home Audience 1 Osteoarthritis of the knee joint: treatment of the knee with drugs. Causes, symptoms and treatment of osteoarthritis

Osteoarthritis of the knee joint: treatment of the knee with drugs. Causes, symptoms and treatment of osteoarthritis

Osteoarthritis of the knee is an inflammatory and degenerative disease. The disease is mistakenly defined as spondylosis deformans. These are somewhat different diseases, although similar in nature. According to the data medical statistics, the described disease is determined in 4-7% of humanity in at a young age(up to 40 years) and in approximately 60% of people over 50, which is determined by the characteristics of wear and tear cartilage tissue. The essence pathological process consists of deformation and destruction of cartilage under the influence of exogenous and endogenous factors. What is the problem at hand?

Osteoarthritis appears to be a deformational and at the same time atrophic pathology, during which cartilage and surrounding anatomical structures and tissues are destroyed.

Osteoarthritis is a particular form of arthritis, involving not only joints, but also bone structures in the pathological process. This is a dangerous, disabling condition that occurs very often. Its development is determined by a number of reasons.

Features of the course of osteoarthritis of the knee joint

Osteoarthritis of the knee is a multifaceted disease. It differs from classical type arthritis in a number of features:

Osteoarthritis is less aggressive. If the patient's disability due to arthritis occurs several years later, osteoarthritis lasts for decades without consequences for the carrier, slowly destroying joints and bones. Here lies the second significant factor.
This is the destruction of bone structures, which is not observed in classic arthritis.
This is about age-related disease , which quite rarely begins at a young age.
Representatives of the stronger sex are most often affected, which is related to the features connective tissue in men.
Tissue destruction occurs for endogenous (internal) reasons, which determines the characteristics of the course of the pathology and the rate of development of symptoms. This is the main difference between osteoarthritis and arthritis.
Finally, the symptoms are very specific.

Otherwise, the disease is similar in manifestations to arthritis. Osteoarthritis is a cross between arthritis and arthrosis, being rather similar to the latter.

Causes of health problems

Osteoarthritis of the knee joint can be defined as a multifactorial and at the same time polyetiological orthopedic disease. This means that a number of pathological factors take part in its development. What are these factors:

Thus, the list of reasons is diverse. Based on the factors, we can name the main risk groups:

Persons suffering overweight(obesity).
Seniors (elderly and elderly).
Representatives of physical professions. IN to the greatest extent Athletes, loaders, builders, general workers and representatives of other professions suffer.
Representatives of the fairer sex wearing uncomfortable shoes or high heels.
Representatives of the stronger sex of any age (due to the characteristics of connective tissue).
Persons suffering concomitant diseases of a chronic nature.

It is necessary to establish the cause in order to prescribe the correct course of treatment and conduct a thorough diagnosis.

Symptoms

The symptoms of osteoarthritis of the knee are quite specific, although it is impossible to distinguish, as they say, “by eye,” arthritis from osteoarthritis and arthrosis. A thorough diagnosis is required. However, you still need to know the symptoms in order to formulate complaints at an appointment with a specialist and respond to the problem in a timely manner. What symptoms prevail:

Pain syndrome. Develops spontaneously. The pain is characterized by moderate intensity in the early stages. Extremely painful to endure advanced stages course of the disease. Intensifies at night and morning time days pass or subside in the afternoon. In the later stages of the disease, the pain does not go away at all and haunts patients constantly. By nature it is aching, pulling and dull. It intensifies with physical activity, as with arthrosis. Discomfort, as a rule, does not have a clear localization.
Discomfortable sensations in the kneecap. It seems to the patient that a foreign object is detected in the joint cavity. This is due to the development of inflammation.
Swelling. Swelling develops as a result of an inflammatory process in the knee joint. The more intense the pathological process and the further it has gone, the more intense it is.
Redness of the joint area. Also caused by inflammation and increased blood flow to the affected knee joint.
Feeling of stiffness in the knee joint. Observed in the morning (especially often), after a period of rest. Stiffness progresses as the pathological process develops. It becomes impossible to adequately control the limb.
Increase in size of the knee joint, formation of immobility of articular surfaces. As the pathological process develops, the cartilage is completely destroyed, the bones begin to rub against each other, which makes the pain syndrome simply unbearable. Urgent treatment is required.
Decreased physical activity lower extremities. It is especially difficult to go up and down stairs.
Crepitus (crunching) of the knee joint.
Difficulty walking, weakness of the affected lower limb.
Knee joint deformities(in later stages).

The symptoms of osteoarthritis are also a cross between the manifestations of arthritis and arthrosis.

Stages of osteoarthritis

If you believe medical practice, several stages can be distinguished (from 3 to 4 stages). Osteoarthritis of the knee is a complex disease that can only be treated in its early stages.

The problem is that the first stage proceeds without severe symptoms. This complicates both diagnosis and treatment. So, what are the stages?

Zero stage. Symptoms are completely absent or minimal. But the pathological processes have already begun. The joint wears out, becomes rough, and cartilage tissue is destroyed. Not all doctors distinguish this stage of the pathology.
First stage. Mild pain develops in the area of articular structures. They radiate to the thighs, legs, etc. There is weakness in lower limbs, increasing fatigue. Symptoms vary from patient to patient.
Second stage. Joint deformities begin. Bone structures are already suffering as the cartilage becomes thinner. Bone growths-osteophytes are formed, interfering with normal movement.
Third stage. Accompanied by severe pain, severe deformities and destruction of the end sections of the bones.

Effective treatment, as already mentioned, is possible only at the first and zero stages.

