Arthritis is the most common joint disease. According to experts, 6. 43% of the population of our country is infected. Men and women suffer from osteoarthritis equally often, however, in young patients there is a slight predominance, and in the elderly - women. An exception to the general picture is arthropathy of the intervertebral joints, which develops 10 times more often in women than in men.
With age, the incidence of the disease increases significantly. Therefore, according to studies, joint disease is detected in 2% of people under 45 years old, 30% of people 45 to 64 years old and 65-85% in people 65 years of age and older. Osteoarthritis of the knee, hip, shoulder and ankle joints has the greatest clinical significance due to its negative impact on patients' living standards and working capacity.
Reason
In some cases, the disease occurs for no apparent reason, such joint disease is called idiopathic or primary.
There is also a secondary joint disease - which develops as a result of some pathological process. The most common causes of secondary joint disease are:
- Trauma (fracture, meniscus injury, ligament rupture, dislocation, etc. ).
- Dysplasia (congenital disorder of joint development).
- Degenerative-dystrophic processes (Perthes disease, osteomyelitis).
- Diseases and conditions in which there is an increase in joint mobility and a weakening of the ligamentous apparatus.
- Hemophilia (joint disease that develops due to frequent genetic disease).
Risk factors for developing joint disease include:
- Elderly.
- Overweight
- Excessive stress on joints or a particular joint.
- Surgical intervention in joints,
- Genetic predisposition (presence of rheumatic diseases in later relatives).
- Hormonal imbalance in postmenopausal women.
- Cervical or lumbar spinal nerve disorders (shoulder arthritis, lumbosacral syndrome).
- Repetitive micro-injury of the joint.
Pathogenesis
Arthritis is a multiprotozoal disease, which, whatever the specific cause of it, is based on a violation of the normal formation and restoration of chondrocytes.
Normally, joint cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, providing the necessary impact absorption and, therefore, reducing the load on adjacent structures (bones, ligaments, muscles, and follicles). With osteoarthritis, the cartilage becomes rough, the joint surfaces begin to "stick" to each other when moving. The cartilage is getting looser by the day. Small fragments from there fall into the joint cavity and move freely in the synovial fluid, injuring the synovial capsule. In the superficial areas of the cartilage, small foci of calcification appear. In the deep layers, fossilized areas appear. In the central region, cysts are formed, communicating with the joint cavity, around which, due to the pressure of intra-articular fluid, areas of liquefaction are also formed.
Pain syndrome
Pain is the most frequent symptom of joint disease. The most prominent signs of joint pain are those associated with physical activity and with weather, nocturnal pain, sudden onset of pain and sharp pain associated with joint blockade. With prolonged exertion (walking, running, standing), the pain increases, and at rest they subside. The cause of nocturnal pain in arthritis is venous congestion, as well as an increase in intravascular blood pressure. Pains are aggravated by adverse weather factors: high humidity, low temperature and high barometric pressure.
The most characteristic sign of arthropathy is the onset of pain - pain that appears during the first movements after rest and disappears with continued movement.
Symptom
The joint process develops gradually, gradually. Initially, the patient worried about mild, short-term, not clearly localized pain that worsens with exertion. In some cases, the first symptom is a crunching sound when moving. Many patients with arthritis report transient joint discomfort and stiffness during their first movements after a period of rest. The clinical picture is then supplemented by nocturnal and weather episodes. Over time, the pain becomes more and more pronounced, with limited movement. Due to the increased load, the joint on the opposite side begins to hurt.
Episodes of exacerbations alternate with episodes of remission. Arthritis exacerbations often occur in the context of increased stress. Due to the pain, the extremities reflexively contract, which can form muscle spasms. The crackling sound in the joint became more and more constant. When resting will appear cramps, discomfort in the muscles and joints. Due to the increasing deformity of the joints and severe pain syndrome, lameness. In the later stages of arthropathy, the deformity is more pronounced, the joint is bent, the movements in it are significantly limited or absent. The support is difficult, when moving patients with osteoarthritis must use a cane or crutches.
Diagnose
Diagnosis is made based on characteristic clinical signs and radiographic findings of joint disease. X-ray of diseased joints (usually done twice): with bone spurs - X-ray of knee joint, with bone spurs - X-ray of hip, . . . X-ray image of hip includes signs. dystrophic changes in the articular cartilage and adjacent bone. The joint space is narrowed, the bone position is deformed and flattened, cyst formation, subchondral fibrosis and osteoblasts are exposed. In some cases, with arthropathy, signs of joint instability are found: axial curvature of the limb, misalignment.
Taking into account radiographic signs, specialists in the field of orthopedics and trauma distinguish the following stages of arthropathy (Kellgren-Lawrence classification):
- Stage 1 (suspected joint) - suspected joint space narrowing, bone cells are absent or present in small numbers.
- Stage 2 (mild joint) - suspected narrowing of joint space, well-defined osteoblasts.
- Stage 3 (moderate osteoarthritis) - the joint space is clearly narrowed, there may be pronounced bone deformities, there may be bone deformities.
- Stage 4 (severe arthritis) - marked narrowing of joint space, large osteoblasts, marked bone deformity and fibrosis.
Sometimes X-rays are not enough to accurately assess the condition of a joint. To study the bone structure, CT of the joints is performed, to evaluate the condition of the soft tissues - MRI of the joints.
The treatment
The primary goals of treating patients with arthritis are to prevent further cartilage destruction and preserve joint function.
During remission, a patient with arthrosis is referred to physical therapy. The set of exercises depends on the stage of osteoarthritis.
Drug therapy in the acute phase of rheumatic disease involves the administration of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of arthritis medications including chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation and eliminate muscle spasms, a patient with rheumatic diseases is referred to physiotherapy. In the period of exacerbation, laser therapy, magnetic field and ultraviolet irradiation are prescribed, in the remission phase - electrophoresis with dimexide, trimecaine or novocaine, electrophoresis with hydrocortisone, inductance, thermal procedures (ozokerite), paraffin), sulfide, radon and bathing. Electrical stimulation is done to strengthen muscles.
In the case of destruction of the joint surface with marked dysfunction of the joint, arthroplasty is performed.