How does osteoarthritis differ from rheumatoid arthritis? Osteoarthritis and rheumatoid arthritis enlarged spleen and lymph nodes

Arthrosis - symptoms

• One of the earliest symptoms of arthrosis is joint pain. At the beginning of the disease, it is practically absent at rest, but appears when the joint is loaded. Most often, osteoarthritis affects the knee (gonarthrosis) and hip (coxarthrosis) joints.
• Dry and rough crunching in the affected joints is another symptom of arthrosis; it occurs when worn-out articular surfaces rub against each other; in the second and third stages, the crunching becomes clearer and louder.
• The next symptom of arthrosis is impaired joint mobility, a gradual reduction in the range of motion associated with muscle spasms, a decrease in the joint space and the appearance of osteophytes (bone growths, spines).
• Symptoms of deforming arthrosis (osteoarthrosis) are modifications of the affected joints, deformation of joint tissue and articulating bones, development of osteophytes, “bursting” with a large volume of synovial fluid, pressing on the joint from the inside.

Pain with arthrosis differs from pain with arthritis mainly in that in the first case the pain occurs with movement and mainly during the day, and in the second it does not depend on movement and usually appears at night. Arthritis pain is more acute and intense.

Causes of arthrosis

One of the causes of arthrosis leading to the disease is aging of chondrocytes, cartilage cells. The total amount of cartilage in the joint may gradually decrease, especially noticeable as old age approaches, as well as after injuries, post-traumatic inflammation, professional constant loads on certain joints (for example, in football players and agricultural workers).

Causes of arthrosis:

• arthrosis as a consequence of injury - post-traumatic arthrosis;
• flat feet;
• sports loads, carrying heavy loads - loaders, weightlifters, football players, ballet dancers are at risk;
• Arthrosis can be caused by endocrine diseases, such as diabetes;
• One of the most common causes of arthrosis and arthritis is infectious and viral diseases.

Arthrosis - treatment

Treatment of arthrosis largely depends on which joint is affected and at what stage of the disease it is. Anti-inflammatory drugs, physiotherapeutic procedures, intra-articular oxygen therapy (saturation of the joint with oxygen), intraosseous blockades are used. It is also possible to treat arthrosis in sanatoriums in favorable climatic conditions with the use of mineral waters and mud. For arthrosis of the knee joints, massage of the lower extremities can be useful, but direct impact on the diseased joint should be avoided, as this can increase the inflammatory reaction in it.

Treatment of arthrosis should take into account the causes of the disease: if you are overweight, then it is necessary to adjust your diet; if the cause is endocrine disorders (diabetes), then treat the underlying disease. Be sure to adjust the physical activity on your joints: for example, replace football with swimming.

Drugs for the treatment of joint arthrosis

To reduce pain and inflammation, the doctor usually immediately after diagnosis prescribes the “gold standard” in the treatment of arthrosis - non-steroidal anti-inflammatory drugs, or NSAIDs. As a rule, they are prescribed intravenously or intramuscularly, so as not to irritate the gastric mucosa and quickly obtain a therapeutic effect. Local use of these agents (ointments and gels) can be considered solely as an addition to the treatment of arthrosis, since their effectiveness is extremely low.

During periods of exacerbation of arthrosis, hormonal corticosteroids are used - hydrocortisone, Kenalog or Diprospan intra-articularly. Additionally, local capsation - an alkaloid of hot pepper - is sometimes used in the form of a patch, ointment or alcohol tincture.

The drugs listed above relieve pain and inflammation, that is, the symptoms of arthrosis. Treatment must be supplemented with chondroprotective drugs, which nourish the joint tissues and start the process of cartilage restoration.

Chondroprotectors for arthrosis

Chondroprotectors used for arthrosis are, as a rule, biologically active additives. They contain substances that promote the restoration of cartilage tissue and improve the quality of synovial fluid. These include chondroitin sulfate and glucosamine. Their peculiarity is a long course of treatment until the first effect is obtained. The problem is the low degree of absorption of these drugs. Although there are also dietary supplements that are as effective as injectable chondroprotectors. It is these effective dietary supplements that will be discussed below.

• Chondromarin is a chondroprotector that restores joint cartilage. It is a source of plastic materials (glucosamine, chondroitin sulfate, soluble collagen, amino acids and trace elements). Due to the oligonucleotides in its composition, it reduces inflammation and pain.
• Chondromarin Cryptos - activates the work of osteoblasts, starts the mechanism of active self-renewal of cartilage tissue.

Despite the fact that these drugs are registered as dietary supplements, their distinctive feature and advantage over other chondroprotectors is that the drugs are in capsules, but the active substances are not destroyed in the gastrointestinal tract, but (thanks to Axis technology) flow through the bloodstream to the joint as if the drug had been injected.

Axis technology made it possible to endow biologically active substances with a very important property for biocorrection: the ability to penetrate biological barriers, while being "invisible" to the immune system and "non-toxic" to the whole organism.

Plastic materials (glucosamine, chondroitin sulfate, soluble collagen, amino acids and trace elements) contained in Chondromarin are in their natural state, which ensures efficient absorption. All these substances, thanks to Axis technology, are delivered directly to the cells of the body. Those cells that need this plastic and mineral material absorb it or convert it into a source of energy. The protein-mineral complex of salmon cartilage contains the necessary components for the restoration of the collagen matrix and the formation of a cartilage structure from it, and is able to support and direct the restoration processes in the right direction.

“For several months now I’ve had pain in my knee in the evening,” “... when I fall asleep I can’t lay my leg down, I rub it with different ointments, nothing helps...”, “my back hurts, I have no strength at all...” - these are typical complaints with which people turn to their doctor doctor. The doctor identifies such patients “from the start”, usually this is a gentle gait, a cane in the hands, rubbing sore joints….

Many people live with this for many years, especially in old age. Pain in the hip joints, pain in the ankle joint when walking, pain in the hands, pain in the shoulders when moving. All this can be attributed to chronic changes in the joints, which are united by one diagnosis - deforming osteoarthritis or osteoarthritis. According to official data, 5-7 percent of men and women are affected worldwide. Men get sick earlier, at the age of 45, women after 55 years, this is due to hormonal characteristics, women more often get sick after menopause.

What happens to joints with osteoarthritis

Normally, the cartilage covering the articular surfaces is elastic, they are actively renewed and can withstand heavy loads. This is achieved by the fact that cartilage molecules are saturated with water. With age, everything changes, elasticity decreases, the body loses fluid and “dries out.”

The amount of lubrication inside the joint decreases, and less cartilage is renewed. Under intense loads and injuries, microfractures, ligament tears occur, and erosions form on the cartilage. Excess weight can also cause stress, which increases pressure on the joints. Hypothermia and arthritis in the past cause damage to bone and cartilage tissue. Osteoporosis (leaching of calcium from bones) also increases the effects of arthrosis.

Any violation of the integrity of bone and cartilage tissue causes an inflammatory process, and inflammation contributes to the growth of bone tissue, but in an incorrect way. This is clearly visible on the phalanges of the fingers of older people - “bones”, scientifically called Heberden’s nodes, become visible. Large joints are also often deformed, mobility in them decreases, and surrounding tissues, tendons and even muscles are also involved. And such an affected joint can no longer function normally, in the morning it is very difficult to “diverge”, in the evening the pain and swelling intensify. With exacerbation, signs of arthritis appear - i.e. active inflammation.

The diagnosis is obvious. Osteoarthritis deformans differs from rheumatoid arthritis, arthritis due to autoimmune diseases, or reactive arthritis in that changes in the blood are minimal. There is no autoimmune component. The main tests we use to detect inflammation in a general blood test are erythrocyte sedimentation rate (ESR), white blood cell count. In a biochemical blood test, tests such as C-reactive protein and rheumatoid factor are prescribed; for osteoarthritis, they are almost no different from the norm.

An X-ray examination of the joint is required to determine the stage of the disease. Because changes in the joint may not correspond to the symptoms of the disease. Severe changes in the joint can occur almost without pain, at the same time the patient may complain of severe pain, although the changes in the joint itself are minimal. To identify disorders of the ligamentous apparatus, inflammation of the synovium - the joint membrane, an ultrasound scan of the joint is prescribed. CT or MRI is prescribed to clarify the changes. And also when surgery is required.

Different joints can be affected, both large ones - hips, knees, shoulders, elbows, and small joints - hands and feet. Depends on which joint was overloaded. If you are overweight, the joints of your legs, hips, and spine suffer more. If the load is placed on the hands during work, the phalanges of the fingers and the wrist joint are affected.