Diagnostic methods

Diagnosis of the disease is carried out by orthopedic specialists or traumatologists if there has been an injury. At the initial appointment, the patient is interviewed and anamnesis is collected. It is necessary to identify all possible factors causing the problem. In the future, specialized studies are prescribed:

X-ray of the knee joint. Makes it possible to assess the condition of joints and bone structures.
The most effective and safe test is MRI diagnostics. It allows you to identify the smallest changes in the musculoskeletal system, but it is expensive, so it is not always prescribed.
Ultrasound examination of the knee joint. Required to assess the condition of soft tissues, as well as cartilage.
Puncture of the affected knee joint.
Finally, the last technique is arthroscopy. It is a minimally invasive endoscopic examination. Gives you the opportunity to examine articular and periarticular structures with your own eyes.

The complex of these procedures is sufficient to make a correct and unambiguous diagnosis. Also for its verification.

Therapy

Treatment is prescribed comprehensively.

Drug treatment

Several pharmaceutical types of drugs are prescribed. Among the most applicable:

Anti-inflammatory drugs of non-steroidal origin. Ketorol, Ibuprofen, Nise, Ketoprofen and others in the form of tablets and ointments.
Corticosteroids, such as Prednisolone and similar drugs.
Muscle relaxants to relax muscle structures.
Antibiotics (as needed).
Analgesics based on metamizole sodium (Analgin, Baralgin).

The complex of these funds is sufficient.

Physiotherapy

Prescribed: electrophoresis, ultrasound treatment, magnetic therapy, laser treatment.

Exercise therapy and diet

Exercise therapy is prescribed only by the attending physician. It is effective only in the early stages. Complexes of exercises are selected by a specialist; there is no average complex. The diet involves avoiding fatty, fried, smoked, and excessively salty foods. The diet should be as rich in vitamins as possible. You need to eat as much dairy products, lean meat (protein), fish, eggs, and plant products as possible.

Osteoarthritis - what is it? We often hear from older people about joint pain. But people who are far from medicine don’t even know how serious it is. Such manifestations may be a symptom of osteoarthritis. This term refers to a whole group of diseases that arise from various reasons with similar symptoms and development mechanisms. All of them lead to the destruction of bone surfaces and articular cartilage.

Cartilage in the joint plays the role of a shock absorber, reducing friction between bone surfaces and is responsible for the functioning of the joint. Normally, cartilage has a uniform structure. As osteoarthritis develops, it begins to gradually deteriorate, the surface of the cartilage becomes uneven, and sometimes it becomes so thin that the bone is exposed. The disease is widespread throughout the world, affecting one fifth of the planet's population. The first symptoms of the disease may appear at the age of 45-50 years. With age, the risk of developing arthritis increases, the patient requires more long-term treatment. However, osteoarthritis of the hip joint cannot be considered a disease of the elderly; it often affects younger people. The disease develops for various reasons: genetic predisposition, excess weight, physical inactivity.

When articular cartilage is destroyed, a person begins to feel pain when changing position or moving. Swelling and crunching occur in the joints. The friction of bone surfaces against each other is clearly felt. Approximately 30% of patients with this diagnosis complain of increased pain after walking. Accurate diagnosis can only be diagnosed by a doctor who is able to distinguish osteoarthritis from other joint diseases.

At x-ray examination Many patients over 40 years of age show signs of cartilage destruction. They are especially pronounced in joints that are subject to the greatest loads, for example, the knees. Very often the disease is asymptomatic until a certain point. It begins with deformation of one of the joints of the fingers or toes, gradually moving to larger joints. You should pay attention to symptoms that get worse after exercise. They indicate the beginning of the pathological process. In some cases, there is stiffness in the joint after sleep or rest, which gradually disappears during active movement.

Over time, the deformation of the joint becomes more pronounced, it loses mobility and can be fixed in one position. There is a proliferation of bone and cartilage tissue, visible to the naked eye. The cartilage becomes denser, and a distinct crunching sound is heard when moving. Nodules form in the joints of the phalanges. The process may occur differently in different joints. For example, the knee joint becomes pathologically mobile, while the hip joint becomes less mobile. Both cases are characterized by severe pain.

Another characteristic symptom of osteoarthritis is back pain that occurs when intervertebral discs are damaged. Over time, the bone tissue grows, squeezing the nerve endings. This leads to loss of sensation in the limbs. In severe cases, osteoarthritis is accompanied by headaches, blurred vision, nausea and vomiting. With further development of the disease, the patient's condition may worsen to the point of dysfunction of the musculoskeletal system.

After diagnosis, the disease begins to be treated using conservative methods. The use of certain drugs depends on the stage of the disease and the condition of the patient’s body. Treatment is aimed at relieving pain and restoring joint mobility. In addition to drug treatment, the patient is prescribed light physical activity: walking, cycling, swimming, physiotherapy. Avoiding walking on uneven terrain, lifting heavy objects, and staying in awkward positions can help reduce stress on your joints.

The doctor selects a set of exercises that help strengthen muscles. Shown wearing orthopedic shoes, use of auxiliary support devices. Non-steroidal anti-inflammatory drugs are prescribed to relieve pain and inflammation. In addition, it is necessary to take chondroprotectors that protect cartilage tissue from destruction. For acute pain, glucocorticosteroids are injected into the joint cavity. The pain disappears after the procedure, but after a while it may arise with renewed vigor. Therefore, such treatment methods are used extremely rarely. Drug treatment It only stops the development of the disease; you can only get rid of its consequences with the help of surgery.

Surgical methods of therapy

There are several surgical treatments for osteoarthritis. The most commonly used procedure is endoprosthesis replacement of a damaged joint. No less common is arthroscopic debridement, in which the affected parts of the cartilage are removed through pre-made punctures with a special instrument. This operation is effective in the early stages of the disease. Many patients note a decrease in the intensity of pain and a return to joint mobility. However, after a few years the disease may return, and the patient will require more complex surgery.

Periarticular osteotomy is a more complex and effective surgical procedure. The bones of the diseased joint are sawed and fixed at a different angle. This helps to redistribute the mechanical load in the affected area. The patient's condition improves significantly, the effect lasts up to 5 years.

