Osteoarthritis: symptoms and treatment
Osteoarthritis is a fairly common disease in which joints are degenerative-dystrophic. Osteoarthrosis, whose symptoms are initially associated with the gradual disintegration of the cartilaginous tissue, and then — with the decay of the subchondral bone and other structural components of the joint, develops against the background of a lack of oxygen in them and can manifest itself in various forms with a different area of localization of the pathological process. In general, this disease is diagnosed in patients aged 40 to 60 years.
As already noted, osteoarthritis (abdominal OA, synovial arthrosis or deforming arthrosis) is a degenerative-dystrophic disease, in which all articular surfaces are subject to pathological changes, which is also supplemented by the formation of marginal osteophytes. Osteophytes — this is a specific growth, formed from the superficial side of bone tissue. Because of the appearance of osteophytes, there is a deformation of the vessels, which is why this disease is also defined as deforming osteoarthritis.
What is noteworthy, this disease is quite ancient, and it can develop both in humans and animals. In favor of this «antiquity» of osteoarthrosis, the results of a study of paleontological findings of bone skeletons of people living in the Stone Age period indicate.
In general, osteoarthritis is one of the most common forms of possible pathologies with joint damage. Based on data obtained from resuscitators in the US and Europe, it is known that this disease is detected on average in 70% of cases of rheumatic diseases. Rheumatic diseases are a group of diseases in which connective tissue is affected, such a lesion can be either systemic or local. Systemic lesions of connective tissue have the form of autoimmune disorders, in which various tissues and organs are simultaneously affected, while local implication involves defeat within a particular area.
Based on general epidemiological studies, it was found that osteoarthritis is a disease that is relevant for 12% of the patients under study at various ages. An increase in the incidence rate, meanwhile, is observed with age. Thus, in patients from the age of 50 years, the disease is diagnosed on average in 27% of cases, while in patients aged 60 and older, osteoarthritis is detected in almost 97% of cases.
Relatively rare result of osteoarthritis development is disability of patients, often against the background of it there are cases of temporary disability.
Osteoarthritis itself is a multifactorial disease, but as the main causes of the development of this disease, usually three variants are indicated, and this is dysplasia, trauma, inflammation (inflammation).
Dysplasia consists in the presence of special congenital characteristics of the joint, causing a violation of its biomechanics. Trauma, in turn, is the most common cause of osteoarthritis. And, finally, the inflammatory process (actually inflammation), it is also a fairly frequent cause of the development of the disease we are considering. Basically, here we are talking about certain autoimmune pathologies (for example, it can be rheumatoid arthritis, etc.), accompanied by inflammation, in some cases, which occurs less often, inflammation is the result of an actual infectious process. The soil for the latter can be such pathologies as staphylococcus inflammation of the joint, as well as its inflammation against the background of certain specific infections (tick-borne encephalitis, syphilis, gonorrhea, etc.). In addition, osteoarthritis is a fairly common variant of complications in the chronic form of hemarthrosis.
There are also certain risk factors that can also play a role in the appearance and development of osteoarthritis, among them the following:
- the discrepancy between the mechanical load on the joint and its inherent ability to counteract such a load (actual biological characteristics are determined either on the basis of the genetic factor or on the basis of the factors acquired)
- genetic factors (in this case, in particular, the role caused by defects of type II of the collagen gene is considered)
- surgery directly touching the joints
- joint injury;
- Endocrine Disorders
- the presence of acquired forms of diseases with joint and bone damage
- lack of female sex hormones («female» problem in which such hormones, estrogens, are absent during the postmenopause), etc.
As a basis for the pathogenesis of the disease we are considering, violations are indicated in which the structure of the hyaline cartilage is affected. Articular cartilage itself is a highly specialized tissue, in its turn, various processes occur, and this is remodeling, synthesis (or anabolism) and degradation (or catabolism) of the extracellular matrix.