Treatment of osteoarthritis

It is important for the patient to reduce the load on the affected joint, be sure to reduce body weight, and when walking it is better to use canes and walkers.
Exercise therapy (physical therapy) is simply necessary for joints. There are many different systems for strengthening muscles and increasing mobility. Of course, if your joints hurt, you can’t do without special exercises. There are many exercises for joints in the Eastern tradition, for example Daruma-taiso is one of the effective and simple systems.

Warming or anti-inflammatory ointments and gels, such as capsicam, bystrum-gel, fastum-gel, are used as an auxiliary and distracting agent. It is impossible to cure them completely, but they can alleviate the condition. Of the old proven methods, compresses with dimexide help, especially in the first days of an exacerbation.

For pain, the doctor prescribes a group of non-steroidal anti-inflammatory drugs in tablets and injections. In the form of injections, most often - diclofenac, ketoprofen. In tablets or capsules - ketoprofen, nimesulide, ibuprofen and more modern drugs - nalgesin, dilaxa. NSAIDs have to be taken for a long time, but we must not forget that long-term use can provoke ulcers of the mucous membrane of the stomach and duodenum and bleeding from these ulcers. Therefore, NSAIDs are usually taken in combination with drugs from the omeprazole group (rabeprazole, pantoprazole) or antacids (Almagel).

Chondroprotectors are taken in long courses from 2 to 6 months. These are preparations containing chondroitin and glucuronic acid - building materials for cartilage (arthra, dona, alflutop). These can be medications or dietary supplements (dietary supplements). There may be drugs in both tablets and injections. Surgeons inject chondroprotectors into the joints.

The effectiveness of chondroprotectors has not been proven by science. From my experience, I can say that people with heart disease, especially those taking complex drug regimens, are better off avoiding them. For the rest, it’s a good idea to take 1-2 courses a year, especially those who suffer from a connective tissue defect, provided that they themselves see the effect of the treatment.

Hormones - glucocorticoids - are used as an auxiliary anti-inflammatory agent, most often in the form of injections into the joints.
For intense pain, the doctor prescribes combination drugs such as pentalgin. If these drugs are ineffective, stronger opioid analgesics (tramadol, Zoldiar) are prescribed.

Physiotherapy, in particular ultrasound, is, according to research, the most effective procedure for the treatment of osteoarthritis. With its help, small growths on the surfaces of joints and salt deposits are broken down. For an anti-inflammatory effect, ultrasound is done with hormonal ointments.

According to the results of the same studies, a magnet is ineffective and in many cases harmful, especially for older people. Its frequent and uncontrolled use can stimulate the oncological process.
The diet is aimed at reducing excess body weight. It should also include substances containing chondroprotectors - cartilage, especially fish cartilage, jelly, jellied meat.

Surgical treatment of osteoarthritis is endoprosthetics, that is, joint replacement. Indications for surgery may be dysfunction of the joint, severity of pain that does not go away with treatment with physiotherapy and analgesics.

Much in terms of joint health depends on us; we need to not be lazy, do gymnastics, monitor our weight, spare our joints, consult a doctor on time, undergo an examination and begin treatment.

N.V. Zagorodniy, professor, doctor of medical sciences, laureate of the Russian Federation Prize in the field of science and technology, head of the departments of traumatology and orthopedics of RUDN University and Moscow State University named after M.V. Lomonosov
V. P. Tereshenkov, Candidate of Medical Sciences, Head of the Department of Orthopedics, Moscow Arthrological Hospital

A polyetiological dystrophic degenerative disease of the joints, characterized by primary degeneration of cartilage with subsequent changes in the articular surfaces, proliferation of marginal osteophytes, leading to deformation, is called ARTHROSIS (from the Greek “arthron” - “joint”). This term has synonyms: osteoarthritis (OA), deforming arthrosis, deforming OA. Many foreign authors define this pathological process as osteoarthritis.

This is one of the most ancient diseases of humans and animals. During paleontological studies, changes in the bone skeleton were found in people who lived in the Stone Age. Thus, in the Neolithic period, according to excavation materials, joint OA reached 20% (perhaps the reasons were living in dark and damp caves, the scarcity and monotony of food, and unfavorable climate).

Ancient medicine often had to deal with OA. In his work “On the Joints,” Hippocrates considers it together with gout and other diseases of the joints. The English doctor V. Geberden described the nodules named after him and considered as one of the manifestations of OA. In the second half of the 19th century, the French clinician J.M. Charcot distinguished OA and rheumatoid arthritis from rheumatic diseases and considered them as the main variants of one pathological process - deforming arthritis. In 1904, the American orthopedist R. Osgood, based on X-ray studies, proposed the term “atrophic arthritis.” However, OA was officially recognized as an independent nosological form only in 1911, when at the International Congress of Physicians in London it was proposed to divide all joint diseases into primary inflammatory and primary degenerative.

Etiology and pathogenesis of OA

OA is one of the common forms of joint disease. It affects 10–12% of the surveyed population of all ages. After 80 years, almost everyone shows signs of OA. Women suffer from OA of the hip and knee joints almost 2 times more often than men, and arthrosis of the distal interphalangeal joints - 10 times more often.

The nature of work and sports leave an imprint on the specific manifestations of OA in various human joints. The dependence of the spread of the disease and its individual variants on the profession has been established. The role of hereditary factors in the occurrence of OA has been determined.

To a certain extent, this disease corresponds to a polygenic model of inheritance, which reflects the polyetiology of OA. The incidence of OA in families of patients is 2 times higher than in the population, and the risk of developing this disease in people with congenital defects of the musculoskeletal system is increased by 7.7 times. The course of the disease is influenced by physical activity and excess body weight. In most cases, the onset of OA occurs between 40 and 70 years of age and affects joints subject to peak loads - the patellofemoral and tibiofemoral joints of the knee, the upper pole of the femoral head in the hip joint, and the distal and proximal joints of the hand. This suggests that OA is an evolutionary heritage of humans.

Deforming OA occurs in different nationalities in different geographical areas. A study conducted in the USA revealed that the prevalence of this disease is more than 15%. In Europe, OA is considered one of the most common forms of joint disease, accounting for 60–70% of all joint diseases. OA leads to loss of ability to work and disability, mainly due to limited range of motion and severe pain.

The factors of development of this disease are of greatest interest to doctors. Knowledge of the nature of their occurrence helps the doctor diagnose OA during a mass examination of the population. It is important to know that many risk factors are related to each other, increasing their mutual influence on the development of OA.

However, despite the close attention of doctors to this problem, the true cause of the disease still remains unclear. The main putative factors for the development of OA conditionally divide it into primary and secondary.

Causes of primary OA

1. Static overloads exceeding the functionality of cartilage tissue
   • heavy physical labor with repetitive stereotyped movements
   • excessive exercise
   • overweight
2. Disturbance of congruence of articular surfaces of cartilage
   • congenital dysplasia (of the hip joint, genu varum, genu valgum)
   • congenital and acquired static disorders (scoliosis, kyphosis, generalized hypermobility of the ligamentous apparatus, flat feet, hyperlordosis)
   • skeletal abnormalities
3. Changes in the physicochemical properties of the articular cartilage matrix
   • mechanical microtraumatization (trauma, cartilage contusion)
   • disruption of the subchondral blood supply to the bone
   • metabolic changes as a result of diseases (gout, pyrophosphate arthropathy)
   • disorders of the endocrine and nervous systems (diabetes mellitus, neurotrophic arthropathy)
   • intra-articular fractures, dislocations
   • chronic hemarthrosis (hemophilia)

Causes of secondary OA

1. Deformation due to
   • mucopolysaccharidoses
   • spondyloepiphyseal dysplasia
   • multiple epiphyseal dysplasia
   • congenital dysplasia of the hip and knee joints
   • epiphysiolysis
   • malunion of fractures
   • drug induction
2. Blood diseases
   • hemophilia
3. Developmental disorders
   • incongruity
   • neuropathy
   • joint instability
4. Metabolic and endocrine diseases
   • acromegaly
   • chondrocalcinosis
   • ochronosis
   • diabetes
5. Bone necrosis
   • idiopathic
   • due to hemoglobinopathy
6. Inflammatory process
   • infection
   • injuries

The disease begins as a result of the development of the risk factors listed above. First, changes occur in the matrix of articular cartilage. It consists of many collagen fibers that hold large polymer molecules (proteoglycan aggregates) that absorb water and make the cartilage elastic. Changes in the matrix occur in the form of excess hydration, rupture of collagen fibers, impaired elasticity and firmness and are accompanied by ultrastructural changes in chondrocytes, loss of proteoglycans and disruption of the structure of the entire cartilage.

During the development of OA, proteoglycans, breakdown products of chondrocytes and collagen, which are antigens that induce inflammation, are released from cartilage tissue. At the same time, 4 classes of cytokines act in different directions on the cellular components of cartilage tissue, synovial membrane, and subchondral bone, which cause catabolic processes that enhance the degeneration of articular cartilage. The course of OA becomes irreversible.

