arthrosis (Arthrosis deformity, popular name - Salt deposition) is a chronic disease of the degenerative -diztrophical joints, in which the destruction of the articular cartilage occurs, joint capsules and bone deformity.
It should be noted that arthritis is a whole set of common diseases that have different origin and close development mechanisms.Most often there are arthrosis of large joints:
- deformity of the arthrosis of the knee joint (gonarthrosis),
- deformation of hip fusion arthrosis (coxarthrosis),
- as well as the arthrosis of the shoulder union.
These are the most severe types of arthrosis.
Arthrosis of the small joints is less common.Most often there is deforming arthritis of the interconnecting joints of the hands as well as the metacarpophalangeal joints of the fingers.Patients mark the pain in the interconnection joints, a decrease in their mobility, the appearance near the seal joints (Geberden and Bushar joints).This type of arthrosis is more common in old age.Often arthritis of the ankle joints occurs.
Polyrythrosis, or generalized arthrosis, is characterized by damage to some joints immediately.
arthrosis Spinal cord connections - spondylarthrosis - belong to the group of spine diseases, although it has a similar mechanism of development with other arthritis.
The main clinical symptom of arthrosis is pain in the joints, a decrease in its mobility.Specific symptoms are determined by the arthrosis phase and depend on the degree of destructive changes in the joint.
Causes of arthrosis
arthrosis It is common to divide into elementary and secondary.Primary (idiopathic) arthritis is a consequence of violation of recovery processes and increased degeneration in the cartilage tissue of the union without any deviation in the work of the whole organism.Secondary arthritis occurs as a result of other pathological processes in the body, or in the already damaged joint by any external effect, with partial destruction of articular surfaces.
Most often, traumatic arthritis is diagnosed in young patients.And in older patients, it is far from always possible to draw a clear limit between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, the factors that contribute to the occurrence and development are known.
The following types of causes that contribute to the development of primary and secondary deforming arthrosis can be distinguished.
Causes of primary arthrosis are hereditary factors
The following hereditary disorders have been identified, which can cause the development of primary arthrosis:
- genetic disorders in the composition of the cartilage tissue of the joint, leading to its accelerated destruction;
- Congenital defects of the muscular -skeletal system (hypermobile of the joints, dysplasia, flat feet and others), which are the cause of the trauma of certain sections of the cartilage tissue of the joint, and, as a result, the appearance of arthrosis.
It is also observed that deformation of the arthrosis of the nodes inter -phalaranx of the upper extremities is mainly found in women and inherited from the female line.
Causes of secondary arthrosis
Secondary arthrosis is a consequence of joint damage.These damage can be caused by various factors.
- Mechanical damage to the joints.This set of factors includes various common damage, intra -articular bone fractures, as a result of which the joint structure is disturbed.The same result is caused by continuous microtraumatization of the joints as a result of excess constant, both static and dynamic loads (for example, athletes).Also, overweight leads to overload and trauma.
Another factor that has a negative effect on the joints (mainly in the hip) is incorrect behavior.
The structure of the joint can also disrupt the surgical intervention. - Common diseases.Arthrosis can be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.)
- Violations of metabolism, diseases of the endocrine system, lack of minerals in the body.Disordisms of various metabolism, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in bone and cartilage composition, synovial fluid, which leads to a violation of recovery processes and gradual destruction of the composition.
- Autoimmune(Gout, condrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), Disordishes hormonal disorders, lack of estrogen In postmenopause, women lead to changes in joint tissue and their gradual destruction.
- Vascular (Atherosclerosis of the lower extremities vessels, endarteritis by destroying, varicose veins) as well as Hypodinamine They cause disturbances of blood circulation in the periarticular tissue, poor blood supply to joint tissue and, as a result, dystrophic changes.
Mechanism of arthrosis development
and developmental arthrosis Begins with the destruction of the cartilage.It is believed that at first there is a violation of blood circulation in the capillaries of the periosteum corneal layer.Since cartilage nutrition occurs due to the intake of nutrients from intra -articular fluid and adjacent bone tissue, circulatory disruption leads to the fact that the cartilage gradually loses elasticity, becomes thinner, the cracks appear in it, the softening of the articular surfaces is disturbed, the amount of synovial fluid is reduced.As a result, it appears Pain and cramping during movements.The width of the joint gap gradually decreases, the bone is formed along the edges of the articular surfaces Osteophyta spikes.
After all, the node is deformed, the amplitude of the movements in it decreases.Thus develops the arthrosis of inclusion associated with the aging of the body.The development of this form of arthritis usually occurs gradually, over the years.
Other forms of large joint arthrosis, for example, post -traumatic, post -infectious, metabolic, intoxication have some other developmental mechanisms, but as a result we get similar changes in coupling.
Symptoms of arthrosis of the joints.The stages and degree of arthrosis
"Classic" is the classification of arthrosis based on clinical and radiological features.According to it, three stages of the development of the disease are distinguished.Corresponds to the classification with the degree of disability maintenance, which distinguishes 3 degrees of arthrosis:
- I rate of arthrosis - the disease does not prevent work, though it complicates it,
- II arthrosis rate - the disease prevents labor performance,
- III Arthrosis degree - loss of working capacity.
