Osteoarthritis is a chronic disease of the joints that is accompanied by degenerative-dystrophic changes in their structures with predominantly damage to the cartilage tissue.The disease progresses slowly and is asymptomatic in the early stages.The cartilage and bone tissue of the joint, its capsule and the periarticular bursa are gradually destroyed, and later the surrounding muscles, ligaments and subcutaneous tissue are also included in the pathological process.
According to the WHO, one in ten people suffers from this disease, and the risk of developing it increases significantly in people over 50 years of age.The knee and hip joints are most commonly affected.The cause of osteoarthritis is the inability of the joint to withstand stress.In response to traumatic influences, inflammation occurs, which leads to pathological processes in the joint tissue.
Patients with arthrosis of the joints require complex treatment, without which the disease leads to reduced ability to work and quality of life, limitation of sports and professional activities and, ultimately, disability.
Classification of osteoarthritis
Based on the cause of occurrence, the disease is divided into:
- primary osteoarthritis - occurs when the cells of the joint's cartilage tissue are destroyed faster than new ones are formed.Most often this is associated with age-related changes, and not the consequence of a specific pathological process in the body;
- secondary arthrosis – occurs against the background of a certain disease or as a result of a joint injury.
Depending on the location, osteoarthritis is divided into localized (affecting fewer than 3 joints) and generalized (affecting more than 3 joints).The latter is also called polyarthrosis.
Causes of osteoarthritis
This disease is the number one cause of pain and activity limitations worldwide.Although age-related changes are considered the main cause, it is often diagnosed in young patients.Women are more susceptible to osteoarthritis than men, although this difference becomes barely noticeable after the age of 70.
Osteoarthritis of the hip, knee, ankle and shoulder joints has the greatest negative impact on patients' quality of life and ability to work.Osteoarthritis of the elbow and jaw joints as well as the hands, feet and spine are less common.
Predisposing factors include:
- Age;
- genetic predisposition;
- intense physical activity associated with sports or professional activities or, conversely, a sedentary lifestyle, which disrupts the normal nutrition of tissues, especially large joints;
- Joint injuries (fractures, cracks, dislocations);
- wearing unsuitable shoes;
- systemic diseases (metabolic disorders, endocrine diseases, neuropathies, gastrointestinal diseases, bleeding disorders);
- poor diet;
- Overweight.
Women are more likely to suffer from this disease as they are more prone to hormonal imbalances.
Symptoms and degree of osteoarthritis
The main clinical sign of osteoarthritis is pain.In the early stages it may be absent, mild or intermittent.As the disease progresses, the pain becomes more noticeable; it can occur during exertion and, in advanced stages, can also be disturbing at rest.
Secondary manifestations of the disease depend on the localization of the process.Most often these are limited mobility in the affected area (especially after sleep or a long period of rest), deformation, swelling and redness in the joint area, grinding and crepitus when moving, sleep disturbances due to pain and the inability to find a comfortable posture, changes in gait and coordination, muscle cramps.
It should be noted that the pathological process in one joint can spread to neighboring ones due to incorrect load distribution or restrictions on movement.
Depending on the severity of the lesion, the following are distinguished:
- Osteoarthritis of the 1st degree – is asymptomatic or the signs are not pronounced, the patient remains able to work and the diagnosis is difficult;
- Osteoarthritis of the 2nd degree - accompanied by severe symptoms, the patient's quality of life decreases, diagnostics shows obvious disorders;
- Osteoarthritis of the 3rd degree – characterized by an increase in clinical symptoms, joint deformation noted externally and diagnostic methods reveal serious intra-articular disorders;
- 4th degree osteoarthritis – results in partial or complete disability;Disorders can be found in all structures of the joint, the surrounding muscles and ligaments.
Diagnosis of osteoarthritis
An orthopedic traumatologist makes a primary diagnosis based on the patient's data on his lifestyle and work activity, the nature and duration of complaints, the dynamics of symptoms and the presence of arthrosis in relatives, also conducts an examination and prescribes tests or consultations with related specialists (endocrinologist, hematologist, nutritionist, gastroenterologist).
Laboratory tests include a general blood test with leukocyte count, hemoglobin level and ESR.These indicators indicate inflammation in the body, which is inevitably present in osteoarthritis.Biochemical parameters measure the content of rheumatoid factor and C-reactive protein.If certain pathologies are suspected, further laboratory blood parameters are checked.Analysis of synovial fluid is also of diagnostic value, revealing pathological cells and inclusions and allowing you to confirm the diagnosis or differentiate another disease.
Instrumental and visual methods for diagnosing arthrosis help not only to detect pathologies, but also to determine the stage of the disease and the degree of involvement of surrounding tissues.The most effective of them are:
- Radiography – is carried out mainly in two projections and is used to detect narrowing of the joint space and the formation of bone growths (osteophytes) at the site of damaged cartilage;
- Magnetic resonance imaging and computed tomography - prescribed in the early stages, when minor changes are not yet visible on the X-ray;
- Ultrasound - used in addition to these methods, helps to detect the accumulation of excess fluid in the joint cavity (for example, a Baker's cyst in gonarthrosis), assess the condition of the surrounding tissues and measure the thickness of the articular cartilage;
- Scintography – involves the intravenous administration of a radioactive drug that accumulates in tissues with inflammatory processes.Such accumulation areas are shown in the images.This makes it possible to detect osteoarthritis in the early stages and carry out a differential diagnosis.
- Arthroscopy – allows examining the joint from the inside by inserting a microcamera into the joint cavity through a small incision.This makes it possible to collect detailed data about the ongoing pathological processes and injuries and to take a biopsy from the affected area.
- histological examination of the synovial membrane – shows an altered ratio of healthy cells and the presence of pathological inclusions in the joint and allows differential diagnosis.
Differential diagnosis allows you to distinguish arthritis from other diseases with a similar clinical picture, including:
- various arthritis (ankylosing, reactive, rheumatoid, psoriatic, infectious);
- gout and pseudogout;
- Diseases of the muscles and ligaments (fibromyalgia, polymyalgia rheumatica);
- arthropathy (diabetic, paraneoplastic);
- congenital diseases (hypoplasia of the femoral head).
Treatment of osteoarthritis
Despite the widespread nature of the disease and well-studied methods, there is no treatment for osteoarthritis.Therapeutic approaches are aimed at eliminating pain, relieving inflammation, restoring joint function and preventing complications.
The choice of therapy depends on the cause, location and degree of osteoarthritis:
- drug therapy in the form of taking tablets for arthrosis (pain relievers and non-steroidal anti-inflammatory drugs, corticosteroids, chondroprotectors), intra-articular or periarticular injections of these groups of drugs, additional use of ointments and gels;
- Physiotherapy during remission (medical electrophoresis, galvanization, acupuncture, electrical stimulation, shock wave therapy, massage, magnetic and laser therapy, cryotherapy);
- therapeutic exercises for arthrosis are prescribed individually, sessions are carried out under the supervision of a specialist;
- In advanced cases, surgical intervention is performed (partial or total joint replacement, suturing or removing a torn meniscus, removal of bone growths and Baker's cysts).
Prevention of osteoarthritis
It is recommended to control the load on the joints, maintain a healthy lifestyle, perform therapeutic exercises, monitor weight and adhere to proper nutrition.
An orthopedic traumatologist helps patients with arthrosis choose knee pads, an orthosis or a bandage to fix the affected joint, reduce the load and prevent injury.
Preventive examinations and timely consultation with a doctor for joint problems allow you to identify the problem at an early stage and avoid serious complications and disability.