Main clinical forms

Hip OA – coxarthrosis (CA) , the most common and severe form of joint damage. Patients with CA account for 30–40% of all OA variants. This disease usually ends with progressive dysfunction of the joint up to its complete loss, causing disability in patients. The frequency of CA disease increases sharply after 45-50 years. Its main clinical symptoms are:

• pain syndrome. The pain is mechanical in nature, its localization is variable. Feels in the hip joint, knee, inguinal fold, buttock
• limited range of motion in the joint. Especially with internal rotation and discomfort when moving in extreme positions. As the disease progresses, movement in the joint becomes more limited. Over time, it assumes a fixed position of flexion, adduction and external rotation. The resulting adductor contracture causes a compensatory skewing of the pelvis with an apparent shortening of the affected limb, and a flexion contracture causes the buttocks to protrude backward when walking and the torso to tilt forward when transferring the body weight to the affected leg

With bilateral damage, a “duck gait” is observed with the body waddling in one direction or the other.

OA of the knee joint - gonarthrosis (GA) . This is the second most common location of OA. GA accounts for 33.3% of all OA cases. The first manifestations of GA occur at 40–50 years of age. Main symptoms:

• mechanical pain. It occurs when walking, especially when going up and down stairs, and subsides at rest. Is it most often localized in the front or inner parts of the joint and can radiate to the lower leg? restriction of movements in the joint. In the initial period, flexion is limited, and later extension is limited; crunching increases during movements.
• impaired joint stability (weakening of the lateral ligaments). Formation of progressive varus deformity (genu varum)
• swelling of the joint. It is usually caused by a combination of bone growths (osteophytes) and the accumulation of exudate in the joint cavity during reactive synovitis
• amyotrophy. Especially the quadriceps femoris

Ankle OA – crusarthrosis (AkrA) . Most often, this is secondary OA, which developed against the background of rheumatoid arthritis or as a result of injury in the ankle joint - severe ankle fractures with rupture of the distal tibiofibular syndesmosis, separation of large fragments of the anterior and posterior edges of the tibia, destruction of the distal epiphysis. According to various authors, KrA ranges from 9% to 25% of all cases of OA. Intra-articular friction is considered an important factor in the development of this disease. Clinically, CrA is characterized

• pain syndrome. The pain intensifies when rolling from heel to toe, when walking on uneven surfaces
• limited mobility in the joint

For stages I and II of traumatic etiology of CrA, conservative treatment is indicated; for rheumatoid etiology, synovectomy is indicated. At stage III of traumatic etiology, arthroplasty is indicated; for rheumatoid etiology, synovectomy with arthrolysis or arthrodesis is indicated.

OA of the first metatarsophalangeal joint refers to a dystrophic degenerative disease of the joints, the etiological factor of which is static overload, trauma or a previous infectious-inflammatory process of the joint. The disease most often occurs after 40 years of age, which is apparently due to mechanical overloads that develop as a result of flat feet. Clinically, OA of the first metatarsophalangeal joint manifests itself

• soreness
• limited mobility of the big toe
• difficulty walking
• bursitis of the serous bursa of the joint
• hallux valgus deformity of the first toe

The clinical picture develops slowly. Pain in the joint occurs after a long walk or when changing shoes to new or tight ones.

Shoulder OA - the most rare form.

Its causes are injuries (intra-articular fractures) and previous diseases (rheumatoid arthritis, gout, chondrocalcinosis, humeral head dysplasia, shoulder-hand syndrome, etc.). In shoulder OA, the subacromial joint is most often affected. Clinically this manifests itself

• painful limitation in shoulder abduction and rotation. Later, adduction contracture develops
• atrophy of nearby muscles

Deformation of the shoulder joint is usually not observed. OA of the true shoulder joint is rare.

Elbow OA . There are post-traumatic, immobilization, dysplastic, metabolic-dystrophic, post-infectious arthrosis. The disease is manifested by a symptom complex, which includes

• pain that worsens after full flexion and extension
• dysfunction of the elbow joint (limited extension and forced position of the joint - slight flexion in the elbow joint), up to the formation of cotraction

OA of the distal (Heberden's nodes) and proximal (Bouchard's nodes) interphalangeal joints of the hand accounts for 20–40% of all cases of atrosis and is observed mainly in women (in a ratio of 10:1). Heberden's nodes are usually multiple, but primarily occur on the 1st and 3rd fingers of the hand. Bouchard's nodes are less common than Heberden's nodes, but often these two forms of arthrosis are combined. It shows up

• pain, swelling and redness of the soft tissues in the joint area
• limited mobility
• characteristic deformation - thickening of the articular end of the bone and subluxation of the joint in combination with local muscle atrophy

OA is characterized by local damage to the joint in the absence of systemic manifestations (increased ESR, dysproteinemia, increased temperature, emaciation, etc.). Only in the presence of reactive synovitis can there be a slight increase in ESR to 20–25 mm/hour.

According to the clinical and radiological picture, different authors distinguish 3–5 stages of the disease. However, there is no strict relationship between clinical and radiological signs in the early stages. Often, with minor radiological changes, severe pain and limited mobility in the joint are noted.

Etiology and pathogenesis of OA

Stage I

Clinical criteria

• feeling of discomfort in the joint, slight crepitus when moving
• pain in the joint with increased load and passing with rest
• Palpation of the joint area is usually painless, discomfort occurs only in case of reactive inflammation
• slight limitation of passive movements, short-term stiffness during the transition from a state of rest to active activity, rapid fatigue of regional muscles
• a decrease in the volume of only those movements that have a small amplitude, for example, internal rotation in the hip or hyperextension in the knee joint. The patient begins to spare the leg, as a result of which mild atrophy of the periarticular muscles develops
• joint function is not affected, the patient walks without additional support

Radiological criteria

• slight narrowing of the joint space
• the appearance of marginal osteophytes due to ossification of articular cartilage
• the joint maintains its normal shape for a long time
• in some cases (attachment of reactive inflammation) the joint space may be widened

Stage II

Clinical criteria

• starting pain in the joint, which is initially long-lasting and then constant, most intense in the evenings, decreases with rest, but usually does not go away completely
• in the hip joint, pain radiates to the groin, ischial area or knee joint
• so-called joint blockade is possible due to the appearance of a “joint mouse” - a bone or cartilage fragment with its pinching between the articular surfaces
• palpation is painful not only in the projection of the joint space, but also in the para-articular tissues
• stiffness of the joint develops, but movements are maintained in a volume sufficient for self-care
• contracture develops, which is mainly extra-articular in nature and can be corrected with conservative treatment
• the function of the joint suffers significantly and its rapid fatigue increases, which limits a person’s ability to work
• Many patients use additional support when walking - a cane

Radiological criteria

• multiple bone growths in the area of ​​the articular surfaces
• narrowing of the joint space by 2–3 times compared to the norm, subchondral sclerosis of the endplates
• the articular surface of the bone is deformed, increased in volume, uneven. In the subchondral layer, bone beams are clearly visible, located according to the direction of excess load

Stage III

Clinical criteria

• the pain is constant, intensifies with any movements (active, passive), especially when going down the stairs
• constant rough crunching sound when moving
• palpation of the joints and periarticular area is sharply painful
• mobility in the joint is significantly reduced, sometimes the possibility of limited rocking movements remains
• the joint is deformed, persistent tendon-muscular contractures develop due to intra-articular changes
• pronounced atrophy of the periarticular muscles
• the volume of the joint often increases due to effusion, which is accompanied by tendobursitis
• walking is impossible without additional support - canes, crutches

Radiological criteria

• almost complete absence of joint space due to significant and often complete destruction of articular cartilage, menisci and degeneration of intra-articular ligaments
• pronounced deformation of the articular surface due to extensive marginal growths and compaction of the articular surfaces of the epiphyses
• severe sclerosis of the articulating bones in the most stressed places, racemose cavities are often detected

In recent years, foreign classifications have also been used to determine the radiological stage of OA. We present one of them: 0 – no radiological changes
I – small osteophytes and osteosclerosis
II – minimal changes (narrowing of the joint space by less than 1/3 of the normal joint width, single osteophytes, subchondral osteosclerosis)
III – moderate manifestations (significant narrowing of the joint space by more than 2/3 of normal, multiple osteophytes, severe subchondral osteosclerosis)
IV – pronounced changes (the joint space is almost not visible, large extensive osteophytes, cystic bone restructuring, articular surfaces are not clearly defined over a long distance)

Examination methods

When clinically assessing joints, all individual characteristics of patients, even those without specific joint disorders, are of interest and should be taken into account.