Matrix in articular cartilage is the basis of its tissue. A special role in the context of considering the normal functioning of the cartilage itself is given to the current ratio of proteoglycans, water, collagen and non-collagen glycoproteins, and a key role belongs to chondrocytes. Chondrocytes are highly differentiated cells of the cartilaginous tissue that produce «unsatisfactory forms» of low molecular weight matrix proteins, for reasons that are not completely specified, which ultimately reduces the depreciation capacity of the cartilage. Chondrocytes are very sensitive to the content in the matrix, their surroundings, proteoglycans, and if it is somehow corrected, then a corresponding reaction on their part occurs, which, by the way, occurs quite quickly.
Thus, the state of the cartilage is directly conditioned by equilibrium in catabolic and anabolic processes. Due to the production of cytokine by the cells of the subchondral bone and synovial membrane, and also due to the influence of chondrocytes, the catabolic processes are enhanced. To ensure the restoration of cartilaginous tissue, activation of synthetic reparative functions of chondrocytes is necessary. This is largely due to growth factors, especially transforming and insulin-like protein, as well as cartilage protein and morphogenetically altered bone protein.
Within the early stage of osteoarthrosis, the state of proteoglycans is changed, they are small, they can absorb water, but they are not capable of retaining it firmly. Water, being in excess, is absorbed by collagen, which, in turn, begins to swell because of this, and its disintegration occurs, which leads to a reduction in the resistance inherent in cartilage. In the future, dehydration develops (that is, a pathological condition develops, caused by a decrease in the amount of water below the physiological parameters of the norm with accompanying disorders, including metabolic disorders), disorganization and, finally, the breakdown of collagen fibers.
Within the progress of the pathological process caused by osteoarthritis, accompanied by a corresponding degeneration, the cartilage is loosened and softened. Also, cracks are formed in it, leaving almost to the bone itself.
Without the necessary depreciation lost against the background of destructive processes in the cartilaginous tissue, the bone surfaces of the joints are in a state caused by unevenness and increased mechanical stress. Because of this, the subchondral bone acquires zones with dynamic overload, due to which microcirculation disorders develop, in particular, it concerns redistribution functions in it. Against this background, subchondral osteosclerosis develops, curvature is characteristic of articular surfaces, cystic reorganization develops, osteophytes are formed.
In pathogenesis, a special role is also assigned to synovitis, an inflammation that affects the synovial membrane on the surface of the joint capsule, while concentrating the inflammatory process only within the limits of this envelope. This inflammation is accompanied by accumulation within the cavity of effusion lined by this membrane (otherwise it is defined as exudate). With synovitis, exudative and proliferative reactions appear in moderate form, and they, in turn, are most pronounced in those areas in which synovial cartilage is fixed.
As a mechanism that causes the involvement of inflammation in the process of cartilage degradation, the synthesis of anti-inflammatory cytokines, due to which, in turn, releases enzymes, whose effect damages proteoglycans and collagen. They also produce the activators of plasminogen and prostaglandins. These processes are reflected in the modeling of inflammation, as well as on the perception of pain. Certain products formed against the background of inflammation (histamine, bradykinin), have the ability to independently stimulate the primary forms of afferent nerve fibers. Anti-inflammatory cytokines, leukotrienes and prostaglandins, in turn, contribute to an increase in the sensitivity of nerve fibers to the impact of environmental factors.
Release of biologically active substances, starting once, further helps to maintain the inflammatory process in the tissues of the joint affected by osteoarthritis. Because of this, the synovium of the joint is damaged when the reactive form of synovitis develops in it, and this is accompanied by an increase in the level of production of anti-inflammatory cytokines.
