Osteoarthrosis (deforming osteoarthritis, popular name - deposition of salts) - a chronic degenerative disease of the joints-degenerative in nature, in which occurs the destruction of the articular cartilage, the capsule of the joint, the deformation of most craps.
It should be noted, that the arthritis is a group of diseases of the joints, have different origins and their loved ones deployment mechanisms. Most often arthritis of large joints:
- deforming osteoarthritis of the knee (gonarthrosis),
- deforming osteoarthritis of the hip joint (coxarthrosis),
- as well as osteoarthritis of the shoulder joint.
This is the most severe kinds of osteoarthritis.
Arthritis of the small joints is less common. It is more common deformity arthritis interphalangeal joints of the hands, as well as of the phalangeal joint big toe of the brush. Patients note pain in the interphalangeal joints, reduction in mobility, appearance close to the joints seals (nodules Heberdena and Bouchard). This is the kind of osteoarthritis is more common in the elderly. Often osteoarthritis of the joints of the foot.
The polyarthrosis, or generalized osteoarthritis, is characterized by the defeat at the same time a lot of joints.
Osteoarthritis of the joints of the spine - spondylolisthesis - refers to a group of diseases of the spine, although is similar to other arthritis development mechanism.
The main clinical symptom of osteoarthritis is pain in the joints, reducing mobility. Specific symptoms are determined by the stage of osteoarthritis and depends on the degree of destructive changes in the leg.
The causes of osteoarthritis
Osteoarthritis taken divided into primary and secondary. Primary (idiopathic) osteoarthritis is a consequence of breach recovery of processes and the strengthening of degeneration of the cartilage of the hip without any abnormality in the functioning of the whole organism. Secondary osteoarthritis occurs as a result of other pathological processes in the body, whether the already destroyed any outside influence of the knee, by the partial destruction of the articular surfaces.
Often traumatic arthropathy is diagnosed in young patients. And in patients older is not always you can spend a clear distinction between primary and secondary osteoarthritis.
Although the exact cause of osteoarthritis is not you can locate the factors that contribute to the appearance and development, are well known.
We can distinguish the following types of reasons that contribute to the development of the primary and secondary deformation of osteoarthritis.
The main causes of osteoarthritis - hereditary factors
Revealed the following hereditary disorders that may cause the development of primary osteoarthritis:
- genetic disorders in the synthesis of the cartilage of the joint, which leads to the rapid destruction?
- congenital anomalies of the musculoskeletal system (hyperactivity of the joints, dysplasia, flat feet and more) that are causing the psychological injury to the individual sections of cartilage tissue of the joint, and, therefore, the appearance of osteoarthritis.
It is also noted that deforming osteoarthritis of the interphalangeal joints of the upper extremities occurs mainly in women and is descended from the female line.
Causes of secondary osteoarthritis
Secondary osteoarthritis is a result of the failure of the joint. These lesions can be caused by a variety of factors.
- Mechanical damage of the joints. In this group of factors includes the various lesions of the joints, intra articular fractures of the bone, in which disrupted the structure of the knee joint. The same effect leads to a permanent micro-fractures in the joints resulting in excessive permanent loads, such as static and dynamic (e. x athletes). Also in intensity, and psychological injury to the joints resulting in obesity.
Another factor, in particular with those who provide negative effect on the joints (mainly hip), is the wrong posture.
Structure of the hip can also disrupt the surgery. - Diseases of the joints. Osteoarthritis can be due to inflammatory diseases of the joints (acute and chronic arthritis, synovitis, the primary aseptic necrosis of the bone tissue, etc.)
- Metabolic disorders, diseases of the endocrine system, the lack of minerals in the body. Various metabolic disorders, lack of calcium, phosphorus and other minerals, vitamins and trace elements cause changes in the composition of bone and cartilage, the synovial fluid, which leads to disruption of the recovery of processes and the gradual destruction of the composition.