To confidently distinguish normal from pathology during joint examination, experience is needed. Each specialist should be well aware of deviations - age, gender, those formed as a result of professional activity, as well as those caused by heredity or diseases that can be identified during the examination. For those suffering from OA, it includes examination of the patient’s joints, palpation, goniometry, determination of the range of motion in the joint and measurement of joint circumference.

When examining a joint, you can identify changes in its appearance due to the development of a pathological process in it. Performed in a standing, sitting and lying position to identify

• joint shapes
• swelling, smoothness of contours and hyperemia of the joint area
• lack of normal folds over joints (for example, interphalangeal)
• muscle atrophy
• asymmetry or irregular delineation of the joint boundaries
• intra-articular effusion
• pathological placement of the limb
• deformations, deformities and contractures
• gait, lameness, excessive mobility

Upon palpation it is determined

• crepitus and crunching in the joint
• sometimes the presence of free bodies in the knee or elbow joints - the so-called “joint mice”
• joint pain
• hypertrophied synovial membrane
• free fluid in the joint with synovitis
• condition of the ligamentous apparatus (in the knee – external, internal, cruciate ligaments)
• muscle tone

The volume and quality of active and passive movements in the joints are studied. Active actions are performed by the patient himself voluntarily. The doctor performs passive exercises in the joint under study with complete muscle relaxation of the patient. With the help of both types of movements, it is possible to most fully identify all the reserves of the motor function of the joint.

It is important in the diagnosis of OA to measure (comparison) the length of the limbs. It can reveal shortening of one of them (on the affected side). Basic goniometric indicators (°) of normal motor function of the joints of the upper and lower extremities

Joint	Flexion	Extension	Internal rotation	External rotation	Lead	Bringing	Suppination	Pronation
Hip	0-120	0	0-45	0-45	0-45	0-30	-	-
Knee	135-150	0	-	-	-	-	-	-
Ankle	0-45	0-30	-	-	-	-	0-30	0-20
Metatarsophalangeal	0-45	0-30	-	-	-	-	-	-
Brachial	0-180	0-60	0-90	0-90	-	-	-	-
Elbow	0-160	0	-	-	-	-	0-90	0-90
Radiocarpal	0-70	0-80	-	-	0-20	0-20	-	-
Metacarpophalangeal	0-90	0-20	-	-	-	-	-	-
Interphalangeal	0-90	0	-	-	-	-	-	-

In recent years, a number of special methods have been developed to clarify and visualize the structure of the affected joint. These include ultrasound scanning of joints (sonography), arthroscopy, and magnetic resonance imaging (MRI).

Among non-invasive methods for diagnosing OA, sonography takes the leading place in terms of information content. Unlike most methods of examining tissues of the musculoskeletal system (radiography, computed tomography), it is not associated with radiation exposure and can be performed repeatedly. This allows this method to be used not only for diagnosing joint diseases, but also for assessing the effectiveness of ongoing treatment measures.

With its help it is possible to determine

• thickness of articular cartilage, which is important in the diagnosis of OA
• even a slight accumulation of fluid in the joint (hemarthrosis, synovitis)
• rupture of the meniscus and ligamentous apparatus
• localization and size of the “articular mouse”, as well as osteophytes and hypertrophied synovial folds
• degenerative changes in intra-articular and periarticular structures

Arthroscopy is a visual examination of the internal cavity of the joint using an arthroscope, one of the important additional examination methods for unclear clinical pictures of various injuries and diseases of the joint. In addition, it has not only diagnostic, but also therapeutic value - with its help it is possible to remove intra-articular bodies, torn parts of the meniscus and cartilage, and foreign bodies.

Arthroscopy has a number of advantages over conventional open joint surgery, including the absence of a large surgical wound and a short postoperative period.

Direct examination of the joint cavity allows without open arthrotomy

• identify degenerative lesions of cartilage tissue and menisci
• detect ligamentous injuries
• assess the condition of the synovial membrane and take a targeted biopsy for further morphological examination
• carry out surgical treatment (menisctomy, meniscectomy, plastic surgery of the ligamentous apparatus)

MRI is based on the physical properties of tissues to produce tomographic images when placed in a strong magnetic field. This is the newest research technique. Its advantages include non-invasiveness, a wide image field, and the ability to obtain sections at any level of interest to the doctor.

MRI makes it possible to accurately assess the spatial relationship between articular surfaces, determine the severity and localization of degenerative-dystrophic changes, identify the presence of small and large cystic cavities, and determine their exact location and size. It helps to identify intra-articular bodies and their relationship with intra-articular structures.

Detection of these signs on MRI is especially important in the absence of any changes on conventional radiographs. Muscle, fat, fluid, tendons, ligaments and cartilage are clearly visible and differentiated from each other on magnetic resonance images.

The specificity of MRI is great: it allows you to detect not only the pathology of the tissues of the musculoskeletal system, but also diseases of adjacent organs, such as arteries, which can imitate diseases of the joints. Thus, this method is superior in information content to all others, especially in the case of unclear symptoms.

MRI is currently undergoing rapid development: the quality of magnetic resonance images is steadily improving, and the technique is becoming more accessible. Its data should be analyzed along with other methods of studying patients suffering from deforming OA.

Treatment

It should be said right away that there is no single treatment regimen for OA. It is aimed at preventing progression, reducing pain and signs of reactive synovitis of the joint, improving joint function, preventing the development of joint deformities, and improving the patient’s quality of life. Treatment should be comprehensive, taking into account the complex etiopathogenesis of the disease, differentiated depending on the form and localization of arthrosis and always observing the stages of the process. Therapy can be roughly divided into

• etiotropic
• pathogenetic
• symptomatic

Etiotropic necessary for secondary arthrosis caused by one of the many diseases that to one degree or another contribute to its development. Such an etiological factor for OA can be trauma or, for example, psoriasis.

In this case, the efforts of doctors should be directed primarily to the treatment of this disease. As for the treatment of the affected joint, it basically comes down to orthopedic correction of its statics, reducing the load on the affected joint, and resort treatment.

the main task symptomatic therapy – to relieve pain and symptoms of synovitis.

Non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids can help here. Moreover, pain relief with their help is indicated at all stages of OA, including stage III, when it essentially becomes the only method that makes life easier for the patient, except, of course, for surgical treatment - arthroplasty.

The use of NSAIDs should be started under the supervision of a physician with periodic examinations and regular blood and urine tests of the patient. This is necessary for the timely detection of intolerance to the drug, its side effects, the selection of an adequate dose, as well as for the development of the final treatment regimen.

Another thing - pathogenetic therapy. Its main task is to prevent the progression of the degenerative process in the articular cartilage tissue, which is possible at stages I and II of the disease. For this purpose, biogenic stimulants are used, drugs that improve blood microcirculation in the tissues of the joint. But the main role here is assigned to the chondroprotectors that have appeared in recent decades and are widely used - drugs whose action is based on

• normalization of biosynthetic processes in chondrocytes
• increasing the resistance of chondrocytes to the effects of enzymes
• inhibition of catabolic processes in cartilage and bone tissue
• protective effect in case of damage to cartilage tissue
• normalization of joint fluid secretion

Therapies

Chondroprotective basic agents

They improve cartilage metabolism, slow down or prevent its destruction. Chondroprotectors contain biologically active cartilage substances.

When choosing one of the following drugs, the doctor should be guided by how the patient's body will react to the drug, whether it is available in pharmacies, and also, which is important for the patient, its price.

Chondroxide is a local drug used for dystrophic degenerative diseases of the joints and spine, OA and intervertebral osteochondrosis. The main active ingredient is the high-molecular polysaccharide chondroitin sulfate, which slows down bone tissue resorption, improves phosphorus-calcium metabolism in cartilage tissue, it accelerates its restoration processes and inhibits the degeneration and destruction of articular cartilage, inhibits enzymes that cause damage to cartilage tissue, and also helps to increase production intra-articular fluid, which leads to a decrease in pain and increased mobility of the affected joints. And stimulation of glycosaminoglycan synthesis by chondrocytes of damaged cartilage ensures even partial restoration of cartilage tissue.
The drug contains another active ingredient - dimethyl sulfoxide, which has anti-inflammatory, analgesic and fibrinolytic effects. It improves the penetration of chondroitin sulfate to the joints. Of these, the most important is the analgesic effect, thanks to which one drug can be used both as a chondroprotector and as a local analgesic.
Chondroxide is produced in the form of an ointment in tubes and is used externally locally.
2-3 times a day it is applied to the skin over the lesion, rubbing for 2-3 minutes. The course of treatment is 2–3 weeks.
Possible side effects include a rare local allergic reaction.
More effective is the use of Chondroxide in osteoarthritis by ultraphonophoresis (see below).