Further outcome of synovitis is the development of sclerosis and lipomatosis. Concomitant factors are the formation of micro-fractures, in particular, subchondral bone, thickening from the bone trabeculae in combination with the formation of round type defects (cysts), vascular lesions, against which intraosseous hypertension develops. At the same time, osteophyto- sis develops, in which the osteophytes that are formed begin to expand, thereby reducing the area within which the joints come into contact. This also contributes to the reduction of pressure on the underlying bone and articular cartilage, but it also causes joint deformity, which can not be avoided in providing these changes. Because of this, the pain syndrome also increases, which is caused by exerting pressure on the soft periarticular tissues.
Tissue hypoxia (lack of oxygen, oxygen starvation) also develops, which occurs on the basis of manifestation in the synovial membrane and in the subchondral bone of exudative-proliferative forms of reactions with concomitant disturbance of microcirculation and regional hemodynamics. Further progression of osteoarthritis determines lesions, with it topical, as irreversible.
Osteoarthritis can be primary, which defines it also as idiopathic osteoarthritis, and secondary, when the disease is the result of certain factors (arthritis, trauma, hypermobility, static disorders, dysplasia, etc.). The above features of the pathogenesis of osteoarthritis correspond to the primary form of this disease, although they can be observed in secondary osteoarthritis. In the latter case, the changes to which the cartilage is subject are more diffuse in nature (that is, the pathological changes have uniformly covered the affected area, which in general consideration for any disease means the uniform spread of such changes in the organ or joint), the secondary reactive synovitis manifests itself in this Weaker form.
In addition to the primary and secondary forms, osteoarthritis can also manifest itself in certain types of lesions, which, in fact, is the basis for determining such forms.
- Coxarthrosis. In this case, the hip is affected, resulting in an impact on the functionality of the pelvis. Because of coxarthrosis, disability can occur, in which the ability to move independently, that is, with your feet, is lost. With the development of the disease for the stage of disability, there is a need for a wheelchair for permanent use and for transportation of the patient.
- Gonarthrosis. In this case, it is a knee injury, that is, an osteoarthritis of the knee. As a rule, in the previous development of the disease, the knee was injured. As the main manifestations can be designated as the impossibility of getting up in the morning, leaning on the affected limb, also at the time of movement there is a throbbing pain. You can alleviate the symptoms of gonarthrosis by walking (that is, you need to disperse).
- Osteoarthritis of the ankle joint. In this form, more precisely the area of localization, the disease develops as a result of any preceding trauma to the shin area, including during normal subluxation or dislocation. As a consequence of this disease, deformity of the shin can be considered.
- Osteoarthrosis of the elbow joint. The manifestation of the disease in the affected area is accompanied by a loss of mobility in any of the possible directions, as well as the appearance of a tingling sensation.
- Shoulder joint osteoarthritis. In this area of localization, the disease is accompanied by the initial appearance of soreness, the patient can not raise his arm high. The main risk, actual for this case of the disease is that the shoulder with it loses its inherent mobility, gradually the muscles in it atrophy.
The degree of osteoarthritis is determined on the basis of the extent of the pathological process, for this disease is characteristic. Consider the basic degrees below.
The first degree of osteoarthritis. In this degree the disease is accompanied by minor manifestations of soreness, the pain appears «pointwise», in frequent cases it is written off for the previous physical overstrain or overfatigue. All the «insidiousness» of this stage of osteoarthritis is that it is practically impossible to determine it by means of any methods of diagnosis. Determine that the patient is sick, can only be based on indirect signs, or when developing an already active form of the inflammatory process in the joint. As the most accurate method of diagnosis is the method of investigation of synovial fluid.
The second degree of osteoarthritis is accompanied by the appearance of a characteristic crunch in the joint and crackling in it, and also a violation of muscle functions. With the marginal form of ossification of the tissues, the mobility of the lower limbs is lost. Treatment of osteoarthritis with methods of traditional medicine in this case is unacceptable, you should consult a doctor.
The third degree of osteoarthritis is accompanied by a practical lack of self-movement functions, it becomes impossible to lift legs or hands. Joints are subject to curvature — in other words, deforming osteoarthritis develops with absolute compliance with this definition. The interarticulate cartilaginous tissue, which is destroyed at this stage, is already absent, the «blow» occurs on all tissues of the affected limb.