- Autoimmune diseases (gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, estrogen deficiency in postmenopausal women lead to changes in the tissues of the joints and gradual destruction.
- Vascular diseases (atherosclerosis of vessels of lower extremities, obliteriruty endarteriit, varicose disease), as well as lack of exercise cause disorders of blood circulation in periarticular tissues, poor blood flow to the tissues of the joint and the result - dystrophic changes.
The mechanism of the development of osteoarthritis
The development of osteoarthritis begins with cartilage destruction. It is considered that in principle occurs a violation of blood circulation in the capillaries of the lung Podhradie layer of the elevator. The way the nutrition of the cartilage due to nutrients from intra-articular fluid and the contiguous bone, disorder of blood circulation leads to the fact that the cartilage gradually loses elasticity, becomes more thin, cracks, smoothness of the articular surfaces is disturbed, it reduces the amount of synovial fluid, ensuring transparency to the public. As a result, you receive pain and critical moment, when it moves. The width of the joint slit is gradually reduced, the edges of the articular surfaces formed bone spikes-osteophytes of the.
Eventually the joint to be deformed, the range of motion in this reduced. It is involutive osteoarthritis, associated with the aging of the body. The development of this form of osteoarthritis usually happens gradually, for many years.
Other forms of arthritis of the large joints, for example, post-traumatic, post-infectious, metabolic, intokshikaie have slightly different mechanisms of development, but as a result we have similar changes in the leg.
The symptoms of osteoarthritis in the joints. The stage and grade of osteoarthritis
"Classic" is considered to be classification of osteoarthritis based on clinical and radiological evidence. In accordance with this emit three stages of disease progression. The corresponding classification according to the degree of conservation of the disability, it emits 3 degrees of osteoarthritis:
- I the degree of osteoarthritis - the disease does not interfere with the implementation of the project, although difficult
- (II) the degree of osteoarthritis - disease hinders the execution of work,
- (III) the degree of osteoarthritis - loss disability.
Consider most of the clinical symptoms and signs of osteoarthritis in each of the stages
Osteoarthritis of 1 degree (the initial stage of osteoarthritis)
In the initial stage of the disease in the morning after resting, there is stiffness, difficulty in movement of joints, which gradually subsides after some period of time after the start of the movement. Maybe some restriction of mobility in the shoulder joint. Intermittently displayed a "starter" of pain (pain at the beginning of the movement after prolonged stay in a state of rest). With sharp movements of the hip tingling, but the pain during movement is not there. The pain in this stage of osteoarthritis appears only when significant and prolonged load, and resolves after rest. At rest and during small loads, pain does not exist. At this stage of the disease, patients rarely seek medical care.
In the x-ray in osteoarthritis of 1 degree of specific changes in the hinge is not visible, sometimes they may seem small osteophytes at the edges of the joint, the joints crack a bit decreased.
Osteoarthritis 2 degrees (the second stage of osteoarthritis)
With the further development of osteoarthritis is pain becomes significant, becomes sharp in nature. A separate critical moment in the hinge is shown in all movements, there has been a noticeable restriction of mobility in the joint (contracture), functional shortening of the limbs, disorders of the biomechanics of the motion, but the mobility of the joint persists. In this stage is characterized by a significant increase in the onset of pain, become sharp and more time consuming. Under the influence of fluorescent physical exercise you receive constant fatigue, sense of pressure in the joints affected, resulting so-called "mechanical pain", caused by the reduction in depreciation of skills of the cartilage tissue of the joint.
Destruction of the public already are quite substantial, the joints already partly deformed.
The x-rays visible visible osteophytes of, narrowing of joint cracks in 2-3 times in comparison with the rule, observed sclerosis subchondral bone and formation of cystic cavities in the epiphyseal area.
Osteoarthritis 2 grade is characterized by a reduction of disability, inability to perform certain projects.