Glucosamine sulfate (per os) compensates for its deficiency, stimulates the biosynthesis of proteoglycans, improves the fixation of sulfur necessary for the synthesis of chondroitin sulfate, and contributes to the normal deposition of calcium in bone tissue.
It is taken orally once a day for 6 weeks, dissolving the contents of one sachet in water, which contains 1500 mg of glucosamine sulfate.

Chondroitin sulfate (per os) slows down the process of cartilage tissue degeneration, has an analgesic and anti-inflammatory effect.
At the beginning of treatment for 3 weeks, 3 capsules (750 mg) are taken orally 2 times a day, later - 2 capsules (500 mg) 2 times a day.

Combined preparations in one dosage form are also used - a combination of glucosamine hydrochloride and chondroitin sulfate sodium (Artra, Teraflex, Chondro).

Synovial Fluid Implants

Currently, hyaluronic acid preparations with high molecular weight are widely used in the treatment of OA. They improve the elasticity and viscosity of endogenous hyaluronan. This is actually an analogue of synovial fluid in the joints. By protecting pain receptors, hyaluronic acid preparations eliminate pain, improve joint mobility by improving shock absorption (elasticity), increase lubrication of intra-articular tissues, protecting articular cartilage from inflammatory mediators.

Ostenil is a high molecular weight enzymatic 1% highly purified hyaluronic acid. The drug acts as a shock absorber, shock absorber, lubricant and filter, allowing the exchange of metabolites and catabolites.
Inject 2.0 ml into the affected joint 3-5 times at weekly intervals.

Synvisc is a high-molecular chondroprotector with a replacement effect and good viscoelastic properties. Stimulates the metabolism of chondrocytes and synoviocytes, inhibits proteolytic enzymes. This sterile, pyrogen-free, viscoelastic fluid containing hylan has a molecular weight similar to that of synovial fluid glycosaminoglycans. It is a derivative of hyaluronan (sodium salt of hyaluronic acid).
Administer 2 ml intramuscularly once a week. Per course – 3 injections. A year later it is repeated.

Fermatron is a 1% solution of sodium hyaluronan with high molecular weight.
2.0 ml is administered intravenously with a break of a week. Per course – 4 injections.

Noltrex is a synovial fluid endoprosthesis, the material is a biopolymer water-containing silver ions “Argiform”. This is a viscous gel-like substance that is highly biocompatible with human tissue. The drug restores the viscosity of the synovial fluid, reduces pain and improves joint mobility.
Administer 2.5 ml intravenously 3 times at weekly intervals.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

The mechanism of their action is associated with inhibition of the activity of cyclooxygenase, the enzyme responsible for the synthesis of prostaglandins. NSAIDs enable the release of norepinephrine in the descending pathways that regulate pain impulses, reducing the pathologically increased pain perception that occurs in chronic pain syndrome. These drugs affect both cell membranes and intracellular signaling systems at the local and spinal levels, as well as local inflammatory mediators, stimulating neuroactive substances. By influencing various pathogenetic components of inflammation, NSAIDs lead to its reduction and analgesic effect.

Currently, more than 100 such drugs of various classes are known. Of these, the most widely used in the treatment of OA is

Acetylsalicylic acid - in tablets of 100, 300, 500 mg. Daily dose – 1–3 g.

Diclovit in suppositories - 1-2 times a day, maximum daily dose - 150 mg. The active substance of the drug, diclofenac sodium, is rightfully considered the leader in the NSAID group in terms of clinical effectiveness, safety and cost of treatment. The use of Diclovit in the form of rectal suppositories eliminates the direct damaging effect on the mucous membrane of the stomach and duodenum and allows for a prolonged effect.

Diclovit gel for external use - a 3-5 cm strip of gel is applied to the joint area 2-3 times a day. In this case, a therapeutic concentration of the active substance is quickly achieved at the site of inflammation with minimal systemic action.

Suppositories and Diclovit gel can complement each other. This allows for greater treatment effectiveness without increasing the risk of side effects.

Diclofenac sodium in tablets - 50-100 mg per day in 1-2 doses, solution in ampoules - 75 mg in 3 ml for intramuscular injection once a day. Per course – 5–10 injections. 5% gel - squeeze 2-3 cm out of the tube and rub into the joint 2-3 times a day.

Indomethacin tablets – 50–100 mg per day in 1–2 doses.

Cefekon N - rectal suppositories used for the treatment of inflammatory and degenerative diseases of the joints. This is a combined drug used in clinical practice as an analgesic that has antipyretic and anti-inflammatory effects. Contains naproxen, caffeine and salicylamide. The mechanism of action of the drug is associated with inhibition of prostaglandin synthesis and an effect on the thermoregulation center in the hypothalamus.
Cefekon N is recommended for acute pain accompanying osteochondrosis, OA, and ankylosing spondylitis. A distinctive feature of the drug is the best balance of effectiveness and safety. Clinical trials have shown that Cefekon N causes a lower risk of cardiovascular complications than other NSAIDs.
The convenient form (rectal suppositories) eliminates the irritating effect on the stomach characteristic of NSAIDs, and also ensures the absorption of the entire dose of the drug, bypassing the liver.
Side effects occur rarely (0.66% of cases) - a mild local allergic reaction: itching and pain in the rectum, which does not require discontinuation of the drug.
Use one suppository 1-3 times a day for 6 days.

Meloxicam is a selective COX-2 inhibitor. Available in tablets.
Application – 7.5 mg – 2 times a day, 15 mg – once a day.

The doctor must warn the patient that All NSAID tablets are taken only after meals! When prescribing these drugs, you should be aware of the possibility of side effects and contraindications to their use.

Proteolytic enzyme inhibitors

By suppressing enzymes that cause proteolysis and destruction of articular cartilage, these agents have an inhibitory effect on both the inflammatory process and the degenerative process, preventing the breakdown of mucopolysaccharides of the main substance of cartilage. Drugs that have an antienzyme effect include aprotinin (contrical and gordox). They are used for severe pain syndrome with symptoms of reactive synovitis.

Contrical - solution is administered intramuscularly at 10 thousand Atre once a week. For a course of treatment – ​​3–5 injections. Repeat after 6–12 months.

Gordox - solution is administered intramuscularly at 50 thousand KIU once a week. Per course – 3–5 injections. Repeat after 6–12 months.

Biogenic stimulants

Aloe liquid extract is an adaptogenic agent that stimulates regeneration processes.

Fibs is a drug that stimulates tissue regeneration processes.
1 ml is administered subcutaneously daily. Per course – 15–25 injections.

Drugs that improve blood microcirculation in joint tissues

Pentoxifylline is an angioprotector, a methylxanthine derivative. The mechanism of action is associated with inhibition of phosphodiesterase and accumulation of cAMP in vascular smooth muscle cells, blood cells, and other tissues and organs. The drug improves microcirculation and oxygen supply to tissues, most notably in the extremities and central nervous system.
Administer intravenously as an infusion of 100 mg (5 ml of solution) per 200 ml of saline once a day. The course includes 15 infusions. Also taken orally, 2 tablets (200 mg) 3 times a day. Patients with a large weight are prescribed 400 mg 3 times a day. The course is a month. IV infusions can be performed not only in a hospital, but also in a clinic in a specially equipped treatment room.

Muscle relaxants

They are prescribed to reduce muscle tone, and in complex therapy to eliminate contractures.

Tolperisone reduces pathologically increased muscle tone, muscle rigidity, and improves voluntary active movements.
Prescribed orally 50 mg (dragees) 2 times a day.

Tetrazepam is a muscle relaxant sedative. Inhibits mono- and polysynaptic reflexes.
Take orally 2 tablets (100 mg) once a day.

Glucocorticosteroids

These drugs include natural hormones from the adrenal cortex. They are prescribed only for symptoms of reactive synovitis. Long-term use significantly worsens the course of the disease due to the damage caused to articular cartilage - inhibition of metabolic processes in chondrocytes, leading to disruption of the matrix organization, which significantly reduces the resistance of the cartilage to stress. Such drugs are prescribed for a short course.

Joint puncture and injection of steroid drugs into it are considered minor surgical procedures that should be performed in an operating room or dressing room. Basic requirements for intravenous administration of drugs:

• strict adherence to asepsis rules
• use of disposable needles and syringes
• when administering steroids to one patient in several joints, a separate sterile needle is used for each
• palpation of the skin area where intramuscular injection is planned is possible only through a sterile napkin
• Do not use the same needle to withdraw the drug from the ampoule and then administer it
• if there is fluid in the joint cavity, before administering glucocorticosteroids, it must be removed using a syringe; in this case, another one is used to administer the drug
• Fluid removed from the joint should be sent for laboratory testing, especially if it has never been studied before

Most often intramuscular and periarticular use:

Hydrocortisone acetate. Administer an injection suspension of 5 ml (125 mg) every 10–14 days. Per course – 2-3 injections.

