Osteoarthritis and a pathology report that affects the connective tissue structures of the apparatus of the musculoskeletal. For the disease that is characterized by progressive course with the gradual destruction of cartilage. Osteoarthritis and diagnosed in the majority of patients works of original art from 65 years as one of the reasons for its development, naturally the process of aging.
The appearance of degenerative-dystrophic pathology of the result of the previous trauma, endocrine and inflammatory diseases, excessive physical exertion or, on the contrary, a sedentary lifestyle. The main symptoms of osteoarthritis are pain in the joint swelling, limitation of movements.
For the diagnosis of pathology conducts instrumentals studies — radiography, arthroscopy, magnetic RESONANCE imaging, CT. Arthritis 1 and 2 severity treated conservatively course of the taking of drugs, physical therapy and massage, exercise therapy. When irreversible destructive changes in the joints, surgery — arthrodesis, arthroplasty.
Pathogenetic working mechanisms
In the is pronounced osteoarthritis changes in the internal connective tissue structures. In the cartilaginous tissue formed deforming erosion, which causes destruction of the collagen fibres and proteoglycans composed of a protein (5-10%), and glycosaminoglycans (90-95%). The result of collagen mesh loses its stability, are starting to be released metalloproteinases that destroy all types of proteins of the extracellular matrix. The degradation and accelerated by the increase of the biosynthesis of collagens I, stromelysin. In general, the values of the enzymes is the control of cytokines (small peptide information molecules. But with the progression of osteoarthritis, the concentration of these proteins decreases which causes the release of a large number of enzymes by damage to cartilage.
Proteoglycans with altered structure absorb begins to water molecules that are unable to maintain. Therefore, the excess of liquid enters in the fibers of collagen. That "fill", you lose strength and elasticity. Composition and qualitative and quantitative synovial fluid is also experiencing changes negative. In osteoarthritis it reduces the concentration of hyaluronic acid. To the hyaline cartilage no longer be sufficient for the regeneration of the amount of nutrients and oxygen. In the cartilaginous tissues formed a focus of softening, and original works of art cracks, specific necrotic growths. Bone head stripped, starting a microtraumatic an offset relative to each other.
Causes and factors predisposing
The causes of primary (idiopathic) osteoarthritis is not yet established. Occurs when the absence of any precipitating factors, therefore, proposed the theory of the hereditary predisposition to rupture premature of cartilage. Secondary osteoarthritis develops as the other d result diseases of the joints, or previous injuries. What can cause degenerative diseases:
- injury of the joint or the proposition connective tissue structures — fracture dislocation of the meniscus injury, a partial tear of muscles, ligaments, tendons, complete, or separation of the bone from the base;
- congenital dysplastic developmental disorder of the joint;
- violation of the endocrine glands, disorder of metabolic processes;
- rheumatism, or rheumatic fever;
- of rheumatoid, reactive, metabolic, psoriatic, or arthritis, gout, polyarthritis;
- purulent arthritis caused by streptococci or Staphylococcus epidermidis staphylococci;
- tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
- degenerative disease, for example, the dissection Legg.
For the development of osteoarthritis predisposes a hypermobility of the joints due to the production of a particular collagen. This disease is diagnosed in 10% of the planet's inhabitants and I don't regarded as a pathology. But the hypermobility and accompanied by weakness of the tendinous-ligamentous apparatus, which leads to frequent injuries, especially ankle (sprains and torn ligaments, sprains).
Cause arthritis sometimes are the disorders of hematopoiesis, for example, haemophilia. Hemarthrosis, or bleeding into the cavity of the joint, the deterioration causing of the trophic cartilage and its destruction.
For the predisposing factors include old age, tension frequent on the joints that exceed the limits of their strength, weight gain, surgery, and hypothermia.
The group of risk includes women in menopause, people living in adverse environmental conditions or contact with chemical toxic compounds. Deficiencies in the diet of foods with vitamins and minerals, creating conditions for the progressive degradation hyaline cartilage.
The clinical picture
The danger of osteoarthritis, the lack of symptoms in the first stage of its development. Pathology and clinically manifests with a slowly, the first signs arise against significant destruction of the cartilage tissue. First, the person sent mild pain, meaning clear the location. Original work of art it Seems that the physical effort — lifting weights, sports training. Sometimes the first clinical manifestation in a crisis, clicks on the stoop or the joint inflexible. The people began to observe certain movements that are difficult. However, in the initial phase of osteoarthritis stiffness occurs in the morning hours and soon disappears.
