Since childhood, we get used to running, jumping, boys love to climb and play football, girls on ropes and much more.And the active lifestyle enters the human mind that over the years, when somewhere the muscle has fired, somewhere has fallen ill, the person does not even pay attention - "Well, think how many times Kolenko has injured."Here, in today's article, we will speak and why the knee can hurt and if it is always the usual result of the net movement.
What is osteoarthritis?
Osteoarthritis -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 lesion of all the components of the joint, mainly cartilage, thin bone, synovial membrane, ligaments, capsules and periarticular muscles, with the formation of marginal osteophytes and a clear or moderately pronounced hidden synovitis.Given that with this disease, pathological changes capture both cartilage and bone tissue.
Osteoarthritis is often called osteoarthrosisand sometimes osteoarthritis.
Statistics (epidemiology)
Among all the diseases of the joints, osteoarthritis represents up to 80% of cases.
The disease develops mainly in the middle and old age.At a young age, osteoarthritis can occur after joint injury, inflammatory processes, as well as with the congenital pathology of the musculoskeletal system.
Signs of X-Ray osteoarthritis are detected in most people over 65 years of age and almost 95% over the age of 70.
Women suffer from osteoarthritis almost twice more often than men.The incidence rate increases during post-menopause.
A big role in the development of osteoarthritis is played by hereditary factors.It has been established that the frequency of development of the disease in the families of patients with osteoarthritis is twice as high as in the population as a whole, and the development of osteoarthritis in people with congenital defects in the musculoskeletal system increases from 7 to 8 times.
Osteoarthritis - CIM
- MKB-10: M15-M19, M47
- MKB-9: 715
- MKB-9-KM: 715.3
Symptoms of osteoarthritis (clinical image)
The clinical manifestations of the disease and their severity depends on the location of the pathological process, the state of health of the patient and the image of his life.
The first signs of osteoarthritis
Arthrosis often gradually begins, imperceptibly for the patient.
The first symptom of the disease is generally short -term minor joint pain (arthralgia), which carries the largest load.These are, first of all, the joints of the lower limbs - the knee, hip joints, plus phalanxes of the first thumb of the foot.From the joints of the upper limb, the interphalngeal joints, the carpale joint of the thumb of the brush is more often affected.
Arthrosis generally begins with the lesion of a joint, but after a certain time, other joints are involved in the process.
The main symptoms of osteoarthritis
With osteoarthritis, patients complain of pain, crunching, restriction of movements in the joint, swelling and joint deformation.
In addition, it is worth lingering on the nature of the pain.With osteoarthritis, mechanical and start -up pain is possible.Mechanical pain occurs with a load on the affected joint.Such pain mainly disturbs 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 exertion.The pressure causes bone beams and the irritation of the painful bone tissue.
The start of the pain appears at the start of the walk, then stops quickly and reproduces during physical effort.Starting pain may appear with the friction of joint surfaces of the affected joint.Small particles of necrotic cartilage fall on the surfaces of cartilage.In the first steps, these particles are pushed into the joint bag cavity and the pain ceases.
With osteoarthritis, pain can be associated with periarthritis and trend (inflammation of soft periarticular tissues, ligament devices and joint bag).This pain only occurs during the movements in which the affected tendons participate, as well as in certain positions of the joint during the movements.
The pathological changes, as a rule, begin with large joints, which are subject to significant physical effort during the day.At the start of the disease, pain occurs following the inconsistency of the possibilities of the microcirculatory channel with the needs of joint tissues.Therefore, to reduce pain, patients slowly take the first stages and only accelerate the pace of walking.The pain may appear after half an hour to two hours on foot or work in a standing position.This is a signal to modify the load, short -term rest or type of work.
At the later stages of the disease, arthralgia can occur with minimum loads on the joint and stay at rest for a long time.This is due to the fact that in the last stages, coarse changes in joint tissues, the destruction of the articular cartilage and the secondary synovitis are formed.With the development of massive and coarse changes in bone bone tissue, its individual fragments can be separated and, falling into the joint gap, cause acute pain.This phenomenon is called the symptom of joint mouse.
