Since childhood, we get used to run, jump, the boys love climbing and playing football, girls on the strings and much more.And the active lifestyle is thus entering the human mind that over the years, when somewhere the muscle has moved away, somewhere the articulation has ill, the person does not even pay attention: "Well, think how many times Kolenko has hurt."Here in today's article we will talk and because the knee can hurt and if this is always the usual result of the acute movement.
What is arthrosis?
Arthrosis -A group of diseases of the musculoskeletal system of different origin, but with similar biological, morphological and clinical manifestations.The basis of their development is the degenerative injury of all the components of the joint, mainly the cartilage, the thin bone, the synovial membrane, the ligaments, the capsules and the periarticular muscles, with the formation of marginal osteophytes and a moderately pronounced synovitis.Since with this disease, pathological changes capture both cartilage and bone tissue.
Arthosis is often called osteoarthritisAnd sometimes osteoarthritis.
Statistics (epidemiology)
Among all joint diseases, arthrosis is up to 80% of cases.
The disease develops mainly on average and in old age.At a young age, arthrosis can occur after lesions of joints, inflammatory processes and with congenital pathology of the musculoskeletal system.
The signs of arthrosis x -raggi are detected in most people over the age of 65 and almost 95%in 70 years.
Women suffer from arthrosis almost twice more often than men.The incidence rate increases during postmenopause.
An important role in the development of arthrosis is played by hereditary factors.It has been established that the frequency of the development of the disease in families of patients with osteoarthritis is twice higher than the population as a whole and the development of arthrosis in people with congenital defects of the musculoskeletal system increases by 7-8 times.
Arthrosis - ICD
- MKB-10: M15-M19, M47
- MKB-9: 715
- MKB-9-KM: 715.3
Symptoms of arthrosis (clinical picture)
The clinical manifestations of the disease and their gravity depend on the location of the pathological process, on the state of health of the patient and the image of his life.
The first signs of arthrosis
Arthosis often begins gradually, imperceptibly for the patient.
The first symptom of the disease is usually a short -term minor joint pain (arthralgia), which brings the largest load.These are, first of all, the joints of the lower ends: the joints of the knee, hip and phalanx more than the first thumb of the foot.From the joints of the upper limb, the interfalnean joints, the carpal articulation of the brush's thumb are more often affected.
Arthosis usually begins with the injury of an joint, but after a while other joints are involved in the process.
The main symptoms of arthrosis
With arthrosis, patients complain of pain, creaking, limitation of movements in the articulation joint, swelling and joint deformation.
Separately, it is worth focusing on the nature of pain.With arthrosis, mechanical and initial pain is possible.Mechanical pain occurs with the load on the articulation concerned.This pain disturbs mainly in the evening at rest, disappears after several hours of rest.The appearance of this type of pain is associated with a gradual increase in bone pressure during physical effort.The pressure causes bone rays and irritation of the painful bone tissue.
The initial pain appears at the beginning of the walk, then stops quickly and recovers during physical effort.The initial pain may appear with friction of the joint surfaces of the articulation concerned.Small particles of necrotic cartilage fall on the surfaces of the cartilage.In the first steps, these particles are pushed into the cavity of the joint bag and the pain ceases.
With arthrosis, the pain can be associated with periartritis and trend (inflammation of soft periarticular tissues, ligamentous apparatus and joint bag).This pain occurs only during the movements in which the affected tendons take part, as well as in certain positions of the joint during the movements.
The pathological changes, as a rule, begin with great joints, which are subject to great physical effort during the day.At the beginning of the disease, pain occurs due to the excrence of the possibilities of the microcirculatory channel with the needs of joint tissues.Therefore, to reduce pain, patients slowly take the first steps and only accelerate the rhythm of walking.The pain may appear after half or two hours on foot or working in a erect position.This is a signal to change the load, short -term rest or the type of work.
In the subsequent stages of the disease, arthralgia can occur with minimal loads on the joint and remain at rest for a long time.This is due to the fact that in the following phases, changes are formed in the joint tissues, the destruction of the joint cartilage and the secondary synovitis.With the development of enormous gross changes in the chese -whery fabric, its individual fragments can be separated and, falling into the joint gap, cause severe pain.This phenomenon is called symptom of the articular mouse.
