Osteoarthritis

Osteoarthritis – the collective name for burned-degenerative diseases in the joints of the apparatus of location and etiology, having in this clinical similar, and the framework of the morphological and the result is manifest with a defeat of the articular cartilage, subchondral bone formations, capsules, ligaments of the device.

Osteoarthritis – the most common disease in rheumatology practice, according to the medical statistics have afflicted up to 1/5 of the total population. Osteoarthritis is the cause of a significant reduction in the quality of life of approximately half of the patients, most of whom becomes disabled. The incidence depends on the age: osteoarthritis is rare in young age, makes his debut, often after 40-45 years of age, while in subjects over the age of 70 years, the signs of the x-ray are defined in the vast majority of cases. At a young age, the prevalence of about 6.5% after 45 years – 14-15%, after 50 years, and 27-30% in subjects over the age of 70 years – 80-90%.

Most often during osteoarthritis in a pathological process involving the small joints of the hand (for women 10 times more often than men), and on the thumb of the foot, joints, intervertebral thoracic and cervical areas of the spine, but also of the knee and hip joints. Osteoarthritis of the knee and hip joints is a place for the severity of the clinical manifestations and negative impact on quality of life.

For osteoarthritis characteristic complete defeat of the joints and accessories of apparatus:

• inflammatory changes of the articular cartilage;
• the involvement in the pathological process by bony structures;
• synovitis – inflammation of the inner lining of the joint capsule;
• bursitis – defeat bags around the joints;
• reactive inflammation of the soft tissues (muscles, subcutaneous tissue, ligaments of the device), it is located in a projection of the joint involved.

Since the main cause of osteoarthritis are inflammatory changes, in a number of western countries call the disease the arthritis. Of medicine terms of arthritis and osteoarthritis you meet just as frequently and involve the same pathological process. Lately in rheumatology practice, the more often it is used the term osteoarthritis, emphasizing the involvement in the pathological process not only the knee, as dynamic, but, and form the bone formations.

The consequences of arthrosis in the absence of proper treatment, become a progressive reduction in the volume of movements in the affected joint, immobilization.

Currently, the approach to the understanding of osteoarthritis has changed dramatically: the disease is considered as an aggressive process of destruction of cartilage tissue of the articular under the influence of inflammation, which requires the execution of an active anti-inflammatory therapy.

Synonyms: arthritis, arthrosis, arthrosis, arthrosis deformans.

Causes and risk factors

In the scientific community is the ongoing controversy about the causes of the defeat of the joints. Some researchers attribute a fundamental role to damage the cartilage lining of the joint surfaces under the influence of various factors, which leads to the rupture of the biomechanics of the joints and degenerative changes surrounding its facilities. Others, however, see the fundamental cause in the defeat of the superficial layer coupling of bony structures that form the joint (for example, due to disturbances of the microcirculation), and the minor changes they consider dystrophy and degeneration of the cartilage.

The causal factors that most often cause the development of osteoarthritis:

• previous acute traumatic damage to the knee (rupture or tearing of the ligaments, injury, dislocation, intra-articular fracture, wounds, penetrating);
• excessive corresponding load, related to certain activities (professional athletes, dancers, people involved in heavy physical work, etc);
• obesity;
• local exposure to low temperatures;
• chronic disease, you are suffering from local micro-circulation (endocrine disease, vascular pathology, etc);
• previous acute infectious disease;
• hormonal changes (pregnancy, menopause);
• the autoimmune diseases, which constitute the damage to the connective tissue;
• connective tissue dysplasia (congenital weakness of this type of fabric, accompanied by a greater mobility of the joints);
• genetic disease – the defect of a gene, which is localized on chromosome 12 and encoding procollagen type II (COL2A1 or VDR gene which controls vitamin D-endocrine system;
• the structural defects and functional abnormalities in the joints of the apparatus;
• mature, elderly and senile age;
• depression of the bone (osteoporosis);
• chronic toxicity (including alcohol);
• transferred to operations on the joints.

In most cases, the arthritis has poles etiological nature, that is, develops when combined with the exposure of different causal factors.

The symptoms of osteoarthritis

Osteoarthritis is not characterized by severe clinical picture, the changes in the joints lead to gradual, slow growing character that is manifested by a gradual increase of the symptoms:

• the pain;
• periodically check the crunch in the affected joint;
• deformation of the joint that appears, and growing with the development of the disease;
• stiffness;
• limitation of the mobility (reduction of the volume of active and passive movement in the affected joint).