When examining the joints, the deformation is remarkable.In addition, with osteoarthritis, there is a thickening of the periathical soft tissues, the hypotrophy of the regional muscles, the displacement of the axis of the member.The thickening of the interphalangian joints with bone growths and the seal of periarticular tissues is called the gerberden nodes.
The pain when you feel the joint is located in the joint deviation, the places of attachment of the joint capsule, but this symptom of the disease is not always.The swelling and the pain of the joint are determined by secondary synovitis.
The violation of joint function in the early stages of osteoarthritis manifests itself by limiting the amplitude of movements.This is due to the lesion of periosematic tissues and synovitis.
In the last stages of the disease, clinical manifestations of contractures develop different in terms of severity.Most often, the functions of the knee and hip joints are altered.
Symptoms of osteoarthritis as a function of the location of pathology
Osteoarthritis with damage to knee joints - Symptoms
The lesion of the knee joints with osteoarthritis is called gonarthrosis.Primary gonarthrosis is developing in women in menopause.Secondary reasons are most often injuries of the knee joint and a violation of the statistics with the curvature of the spine, flat feet.Patients complain of pain in the knee joint that occur during movements, especially when you get on the stairs.Pain is located in the front or inside the knee joint.The movements of the joint are limited: first flexion and subsequent extension.In move, a crunch often appears.With the development of a reactive synovitis, pain during movements intensifies and worries at rest.Swelling of the joint, pain during palpation, redness (hyperemia) and an increase in skin temperature are determined.Over time, due to bone growths, the deformation of the knee joints occurs.
Osteoarthritis with damage to hip joints - Symptoms
The lesion of the hip joints is called COKSARTROSE.It is the most severe form of osteoarthritis.The causes of the disease can be a congenital dysplasia of the hip, injuries, menopause joints.Patients suffer in the joints during the movements, in a standing position.The restriction of movements in the joint gradually increases (first internal and external rotation, subsequent flexion).There is lameness associated with shortening the member.With bilateral damage, the duck's approach is typical.The atrophy of the thighs and buttocks muscles develops.There is no swelling of the joints with a cartrosis.Palpation determines the limited pain in the femoral head.
At the initial stage of osteoarthritis, joint functions are preserved.With the subsequent development of the disease, it is first temporarily limited, then the work capacity is completely lost, the patient loses the capacity of himself, needs external aid.
The causes of osteoarthritis
Osteoarthritis is based on primary degeneration of articular cartilage with destructive changes that accompany it in the bones that form the joint.Such degeneration occurs following an imbalance between the mechanical loads on the articular surface of the cartilage and the possibility of compensation for this load.
In the development of degenerative changes in articular cartilage, several factors can participate simultaneously:
- functional overloads, including professionals, households and sports, causing a cartilage mycotraumator;
- joint injuries;
- Infectious and non -specific inflammation of the joint;
- Joint dysplasia, leading to a violation of the comparison of joint surfaces;
- Violation of the body statistics following the curvature of the spine (cyphosis, scoliosis, pathological lordosis, etc.), flat feet;
- Chronic hemarthrosis:
- Diseases with metabolic disorders (drop, obesity, chondrocalcinosis);
- Osteodistrophy or pedget disease;
- osteomyelitis;
- Pathology of the peripheral nervous system with loss of sensitivity;
- Endocrine pathology (acromegaly, diabetes, amenorrhea, hyperthyroidism);
- Hereditary trend.
Risk factors of osteoarthritis include elderly age, female sex, obesity.
Development mechanism
Metabolic cartilage disorders are based on quantitative and qualitative changes in the main substance of the cartilage.The main substance consists of proteoglycans which ensure the stability of collagen.The development of osteoarthritis is accompanied by insufficient training or increased destruction of the components of the cartilage.
With osteoarthritis in the cartilage fabric, hyaluronic acid content, chondroitin and keratin decreases.In addition, altered proteoglycans lose the ability to keep water.It is absorbed by an inflated collagen, causing a decrease in cartilage resistance.
If the chondrocytes are damaged, they begin to produce collagen and proteoglycans not characteristic of the normal cartilage fabric.These modified substances lead to the loss of biochemical qualities of the cartilage.