Osteoarthritis - chronic illness, from which it is almost impossible to recover completely. However modern methods Treatments can slow down and even stop the development of the disease in the early stages, which significantly improves the patient’s quality of life.

The sooner you see a doctor, the greater your chances of long-term remission.

Osteoarthritis (syn: degenerative joint disease, osteoarthritis hypertrophic osteoarthritis, osteoarthritis) is directly related to neck and back pain. Osteoarthritis is chronic pathology joint, characterized by destruction and potential loss of articular cartilage consistent with other joint changes including bone hypertrophy (osteophyte formation). Symptoms include gradual development of pain that is worsened or triggered by activity, stiffness that improves less than 30 minutes after activity begins, and rarely swelling of the joint. The diagnosis is confirmed by radiography. Treatment includes physical measures (including rehabilitation), medications and surgery.

Osteoarthritis is the most frequent illness joints, the symptoms of which appear at the 4th - 5th decade of life and are almost global at the age of 180 years. Only half of those with osteoarthritis develop symptoms of the disease. Before the age of 40, osteoarthritis occurs in men due to injury. Women predominate between the ages of 40 and 70, after which the ratio of men to women levels off.

Pathophysiology of osteoarthritis

Normal joints have little friction during movement and do not wear out from normal use, overuse, or injury. Hyaline cartilage does not have blood vessels, nerves and lymphatic vessels. It consists of 95% water and extracellular matrix and only 5% chondrocytes. Chondrocytes have the longest cell cycle (similar to CNS cells and muscle cells). The condition of cartilage and its function depend on alternating pressure and its release with weight bearing and use (pressure forces water out of the cartilage into the joint cavity and into the capillaries and venules, while release allows the cartilage to expand, take on water and absorb essential nutrients).

Osteoarthritis begins with tissue damage due to mechanical trauma (for example, a meniscus tear), the entry of inflammatory mediators from synovial fluid into cartilage, or disruption of cartilage metabolism. Tissue damage stimulates chondrospinal repair, which increases the synthesis of proteoglycans and collagen. However, the production of enzymes causing damage cartilage, such as inflammatory cytokines, which are normally found in small quantities, also increase. Inflammatory mediators initiate an inflammatory cycle, which further stimulates chondrocytes and intrinsic synovial cells, ultimately leading to cartilage destruction. Chondrocytes undergo apoptosis. As the cartilage is destroyed, the exposed bone becomes compacted and sclerotic.

Osteoarthritis involves all tissues of the joint. The subchondral bone hardens, infarcts, becomes osteoporotic, and subchondral cysts occur. The tendency for bone to regenerate causes subchondral sclerosis and the development of osteophytes along the edge of the joint. The synovium becomes inflamed, thickens, produces synovial fluid of lower viscosity and larger volume. Periarticular tendons and ligaments become tense, tendonitis and contractures develop. As the joint becomes hypomobile, the surrounding muscles weaken and perform less of a stabilizing function. The menisci crack and may become fragmented.

Osteoarthritis of the spine can cause severe hardening and proliferation of the posterior longitudinal ligament at the disc level, leading to ventral compression spinal cord; hypertrophy and hyperplasia of the ligamentum flavum often causes posterior compression of the spinal cord. In contrast, the anterior and posterior spinal root ganglia and the common spinal nerve are relatively well protected in the intervertebral foramen, where they occupy only 25% of the free and well-protected space.

Symptoms of osteoarthritis

Osteoarthritis begins gradually in one or more joints. The pain is early symptom, sometimes described as deep-seated pain. Pain usually increases with body weight pressure ( vertical position) and decreases at rest, but becomes constant over time. Stiffness is felt upon awakening or after physical rest, but lasts less than 30 minutes and decreases with movement. As osteoarthritis progresses, movement in the joint is limited and tenderness and crepitus or creaking in the joint occur. Proliferation of cartilage, bone, ligaments, tendons, capsule, synovial membrane in combination with varying degrees joint effusion, eventually leading to joint enlargement, characteristic of osteoarthritis. As a result, flexion contracture may develop. Rarely, acute severe synovitis may develop.

Most often, with generalized osteoarthritis, the distal interphalangeal joints and proximal interphalangeal joints are affected (Heberden and Bouchard nodes develop), the first carpo-metacarpal joint, intervertebral discs and zygoapophyseal joints of the cervical and lumbar vertebrae, the first metacarpophalangeal joint, the hip and the knee.

Osteoarthritis of the cervical and lumbar spine can lead to myelopathy or radiculopathy. Clinical symptoms myelopathy is usually mild. Radiculopathy may be clinically significant, but is uncommon because nerve roots and the ganglia are well protected. Failure vertebral arteries, spinal cord infarction, and compression of the esophagus by osteophytes may occur, but are uncommon. Symptoms of osteoarthritis may also originate from the subchondral bone, ligamentous structures, synovium, periarticular bursae, capsules, muscles, tendons, discs, periosteum, as they all have nociceptors. Increased venous pressure under the subchondral bone in bone marrow may cause pain (sometimes called “bony horn”).

Osteoarthritis of the hip causes a gradual decrease in range of motion.

Pain may be felt in groin area, in the area of the greater trochanter and be reflected in the knee. When the cartilage of the knee joint is lost (medial cartilage is lost in 70% of cases), the ligaments become weak and the joint loses stability, local pain arises from the ligaments and tendons.

Tenderness on palpation and pain on passive movement are relatively late symptoms. Muscle spasms and contractures maintain pain. Mechanical blockade due to the presence of loose bodies in the joint cavity or an abnormally located meniscus can lead to blockade (locking) of the joint or its instability. Subluxation and deformities may also develop.

Erosive osteoarthritis of the hand can cause synovitis and cyst formation.

It primarily affects the distal and proximal interphalangeal joints. The first carpo-metacarpal joint is involved in 20% of cases of osteoarthritis of the hand, but the metacarpophalangeal joints and wrist are usually not affected.

