Osteoarthritis is a chronic disease in which the structure of the connective tissue of the musculoskeletal system is damaged. The disease is characterized by a progressive process, on a gradual destruction of cartilage tissue. This pathology is diagnosed in many people over the age of 65, because one of the factors that contribute to this condition is the natural aging process in the body.
Disease description
A post-traumatic, endocrine and inflammatory disease, physical overload or, conversely, inactivity can cause the development of degenerative-dystrophic disease. The main sign of joint disease: joint pain with edema and limited activity there.
To diagnose the disease, they turn to the help of instrumental techniques - X-rays, arthroscopes, CT and MRI. In the treatment of stage 1 and 2 joint disease, conservative methods are used - medication, physical therapy, massage, and physical therapy exercises. If irreversible destructive changes have occurred in the joint tissue, then a surgery - joint surgery or endoscopy is needed.
The mechanism of the pathogenesis
Osteoarthritis is characterized by marked changes in the structure of connective tissue. The formation of deformed erosion occurs on cartilage, as a result collagen and proteoglycan fibers are destroyed, containing proteins (5-10%) and glycosaminoglycans (90-95%).
As a result, the stability of the collagen network decreases, the metalloproteinase is released and all forms of proteins in the extracellular matrix are destroyed. Accelerated destruction occurs due to the fact that the biosynthesis of collagenases and stromelysin is increased.
As a rule, when enzymes are present in the body in normal amounts, they keep the level of cytokines - small peptide information molecules - under control. If osteoarthritis progresses, the concentration of this protein is reduced, so the enzymes that affect the cartilage are released in large amounts.
Consequently, proteoglycans with a distorted structure will absorb water that they cannot capture. For this reason, the excess fluid penetrates the collagen fibers, beginning to "swell", resulting in loss of strength and elasticity.
The qualitative and quantitative composition of the match has also changed for the worse. Against the background of joint disease, a decrease in the concentration of hyaluronic acid is observed in it. The transport of nutrients and oxygen to the hyalinized cartilage tissue stops at the volume needed to restore it. In cartilage, floppy drives form, then specific cracks, necrotic foci. Then the bare head begins to show, microscopic injuries appear on the background of interrelated displacement.
What triggers the development of the disease
Why primary (idiopathic) joint disease develops is unknown. Such a disease develops without the influence of any factors, so doctors believe that the cause of this problem lies in the genetic tendency to the premature destruction of cartilage. Formation of secondary joint disease occurs as a complication of other joint diseases or on the background of an injury.
The presence of the following can cause the formation of degenerative-dystrophic pathology:
- injury to joint tissue or near connective tissue structure in the form of fracture, dislocation, meniscus injury, partial or complete fracture from bone of muscle tissue and ligaments, tendons;
- congenital dysplasia in the development of joints;
- dysfunction of the endocrine system glands, metabolic disorders;
- rheumatism or rheumatic fever;
- polyarthritis, rheumatism, reactive arthritis, metabolic, gout or psoriasis;
- purulent arthritis whose cause lies in the action of streptococci, epidermis or staphylococcus aureus;
- tuberculosis of any site, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative-dystrophic diseases, for example, osteomyelitis.
An increase in joint tissue mobility, observed on the basis of the production of special collagen fibers in the body, may contribute to the formation of joint disease.A similar phenomenon is observed in 10% of people living on the planet, it is not considered a disease.Although, on the basis of high motor capacity, the tendon-ligament system is weakened, so a person is susceptible to injury, especially in the ankle joint, in the form of a sprain andrupture of ligamentous tissues, dislocation.
In some cases, problems with the hematopoietic function (eg, hemophilia) can lead to the formation of a joint disease. Against the background of hereditary disease (hemorrhage into the joint cavity), the blood supply to the cartilage tissue is impaired, so it begins to collapse.
Among the causative factors, it is important to note the presence of old age, the frequent load on joint tissue exceeds the limits of strength, excessive body weight, undergoing surgeries, Hypothermia.
Risk group includes women during menopause, citizens living in adverse environmental conditions or exposure to hazardous chemicals. If the diet does not contain enough vitamins and minerals, the conditions for gradual destruction of the hyaluronic cartilage tissue.
Symptoms
Arthritis is very dangerous because the first stage of formation has no symptoms. Manifestation of the clinical picture of the disease occurs over time, the main symptoms appear with significant destruction of the cartilage.At first, the patient felt that the mild pain syndrome was not clearly localized.Occurs after exertion - lifting heavy objects, practicing sports.
In some cases, the first sign a person will notice is a scratching and clicking noise when flexing or widening the joints. Patients find it difficult to walk sometimes. Although in the early stages of joint disease development, movement problems appear only in the morning and quickly pass away.
With the further development of the pathology, a painful sensation begins to appear at night, as a result of which sleep function is disturbed and also appears chronic fatigue. When the disease turns 2, the intensity of pain increases on the background of changes in weather, exacerbations of chronic diseases, acute respiratory viral infection.