Immune disorders are of great importance in the development of osteoarthritis.The destruction of cartilage proteoglycans is accompanied by the appearance of cellular and humoral immune reactions.In turn, this causes progressive fibrosis and sclerosis of the synovial membrane, pathological changes in the intra-articular synovial fluid and a violation of cartilage.The lower synovial shell supports the progression of degenerative changes in the articular cartilage.
A hereditary factor has a certain value in the development of osteoarthritis.
Classification of osteoarthritis
Arthritis is divided into two groups: primary and secondary.
In distribution (primary osteoarthritis):
- local (with damage to three joints)
- Common or generalized, polyarthrosis (defeat of three or more joints).
Depending on the (secondary) destination:
- A. Tasobé joint (Cokesartrose);
- A. knee joint (gonartrose);
- A. The elbow joint;
- A. shoulder joint;
- A. Spine;
- A. Cervical Department (Unkoarthrosis);
- A. Hands;
- A. Ankle joint (Cruzartrose)
- A. Stop.
By etiology:
- post-traumatic
- metabolic
- Due to endocrine pathology.
Diagnosis of osteoarthritis
The variety of clinical manifestations and variants of osteoarthritis makes it difficult for the early diagnosis of the disease.Falseness of the diagnosis is also associated with the lack of specific symptoms, the hidden appearance of the disease.The definition of factors contributing to the definition of factors contributing to the development of osteoarthritis:
- chronic joint trauma;
- long -term execution of stereotypical movements;
- Physical activity on the joint for a certain time;
- violation of salt or fat metabolism;
- Hereditary vices of the musculoskeletal system.
An X -ray examination is the most important meaning in the diagnosis of osteoarthritis.A vision radiography of the two knee joints is carried out in direct position, a folded position, in addition in a lateral position.The classic signs of osteoarthritis on radiography are: narrowing of the joint gap, presence of osteophytes, subchondral bone sclerosis and subchondral cysts.There are the following steps for radiological changes in osteoarthritis:
- 0 - There are no changes.
- I - Radiologically doubtful signs.
- II - Minimum changes (slight narrowing of the joint gap, subsidiary osteosclerosis, unique osteophytes).
- III - Moderate manifestations (moderate narrowing of the charter, multiple multiophytes).
- Iv- Changes expressed (the joint difference is not visible, several coarse osteophytes are determined), the synovitis is often present.
In the presence of these symptoms, other tools are not necessary.
In their absence or low severity, joints, MRI, scintigraphy are carried out.
Clinical tests of blood, urine and synovial intra-articular liquid are not included in the list of compulsory studies for the diagnosis of osteoarthritis.But these tests are necessary to exclude these joint pathologies.
The main clinical and diagnostic signs of osteoarthritis:
- Mechanical joint pain;
- fatigue;
- a feeling of instability in the joints of the lower limbs;
- damage the joints of the first finger of the foot and hands;
- the gradual appearance of the disease;
- slow progressive current;
- joint deformation;
- regional muscles hypotrophy;
- recurring synovitis;
- restriction of movements in the joint;
- X-ray changes.
Osteoarthritis should be differentiated by damage to joints with rheumatoid, infectious, metabolic and reactive arthritis.
Rheumatoid arthritis, unlike osteoarthritis, begins with the inflammation of the small joints of the hands and feet.It is characterized by intense pain of the inflammatory type, a morning rigidity of the joints, the presence of rheumatoid nodules.
Gotric arthritis is mainly found in men.A high local activity with acute paroxysmal pain in the first phase joint of the thumb of the foot is characteristic.With the drop, the presence of Tofus is typical, on radiography, there is "punch".
Psoriatic arthritis is characterized by lesions of the skin, in particular the scalp, the deformation in the shape of a pin spin and a bright color brilliant of the skin above the affected joints.
Infectious arthritis is characterized by an acute beginning, rapid development and course, acute pain, high temperature and the efficiency of antibacterial therapy.
Osteoarthritis
The treatment of osteoarthritis should be long, complex.The basic principles of osteoarthritis treatment:
- Unloading of joints (correct mobility mode and mechanical loads, dosed walking, reduction in body weight, exclusion of prolonged stands, weight use, strengthening of the muscle-ligament using physiotherapy, massage, electrical stimulation).