Let us consider in more detail the clinical symptoms and signs of arthrosis in each of these stages
1st degree arthrosis (initial stage of arthrosis)
In the initial phase of the morning disease, after rest, stiffness, the movement of difficulty in the joints, which gradually passes some time after the movement begins.Probably some restrictions of mobility in the union.Periodically, "initial" pain appears (pain at the beginning of movement after a long stay at rest).With sharp movements, joint joints, but no pain during movement.Pain at this stage of arthritis only appears with a significant and prolonged load, and descends after rest.There is no pain alone and with low loads.At this stage of the disease, patients rarely see a doctor.
In the X -ray with arthritis of 1 degree arthritis of particular changes in the joint is not visible, sometimes small osteophytes along the ends of the joint may be visible, the articular gap is slightly narrowed.
2 degree arthrosis (second stage of arthrosis)
With further development of arthrosis, the pain becomes more important, acquires an acute character.A particular crisis in the union appears with each movement, there is a noticeable limitation of union mobility, functional shortening of the limbs, damaged biomechanics of movements, but the joint mobility is still preserved.This stage is characterized by a noticeable strengthening of initial pain, they become acute and longer.Under the influence of the physical activity of the day, constant fatigue, the feeling of pressure on the affected joints, the so -called "mechanical pain" called caused by a decrease in the absence of the joints of the joint of the joints.
The destruction in the union is already quite significant, the nodes are already partially deformed.
In radiographs, visible osteophytes are visible, the narrowing of the joint gap is 2-3 times compared to the norm, the subcondrial bone sclerosis and the formation of cystic cavities in the epiphysis area are observed.
2nd degree arthrosis is characterized by a reduction in working capacity, the inability to perform certain types of work.
3 -degree arthrosis (third stage of arthrosis)
arthrosis 3 degrees are a severe, neglected stage of the disease.At this stage, there are:
- significant deformation of the joint (due to the growth of bones and fluid accumulation in the joint cavity);
- a sharp restriction of movements, up to preserve only rocking movements;
- Sharp pain not only when moving, but also in a state of complete rest - persistent pain associated with nearby muscle reflex pain as well as the development of reactive synovitis;
- joint inflammation,
- Nodes sensitivity to weather change.
- The muscles around the knee are bad and atrophied;
The axis axis is deformed, visibly dependent on the varus or valgus of the legs (ie, in the form of the letter "O" or "X").
In the 3th degree arthrosis radiographs, almost complete disappearance of the common gap is observed, severe deformation of the articular surfaces, there are high regional osteophytes.Articular mice and calcification of paraological tissue can be determined.
At 3 degrees, the disease has gone too far, often the cause of constant disability.Manifested as follows:
- The pain becomes persistent and painful: walking, and especially the origin and climbing of the stairs - a difficult test for the patient;
- Crunch loudly in every move, good -for others;
- Node deformity is strongly expressed, movements are limited only by a small or even impossible amplitude;
The photographs show the destruction of intra -articular structures (ligaments and meniscus), as well as complete cartilage erosion and sclerosis signs (replacement of functional organs and connective tissue structures).
4th degree arthrosis
State of complete destruction of union arthrosis, when the joint completely stops functioning is often distinguished at a particular degree - 4 degrees of arthrosis.There is a so -called "joint blockade" - an acute pain syndrome, in which even limited movement in a diseased joint is impossible.The fourth degree of arthritis is associated with unbearable joint pain, which are not even removed from powerful medication and intense physiotherapy.Complete ankilosis (joint fusion) or neoarthrosis (forming a fake joint between the displaced bone edges) is possible.Independent movement in both cases is almost impossible.
In the photograph, rough sclerosis of the surfaces of Sattime with pronounced cystic enlightenment, the melting of bonding bones in the joint gap is visible.The development of the disease at this stage almost always means disability, which can only be prevented by the implantation of the artificial joint prosthesis.
The treatment of arthrosis
Treatment of arthrosis at the initial stage of the disease
It is best to start treating arthritis as soon as possible, with the appearance of the first signs - cramping in the joints, difficulty in motion.At this stage, medicines are useful -Condroprotectors that improve cartilage structure as well as vitamin mineral complexes.
Physical medical education, proper nutrition, and preventive measures are important.It should be noted that the prevention of arthritis is also of great importance to prevent the disease from worsening.
Treatment of arthrosis 2 - 3 degrees
Although it is already impossible to fully cure arthritis of 2-3 degrees, however, the process of its development can be significantly obstructed.The treatment of arthrosis at this stage includes the following stages:
- Removing or reducing pain syndrome
- Remove inflammation in the joint.
- Improve the reset of cartilage and slow down the degenerative processes in it.
In the acute period, the treatment of arthritis begins with the elimination of pain.For this, non -adids (NSAIDs) anti -inflammatory drugs are used, analgesics are used.Intra -articular corticosteroid injections are possible.It is necessary to reduce the load on the joint, you cannot walk or stay for a long time, to set up heavy objects.
After the removal of acute pain syndrome, the main task is to ensure, as much as possible, activation of recovery processes in common and periarticular tissue: improvement of blood circulation, increased metabolism, elimination of inflammatory processes.The chondroprotectors, vasodilating drugs, as well as therapeutic exercises and physiotherapy are written.
Treatment of 4 degree arthrosis
At this stage of the disease, the knot is almost completely destroyed.In this case, an exit remains - surgery and replacement of the diseased node with an endoprostese.The endoprostese significantly improves the motility of the joint, allows the patient to resume active life, at least, to get rid of the pain.