Physical activity is significantly reduced. Mobility is hindered by thinning cartilage tissue and the patient's deliberate restriction of movement to prevent pain. This increases the load on the tissue of the opposite joint, contributing to further destruction of the joint.
Arthritis is characterized by other specific characteristics:
- Pain
- leads to the appearance of spasm in skeletal muscle and the formation of muscle spasm (limited passive motor function of the joint);
- scratching in the joint tissue, clicking, clicking in a continuous motion, actually arises in each bone movement in relation to each other;
- suffer from frequent muscle cramps;
- deformed joints, leading to impaired posture and gait;
- markedly deformed to the curvature of the joints with significant or complete loss of motor activity in them based on the background of acute 3 arthritis.
If the degeneration of the knee, ankle, or hip joint has progressed to stage 3, a person must use a cane or crutches when moving.
If you do not get treatment in time, the disease begins to progress, relapses begin to bother you often, besides, exacerbations appear more and more over time. The morning tension does not go away for a long time, gradually becoming permanent.
When examining a person with stage 1 osteoarthritis, the doctor found that the joint tissue was only slightly edged with completely preserved motor function. Stage 2 of the disease is manifested by a feeling of pain and slight deformity to the touch. Formation of thickened bone near the synovial cavity.
Arthritis is characterized by the formation of bursitis - bursitis in the hip, ankle, knee, or shoulder joint. The main symptom of this disease is the development of a circular seal near the joint, and when pressed, you can feel how the fluid inside moves. With acute bursitis, temperature can rise to 37-38 degrees, headache, digestion.
Diagnostic measures
The disease is diagnosed based on research results by instrumental methods, clinical characteristics, pathological data, and complaints of patients. In this case, a clinical study of blood and urine was not very informative - all readings remained within the normal range, if the cause of the joint disease was not in the metabolic problems.
If bursitis develops, erythrocyte sedimentation rate increases (up to 30 mm / h), white blood cells and fibrinogen increase in the blood.This indicates the presence of acute or chronic inflammation in the body.Biochemical and immunological parameters vary with secondary rheumatoid disease.
The most informative way to detect degenerative-dystrophic diseases is to take X-rays on 2 slides (side and straight).
On the X-ray image, arthritis is visualized as follows:
- At an early stage, there are no X-ray signs.
- In the early stage, the pathology is envisioned as an irregular, irregular narrowing of the joint cavity. The edges on the bone plates are slightly flattened, the original bone-forming cells are formed (sometimes absent).
- In the second stage, the image shows an image in a markedly narrow form of the cavity in the joint, 2-3 times exceeding the norm. Bone tissue is formed in large numbers, the formation of bone tissue under cartilage is noted. Enlightenment is like a cyst that appears in the appendage.
- In the third stage, it clearly shows sub-cartilage fibrosis and posterior large bone cells. Common space shrunk significantly.
- In the fourth stage, the giant bone cells are formed, the joint space is almost completely fused, the bone appendages that make up the joint are deformed and compressed.
If the doctor has any doubts about the diagnosis after examining the X-ray images, the patient is assigned to computed tomography. To assess the condition of the connective tissue located near the joint, an MRI is performed. The use of contrast allows you to monitor the dynamics of how tissues are supplied with blood, to determine the level of inflammation in bursitis.
Treatment of arthritis
At present, it is not possible to completely cure joint disease, as pharmacological agents that restore cartilage tissue do not exist.The primary goal of treatment is to prevent further disease development, and keep joints moving.Treatment for arthritis is long and complex, and involves the use of topical and systemic medications.
Patients should not overload joints, limit movement with the help of orthopedic tools - orthopedic tools, elastic bands. Overweight people will have to adjust their diets to lose weight over time and begin it.
When remission stabilizes, the patient needs to perform therapeutic exercises every day. At first, you will have to perform under the supervision of a specialist, later, you need to exercise yourself at home. In addition to the physiotherapy, you can sign up to the pool, do yoga or ride a bike.
To reduce the intensity of pain, the use of drugs of different pharmacological groups is prescribed:
- Nonsteroidal anti-inflammatory drugs in the form of tablets, ointments, solutions for intravenous administration.
- Inject an anesthetic into the joint with the addition of glucocorticosteroids.
- Muscle relaxants to relieve muscle spasms and spasms.
In addition, the regimen for arthritis involves the use of B vitamins, sedatives, if necessary - antidepressants and sedatives. It is imperative to specify chondroprotectors in the form of a long course.The vehicles of this heading contribute to the recovery of firmware.
In order to increase the clinical performance of joint tissue, it is necessary to perform physiotherapy procedures - laser therapy, magnetotherapy, UHF.
Any painful manifestation of the joint is the basis for seeing a doctor immediately. Treatment is carried out in the early stages of the development of joint disease to help prevent destructive processes in the cartilage, to prevent disability and disability.