Triamsinolone acetate. Administer 1 ml (40 mg) of injection suspension every 10–14 days. Per course – 2-3 injections.

Betamethasone phosphate. Administer 1 ml of solution for injection every 10–14 days. Per course – 2-3 injections.

Methylprednisolone acetate. Enter 1 ml (40 mg) suspension for injection every 7-14 days. Per course – 1–3 injections.

Dalargin is a domestic drug, which has also been prescribed in recent years for the treatment of reactive synovitis in patients with OA. It is a white crystalline powder. Produced in ampoules of 1 mg. It is diluted in 1 ml of 0.5% novocaine solution for intramuscular administration.
Dalargin does not penetrate the blood-brain barrier and does not have a central effect, although its structure is similar to endorphins that are produced in the central nervous system. It has analgesic, anti-inflammatory, immunomodulatory effects.
Prescribe 1 mg every 3–7 days. Per course – 3–5 injections.

Intraosseous dereception

To eliminate pain, intraosseous injection of anesthetics under pressure is used, which mechanically damages the baroreceptors of bone tissue and thus relieves pain. In addition, a small amount of blood is released through the intraosseous canal formed by the needle, resulting in a decrease in intraosseous pressure and, consequently, a decrease in pain.

With CA, dereception of the greater trochanter is performed. To do this, use an intraosseous needle with a conductor, which pierces the soft tissues after preliminary local anesthesia with a 0.5% solution of novocaine. When the end of the needle reaches the periosteum, make several semi-rotational movements under pressure and insert the needle into the spongy part of the greater trochanter to a depth of 2 cm. Then the needle is pulled back a few millimeters, the guide is removed, after which blood is shown from the cannula, which indirectly indicates increased intraosseous pressure. A syringe with a 2% trimecaine solution is inserted into the needle cannula and 2–4 ml of it is injected. In this case, the first portions of the anesthetic cause severe pain in the patient, but after administration of 1 ml it subsides.

In GA, intraosseous dereception is performed in the area of ​​the tibial tuberosity. For arthrosis of the ankle joint and heel spurs, injections of anesthetic into the heel bone are quite effective. A 2% solution of 2–4 ml of trimecaine is used. The course - 3-5 injections with a frequency of 5 days.

Preparations for local and symptomatic treatment of OA

They are used in the form of ointments, applications, aerosols, patches and other dosage forms as painkillers, anti-inflammatory and “distracting” factors.

Espol is a herbal preparation for the treatment of closed injuries of joints and muscles, joint bruises without compromising the integrity of the skin, and pain in joint syndrome due to deforming OA. The main active ingredient is capsaicin, contained in capsicum extract. The strong point of the drug is a balanced set of effects. It has a distracting, analgesic, warming, absorbent and anti-inflammatory effect.
The analgesic effect of the drug is realized through the formation and release of endorphins and enkephalins in the central nervous system, which have an endogenous analgesic effect.
Espol improves blood supply to the lesion and increases vascular permeability, resulting in improved drainage of the pathological lesion.
Due to the high concentration of the active substance in the affected area, which persists for 8 hours, the drug can be recommended for the local treatment of OA and arthritis.
Available as an ointment in tubes (30 g). It is applied to the sore joint 2-3 times a day. The course is 10-14 days.
Contraindications: individual intolerance to the drug, pregnancy and lactation.

Dimethyl sulfoxide has the ability to penetrate biological membranes, including skin barriers, without damaging them. The drug has anti-inflammatory, local anesthetic, antispasmodic, and anti-edematous effects.

Ketoprofen is an analgesic, anti-inflammatory agent in gel form. It inhibits cyclooxygenase and inhibits the synthesis of prostaglandins.
After squeezing 3-5 cm of gel from the tube, the drug is applied to the skin and gently rubbed until completely dry 2-3 times a day. The course is 7-14 days.

Bischofite is a natural mineral with a high content of calcium, sodium, potassium, iodine, copper, iron, silicon, molybdenum, and titanium salts. Used in the form of compresses, baths, applications, ointments (bisholin). The drug is prescribed for OA to improve blood circulation, reduce pain, and reduce muscle contractures.

Paraffin and ozokerite - their applications are prescribed to the affected joint (temperature - 50-55°C) for a course of 10-15 procedures.

Paracetamol is the drug of choice for symptomatic treatment (reducing pain and inflammation in the joints). Available in tablets and capsules of 250, 500 mg, 1 g.

Physiotherapy

It is aimed at reducing pain, muscle spasms, stiffness in joints, and eliminating contractures. According to the effect they provide, physiotherapy methods are divided into procedures

• general action (electrosleep, acupuncture)
• for pain relief (electrophoresis of novocaine, analgin with dimexide, sinusoidal modulated currents, ultrasound, magnetic and laser therapy)
• local to the joint area - medicinal electro- and ultraphonophoresis, diadynamic, magnetic and laser therapy, heat therapy
• Chondroxide ointment may be recommended for ultraphonophoresis. It has been proven that the inclusion of this technique in the OA treatment program promotes rapid relief of pain and restoration of motor activity of the affected joint. The method is safe and does not cause side effects
• eliminating joint stiffness - ultraphono- and medicinal electrophoresis on the joint area, electromyostimulation, traction and hydrokinesitherapy
• aimed at treating reactive synovitis - medicinal electrophoresis, ultraviolet irradiation, cryo- and UHF therapy

Massage and physiotherapy exercises

These are the most important methods for restoring and improving joint function in patients with OA.

Massage has an analgesic, anti-inflammatory effect, helps restore joint function, reduces excess tension, improves their trophism, tone and strength.

Types of massage:

• classic (general and local)
• reflex
• spot
• hardware (vacuum, vibration, pneumatic compression)
• underwater (jet, general and local vortex)

Physical therapy has its own characteristics for OA. Exercises should be aimed at strengthening muscles without increasing the load on the articular surface. The main criterion when selecting the necessary physical exercises is the functional state of the neuromuscular system.

Rules of therapeutic exercises for OA :

• the movements performed should not be too intense, painful, or traumatic to the affected joint
• gradual increase in range of movements, frequency of repetitions is determined by the condition and readiness of the muscular-ligamentous apparatus
• alternation of active and passive movements with isometric muscle contraction
• avoiding movements that cause pain
• exercises are carried out in a lying or sitting position
• compliance of the adequacy of the loads with the individual capabilities of the patient
• targeting of techniques to a specific joint

Therapeutic exercises for OA are aimed at

• maintaining joint mobility
• strengthening the periarticular muscles and stabilizing the joint
• increasing endurance of periarticular muscles
• their relaxation and improvement of blood circulation conditions in the limbs
• improving leg support and arm performance

The regimen for using therapeutic exercises is developed based on an assessment of the changes made by the disease and must correspond to both the stage of OA and its individual characteristics.

Orthosis therapy and joint unloading. Orthoses are functional devices that have the structural and functional characteristics of the musculoskeletal system. Essentially, this is the exoskeleton of a limb, structurally reflecting its anatomy and biomechanics. Static, dynamic, semi-rigid and soft therapeutic and prophylactic orthoses are manufactured individually for each patient.

To unload the joints it is necessary

• compliance with the motor regime (exclude long walking, long standing in one position, carrying heavy objects)
• walking with the help of additional support (cane, shortened crutches) with rest stops
• use of orthopedic and simply comfortable shoes, insoles and arch supports

Using additional support can reduce the load on the sore joint. The cane should be held in the hand opposite to the affected joint. The use of orthopedic bandages for the knee, ankle, wrist joints, and insoles-supports is essential during walking and exercise, protecting the joints from overload and preventing the progression of the disease.

Overweight patients have a more difficult time with OA, especially of the knee joints, so weight loss correction can reduce pain and increase physical activity.

Surgical treatment

Recent decades have been characterized by great achievements in orthopedics. First of all, this applies to the surgical treatment of a number of diseases and deformities as a result of the development and introduction into medical practice of new materials, fixators, structures and endoprostheses, which has qualitatively changed the approach to the treatment of joint diseases. For OA, both palliative and radical operations are performed. Currently the most common

• types of arthroplasty for leveling the articular surfaces, temporarily ensuring their congruence, with the opening of the subchondral bone to allow fibroblasts and stem cells to enter the joint cavity, giving rise to the formation of fibrous cartilage, and with opening access to the source of cartilaginous differential
• mosaic plastic used to close small (up to 4 cm) monolayer cartilage defects - consequences of traumatic damage? osteotomies for axis correction and unloading of individual areas of the articular cartilage
• arthrodesis
• tenotomy - dissection of the tendon in order to restore imbalanced muscles or eliminate contracture
• osteocryoanalgesia is a method of surgical treatment of pain in OA, consisting of tunnelization and cryodestruction of the subtrochanteric region of the femur
• endoprosthesis replacement is the most radical method of treating OA using metal-polymer or ceramic endoprostheses that take into account the biomechanics of the joints

All modern endoprostheses are divided into 2 large groups - cemented and cementless fixation. Indications for the use of cementless endoprostheses are the young age of patients (younger than 50–60 years), good bone base, conical shape of the medullary canal of the femur.

