Arthrosis (Deformation of arthrosis, folk name - salt deposition) is a chronic disease of the joints degenerative -dystrophic, in which the articular cartilage is destroyed, the capsules of the joints and the bone deformity.
It should be noted that arthrosis is a whole group of joint diseases that have different origin and close development mechanisms.Most often there is arthrosis of large joints:
- Deformity of the knee joint arthrosis (gonarthrosis),
- Thigh joint arthrosis (coksartrosis),
- Also shoulder joint arthrosis.
These are the most severe types of arthrosis.
Small joint arthrosis is less common.Most often there is deformed arthrosis of the interphalalancial joints of the hands, as well as the metacarpophalangal joints of the fingers.Patients indicate pain in the interfalance joints, their mobility decrease, the appearance of the seals near the joints (gerder and bushy nodes).This type of arthrosis is more common in old age.There is often arthrosis of the joints of the foot.
Polygrosis, or generalized arthrosis, is characterized by several joint damage simultaneously.
Arthrosis Spinal joints - spondylarthrosis - belongs to a group of spine diseases, although it has a similar mechanism for development with other arthrosis.
The main clinical symptom of arthrosis is the pain of the joint, the decrease in its mobility.Specific symptoms are determined at the stage of arthrosis and depending on the degree of destructive changes in the joint.
Causes of arthrosis
Arthrosis It is usually divided into primary and secondary.Primary (idiopathic) arthrosis is a disruption of recovery processes and degeneration in the cartilage tissue, without any deviations throughout the body.Secondary arthrosis occurs as a result of other abnormal processes in the body, or in the joint that is already damaged by any external effect, partial destruction of articular surfaces.
Most often, traumatic arthrosis is diagnosed in young patients.And in elderly patients, it is always possible to draw an obvious border between primary and secondary arthrosis.
Although the exact cause of arthrosis cannot be determined, there are well -known factors that contribute to events and developments.
The following causes that contribute to the development of primary and secondary deformation arthrosis may be distinguished.
The causes of primary arthrosis are hereditary factors
The following hereditary disorders have been identified that can lead to the development of primary arthrosis:
- Genetic disorders in the cartilage tissue of the joint, which results in accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermen, dysplasia, flat legs, etc.), which cause trauma to certain sections of the cartilage tissue and, as a result, the appearance of arthrosis.
It has also been noted that the deformation of the arthrosis of the inter -phalanx joints is mainly found in women and inherited by female line.
The causes of secondary arthrosis
Secondary arthrosis is the result of joint damage.This damage can be caused by various factors.
- Mechanical damage to the joints.This group of factors includes various damage to the joints, fractures of the bone intraocular bone, resulting in a joint structure disrupted.The same result is due to the constant micromtrumatization of the joints, as a result of excessive constant loading, both static and dynamic (for example, in athletes).Also, obesity causes overload and trauma.
Another factor that has a negative impact on the joints (mainly on the thigh) is the wrong posture.
The structure of the joint can also prevent surgical intervention. - Joint diseases.Arthrosis can be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aptic necrosis of bone tissue, etc.)
- Disruption of metabolism, diseases of the endocrine system, deficiency of minerals in the body.Various disorders of metabolism, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in bone and cartilage, synovial fluid, which causes disruption of recovery processes and gradual destruction of the composition.
- Autoimmune diseases(Gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), Hormonal disorders, estrogen deficiency During postmenopausal, women cause changes in the tissues of the joints and their gradual destruction.
- Vascular diseases (Atherosclerosis of the lower extremity vessels, destruction of Andararitis, varicose veins), as well Hypodynamia They cause circulation disorders in the periarticular tissues, poor blood supply to the joint tissues and, as a result, dystrophic changes.
Arthrosis Development Mechanism
Development Arthrosis It begins with the destruction of the cartilage.It is believed that in the beginning there is a disorder of blood flow to the periosteum corneal layer capillaries.Since cartilage is due to intraocular fluid and the intake of nutrients from the surrounding bone tissue, the blood circulation is delayed by the fact that the cartilage gradually loses elasticity, becomes thinner, cracks on it, and the smoothness of the articular surfaces.As a result, it appears Pain and crisis during movements.The joint gap width gradually decreases, the bone is formed along the edges of the articular surfaces Osteophyta spikes.
Finally, the joint is deformed, the amplitude of the movements decreases.Thus, intimate arthrosis develops associated with body aging.This form of arthrosis is usually developed gradually over the years.
Other forms of arthrosis of large joints, such as post -traumatic, post -tin, metabolic, intoxication have several other developmental mechanisms, but as a result we make similar changes in the joint.
Symptoms of joint arthrosis.Stages and quality of arthrosis
"Classic" is the classification of arthrosis based on clinical and radiological characteristics.Accordingly, three stages of disease development are distinguished.It corresponds to the classification of disability maintenance, which distinguishes 3 degrees of arthrosis:
- The degree of arthrosis - the disease does not interfere with the work, though it makes it difficult to do so,
- Grade II arthrosis - the disease prevents work from performing,
- Arthrosis III degree - Loss of work capabilities.
