Osteoarthritis (osteomyelitis, the popular name - of salt deposits) - a chronic disease of the joints degenerate degenerative nature, which results in the destruction of articular cartilage, the capsule of the joint, the deformation of the same bones.
It should be noted that osteoarthritis is a group of diseases of the joints, with origins and close relatives of the mechanisms of development. The more often arthritis of the large joints:
- osteomyelitis of the knee joint (gonarthrosis),
- osteomyelitis of the hip (coxarthrosis),
- as well as osteoarthritis of the shoulder joint.
It is heavier than the other types of osteoarthritis.
Osteoarthritis of the small joints are more rare. More often meet of distortion osteoarthritis of interphalangeal joints of brushes, and metacarpal-phalangeal major joints of the fingers. Patients report pain in the interphalangeal joints, a decrease of their mobility, the appearance near the joints of the joints (nodules Heberdena and Bouchard). It is a view of osteoarthritis are more common among the elderly. Often, the encounter of osteoarthritis of the joints of the foot.
The polyarthrosis, or generalized osteoarthritis is characterized by lesions of multiple joints.
Osteoarthritis of the joints of the spine - spondiloarthrosis - refers to a group of diseases of the spine, the less similar with other arthritis the mechanism of development.
The main clinical symptom of osteoarthritis is pain in the joint, a decrease in its mobility. The specific symptoms are determined by the stage of osteoarthritis and depend on the extent of the changes destructive to the joint.
The causes of osteoarthritis
Osteoarthritis can be divided into primary and secondary. Primary (idiopathic) osteoarthritis is the result of disturbances in the process of repair and strengthening of the degeneration in the cartilage of the joint without any hitch in the working of the whole body. Secondary osteoarthritis occurs as the result of other pathological processes in the body, already damaged by a cause external to the joint, in the case of destruction of the articular surfaces.
The most often traumatic osteoarthritis is diagnosed in young patients. And older patients is not always possible to establish a clear distinction between primary and secondary osteoarthritis.
Although the exact cause of the arthritis cannot be determined, the factors that contribute to the emergence and development, are well known.
You can select the types of reasons that contribute to the development of the primary and secondary crippling osteoarthritis.
The primary causes of osteoarthritis - hereditary factors
Identified the inherited disorders that can lead to the development of primary osteoarthritis (oa):
- genetic disorders in the composition of the cartilage of the joint, leading to its accelerated destruction;
- congenital malformations of the musculoskeletal system (the hypermobility of the joints, dysplasia, flat feet and other) are to the traumatic origin of individual parcels of cartilaginous tissues of the joint, and, as a consequence, the onset of osteoarthritis.
It was also observed that the arthrosis deformans interphalangeal joints of the upper limb occurs primarily in women and is inherited by the female line.
The reasons of occurrence of secondary osteoarthritis
Secondary osteoarthritis is the result of lesions of the joint. These damages can be caused by many different factors.
- The mechanical damage of the joints. This group of factors, including a variety of injuries to joints, intra disease, the result of which broke the structure of the joint. The same result constant mikrotravmatizatsiya joints a result of the permanent static loads and dynamic (e.g., in athletes). Also to the strain and trauma of the joints leads to obesity.
Another factor that has a negative impact on the joints (mainly of the hip), is a poor posture.
The structure of the joint can also disrupt the intervention. - The diseases of the joints. Osteoarthritis can be due to inflammatory diseases of the joints (acute and chronic, arthritis, synovitis primary aseptic necrosis bone, and others)
- Disorders of metabolism, diseases of the endocrine system, the mineral deficiency of the body. Of various disorders of the metabolism, 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 an alteration of the regeneration process and the progressive destruction of the composition.
- Autoimmune diseases (gout, chondrocalcinose, hemochromatosis, psoriasis, rheumatoid arthritis), hormonal disorders, the deficiency of estrogen in post-menopausal women in women can lead to changes in the tissues of the joints and gradual destruction.