- Conservative correction of static disorders (use of orthopedic shoes, corsets, supervisors).
- The impact on global metabolism and blood circulation (the use of biostimulants, vasodilating drugs, balneotherapy and physiotherapy twice a year).
- Elimination of reactive synovitis, anti-inflammatory therapy.
Osteoarthritis patients have 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 blood vessels, normalizes exchange in chondrocytes.With osteoarthritis, it is necessary to drink enough liquid (at least 8 glasses of water per day).
The drug treatment of osteoarthritis includes the use of rapid anti -inflammatory drugs and pain relievers (non -steroidal anti -inflammatory drugs - NSIDS), basic drugs - chondroprotectors.No-?Non-selective and selective TSO-2 inhibitors are used from NSAIDs.
As local therapy for affected joints, NSAIDs in the form of ointments or gel are used.
In the presence of reactive synovitis, tendonitis or tendovaginitis, when the treatment of NSAIDs is ineffective, appropriate, intraticular or intramuscular administration of corticosteroids.
Basic treatment with chondroprotectors (chondroitin, glucosamine, hyaluronic acid) is used to prevent joint degeneration of cartilage.
The treatment of chondroprotectors is indicated in the clinical and radiological stages of the II-III of osteoarthritis.
In addition to direct chondroprotectors, drugs that stimulate restoration of cartilage fabric (biogenic stimulants) are used.These drugs are used during remission, in the absence of a reactive synovitis.
With osteoarthritis, drugs that improve microcirculation are also indicated.In the presence of varicose veins of the lower limbs, the correction of the venous blood circulation is necessary.
In patients with osteoarthritis, it is necessary to diagnose and treat osteoporosis in a timely manner.
Osteoarthritis physiotherapy
Physical treatment methods are also linked to basic osteoarthritis therapy.Under their influence, metabolic processes, microcirculation of blood and tissue fluid are stimulated, neurogumoral regulation is restored.
The processing complex with osteoarthritis includes inductormic, microwave, pulsed currents, electrophoresis of drugs and magnetotherapy.To eliminate synovitis, ultraviolet irradiation from the area of the joints assigned to doses of erythema, an electric field of ultra-high frequency, electrophoresis with analgin, dimyide or hydrocortisone is used.
For the prevention of the increase in osteoarthritis, it is recommended to reduce body weight, to avoid an increase in loads on the joints, to walk in an abolished area, of increased humidity and hypothermia.An individual selection of shoes and supervisors is important.
With gonarthrosis, regular physical exercises, swimming, cycling to strengthen the muscles.Heavy and light athletic classes, football is not recommended.
Therapeutic exercises are carried out differently, in a sitting position, lie, in the pool.The movements should not be intense, traumatic, their volume and their number of repetitions are gradually increasing, avoiding overloads.
Popular and effective methods for treatment of osteoarthritis also include massage and kinesapes.
With significant changes in joints with deformation, mobility restriction, surgical treatment is recommended.Arthroplasty, endoprothetics, osteotomy are carried out.
Prognosis for the disease
Primary osteoarthritis rarely leads to total handicap.In the presence of a reactive synovitis, patients become temporarily disabled and sometimes they are forced to change the profession.With secondary cocarchy, the prognosis is less favorable due to the rapidly progressive course of the disease with the development of a significant altered articulated function.In such cases, disability can occur over several years of illness.
Osteoarthritis prevention
The primary prevention of osteoarthritis should start in childhood.It's as follows:
- Prevention and treatment of scoliosis;
- Correction of flat feet 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;
- Alternate work sitting at a table with a walk;
- The correct organization of work and the rest of the employees of companies where there is a strong physical activity.
Secondary prevention provides measures that prevent the development of a recurring reactive synovitis.These include dosed walking, the restriction of physical effort, walking with support and other measures that unload the joints.With severe symptoms of osteoarthritis, it is necessary to constantly take basic drugs.General strengthening therapy, improving blood circulation and metabolism, the annual treatment of the SPA is recommended.
What doctor will he go to?
- Rheumatologist
- Orthopedist