Consider in more detail the clinical symptoms and signs of arthrosis at each of these stages
First degree arthrosis (the initial stage of arthrosis)
In the early stages of the morning, after rest, the firmness of the joints is difficult to move in the joints, which gradually passes after the movement begins.Perhaps some limitation of mobility in the joint.Periodically, "starting" pains arise (pain at the beginning of movement, after a long time).With sharp movements, joint crushes, but there is no pain during movement.At this stage of arthrosis, the pain appears only with a significant and prolonged load and is born after rest.The pain is not alone and low loads.At this stage of the disease, patients rarely see a doctor.
The first degree of arthrosis of special changes in the joint does not appear on the X -ray image, sometimes small osteophytes along the edges of the joint, can be visible, the articular gap is slightly narrow.
2 degree arthrosis (second stage of arthrosis)
With the further development of arthrosis, the pain becomes more important, gaining acute nature.Clear crispy in the joint appears in any movement, there is a noticeable limitation of mobility (contracture), functional reduction of limb, impaired biomechanics, but joint mobility is still protected.At this point, the initial pain is noticeable, they become acute and long.Under the influence of the physical activity of the day, constant fatigue arises, pressure in the affected joints, so -called "mechanical pains" arise by reducing shock capacity containing the cartilage tissue of the joint.
Destruction of the joint is already quite important, the joints are already partially deformed.
Radiographs are visible osteophytes, joint gap narrowing 2-3 times compared to the norm, subcondial bone sclerosis and the formation of cystic cavities in the epiphysis zone.
2nd degree arthrosis is characterized by a decrease in work capabilities, the inability to perform certain types of work.
Arthrosis 3 degrees (third stage of arthrosis)
Arthrosis 3 degrees is a severe, neglected stage of the disease.At this point, there is:
- Significant deformation of the joint (due to the growth of bones and accumulation of fluid in the joint cavity);
- A sharp restriction of movements only before the rock movements are maintained;
- Severe pain not only during movement but also in a full rest - permanent pain associated with reflex cramps of nearby muscles, as well as the development of reactive synovitis;
- Joint inflammation,
- Sensitivity to joints in weather change.
- The muscles around the knee are sympathetic and atrophic;
The axis of the limbs is deformed, noticeably varusy or valgus curve in the legs (ie the letter "O" or "X" letter).
On radiographs of 3rd degree arthrosis, the joint gap is almost complete disappearance, severe deformation of the articular surfaces, and multiple regional osteophytes are observed.Articular mice and calcification of paraticular tissues may be determined.
In 3 degrees, the disease has gone too far, often this is the cause of constant disability.It manifests as follows:
- The pain becomes permanent and painful: walking, especially the origin and climbing of the stairs - a difficult test for the patient;
- Loud crunch in any movement, well -released others;
- The deformation of the joints is strongly pronounced, the movements are limited to a small amplitude or even impossible;
The pictures show the destruction of intra -the -ligament structures (ligaments and menskus), as well as signs of cartilage and sclerosis (replacement of functional organs and structures of connective tissue).
4th grade arthrosis
The state of complete destruction of the joint Arthrosis, When the joint stops completely functioning, it is often distinguished by a separate - 4 degrees of arthrosis.There is a so -called "joint blockade" - acute pain syndrome, where limited movement in the sick joint is impossible.The fourth degree of arthrosis is accompanied by unbearable joint pain that is not removed by strong medications and intense physiotherapy.Complete ankylosis (fusion of joints) or neoartrosis (false joint formation between the displaced ends of the bones).Independent movement in both cases is almost impossible.
In pictures, with obvious cystic enlightenment, the issue of coarse sclerosis of surfaces, the fusion of visible bones is a joint gap.The development of the disease at this stage is almost always a disability that can only be avoided by implantation of artificial joint prosthesis.
Treatment of arthrosis
Treatment of arthrosis at the initial stage of the disease
It is best to start treatment for arthrosis as early as possible, with the first signs of shredded joints, difficulty in movement.At this point, the drugs are useful -co -producers that improve the cartilage structure as well as vitamin -mineral complexes.
Medical physical education, proper nutrition, as well as preventive measures are important.It should be noted that the prevention of arthrosis is also important to prevent exacerbation of the disease.
Arthrosis treatment of 2 - 3 degrees
Although it is already impossible to completely cure 2-3 degrees of arthrosis, its development process can be noticeably delayed.Arthrosis treatment at this stage involves the following stage:
- Removing or reducing pain syndrome
- Remove inflammation in the joint.
- Improve the restoration of the cartilage and slow down degenerative processes.
In the acute period, treatment of arthrosis begins with the elimination of pain.Analgesics (NSAIDs) are used for this.Intracular injections of corticosteroids are possible.It is necessary to reduce the load on the joint, you cannot walk or do not stand for long, raise heavy objects.
After removing acute pain syndrome, the main task is to ensure, as far as possible, activate recovery processes in joint and periarticular tissues: improve blood circulation, increase metabolism, eliminate inflammatory processes.Chondroprotectors, vasodilatory medicines, as well as therapeutic exercises and physiotherapy are prescribed.
Treatment of arthrosis 4 degrees
At this stage of the disease, the joint is almost completely destroyed.In this case, one exit remains - surgery and diseased joint replacement with endoprosthesis.Endoprosthesis significantly improves joint mobility, allows the patient to renew his active life, at least to escape the pain.