Cemented endoprostheses are used in patients over 65–70 years of age, as well as in the presence of signs of osteoporosis and a wide bone marrow cavity.

Endoprosthesis replacement occupies the main place in the surgery of this pathology, with up to 80% of all operations being hip joint replacement. Currently, 1.5 million endoprosthetics are performed in the world per year, of which 500 thousand are in the USA, 150 thousand in Germany and only 12 thousand in Russia.

Hip endoprostheses are divided into unipolar and total based on the volume of their replacement. The former replace only the head and neck of the femur, the latter also replace the acetabulum.

Knee replacement accounts for 15–20% of all such operations. 4 types of endoprostheses are used depending on the degree of degenerative changes. As for other joints, replacing them with endoprostheses has a small share among all similar operations.

It is difficult to overestimate the positive aspects of joint replacement. These operations relieve patients of pain, restore movement, eliminate contractures, and make it possible to return to work.

For the manufacture of endoprostheses, high-quality metal alloys, polyethylene and ceramics are used using the most advanced technological processes. Most often these are alloys of cobalt and chromium, titanium, aluminum and zirconium ceramics, which ensure the functioning of the endoprosthesis for 20–30 years. Then it can be replaced with a revision one.

Arthrosis and arthritis are diseases characterized by pathological changes in the joints, however, the difference between arthritis and arthrosis is significant. In order to understand how arthritis differs from arthrosis, it is necessary to consider the etiological factors, pathogenesis, symptoms of arthritis and arthrosis. Treatment of arthrosis and arthritis also has different approaches.

What is arthritis, arthrosis? How do joint lesions manifest in arthritis and arthrosis, what is the difference? In arthrosis and arthritis, the differences are due to the mechanism of occurrence of pathological changes.

Arthrosis and arthritis treatment is long-term, multicomponent. Often, as a result of untimely treatment, arthritis and arthrosis can be considered as successive stages of the pathological process. Having understood what arthritis and arthrosis are, we will determine the differences between arthrosis and arthritis.

Arthritis, classification

Arthritis is caused by inflammatory changes, combines both the pathology of the joints themselves and is a symptom of other diseases that occur with their damage. How to treat arthritis depends on establishing the cause of the inflammatory process.

According to the etiological factor, there are:

• Primary - rheumatoid, rheumatoid arthritis, ankylosing spondylitis, Still's disease, others.
• Secondary – complications of an infectious, non-infectious process (reactive for chlamydial infection, hepatitis, diseases of the gastrointestinal tract, septic lesions).

By the number of affected joints:

• Monoarthritis – when a single joint is affected.
• Polyarthritis – when a group of joints is affected.

According to the nature of the disease:

• Acute – with a clear clinical picture of inflammatory changes in the connective tissue of the joint.
• Subacute – an intermediate option, the stage of resolution of an acute condition.
• Chronic – with a blurred clinical picture, slow progression, periods of attenuation and exacerbation.

Osteoarthritis, classification

Deforming osteoarthritis, rheumatoid arthrosis or arthrosis is a disease based on degenerative changes associated with the destruction of all structures of the joint, cartilage layer, ligaments, muscles, tendons, bones. These are the main differences between arthrosis of the joints and arthritis, leading to irreversible deformations of the affected articular surfaces, dysfunction, and disability of the patient.

• Idiopathic - without an established cause. The pathological process is based on an autoimmune mechanism of damage (primary rheumatoid arthrosis in young patients).
• Secondary osteoarthritis is the result of metabolic disorders, trauma, and inflammation. For example, rheumatoid arthrosis, which arose after suffering rheumatoid arthritis.

Arthritis, causes

Risk factors are:

• Disturbance of metabolic processes in the body.
• Factor of hereditary predisposition.
• Infectious diseases.
• Immunodeficiency conditions, the presence of autoimmune diseases, allergic manifestations.
• Increased load on the musculoskeletal system due to professional activity, traumatic component.

Arthrosis, causes

Risk factors for developing osteoarthritis are:

• Age. Osteoarthritis is a disease of older people, with the exception of rheumatoid arthrosis, which occurs in adolescence. According to WHO statistics, arthropathy affects about 10% of the world's population.
• Physical overload, injury, excess weight, which increases the load on the joint. Large joints suffer more than others: the hip - coxarthrosis, the knee - gonarthrosis.
• Hereditary factor: features of metabolic processes, structure of cartilage tissue.
• Previous inflammatory processes without proper therapy.

Arthritis, symptoms

Regardless of the cause of the disease, the signs of the disease have a similar clinical picture in the acute phase of the process and during the period of exacerbation of the chronic course of the disease.

• Pain is the first symptom. It has varying intensity, is often permanent, and does not depend on physical activity.
• Hyperemia of the skin of the joint area, local increase in temperature (the joint area becomes hot to the touch), severe swelling.
• The presence of effusion (fluid) in the cavity of the joint capsule. Microbiological and cytological examination of fluid from the inflamed cavity are important for diagnosis and establishment of the causative factor. The knee joints are most often affected. The presence of inflammatory fluid inside the joint capsule is the difference between arthritis and arthrosis of the knee joint.
• Extra-articular manifestations of the underlying disease: increased body temperature, vascular damage - vasculitis, heart valves, lung diseases - alveolitis, pulmonitis, kidney damage - nephritis, skin manifestations, hematological changes - anemia, increased number of peripheral blood platelets.
• Limitation of range of motion in the joint, dysfunction.

Osteoarthritis, symptoms

Symptoms of arthrosis are caused by long-term malnutrition and blood supply to the cartilaginous plate. Cartilage loses its elasticity, becomes thinner, and growths - osteophytes - form from the bone tissue inside the joint cavity, irreversibly deforming the articular surface, disrupting functionality, causing pain, and significantly limiting mobility.

• Pain. The onset of the disease is characterized by moderate intensity, aching, constant pain. Increased pain is associated with an increase in degenerative changes in cartilage and deformities. The pain can vary and be temporary: from morning stiffness to constant and subsiding throughout the day. A rapid, intense increase in pain is a poor prognostic sign.
• Visible deformation.
• Functional disorders: flexion, extension.
• Characteristic crunching sound when moving.
• Developing joint immobility leads to disability in patients.

Osteochondrosis is a common pathological condition of the spine, based on the same changes in cartilage tissue as with arthrosis.

Diagnostics

Diagnosis of arthritis and arthrosis is aimed at identifying the main cause of the disease, determining the degree of activity of the process, assessing the prognosis and effectiveness of treatment, and timely diagnosis of complications of the disease.

The set of diagnostic tests includes general clinical laboratory tests, instrumental studies of the liver, kidneys, X-ray diagnostic measures, microscopic and bacteriological studies.

• Distinctive features of arthritis of different etiologies are: an increase in the erythrocyte sedimentation rate, an increase in the level of leukocytes in the peripheral blood, which makes it possible to determine the severity of inflammatory changes, an increase in C-reactive protein in the blood plasma - an important laboratory diagnostic test.
• X-ray examination allows you to see a characteristic picture for inflammatory changes in the articular surfaces.
• MRI is the most informative method for detecting inflammatory changes inside the joint capsule.
• Ultrasonography with Doppler is used.
• In difficult cases, arthroscopy can be performed for the purpose of differential diagnosis and treatment.

A fairly informative method that allows you to establish a diagnosis and differentiate arthrosis or arthritis is an x-ray examination. Depending on the detected changes, the degree of deformation of the intra-articular cartilage and the width of the joint space, four degrees of pathological changes in arthrosis are distinguished.

Arthritis, treatment principles

Treatment of arthritis is long-term, the main goal is to cure the disease that has caused inflammatory changes in the joint capsule or to achieve a long-term disease-free course of the disease, prevent the development of irreversible changes, deformities, and improve the quality and life expectancy of patients.

The following are widely used for treatment:

• Medicinal methods of influence. Depending on the etiological factor, the following are used: antibacterial, non-steroidal anti-inflammatory drugs, hormones, the introduction of anti-inflammatory drugs directly into the joint cavity, in severe forms of the disease of a rheumatic nature, chemotherapy drugs are prescribed.
• Non-drug treatment. An important role is played by physical therapy, adherence to a diet, a healthy lifestyle - quitting smoking, alcohol, physical therapy, timely orthopedic care and correction of existing disorders, and prevention of exacerbations of concomitant diseases.
• The surgical method is not the method of choice for treatment. This is a means of providing assistance to patients in particularly difficult cases - with the development of severe complications, severe pain, or the ineffectiveness of the first two treatment methods. It has limitations and certain indications for use.