The disease progresses the pain is sent only at night in the un causing any disorder of the child, but the onset of the chronic fatigue. The intensity of the pain syndrome in the second stage increases with the change of climate, exacerbation of chronic diseases of the infection. Noticeably reduced range of movement. The reason for the stiffness becomes in the thinning of cartilage and deliberate of a person restriction of movements in an attempt to avoid examining the pain. This leads to an un increase of the load on the opposite joint, which is more damage it causes. For osteoarthritis characteristic in l and other specific symptoms:
- the causes pain and spasms skeletal muscles and development of contractures of muscle (restriction of passive movements of the joint);
- the crisis in the joints, clicks, crackle permanent becoming in movement, it is produced in almost all of the displacement of the bones relative to each other;
- often, there are painful muscle cramps;
- the joints are deformed, which leads to the disorders of posture and gait;
- in the third stage of the arthrosis deformation s expresses so vividly the joint is bent, and the volume of movements in them significantly reduced or completely absent;
- in the third grade of osteoarthritis of the knee, ankle, hip joint when moving the patient uses the un club or crosses.
If it is not treated the disease progresses, and in its course of remission s alternate with recurrences, and the frequency of exacerbations increases all the time. Stiffness in the morning, now does not disappear for a long time, it becomes permanent.
Examine the un patients with osteoarthritis of 1 degree, the doctor noted a slight inflammation of the joint and total security that the range of motion. In the pathology of 2 degrees palpation reveals pain and weakly expressed deformation. In the region of the articulation of the space observed the formacio d bone nodules.
A For osteoarthritis characterized by the development of synovitis — inflammation of the membrane " of the hip synovial, knee, ankle, joints of the shoulder. The main symptoms becomes formacio integral of the person in the stamp of the field joint, by pressing on which there is the un the displacement of the fluid (varies with installation). Acute synovitis may be accompanied by an object the increase of the temperature of 37-38°C, headaches, digestive disorders.
Diagnosis
The diagnosis put on the basis of results of instrumental investigations, clinical features, anamnesis, complaints of patients. General Analysis of blood and urine uninformative — all values remain within the limits is the arthritis if it is not enabled by metabolic disorders. With the development of synovitis increases the rate of erythrocyte sedimentation (30 mm/hour) in the blood increases the level of leukocytes, and his fibrinogen. This indicates that occur in the body, acute or chronic inflammatory process. Changes in biochemical and immune parameters occur in secondary forms of osteoarthritis.
The method is more informative in diagnosis of degenerative-dystrophic pathology — front and in x-ray side of the projections.
| Stage of osteoarthritis, according to the classification of Kellgren-Lawrence (1957) | Radiographic signs language pathology |
| Initial | Signs of the absence of radiological |
| Primer | Indistinct, irregular narrowing of the joint space. The un small flattening of the edges of the bone of the plates, the formacio of osteophytes initial or the lack of the same |
| Second | Marked reduction of the joint space greater than the norm by 2-3 times, the formacio of a large number of osteophytes, subchondral osteosclerosis. The appearance kistevidnyj enlightenment in the epiphyses |
| Third | The appearance of expressed subchondral osteosclerosis and large marginal osteophytes, significant reduction of the joint space |
| Fourth | The formacio thick massive osteophytes, the almost complete fusion of the joint space, the deformation and compaction of the epiphyses of the bones that form the joint |
Original works of art to be able to study If the images of two rays from x to the doctor questions to have in establishing a diagnosis, prescribe a ct scan. And to assess the state, located around the joint connective tissue structures of MRI. S When using the change in the dynamics to evaluate the flow of blood to the tissues, the stage of the inflammatory in the process of developing synovitis.
Early methods of therapy
Osteoarthritis and still incurable disease, as there are no drugs for the regeneration of cartilage. The main task of treatment becomes the prevention of disease progression, preservation of joint mobility. The long and the treatment and complex, using both local and systemic drugs. The patients must prevent to examine the tensions are serious in the joint, and if necessary, to limit the range of motion orthopedic devices such as braces, bandages, elastic. Patients with excess weight, you need to make adjustments to the diet for a gradual loss of weight and the diet.
Original works of art to get the un sustained remission of patients shown daily events of therapy sessions. Formacio The first is carried out under the guidance of un physiotherapist, original works of art that makes the patient exercises at home. Physical therapy can be supplemented with swimming, yoga, Cycling.
To reduce the severity of pain prescribers destinations of clinical and pharmacological groups:
- anti-inflammatory drugs non-steroidal in the form of ointments, tablets, solutions for the administration parenteral the ingredients'assets;
- the injections in the set of solutions of anesthetics in combination with corticosteroids;
- muscle relaxants to eliminate the muscle spasms and restrictive contractures.
In the scheme of therapeutic includes the B vitamins, sedatives, and if necessary, tranquilizers and antidepressants. Also, a named chondroprotectors long course of reception. T This group of drugs only have the ability to restore partially cartilage.
To enhance their clinical activity carried physiotherapy — laser therapy, magnetic field, UHF-therapy.
Any joint pain should be a un sign for the immediate treatment to the doctor. The therapy conducted in the initial phase of osteoarthritis, it will help to stop the destruction of cartilage, to avoid examining the loss of health and disability.