How is osteoarthritis classified?

Osteoarthritis is classified into primary (idiopathic) and secondary with known causes. Primary osteoarthritis may be localized to a specific joint (for example, chondromalacia of the patella is soft form osteoarthritis, which occurs in young people). If primary osteoarthritis involves more than one joint, it is classified as primary generalized osteoarthritis. Primary osteoarthritis is usually subdivided according to the location of the lesion (eg, hand, foot, knee, hip). Secondary osteoarthritis develops as a result of conditions that alter the microenvironment of cartilage. These are significant injuries congenital anomalies cartilage, metabolic defects (eg, hemochromatosis, Wilson's disease), post-infectious arthritis, endocrinopathies, neuropathic changes, diseases that damage the normal structure and function of hyaline cartilage (eg, rheumatoid arthritis, gout, chondrocalcinosis).

Diagnosis of osteoarthritis

Osteoarthritis should be suspected in patients with gradual development of symptoms and signs, especially in adults. If osteoarthritis is suspected, radiography of the most symptomatic joints should be performed. X-rays typically reveal marginal osteophytes, joint space narrowing, increased subchondral bone density, subchondral cysts, bone remodeling, and enlargement joint fluid. X-rays of the knee in the standing position are most sensitive for detecting joint space narrowing.

Laboratory tests for osteoarthritis are normal but may be needed to rule out other diseases (eg, rheumatoid arthritis) or to diagnose diseases causing secondary osteoarthritis. If increased synovial fluid occurs with osteoarthritis, testing it may help differentiate osteoarthritis from inflammatory arthritis; with osteoarthritis, the synovial fluid is clear, viscous and contains no more than 2000 leukocytes per 1 μl. Osteoarthritis affecting joints of an unusual location should raise suspicion that it is secondary; research in this situation should be aimed at identifying the primary disease (for example, endocrine, metabolic, neoplastic, biomechanical).

Treatment of osteoarthritis

Osteoarthritis usually progresses periodically, but rarely, without obvious cause, stops or regresses. The goal of treatment is to reduce pain, maintain joint motion, and optimize joint and general function. Primary treatment osteoarthritis includes physical activities (fehabilitation), support devices, strength exercises, flexibility, endurance; modification of daily activity. Adjuvant treatment for osteoarthritis includes NSAIDs (eg, diclofenac, lornoxicam), tizanidine, and surgery.

It is advisable to begin rehabilitation treatment of osteoarthritis before signs of disability appear. Exercises (various movements, isometric, isotonic, isokinetic, postural, strength) maintain cartilage health and increase the resistance of tendons and muscles to motor stress. Exercise can sometimes stop or even reverse the progression of osteoarthritis of the hip and knee. Stretching exercises should be performed daily. Immobilization for a more or less long period of time can contribute to contractures and worsen the clinical course. However, some rest time (4-6 hours per day) can be beneficial to maintain a balance of activity and rest.

Modification of daily activity may be helpful. For example, a patient with osteoarthritis lumbar region spine, hip or knee should avoid deep soft chairs and positions associated with postural overload and accompanied by difficulties in getting up. Regular use of a popliteal pillow contributes to the development of contractures and should be avoided. The patient should sit with a straight back without sliding in a chair, sleep on a hard bed and use devices to comfortably adjust the driver's seat with a forward tilt, do postural exercises, wear comfortable shoes that support the foot or shoes for athletes, continue to work and physical activity.

Pharmacotherapy is an addition to the physical program. Acetaminophen in doses greater than 1 g per day may reduce pain and be safe. But more powerful analgesic treatment may be required.

NSAIDs may be considered if the patient has refractory pain or signs of inflammation (redness, local hyperthermia). NSAIDs may be used concomitantly with other analgesics (eg, tizanidine, tramadol, opioids) to achieve better control of pain and symptoms.

Muscle relaxants (usually in low doses) rarely relieve pain from spasming muscles supporting an osteoarthritis joint. In older people, however, they may tend to have more side effects than benefits.

Oral corticosteroids have no role. However, intra-articular injection of depot corticosteroids helps reduce pain and increase range of motion in the joint in the presence of synovial effusion or inflammation. These medications should not be used more than 4 times a year in any affected joint.

Synthetic hyaluronidase (analogue hyaluronic acid, a normal component of the joint) can be injected into the knee joint to relieve pain for a long time (over a year). Osteoarthritis is treated with a series of 3 to 5 weekly injections.

For osteoarthritis of the spine, knee or first carpometacarpal joint, various options can be used to reduce pain and restore function, but maintaining mobility must include specific programs physical exercise. For erosive osteoarthritis, exercises to increase range of motion can be done in warm water, which helps avoid contractures. Other ways to reduce pain include acupuncture, transcutaneous electrical nerve stimulation, and topical capsaicin therapy. Laminectomy, osteotomy, and total joint replacement should only be considered if nonsurgical treatment fails.

Glucosamine sulfate 1500 mg per day appears to reduce joint pain and wear, chondroitin sulfate 1200 mg per day may also reduce pain. Their effectiveness has yet to be proven. Experimental studies are evaluating the feasibility of chondrocyte transplantation.

Osteoarthritis is another name according to the International Classification of Diseases ICD - 10 - osteoarthritis. This is a degenerative disease of the joints that leads to loss of joint function. The disease begins at 20–30 years of age, develops gradually, and a clear clinical picture is observed after 40. In old age, pathology of varying severity is observed in 70% of the population.

According to the US National Center for Chronic Disease Prevention, more than 46 million people worldwide suffer from various forms arthritis. The most common type is osteoarthritis.

What is osteoarthritis

For a better understanding of the pathogenesis, briefly about the structure of the joint: it is an articulation of two or more bones covered with thin cartilage, which serves as a shock absorber during movement. The joint cavity (synovium) contains intra-articular fluid, which reduces friction during movement. The joint is covered with a sheath of connective tissue (capsule). Movement and strength are provided by the muscular-ligamentous apparatus.