The pain from osteoarthritis port stupid transient in nature, appears to be moving against the background of the load, by the end of the day (it can be so intense, that does not allow the patient to sleep). Permanent, non-mechanical nature of the pain of osteoarthritis is not characteristic and indicates the presence of active inflammation (subchondral bone, the synovial membrane, the ligaments of the device or periarticular muscle).

Most patients can see the presence of the so-called starting pain arising in the morning after waking up or after a long period of inactivity and the passage in the course of physical activity. Many patients choose this condition as the need to "develop the joint" or "diverge".

Osteoarthritis is characterized by morning stiffness, that has a clear localization, and is of short duration (not more than 30 minutes), it is sometimes perceived by patients as "the sense of jelly" at the joints. Perhaps the feeling of disturbance, stiffness.

With the development of reactive synovitis to the main symptoms of osteoarthritis of unite:

• pain and a local increase of the temperature, defined by palpation of the affected joint;
• constant pain;
• the increase of the joint to the extent swelling of the soft tissues;
• the progressive reduction of the volume of movements.

For osteoarthritis the characteristic rise in coupling to the extent swelling of the soft tissues.

Diagnostics

The diagnosis of osteoarthritis is based on the assessment by anamnestic data, the typical manifestations of the disease, the results of instrumental methods of research. Changes exponential in general and biochemical blood tests for arthritis are not typical, they appear only when the active development of the inflammatory process.

Instrumental method of diagnosis of osteoarthritis is the x-ray, diagnostic in ambiguous cases recommended to have a computer or magnetic resonance imaging.

Osteoarthritis of the knee and hip joints is a place for the severity of the clinical manifestations and negative impact on quality of life.

For more diagnostic methods:

• arthroscopy;
• ultrasound evaluation of the thickness of the articular cartilage, the synovial membrane, was structured bags, the presence of the liquid);
• scintigraphy (assessment of the status of bone tissue, the heads of the bones that form the joint).

The treatment of osteoarthritis

Drug therapy:

• non-steroidal anti-inflammatory drugs – relief of pain and signs of inflammation during exacerbations;
• glucocorticosteroid hormones – injection intra-articular introduction for the relief of the phenomena of synovitis; apply limited, in cases where it is necessary in the shortest possible time to eliminate the painful symptoms;
• antifermental funds (inhibitors of proteolysis) to prevent the progression of dystrophic and degenerative processes in cartilage and bone tissue;
• anti-spasmodic – helps eliminate local muscle spasm of a segment;
• anabolic drugs to speed up the regeneration of damaged tissues;
• drugs aimed at the correction of the properties of the blood, the strengthening of the vascular walls, increasing their elasticity and tissue regeneration – to help strengthen the walls of blood vessels microcirculatory river bed, providing an adequate supply of blood to the injured area;
• tools that improve the microcirculation;
• medicines for joints, despite their massive use in therapy of arthritis, in large placebo-controlled studies the clinical efficacy of this group of drugs is not proven.

Physiotherapy techniques used for the treatment of osteoarthritis:

• massage regional muscles, improves blood circulation and relieves local spasm;
• active kinesitherapy, that is, the execution of exercises with osteoarthritis with the use of special sports equipment;
• medical gymnastics with arthritis;
• laser therapy;
• ultrasound treatments;
• therapeutic baths, mud baths, paraffin, etc

The ineffectiveness of methods of exposure, the presence of complications, recourse to the surgical treatment of osteoarthritis:

• decompression meta-epiphysis and reprogrammed bone on the inside of the block (lower intraosseous pressure in the area concerned);
• corrective osteotomy;
• replacement of the joints.

In the early stages of the disease apply mechanical, laser device (the surface of the damaged cartilage, removing devitalized phases). This method is effective for relieving pain, but it is a temporary effect – 2-3 years.

The possible complications and consequences

The consequences of arthrosis, especially in the absence of proper treatment, become:

• the progressive reduction in the volume of movements in the affected joint;
• immobilization.

Forecast

Forecast for the life of a good omen. Auspicious social and labour prognosis depends on timeliness of diagnosis and start the treatment, you reduces when you make a decision on the surgical treatment of the disease in case of need.

Prevention

1. The refusal by intensive workloads, long static voltage of the affected joint.
2. Wear orthotics, if necessary.
3. Diet with arthritis, aiming at the reduction of body weight.
4. To prevent hypothermia.
5. Complete treatment for acute injuries of joints up to complete healing with the obligation to restore.
6. Dispensary observation if signs of osteoarthritis.