During the joint examination, the deformation is noteworthy.In addition, with arthrosis, there is a thickening of the periastinal soft tissues, hypotrophy of the regional muscles, movement of the axis of the limb.The thickening of the interfaces joints with bone growths and the seal of the periarticular tissues is called Gerberden knots.
The pain when you feel the articulation is located in the joint gap, the places of attachment of the joint capsule, but this symptom of the disease is not always.The swelling and pain of the joint are determined by secondary synovitis.
The violation of the joint function in the early stages of arthrosis occurs with a limitation of the amplitude of the movements.This is due to the injury of periosematic tissues and synovitis.
In the subsequent stages of the disease, the clinical manifestations of the contractures develop different in terms of gravity.Very often, the functions of the knee and hip joints are compromised.
Symptoms of arthrosis depending on the location of the pathology
Arthrosis with damage to the knee joints - symptoms
The injury of the knee joints with arthrosis is called Gonartrosi.Primary gonartrosis develops in women in menopause.The reasons of the secondary are often injuries to the knee joint and a violation of the statistics with curvature of the spine, flat feet.Patients complain about the pain in the knee joint that occurs during the movements, especially when the stairs rise.The pain is located in the front or inside the knee joint.The movements in the joint are limited: first decline and subsequent extension.When it moves, a crunch often appears.With the development of reactive synovitis, the pain during movements intensifies and worries rests.The swelling of the joint are determined, the pain during palpation, the redness (hyperemia) and an increase in skin temperature.Over time, due to bone growths, the deformation of the knee joints occurs.
Arthrosis with damage to the hip joints - symptoms
The injury of the hip joints is called Coksartrosis.This is the most serious form of arthrosis.The causes of the disease can be congenital dysplasia of the hip joints, injuries, menopause.Patients have joint pain during movements, in an upright position.The restriction of movements in the joint is gradually increasing (first internal and external rotation, subsequent decline).There is a lame associated with the shortening of the limb.With bilateral damage, the duck pace is typical.The atrophy of the muscles of the thighs and buttocks develops.There are no swelling of the joints with cartrosis.Palpationly determines the limited pain in the head of the femur.
In the initial phase of arthrosis, the joint functions are preserved.With the further development of the disease, it is first temporarily limited and therefore the ability to work is completely lost, the patient loses the ability of car -cura, needs external help.
The causes of osteoarthritis
Arthosis is based on the primary degeneration of joint cartilage with the destructive changes of accompaniment in the bones that form the articulation.This degeneration occurs due to an imbalance between mechanical loads on the joint surface of the cartilage and the possibility of compensation for this load.
In the development of degenerative changes in the joint cartilage, several factors can simultaneously participate:
- Functional overloads, including professionals, family and sports, causing cartilage mycotrauma;
- joint injuries;
- Infectious and non -specific inflammation of the joint;
- joint dysplasia, which leads to a violation of the comparison of joint surfaces;
- Violation of the body static due to the curvature of the spine (cifosi, scoliosis, pathological lordosis, etc.), dishes;
- Chronic emartrosis:
- diseases with metabolic disorders (gout, obesity, condrocalcinosis);
- Osteodish accident or pedget disease disease;
- osteomyelitis;
- pathology of the peripheral nervous system with loss of sensitivity;
- Endocrine pathology (acromegalia, diabetes, amenorrhea, hyperthyroidism);
- Hereditary tendency.
The risk factors of arthrosis include elderly age, female sex, obesity.
Development mechanism
Metabolic disorders in the cartilage are based on quantitative and qualitative changes in the main substance of the cartilage.The main substance consists of proteoglycans that provide collagen stability.The development of osteoarthritis is accompanied by insufficient formation or by greater destruction of cartilage components.
With osteoarthritis in the cartilage tissue, the content of hyaluronic acid, chondroitin and keratin decreases.In addition, altered proteoglycans lose their ability to retain water.It is absorbed by a collagen that swells, causing a decrease in cartilage resistance.
If the chondrocytes are damaged, they begin to produce collagen and proteoglycans not characteristic of the normal cartilage tissue.These altered substances cause the biochemical quality loss of cartilage.