Osteoarthritis, treatment

Rheumatoid arthrosis is treated comprehensively, including:

• Non-drug therapy. In rheumatoid arthrosis, treatment includes physiotherapy exercises, physiotherapy, protective regimen, load reduction, dieting, weight loss.
• Drug treatment is associated with pain relief. Non-steroidal anti-inflammatory drugs and hormonal drugs are more often prescribed.
• Surgical methods of treatment: plastic surgery, arthrodesis, prosthetics of large joints (knee, hip).

Prevention of exacerbations

Due to the possibility of a protracted, chronic course of the disease, the development of complications, regardless of the cause of their occurrence, patients are subject to constant or long-term observation, rehabilitation measures developed taking into account individual characteristics and the nature of the disease.

Of important preventive value are:

• Treatment of inflammatory diseases of the musculoskeletal system, carrying out a complex of rehabilitation measures after injuries.
• Limiting exercise, a healthy lifestyle, proper balanced nutrition as a factor in the fight against excess weight.
• Timely orthopedic correction of bone deformities acquired during life.

What are arthritis and arthrosis, how does arthritis differ from arthrosis and signs (presented in table form):

Remember, at the first signs of trouble, it is important to contact a specialist in a timely manner. Delayed initiation of treatment increases the risk of possible negative consequences of the disease.

Osteoarthritis and arthritis are very similar joint diseases due to their identical manifestations and symptoms, in particular in the early stages of development. However, they should be distinguished.

Arthrosis and arthritis according to ICD 10

Each doctor upon diagnosis diagnosis is based on ICD(International Classification of Diseases) to select the correct treatment.

ICD-10 defines arthritis as a joint disease inflammatory in nature. The term translated from Greek means “joint”. In accordance with ICD-10, the disease is characterized by an infectious, traumatic and dystrophic nature. The arthritis code in ICD-10 starts with M00 and ends with M99.

The International Classification of Diseases identifies many causes of arthritis. This could be constant minor injuries, nervous strain, metabolic disorders, and so on. Arthritis can affect not just one joint, but an entire group, in particular the limbs. Therefore, arthritis is classified according to ICD-10 into monoarthritis and polyarthritis. Pathology has recently increasingly forced women and men aged 25-40 to treat themselves. The most common is arthritis of the knee and shoulder joints, although in general the disease can affect a wide variety of joint elements.

In accordance with the ICD-10, the initial signs of arthritis are distinguished - inflammation of the joint and pain in it, limitation of mobility. Not treating these symptoms means waiting for the next, namely, fever, joint deformity.

To classify another disease - arthrosis - ICD-10 is also used. In the world, an illness according to ICD-10 is most often called "osteoarthritis", in the West the term "osteoarthritis" is even more popular. ICD-10 divides such a disease into polyarthrosis (the most serious type of arthrosis affecting several joints), coxarthrosis, gonarthrosis, carpal and metacarpal arthrosis of the joints, other arthrosis of a destructive-degenerative nature (neck, ankle, shoulder joint, etc.).

Arthritis can affect not only one joint, but a whole group, in particular, limbs. According to ICD-10, codes are assigned from M15-M19.

Similarities between arthrosis and arthritis

Not only arthritis, but also arthrosis occurs with inflammatory processes. Osteoarthritis is not always characterized by inflammation, however, if it does occur, then such a disease is called "arthritis-arthritis".

Risk groups: depending on age, the older, the more likely it is to meet a particular pathology. The only caveat: arthritis occurs a little earlier than arthrosis. According to statistics, people over 45 are at risk of two diseases at the same time.

Similar symptoms: both the first and second diseases cause intense pain. Joints swell, bones become deformed, mobility is limited - all these are common symptoms of two ailments, forcing urgent treatment of the disease.

Differences between arthrosis and arthritis

Pain occurs and manifests itself in different ways. With arthritis, the pain syndrome, as a rule, worries at night and at rest. With arthrosis, joint pain occurs after prolonged stress on the affected area.

Differences in inflammatory processes. During the development of arthrosis, only the diseased joint becomes inflamed. During the second disease, inflammatory processes occur throughout the body.

Osteoarthritis is characterized by the formation of osteophytes - spike-shaped deposits of salts, while in arthritis the doctor does not detect such formations.

Unlike arthritis, arthrosis is a chronic disease that progresses slowly over many years.

Osteoarthritis is more common than arthritis. According to statistics, only 2% of the planet's population is affected by the second disease, while the first accounts for more than 10%.

A sign of osteoarthritis is specific crunch when rotating joints. There are no similar symptoms with other illnesses.

Arthritis often affects other organs and systems of the human body, including: the heart, liver, kidneys, and the human autoimmune system.

Arthrosis pain syndrome can be calmed in the first stages of development of the disease by simply selecting a comfortable body position, a posture in which the pain goes away. In turn, arthritic pain syndrome is very “capricious”, so changes in position, warm compresses, cold procedures and other similar methods of treatment will not have any effect on it.

The pain in osteoarthritis is dull and aching with infrequent “shooting” in the area of ​​the affected joint. Arthritis pain is much stronger and more intense.

What type of disease (arthrosis or arthritis) is identified by modern medicine through a comprehensive examination. It includes computed and magnetic resonance imaging, radiography, and biochemical blood tests.
During arthritis, white blood cells in the blood increase their normal characteristics, in addition, an excess of the sedimentation rate of red blood cells (erythrocytes) and other abnormal phenomena of inflammatory processes are observed. In a situation with arthrosis, the listed indicators will be normal. The doctor determines the disease using fluoroscopy by identifying abnormalities in the bones.

Joints affected by arthrosis and arthritis

With osteoarthritis, the knee joint is affected in a third of cases. Osteoarthritis of the knee joint called gonarthrosis. Gonarthrosis, like other types of arthrosis, is deforming character. Knee joint disease occurs more often than other degenerative-destructive pathologies due to frequent loads on the knee. In the early stages, knee joint disease manifests itself as severe pain during exercise. There is no pain syndrome at rest.

Massage of the knee joint in the early stages can reduce the negative symptoms of the disease as well as limiting stress on the knee.

Arthritis of the knee joint very similar to knee arthrosis, however, it also has its own characteristics. In the case of arthritis, the pathology occurs in an infectious way, most often due to metabolic disorders. The difference also lies in the age group of patients and the consequences. As noted earlier, people under 40 years of age can develop arthritis. The consequences of arthrosis of the knee joint are disability, while arthritis causes disruption of the functioning of internal organs and even death.

Features of the treatment of arthritis and arthrosis lie in their similar therapy. However, drug treatments for knee diseases are different for both ailments. The doctor must consult the patient on one or another method of treatment and prescribe complex therapy. Only comprehensive treatment methods will help cope with joint diseases.

In addition to the knee, arthrosis of the hip, metatarsophalangeal, and shoulder joints has also become widespread.

The peculiarity of arthritis is that the disease does not have any prominent manifestation. Basically, the disease affects several joints at once (polyarthritis), due to its standard causes - a “walking” infection and metabolic disorders.

But which joint, besides the knee, is most often common to both ailments? According to statistics, such a disease is pathology of the shoulder joint.

The shoulder accounts for a significant percentage of joint diseases. Among other things, this is also one of the most problematic areas.

The causes, symptoms and diagnosis in both cases are very similar, with the exception of some features unique to a particular disease. In terms of drug treatment, the doctor prescribes the same drugs for shoulder disease: analgesics, non-steroidal anti-inflammatory drugs, chondroprotectors and others. For treatment specifically shoulder arthritis your doctor may also prescribe steroid injections.

Important! Never take medications without your doctor's knowledge. Only a doctor can prescribe the correct therapy.

Good results in the treatment of diseases of shoulder arthrosis and arthritis are demonstrated by courses of physiotherapy, therapeutic exercises, and proper diet. To combat diseases of the shoulder joint, the doctor determines the correct diet and agrees with the patient on the use of folk remedies. As with other arthrosis and arthritis, the main thing for diseases of the shoulder joint is to increase the intake of the building material of cartilage tissue.

Medicine of our time is easily able to determine what type of disease a patient has. This is very important in relation to arthrosis and arthritis. Due to the similarity of the diseases, they have serious distinctive characteristics. The attending physician prescribes a course of treatment only after accurately determining the type and type of joint disease. If you have discovered a problem with your joints, treat it urgently while the disease is in its early stages! Take care of yourself.