The wear and tear of the joints, caused by physiological reasons under the influence of provoking factors and immune mechanisms, plays a role in the development of the disease.

Wear joints leads to a decrease in the elasticity of cartilage tissue. The cells that produce normal collagen die. The remaining chondrocytes produce atypical collagen that is unable to maintain elasticity. Depressions form on the surface of the cartilage, then cracks. Gradually, the cartilage becomes so thin that when the articular surfaces touch, acute pain occurs and the person cannot move. The pain intensifies when the ligaments and tendons involved in the process are sprained, as well as when cartilage fragments (detritus) enter the synovial fluid. Joint mobility is limited.

In young people, the synthesis and breakdown of cartilage cells - chondrocytes - is balanced. In response to provoking factors, catabolism (decay) is immediately compensated by anabolism (synthesis of new cells). With age, catabolism begins to predominate, which leads to degenerative processes affecting the joint and adjacent tissues.

Along the edges of the joint, in place of cartilage, bone tissue grows, forming outgrowths - osteophytes. The joint loses its shape and becomes deformed. Hence another name for the disease – deforming osteoarthritis.

Immune mechanisms are triggered under the influence of provoking factors and are characterized by a pathological immune response - the production of antibodies to one’s own cells. The erosive type of osteoarthritis has an autoimmune origin.

Factors leading to osteoarthritis

Degenerative changes in cartilage are caused by:

physiological processes of aging;
excess weight caused by metabolic disorders, in a sedentary manner life, edematous syndromes of various etiologies (hormonal, renal, cardiac);
joint trauma caused by an accident or occupational characteristics (arthritis of the knee in football players, elbow and shoulder joints in those who work for a long time with a jackhammer, epicondylitis elbow joint golfers and tennis players);
hereditary predisposition ( genetic defect genes encoding the synthesis of cartilage collagen);
unhealthy diet with a predominance of fats and carbohydrates, drinking poor-quality water;
congenital increased joint mobility;
infections;
systemic autoimmune diseases connective tissue;
endocrine diseases;
hypothermia, especially in combination with high humidity;
bad habits (alcohol abuse, smoking).

Classification and symptoms

By origin Osteoarthritis can be primary or secondary, occurring after injury or against the background of other diseases.

By localization:

Localized – knee joint (gonarthrosis), hip (coxarthrosis), shoulder, elbow, hands, feet, spine (spondylosis);

Generalized – osteoarthritis of different groups of joints.

Main symptoms:

pain that increases with movement and decreases with rest;
“starting” stiffness, which goes away after 15 – 20 minutes;
crunching, clicking when moving;
swelling, accompanied by redness, hyperthermia;
reduction in range of motion until complete immobilization;
deformation visible to the naked eye;
bony outgrowths (nodes) in the joints of the hand.

Osteoarthritis of the knee joint or gonarthrosis

According to statistics, it covers 34% of cases of the total number of arthritis. The disease occurs in several stages:

A person experiences minor short-term pain after an awkward movement.
The patient feels increasing fatigue in the legs after long walk, lifting weights. Destructive processes begin in the cartilage.
The cartilage becomes thinner, there is no shock absorption, and friction of the joint surfaces causes pain. Due to the absence of nerve endings in the cartilage, the pain is not as intense. When involved bone tissue, having nerve endings, the pain syndrome is pronounced.
Osteophytes are formed. The degenerative process extends to the muscles and tendons. Swelling appears, bending - straightening the leg occurs with difficulty. While walking, acute pain with a crunching sensation occurs, due to which motor activity is limited.

Osteoarthritis of the hip joint or coxarthrosis

The most common type of osteoarthritis (42% of cases). It begins with a feeling of discomfort in the groin area in the morning. You feel stiffness and pain after lifting weights or going for a long walk. The discomfort goes away quickly.

Algia gradually spreads to the thigh, knee area, wears aching character. At rest it decreases. After a long walk, lameness appears. Next, the musculo-ligamentous apparatus of the thigh is involved in the process.

With severe deformity, the limb is shortened, lameness is constant. Destruction covers the hip joint area and adjacent tissues.

Shoulder osteoarthritis

According to statistics, more than 16% of the world's inhabitants suffer from this type of disease. The detailed clinical picture is represented by pain, crunching, and limited movement in the shoulder and collarbone area. The patient has difficulty raising his arm and is unable to comb his hair. In advanced cases, arthralgia is constant. The patient cannot sleep at night or touch the joint. Even the slightest movement causes arthralgia. The joint swells, turns red, and becomes deformed.

Elbow osteoarthritis

Characteristic are “grinding” and “jamming” in the elbow area. The first symptom is caused by friction of the joint surfaces due to loss of elasticity and thinning of the cartilage. The second is the restriction of movement due to the entry of detritus into the interarticular space.

In the later stages, the process spreads along the ulnar nerve to the distal parts of the limb: the patient feels numbness in the fingers (ring and little fingers). An enlarged joint (due to the accumulation of synovial fluid and swelling) puts pressure on the nerve endings, causing a tingling sensation. The joint stops straightening (flexion), causing pressure on ulnar nerve intensifies, " carpal tunnel syndrome", caused by prolonged compression of the nerve at its location - the muscular-fibrous tunnel. The pain worsens in cold weather.

Osteoarthritis of the ankle

The most common cause of disability. The disease has several degrees.

1 degree. Minor short-term pain during long walking, sports and physical activity that passes quickly. Changes on the RG are not visible.
2 degree. Arthralgia is constant, both during movement and at rest, aching, intensifies after sleep when trying to stand on your feet (starting pain). The joint is swollen, hyperemic, hot to the touch. Pronounced changes in the RG.
3 degree. Joint changes are visible to the naked eye, the limb is clamped in one position. A characteristic symptom is the inability to stand on one's feet. The RG shows signs of a degenerative process.