Osteoarthritis 3 degree (the third stage of osteoarthritis)
Osteoarthritis 3 degrees - it's a tough, advanced stage of the disease. At this stage, it is observed:
- significant deformation of the joint (due to the increase of the bones and accumulation of fluid in the cavity of the synovial);
- active limit of motion, until you save only rocking moves?
- acute pain not only in driving but also in a state of complete tranquility - chronic pain associated with reflex spasm of the surrounding muscles, as well as the development of reactive synovitis;
- inflammation of the joints,
- the sensitivity of the joints to the change in the weather.
- the muscles around the knee the spastic and atrophic;
Shaft ends, deformed, significant varus or valgus curvature of the foot (i.e. in the shape of a "Z" or "X").
The x-rays when osteoarthritis 3 degrees is observed almost complete disappearance of the articular slit, expressed by the deformation of the articular surfaces, extensive multiple edge osteophytes of the. May be determined jointly by the mouse and calcification para-articular tissues.
In 3 degrees of disease goes too far, often it is already causing the attitude of the disability. It manifests itself as follows:
- the pain becomes permanent and painful: walking, and especially the descent and climbing stairs - test for the patient?
- a loud crackle under any of moves, good sound others?
- deformation of the joints especially intense, the moves are limited to only a small range, or even impossible?
In the pictures it seems the destruction of intra-articular structures (ligaments and meniscus), as well as complete abrasion of the cartilage and signs of multiple sclerosis (replacement of work of organs and structures of the connective tissue).
Osteoarthritis 4 degree
The situation with the complete destruction of the joint during osteoarthritis, when the joint is fully ceases to function often emit in a separate - 4 grade of osteoarthritis. There is the so-called "exclusion of the public" - acute pain syndrome, which is not possible for even the limited movement on a sick leg. Fourth degree of osteoarthritis accompanied by unbearable pain in the joints, which are not removed even strong pain medication and strong go in for physical therapy. It is possible the complete ankylosis (fusion of the hip) or newartriot (education fake joint between the displaced ends of the bone). Independent movement and on both occasions it's almost impossible.
The photos are visible rugged sclerosis soslanovna surfaces with a strong kistoznymi the enlightenment, the accretion of associated bones in the region of the articular fissure. Progression of the disease at this stage is almost always means a disability, which can only prevent implantation of an artificial denture of the public.
The treatment of osteoarthritis
The treatment of osteoarthritis in the primary stage of the disease
To start the treatment of osteoarthritis better as early as possible, when the first signs - rattling in the joints, difficulty in movement. At this stage it is useful drugs - chondroprotectors, improve the structure of cartilage, and vitamin-mineral complexes.
It is important to have a therapeutic exercise, proper diet, and prevention activities. It should be noted, that the prevention of osteoarthritis is of great importance for the prevention of the disease.
The treatment of osteoarthritis 2 - 3 degrees
Although completely cure the osteoarthritis of 2-3 degree is impossible, however, the process of development can be noticeably braking. Osteoarthritis treatment at this stage includes the following stages:
- removal or reduction of pain syndrome
- the exception of inflammation in the joint.
- to improve the rehabilitation of cartilage and slow the degenerative processes of the.
In the acute period of treatment of osteoarthritis starts with pain management. For this purpose they used non-hormonal anti-inflammatory drugs (NSAIDS), analgesics. Not intra articular injections of corticosteroids. You need to reduce the load on joints, not for a very long time to walk or to stand, to lift heavy objects.
After the removal of the acute pain syndrome main task is to ensure, to the extent possible, the enhancement of recovery processes in the joint and periarticular tissues: improvement of blood circulation, increase metabolism, treat inflammation. Appointed chondroprotectors, - vasodilators drugs, as well as therapeutic exercises and physiotherapy.
The treatment of osteoarthritis 4 degree
At this stage of the disease of the hip almost to the ground. In this case there is only one way out - the operation and replacement of the knee joint of the patient endoprosthesis. Endoprosthesis significantly improves the mobility of the hip, allowing the patient to resume an active life, at least, to get rid of the pain.