Of great importance in the development of arthrosis are immune disorders.The destruction of cartilage proteoglycans is accompanied by the appearance of immune reactions of the cell and humoral type.In turn, this causes progressive fibrosis and sclerosis of the synovial membrane, pathological changes in the intraarticular synovial fluid and a violation of the cartilage.The lower synovial shell supports the progression of degenerative changes in the joint cartilage.
A hereditary factor has a certain value in the development of osteoarthritis.
Classification of osteoarthritis
Arthosis is divided into two groups: primary and secondary.
In distribution (primary arthrosis):
- Local (with three joint damage)
- Common or generalized polyrtrosis (defeat of three or more joints).
Depending on the destination (secondary):
- A. Tasibata joint (cokesartrosis);
- A. The joint of the knee (gonartrosis);
- A. The joint of the elbow;
- A. the shoulder articulation;
- A. vertebral column;
- A. Cervical department (Unkoarthrosis);
- A. Mani;
- A. arrived at the ankle (cruzartrosis)
- A. Stop.
For etiology:
- post -traumatic
- metabolic
- due to endocrine pathology.
Diagnosis of arthrosis
The variety of clinical manifestations and arthrosis variants makes early diagnosis of the disease difficult.The falsehood of the diagnosis is also associated with the lack of specific symptoms, the hidden onset of the disease.Of great importance is the definition of factors that contribute to the development of osteoarthritis:
- Chronic joint trauma;
- Long -term execution of stereotyped movements;
- physical activity on the joint for a time;
- violation of salt or fat metabolism;
- Hereditary inheritance of the musculoskeletal system.
A X -ray examination is of the most important meaning in the diagnosis of arthrosis.A visualization radiography of both knee joints is performed in a direct position, a bent position, in addition in a side position.The classic signs of arthrosis on the X -ray are: narrowing of the joint gap, presence of osteophytes, sub -controlle bone sclerosis and subcondered cysts.There are the following phases of radiological changes in arthrosis:
- 0 - There are no changes.
- I - Signs radiologically Dubbie.
- II - minimum changes (light narrowing of the joint gap, subsidiary osteosclerosis, individual osteophytes).
- III - moderate events (moderate paper narrowing, more osteophytes).
- IV- expressed changes (the joint gap is not visible, rude osteophytes are determined), synovite is often present.
In the presence of these symptoms, no further tools are needed.
In their absence or low gravity, joints, magnetic resonance imaging, scintigraphy.
Clinical tests of blood, urine and intraarticular synovial fluid are not included in the list of mandatory studies for the diagnosis of arthrosis.But these tests are necessary to exclude these joint pathologies.
The main clinical and diagnostic signs of arthrosis:
- Pain in the mechanical joint;
- fatigue;
- a feeling of instability in the joints of the lower ends;
- damage to the joints of the first finger of the foot and hands;
- the gradual beginning of the disease;
- Slow progressive current;
- joint deformation;
- Hypotrophy of the regional muscles;
- Recurrent synovitis;
- restriction of movements in the joint;
- Changes of X -rays.
Arthosis must be differentiated with damage to the joints with rheumatoid arthritis, infectious, metabolic and reactive arthritis.
Rheumatoid arthritis, unlike arthrosis, begins with the inflammation of the small joints of the hands and feet.It is characterized by intense inflammatory pain, morning stiffness of the joints, presence of rheumatoid nodules.
Gotric arthritis is mainly found in men.The high local activity with acute paroxysmal pain in the first most phalanx articulation of the thumb of the foot is characteristic.With gout, the presence of Tofus is typical, on the X -ray there are "punches".
Psoriatic arthritis is characterized by skin lesions, in particular the scalp, deformation in the shape of a fuse of the fingers and a bright raspberry color of the skin above the joints concerned.
The infectious arthritis is characterized by an acute start, rapid development and a course, acute pain, high temperature and the effectiveness of antibacterial therapy.
Treatment of osteoarthritis
The treatment for arthrosis should be long, complex.The basic principles of arthrosis treatment:
- Downloading of the joints (the correct mode of mobility and mechanical loads, dosed walk, reduction of body weight, exclusion of the prolonged position, wearing weights, strengthening the muscle-legal system using physiotherapy exercises, massage, electrical stimulation).
- Conservative correction of static disorders (use of orthopedic shoes, corsets, supervisors).