Osteoarthritis of the hands

Another name is “Nodular osteoarthritis”. Women over 45 years of age are susceptible. In addition to the mentioned etiological factors, the characteristics of the profession associated with monotonous finger movements play a role - secretary, weaver. During the onset of the disease, the woman does not experience severe pain. Gradually, characteristic nodules form in the area of the hands - thickening of bone tissue

Bouchard's nodes are located on the dorsum of the hand and affect the proximal interphalangeal joints. The nodules are painless to the touch and can lead to limited joint mobility.

Heberden's nodes are localized on the distal interphalangeal joints of the middle and index fingers. Less common on other fingers of the hand. Menopausal women experience severe pain.

The formation of nodules can last up to 5 years, occasionally manifesting as discomfort. By the end of the formation of nodules, pronounced degenerative articular changes are visible.

Only the myocardium works more intensely in the body than the foot. Therefore, the articular cartilage of the metatarsus wears out quickly.

The first symptoms - fatigue after a long walk and stiffness after sleep - quickly pass. As inflammation develops, the foot becomes swollen, red, and hot. Arthralgia is observed when moving. The first metatarsophalangeal joint is deformed and forms a “bone”. Then the remaining toes become bent. Due to severe pain, it is impossible to step on the leg, movements are severely limited.

Spinal osteoarthritis or spondylosis

Degenerative-dystrophic damage to the cartilaginous surfaces of intervertebral discs. Most often affects the cervical and lumbar regions.

Etiology

Common etiological factors characteristic of osteoarthritis play a role in the development of the disease, as well as:

improper load distribution (spinal curvature, flat feet, subluxations and dislocations of the hip joint);

congenital anomalies of the spinal column;

inflammatory processes in the spine;

intervertebral hernias.

There is evidence that up to the age of 45, men who perform heavy physical activity due to their occupation are susceptible to spondylosis; by the age of 50, the indicators are compared; after this age, the disease predominates in women.

Clinic

Algias or pain with spondylosis are:

mechanical - at the end working day associated with heavy physical stress on the spine. At night the pain subsides;
venous – aching, occurs at night, caused by stagnation venous blood in the vertebral vessels;
starting - appear immediately upon awakening, short-term, disappear 15 minutes after making movements;
false-hearted - when involved cervical spine the pain radiates to left hand, chest, which forces the patient to consult a cardiologist. Characteristic changes in the RG confirm the diagnosis of spondylosis.
permanent - expressed as the process progresses, caused by pinched nerve fibers and muscle spasm.

The pain is accompanied by limited mobility, swelling and hardening in the spine, and changes in posture.

With osteoarthritis of the cervical spine, symptoms of impairment are observed cerebral circulation– dizziness, tinnitus, increased A/D, headaches.

Osteoarthritis of the lumbar region is characterized by pain caused by the growth of bone tissue - osteophytes (spurs) pressing on the nerve endings. The algias are aching and constant, intensifying towards the end of the day. Patients choose comfortable position body - “fetal position”. With further growth of osteophytes, spinal nerve roots may be involved and symptoms of radiculitis may appear. There is pain in the legs, paresthesia (a feeling of numbness, “crawling goosebumps”, “running electric current"), intermittent claudication (unlike vascular claudication, after bending the body forward, claudication disappears).

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Polyosteoarthritis

Polyosteoarthritis (generalized osteoarthritis) is a chronic degenerative-dystrophic disease of joints of different groups (three or more).

According to ICD-10, pathology has the following forms:

primary generalized osteoarthritis;
Heberden's nodes with arthropathy ( secondary lesion joints against the background of other pathologies);
Bouchard nodes with arthropathy;
secondary multiple arthrosis caused by metabolic disorders, including post-traumatic polyosteoarthritis;
erosive osteoarthritis (autoimmune etiology).

According to clinical manifestations, the following forms are distinguished:

Asymptomatic – typical for young patients. Short-term pain and crunching in several joints are noted after physical activity. Heberden's nodes form on the fingers. There are often convulsions in calf muscles. The range of motion is preserved or slightly reduced. There are no changes to the RG.
Manifest –

a) Slowly progressive – in patients of any age. Pronounced changes characteristic of osteoarthritis appear 5 years after the onset of the process.

b) Rapidly progressive - more often in young people, manifests itself in the first 4 years after the onset of the disease.

Polyosteoarthritis most often affects the knee joint, hip joint, hands, and spine. Characteristic symptoms appear in several joint groups at once. Inflammation spreads to periosteal tissues, tendons, and ligaments.

Consequences of generalized osteoarthritis

Absence timely diagnosis and treatment, the duration and generalization of the process can lead to the following consequences:

ankylosis (immobility) of the joint due to the replacement of cartilage tissue with bone and loss of the joint’s function. Restriction of motor activity can develop into lameness (if the joints of the legs are affected) up to complete immobility, leading to disability;
with cervical spondylosis, cerebral circulation may be impaired, leading to stroke, cerebral infarction, and sometimes death;
with lumbar – the occurrence of lumbosacral radiculitis, ischalgia;
osteochondrosis of intervertebral discs;
periarthritis, tendovaginitis;
secondary reactive synovitis - secondary inflammation of the synovium;
hemarthrosis – bleeding into the joint cavity;
osteonecrosis of the femoral condyle - death of bone tissue as a result of impaired blood supply;
external subluxation of the patella.

Diagnostics

Diagnosis is based on a thorough history taking, consultation with a rheumatologist or orthopedist, which reveals the degree of functioning of the joint, and instrumental research methods.

Instrumental methods include:

X-ray is the main method for determining the size of joint spaces, the presence of osteophytes, cysts, nodules, the degree of deformation, and changes in the spine;
MRI of the joint;
Ultrasound, CT scan of the spine;
synovial puncture;
diagnostic arthroscopy to study synovial fluid, cartilage tissue, and take material for biopsy.

Treatment

The treatment is long-term, staged and complex.