- Vascular diseases (atherosclerosis of vessels of lower extremities, occlusive disease, varicose disease), as well as the lack of exercise cause disorders of the blood circulation in the tissues, periarticular, poor blood irrigation of the tissues of the joint and degenerative changes.
The mechanism of development of osteoarthritis
The development of osteoarthritis begins with the destruction of the cartilage. It is estimated that, in the beginning of the violation of blood circulation in the capillaries Podhradie layer periosteum. Because the nutrition of the cartilage occurs due to the receipt of nutrients from liquid intra-articular and contiguous bone, the violation of blood circulation results in progressive cartilage loses its elasticity, becomes more thin, there are cracks, smoothing of articular surfaces disturbed, reduces the amount of synovial fluid, ensuring a sliding of the joint. As a result, there is the pain and popping sound when movement. The width of the joint space, decreases gradually, on the edges of the articular surfaces of bone are formed spikes-osteophytes.
Finally, the joint deforms, the amplitude of the movements decreases. And develops involutive osteoarthritis, linked to the ageing of the body. The development of this form of osteoarthritis is usually happens gradually, over many years.
Other forms of arthritis of the large joints, for example, post-traumatic, infection, metabolic, intoxication, several other mechanisms of development, but in the sequel, we get similar changes in the joint.
The symptoms of osteoarthritis of the joints. The stage and grade of osteoarthritis
The "classic" is considered as the classification of oa on the basis of the clinical-radiological signs. According to it, there are three stages of development of the disease. It corresponds to the classification by degree of conservation of work capacity, distinguishes 3 degrees of osteoarthritis:
- I the degree of osteoarthritis - the disease is not an obstacle to the accomplishment of the work, although it is difficult,
- Grade II osteoarthritis is a disease that prevents the work,
- (III) the degree of osteoarthritis - the loss of ability to work.
Look at it in detail the clinical signs and symptoms of osteoarthritis on each of these stages
Oa 1 (initial stage of osteoarthritis (oa)
In the initial phase of the disease, in the morning, after rest, stresses, stiffness, difficulty of movement in the joints, which gradually takes place shortly after the beginning of the movement. May be a limitation of the mobility of the joint. Periodically, there is a "departure" from the pain (the pain at the beginning of the movement, after a long stay in a state of rest). During the movements of the articulation of the tingling, but the pain when driving not. The pain at this stage of osteoarthritis appears only when the large and long duration of the load, and fades out after the rest. Single and small loads of the pain is absent. At this stage of the disease the patients rarely go to the doctor.
On the picture, with the osteoarthritis of 1 degree a lot of change in the articulation is not visible, can sometimes be visible as small osteophytes on the edges of the joint, the joint of the slit is a little reduced.
Osteoarthritis of degree 2 (the second stage of osteoarthritis)
During the pursuit of the development of osteoarthritis of the pain is substantial, becomes acute. A cracking in the joint appears in all the movements, we observe a reduction of the mobility of the joint (contracture), functional shortening of a member, a violation of the biomechanics of the movements, but the mobility of the joint and over again. At this stage, is typical of a significant improvement in the start of the pain, they economic pointed and longer. Under the daily influence of the physical load appears constant fatigue, a feeling of pressure in the affected joints, there arise the so-called "mechanical pain caused by the decrease of the damping capacity cartilaginous tissues of the joint.
The destruction of the joint is already quite large, the joints are already partially deformed.
The x-rays are visible visible osteophytes, narrowing of the joint space 2-3 times compared to the standard, there is sclerosis of the subchondral bone and the formation of cystic cavities in epiphyseal area.
Osteoarthritis of degree 2 is characterized by a decrease of the working capacity, inability to perform certain types of work.
