:
- the pain causes spasms of the skeletal muscle and the development of muscle contractures (constraints on passive joint movements);
- the creaking of the joints, blows of the whip, the rattle during the move become permanent, occur almost every displacement of the bones relative to one another;
- you frequently experience painful muscle cramps;
- the joints are deformed, which leads to the disorders of posture and gait;
- in the third stage of arthrosis deformation expressed so brilliant, that it is now distorted, and the volume of movements in them significantly reduced or completely absent;
- with osteoarthritis of third degree of knee, ankle, hip, sick with the movement enjoys a stick or crutches.
If left untreated, the malocclusion progresses, and in its course of remission and replaced a relapse, and the frequency of exacerbations all the time increases. Stiffness in the morning, now does not disappear for a long period of time, becomes a constant.
Of the examination of a patient with osteoarthritis of grade 1, the doctor observes a slight swelling of the articulation and the complete security of the volume of movements. In the malocclusion of grade 2 palpation locates the pain and weakly expressed in the deformation. In the area of the joint space we observe the formation of bone swelling.
For osteoarthritis the characteristic development of synovitis — inflammatory process in the sheaths synovial hip, knee, ankle, shoulder. The leader of the symptom becomes education rounded estate in the area of articulation, sensitive to pressure that feels displacement of fluid (fluctuation). Acute synovitis may be accompanied by an increase of the temperature up to 37-38°C, headache, digestive problems.
Diagnostics
The diagnosis will be issued on the basis of the results of the instrumental examinations, the characteristics of the clinical picture, anamnesis, complaints of patients. Common analysis of blood and urine uninformative — all the values remain in the standard, if the osteoarthritis is not caused by a malocclusion metabolic. With the development of synovitis increases the erythrocyte sedimentation rate (30 mm/hour), in the blood increases the level of white blood cells, and fibrinogen. This indicates that flows in the body, acute or chronic, is an inflammatory process. Changes in the biochemical and immunological indicators occurs when secondary forms of osteoarthritis.
The most informative method of diagnosis of degenerative diseases-degenerative diseases malocclusion — radiography in direct and lateral projection.
| Stage of osteoarthritis in accordance with the classification of Kellgren-Lawrence (1957) | The signs x-ray of malocclusion |
| The initial | The absence of signs, and radiological |
| The first | Indistinct, irregular narrowing of the joint space. A slight flattening edges of the bony plates, the initial formation osteophytes or the lack thereof |
| The second | The marked reduction of the joint space, exceeds the value of the standard 2-3 times, the formation of a large number of osteophytes, osteosclerosi subchondral. The appearance kistevidnyj unpredictable due to lighting in the epiphysis |
| The third | The appearance expressed subchondral of osteosclerosis and large regional osteophytes, a considerable reduction of the joint space |
| The fourth | Training hard massive osteophytes, the almost total remodeling of the joint space, the deformation of the gasket and the epiphyses of the bones that form the joint |
If, after studying the x-ray images to the doctor there are doubts about the appointment of the diagnosis, it is assigned to a TAC. And for the evaluation of the state near the knee the connective tissue structures, performed step-by-step a magnetic RESONANCE imaging. When you use the contrast in dynamic to evaluate the blood supply to the tissues, to set the phase of the inflammatory process with the development of synovitis.
The main methods of therapy
Osteoarthritis is an incurable disease, just as there is no pharmacological drugs for the regeneration of cartilage tissue. The main goal of therapy becomes a warning of the progression of malocclusion, the maintenance of joint mobility. The treatment of long, complex, and with the use of local and system medications. Patients should avoid heavy-loads in common, if necessary, limit the amount of movement of the orthopedic devices — the lokomat, elastic bandages. Patients with excess weight, you need to make changes in the diet for the gradual reduction of the weight and follow a diet.
After the achievement of a stable remission, patients showing daily lessons of physical therapy. The first training took place under the guidance of a medical THERAPY, the patient then performs a series of exercises at home. Physical THERAPY can be integrated swimming, yoga, cycling.
To reduce the severity of the pain prescribed different drugs the clinical-pharmacological groups:
- non-steroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral administration with active principles;
- injection in the articulation of solutions of anesthetics in combination with corticosteroids;
- muscle relaxants to eliminate the muscle spasms and restrictive contractures.
In the regimens included are the B-group vitamins, sedatives, if necessary — of sedatives and antidepressants. Necessarily assigned chondroprotectors for a long course of reception. This is the only group of drugs, with the ability to partially restore cartilage tissue.
To improve their clinical activities take place treatments, physiotherapy, laser therapy, magnetic fields, UHF-therapy.
Any joint pain should be a signal for immediate medical treatment. The therapy, carried out in the initial stage of arthrosis, allow you to stop the destruction of the cartilage, prevent the loss of integrity, and visual disabilities.