In the first stages, it is necessary to reduce the load on the affected joint, limit physical activity, avoid lifting heavy objects, and use a cane when walking. Medication therapy includes:

, analgesics to relieve pain and inflammation;
chondroprotectors, restoring cartilage and preventing its further destruction;
immunosuppressants that suppress immune activity in autoimmune etiology;
antibiotics for the infectious nature of the disease;
vitamin therapy.

In the later stages, when NSAIDs are ineffective to relieve pain, intra-articular blockades with glucocorticoids are indicated. For severe swelling, therapeutic punctures are used and dehydration therapy is prescribed.

In addition to medication, complex treatment includes physiotherapy, Exercise therapy, balneotherapy, sanatorium — resort treatment.

In the presence of complications, indicated surgical methods:

endoprosthetics – damaged tissues of the knee or hip joint are replaced with a prosthesis;
arthrodesis is the artificial creation of ankle immobility in order to restore supporting function.
surgery to replace damaged chondrocytes with stem cells that promote rapid recovery and increasing the body's defenses (the method is effective in the early stages of the disease).

In cases of acute cerebrovascular accident, intensive care in the hospital, in the intensive care unit.

Prognosis and prevention

The prognosis of osteoarthritis depends on the duration, severity, generalization of the process, the presence of complications, the age of the patient, and concomitant chronic diseases that weaken the immune system.

Prevention consists of:

uniform distribution of loads on joints;
regular physical education;
giving up bad habits;
proper nutrition;
timely treatment of chronic diseases;
compliance with safety rules in situations with a risk of injury.

Medical nutrition

The diet for osteoarthritis contains foods that slow down the destruction of cartilage tissue and joint deformation: dairy products, meat and fish low-fat varieties, cereals, seafood, vegetables, fruits (except tomatoes), juices. It is forbidden to eat tomatoes, yolks, sweets, fatty, spicy foods.

General diet rules:

eat small and often meals;
drink more water;
there is boiled, stewed, steamed;
Avoid fried and smoked foods.

- This is the most common cause of pain in the knee and hip joints!

It is also one of the common reasons for prosthetics (replacement) of hip and knee joints. Given the fact that this disease mainly affects people over 50 years of age, as well as the fact that the population's life expectancy is increasing, it was predicted that in 2020 osteoarthritis will become the fourth most common cause of disability. This disease is already the most common cause of disability in older people in the UK.

Overview of Osteoarthritis

Osteoarthritis is a chronic joint disease that primarily affects the articular cartilage that covers the surfaces of the bones that form the joint. IN medical literature the disease is also called deforming osteoarthritis, and patients often use the terms “arthrosis” or “salt deposition.” The latter term does not entirely correctly reflect the essence of the disease, since with osteoarthritis, it is not the deposition of salts in the cartilage that occurs, but a metabolic disorder in it. The cartilage loses its elasticity, becomes rough and begins to deteriorate. Gradually, these changes lead to a deterioration in the gliding of articular surfaces and disruption of shock absorption, which is normally softened by articular cartilage. Osteoarthritis most often develops in the knees, hips and small joints of the hands.

Life osteoarthritis does not threaten, but significantly impairs movement in the affected joints. People with osteoarthritis spend more time and energy doing everyday activities. Osteoarthritis is one of the common reasons for hip and knee replacements. According to forecasts, the increase in life expectancy will lead to the fact that in 2020 osteoarthritis will become the fourth most common cause of disability. This disease is already the most common cause of disability in older people in the UK.

Symptoms of osteoarthritis

The most important symptom osteoarthritis- pain in the affected joint (or joints), which is especially aggravated by movement (which is why it is called “mechanical”). Initially, pain in the joint appears during exacerbations, but if the disease is not treated, it becomes permanent. Depending on which joint is affected, pain may occur when different movements. So, if the knee joints are affected (osteoarthritis of the knee joints is called “gonarthrosis”), then pain occurs in them when going down the stairs (when bending). And for osteoarthritis hip joints(also called “coxarthrosis”), hip pain is typical, but it can also be bothersome discomfort knee, groin, buttocks. Sometimes the intensity of pain changes depending on the weather - temperature, humidity, atmospheric pressure (weather dependence).

Over time, the mobility of the affected joint also decreases: incomplete flexion, abduction. Sometimes “joint blockade” may occur - sharp pain and limitation of movement (this is due to pieces of cartilage getting between the surfaces of the joint - “joint mouse”). The pain usually subsides after a few gentle movements.

Cracking, squeaking, or crunching in joints (crepitus) may be bothersome when moving. Their cause is friction of the articular surfaces of the bones.

External changes in the joint (increase in its volume, redness, increased temperature of the joint compared to others) occur infrequently. They may be associated with inflammation of the joint (arthritis) during an exacerbation, bone growth around the joint and other changes in the tissues located next to the joint (ligaments, muscles, etc.). For example, with osteoarthritis of the joints of the hands, the formation of nodules on the fingers (Heberden and Bouchard nodes) is characteristic.

Causes of osteoarthritis

Osteoarthritis develops as a result of metabolic disorders in cartilage tissue, gradually leading to its destruction. It is believed that this process can occur due to two main reasons:

damage to normal cartilage in the joint due to excessive loads (injuries, permanent minor injuries, etc.);
hereditary weakness of cartilage under normal loads (this cause is much less common).

As a result of the initial damage, processes are launched in the joint that lead to the gradual destruction of cartilage. Other factors also contribute to damage.

Thus, as a result of the formation of bone growths (osteophytes) along the edges of the articular surfaces, it leads to a redistribution of the load on the joint, as a result of which its individual parts are injured and destroyed faster. The growths on radiographs look like spikes (popularly called “salt deposits”).