Osteoarthritis of the 3rd (third stage of osteoarthritis)
Osteoarthritis 3 able is heavy, launched on the stage of the disease. At this stage, we observe:
- a large deformation of the joint (because of the spreading of the bones and accumulation of fluid in the articular cavity);
- the strong limitation of motion, up to save only rocking movements;
- a sharp pain is not only the movement, but in a state of complete rest ongoing pain associated with a spasm reflex in the muscles nearby, as well as the development of a reactive synovitis;
- the inflammation of the joints
- the sensitivity of the joints to a weather change.
- the muscles around the knee spasmatic and nonfonctionnels;
The axis of the member deformed, obviously in a varus or valgus curvature of the foot (that is to say, in the form of the letter "O" or "X").
The x-ray with osteoarthritis of the 3 degrees, we observe the almost complete disappearance of the joint space, expressed deformation of the articular surfaces, large multi-edge of osteophytes. Can be joint to the mouse and calcification para-articular tissues.
3 the degree of the disease is gone far, far away, often, it is already the cause of a disability. Manifests itself as follows:
- the pain is constant and painful: the walk, and especially the descent and ascent of the stairs is a painful task for the patient;
- strong biting in all the movements, though audible to others;
- the deformation of the joints strongly expressed, the movements are limited to only a small amplitude, or even impossible;
On the pictures you see to the destruction of structures intra-articular (ligaments and menisci), as well as the wear and tear of the cartilage and signs of multiple sclerosis (replacement of functioning of the organs and structures of the connective tissue).
The arthrosis of 4 degrees
The state of the total destruction of the joint during osteoarthritis, when the joint is completely ceases to function often isolated in a 4 the degree of osteoarthritis. It is observed that the so-called "blockade of the joint" - acute pain syndrome, which is impossible, even limited motion in the diseased joint. The fourth degree of osteoarthritis is accompanied by unbearable pain in the joints, which are not removed, even powerful analgesic medication and intense physiotherapy. Available complete ankylosis (concretion of the joint) or newartriot (formation of a false connection between the staggered ends of the bones). The independent movements in the two cases, it is virtually impossible.
On the pictures is visible coarse of multiple sclerosis soslanovna surfaces with cystic have given to the decline in the maximum, the coalescence of adjoining bone in the area of the joint space. The development of the disease at this stage is almost always synonymous with disability, to prevent what can only the implantation of artificial prosthesis in the joint.
The treatment of osteoarthritis
The treatment of oa at an initial stage of the disease
Begin to treat osteoarthritis better, as soon as possible, at the onset of the first signs of cracking in the joints, difficulty moving. At this stage useful drugs chondroprotectors, improve the structure of cartilage, as well as vitamins and minerals complex.
The importance of a physiotherapy, nutrition, and prevention. It should be noted that the prevention of osteoarthritis is of great importance, and to avoid an aggravation of the disease.
The treatment of osteoarthritis 2 - 3 degrees
Although cure osteoarthritis 2-3 degrees is already impossible, but the process of its development can be significantly curtailed. The treatment of osteoarthritis about this phase includes the following steps:
- withdrawal or reduction of the pain syndrome
- to relieve the inflammation in the joint.
- improve the recovery of the cartilage and slow down degenerative processes in it.
In the acute phase, the treatment of osteoarthritis begins by eliminating the pain. For this, it uses non-nonsteroidal anti-inflammatory drugs (NSAIDS), analgesics. Possible intra injections of corticosteroids. It is necessary to reduce the load on the joints, does not have the time to walk or stand, lift heavy objects.
After the withdrawal, acute pain syndrome, the main challenge is to ensure, to the extent possible, to enhance the repair processes in the joint and the tissue periarticular: improvement of blood circulation, metabolism, elimination of inflammatory processes. Are appointed chondroprotectors, vasodilator drugs, as well as the physiotherapy and physical therapy.
The treatment of osteoarthritis 4 degree
At this stage of the disease of the joint is already almost completely destroyed. In this case, there remains only one output of the operation, and the replacement of the joint of the patient to the prosthesis. The total hip replacement, significantly improves the mobility of the joint, allows the patient to resume an active life, at least, to get rid of the pain.