- The impact on overall metabolism and blood circulation (the use of biostimulants, vasodilated drugs, bathing courses and physiotherapy twice a year).
- Elimination of reactive synovitis, anti -inflammatory therapy.
Artosis patients show a diet with a limitation of salt, sugar, strong tea, coffee, smoked meats, sharp dishes.This improves the sensitivity of vascular and joint receptors, restores the tone of the blood vessels, normalizes the exchange in condrocites.With arthrosis, it is necessary to drink quite liquid (at least 8 glasses of water per day).
The pharmacological treatment of arthrosis includes the use of antimammator and painkillers in rapid action (anti -anti -inflammatory drugs non -steering -fans), basic drugs -condoprotectors.Not-?Non-selective and selective TSO-2 inhibitors are used by fans.
As a local therapy for the joints concerned, fans are used in the form of an ointment or gel.
In the presence of reactive synovitis, tendonitis or tendovaginitis, when the treatment of fans is ineffective, an appropriate intramuscular or intramuscular administration of corticosteroids.
Basic therapy with chondroprotectors (chondroitin, glucosamine, hyaluronic acid) is used to prevent the degeneration of the joint cartilage.
The treatment of chondroprotectors is indicated in the clinical and radiological phases of arthrosis I-III.
In addition to direct chondroprotectors, drugs are used that stimulate the restoration of the cartilage tissue (bigenic stimulants).These drugs are used during remission, in the absence of reactive synovitis.
With arthrosis, drugs that improve microcirculation are also indicated.In the presence of varicose veins of the lower ends, the correction of venous blood flow is required.
In arthrosis patients, it is necessary to diagnose and treat osteoporosis in a timely way.
Arthrosis physiotherapy
The physical treatment methods also concern the basic therapy of arthrosis.Under their influence, the metabolic processes are stimulated, the microcirculation of the blood fluid and tissue, neurogumoral regulation is restored.
The complex treatment complex includes inductormia, microwave therapy, pulsate currents, electrophoresis of drugs and magnetotherapy.To eliminate the synovitis, the ultraviolet irradiation of the joints affected area in the doses of erythema, an ultra -alta frequency field is used, electrophoresis with analgino, dimexide or hydrocortisone.
For the prevention of the progression of arthrosis, it is recommended to reduce body weight, avoid an increase in loads on the joints, walking in a suppressed area, increased humidity and hypothermia.An individual selection of shoes and supervisors is important.
With gonartrosis, regular physical exercises, swimming, cycling have shown to strengthen the muscles.Heavy and light athletics classes, football is not recommended.
Therapeutic exercises are performed differently, in the sitting position, lying down, in the pool.Movements should not be intense, traumatic, their volume and the number of repetitions have gradually increased, avoiding overloads.
Popular and effective methods for the treatment of arthrosis also include massage and Kinesitherapia.
With significant changes in the joints with deformation, the restriction of mobility, surgical treatment is recommended.Arthroplasty, endoprothetic, osteotomy are performed.
The prognosis of the disease
Primary arthrosis rarely leads to complete disability.In the presence of reactive synovitis, patients become temporarily disabled and sometimes they are forced to change the profession.With the secondary cocarchy, the prognosis is less favorable due to the rapidly progressive course of the disease with the development of a significant compromised joint functionality.In such cases, disability can occur in several years of illness.
Prevention of osteoarthritis
The primary prevention of arthrosis should start during childhood.It is the following:
- Prevention and treatment of scoliosis;
- Correction of the plates using special supervisors;
- Physical education lessons to strengthen muscles and ligaments;
- rational nutrition and prevention of metabolic disorders;
- restriction of heavy sports in childhood and adolescence;
- Alternated work sitting at a table with walking;
- The correct organization of work and the rest of the employees in companies where there are strong physical activities.
Secondary prevention provides for measures that prevent the development of recurrent reactive synovitis.These include dosed walk, limitation of physical effort, walking with support and other measures that unload the joints.With serious symptoms of arthrosis, it is necessary to constantly take basic medicines.General strengthening therapy is recommended, the improvement of blood circulation and metabolism, the treatment of the annual Spa.
In which doctor will it go?
- Rheumatologist
- Orthopedic