Due to destruction, cartilage loses its elasticity (firmness). Healthy cartilage is a strong, elastic substance that, like an elastic lining, covers the rubbing surfaces of the joints. However, when damaged, microcracks form on its surface. Over time, they deepen, small and then larger cartilaginous fragments are separated. This process develops over many years and can lead to complete destruction of the cartilage. Doctors call this process and its results degenerative changes. As a result, the surfaces of the bones begin to literally touch each other.

Risk factors for osteoarthritis

The following are risk factors for developing osteoarthritis knee and hip joints:

Elderly age.
Female.
Excess body weight.
Hereditary predisposition (especially for small joints of the hand).
Joint injury.
Removal of the meniscus of the knee joint.
Professional sports.
Hard physical labor.
Frequent climbing of stairs, lifting of significant weights.
Prolonged squatting or kneeling position.
Daily walking over long distances (more than 3 km).

Prevention of osteoarthritis

Prevention osteoarthritis is to influence its risk factors (factors that increase the likelihood of developing the disease).

It must be remembered that it is impossible to influence some factors (gender, hereditary predisposition and elderly age extremely difficult to change).

However, other dangers can be avoided.

It is very important to maintain optimal body weight. Therefore, proper nutrition and well-organized physical activity are an important step in preventing joint problems in the future.
When playing sports that pose a danger to joints, you need to take all permissible precautions and use special methods of protection (knee pads, wristbands, etc.).
It is advisable to choose sports that do not pose a danger to the joints (this is especially important for those who have a hereditary predisposition).
You should avoid prolonged walking on stairs, squatting and kneeling.
If you have flat feet, you need to wear special orthopedic devices.

Complications of osteoarthritis

Osteoarthritis does not affect internal organs. This local disease joints.
Therefore, there are no life-threatening complications with this disease. But as the pain progresses, it forces you to pick up a stick and disturbs sleep, i.e. significantly worsens a person’s quality of life, bringing him constant suffering.

Diagnosis osteoarthritis based on questioning, examination of the patient and results laboratory examination; In addition, radiography may be required and ultrasonography joint

Most often, laboratory parameters (blood tests) are not changed; their study is necessary to exclude other diseases with a similar clinical picture (primarily rheumatoid arthritis). X-ray examination of the affected joints is of great importance, since it often reveals changes characteristic of osteoarthritis - narrowing of the joint space (the distance between the bones in the joint), marginal bone growths (osteophytes) and other signs (Figure 1). Ultrasound is performed to further evaluate the thickness of the articular cartilage, the condition of the joint capsule, and the tissues adjacent to the joint.

Figure 1. X-ray of the knee joint in a patient with osteoarthritis. In the right (medial) part of the joint, the distance between the bones is reduced (the joint space is narrowed).

Treatment of osteoarthritis

Basis of treatment osteoarthritis constitute measures to protect joints from the effects of factors that cause progression of the disease. Important also have drug treatment and physiotherapy.

It must be remembered that currently there are no drugs that could restore destroyed articular cartilage.

What medications are taken for osteoarthritis?

The goal of drug therapy for osteoarthritis is to eliminate the symptoms of the disease (reduce pain and improve mobility in the joint). This is achieved with the help of painkillers and non-steroidal anti-inflammatory drugs. For moderate pain, it is preferable to use paracetamol or ibuprofen tablets. Can be used local drugs(creams or gels) with analgesic and anti-inflammatory effects. They are applied to clean skin over the joint 2-3 times a day. For severe pain, diclofenac tablets are used. You should remember side effects medicines this group. In particular, long-term use paracetamol in a dose of more than 4 g/day. may cause liver damage or increased blood pressure. For elderly patients, the dose of paracetamol should not exceed 3.2 g/day. Nonsteroidal anti-inflammatory drugs have bad influence on gastrointestinal tract and can cause inflammation of the mucous membrane or ulcerative process. Therefore, the doctor must decide on the prescription of these medications (as well as the dosage, duration and method of use).

There is evidence that some positive effect on initial stage osteoarthritis Drugs that improve the structure of cartilage - chondroprotectors (glucosamine, chondroitin sulfate - are similar in structure to the natural components of cartilage) can help. As a result of their long-term use, some patients experience improved joint mobility and reduced pain.

Sometimes the doctor may prescribe intra-articular administration of medications: glucocorticoids - for quick removal inflammation in the joint, sodium hyaluronate solutions - to improve gliding in the joint. This treatment method provides a pronounced effect after the first injection; some patients subsequently require this procedure even with slight discomfort. It should be remembered that this treatment method does not affect the progression of the disease, but only reduces the severity of its manifestations. Frequent, unnecessary intra-articular injections can harm the joint.

Prosthetic surgeries for osteoarthritis

In case of severe osteoarthritis accompanied by strong constant pain and severe limitation of mobility, the doctor may suggest prosthetic surgery (replacement) of the affected joint (hip or knee). Prosthetics can significantly expand the physical activity of a patient with osteoarthritis. In cases where prosthetics are planned, the patient needs to control his body weight, since this operation is contraindicated in case of obesity.

Spa treatment for osteoarthritis

Treatment at the sanatorium allows comprehensive rehabilitation(impact therapeutic mud, baths, saunas, physiotherapeutic procedures, massages, physical therapy). Important role plays a change of environment, relieving stress, staying in fresh air. Sanatorium-resort treatment can be carried out only without exacerbation of the disease. It must be emphasized that the sanatorium-resort course of treatment represents only one stage of a long rehabilitation process, and the main importance belongs to lifestyle changes (constant monitoring of body weight and regular exercise).

How to relieve joint pain yourself

Applying cold or heat to the sore joint can significantly reduce pain. You need to try both methods and choose the one that helps more. Cold (finely crushed ice or frozen peas, wrapped in a cloth/towel) is applied to the affected joint for 10-15 minutes (but no longer!) every hour. Warming the joint, for example using a heating pad, a special lamp or a bottle of hot water, especially useful before physical education. In general, with osteoarthritis, as with many other joint diseases, it is recommended not to overcool the joints and keep them warm.