Osteoarthritis: common symptoms
Osteoarthritis is accompanied by a primary lesion of the joints, which account for the greatest burden, and this is the knee and hip joints, the first metatarsophalangeal joint. When the upper limbs are affected, proximal and distal interphalangeal joints are often affected, and other joints are much less likely to be detected in the form of the pathological process in question. The onset of arthrosis corresponds to the onset of a monoarticular disease, although after a while other symmetrically located joints are connected to its manifestation.
Some patients face joint damage in a multiple manifestation, in this case it is a case of polyostoarthrosis, and as the statistics indicate, within the framework of consideration of relatively recent time periods, the frequency of occurrence of polyosteoarthrosis increases the diagnosis of this type of disease.
In general, if we consider osteoarthritis, then its beginning, as already noted in the section of the degrees of this disease, can be designated as imperceptible and equated to normal overwork and other similar conditions. Symptoms of osteoarthritis appear in an indistinct form, often, if you try to determine the prescription of a certain symptomatology, the patient can not remember when and how it manifested itself for the first time. The crunch in the joints appears in an unexpected way, during movements, minor but periodic pains also appear, they arise against the background of the previous physical overload. All this symptomatology quickly disappears at rest. In the future, as the disease progresses, the intensity of pain sensations is manifested «incrementally,» and such feelings arise as a result of exposure to any type of load. The duration of the manifestation of pain is also increased, sometimes the pain makes itself felt at night.
As the opposite of the so-called «inflammatory pain» (pain in arthritis), it can be noted that the pain syndrome that occurs with arthrosis is mainly mechanical in nature of occurrence, that is, it is preceded by a certain load on the affected joint that occurs in Time of walking and with support on the affected limb. In a state of rest, as a rule, there is no pain. The greatest intensity of pain is noted in the evening, their appearance is preceded by an increased daily workload, the nature of the pain is dull. In general, the pathogenesis (acute for the emergence and development of the disease or certain conditions of the body of the mechanism of action, their provoking) pain in osteoarthritis is complex enough, based on certain types of mechanisms that cause pain, the course of this disease can be characterized by its various variations.
Basically, the cause of pain in osteoarthritis is the actual reactive synovitis, spasm of the muscles located near the affected joint and periarthritis. The reactive synovitis is accompanied by «starting pains» — that is, such pains that appear during the first steps. With further walking, the pain quickly disappears, its renewal is already observed as a result of continuing physical exertion. Appearing pain can begin due to the actual friction of the cartilage affected by the pathological process, each other, in particular, this is due to the settling of cartilaginous detritus on their surface. Detritus are elements in the form of fragments formed from necrotic cartilage, that is, cartilage with tissue death in it, necrotic cartilage. The first movements of the joint lead to the fact that detritus is being ejected into the joint cavity, which, in turn, stops the pain.
Also, as a synovitis satellite, tendobursite may act, in this case the pain appears against the background of previous movements, in which the affected tendon is contracted. Due to the appearance of reflex spasm in the nearby muscles, pain occurs as a result of any movement of the joint. With progressive fibrosis, to which the joint capsule is subjected, the nerve endings are subject to compression, which also causes pain, especially when it occurs against the background of the extension of the capsule caused by the movement of the joint.
Venous hyperemia develops in the subchondral bone, this term generally implies a condition under which the increased blood filling of organs and tissues, including certain parts thereof, that occurs as a result of a violation of the outflow of blood through the veins. Also develops a stasis — a condition in which a tubular organ stops its physiological contents.
Because of these two phenomena, continuous dull pain occurs, noted at night, when walking, such pain disappears. If the arthrosis is localized in the region of the hip joint, then the reflex spread of pain to the knee joints develops, or it manifests itself in the same way as ischialgia. In these cases, a patient with coxarthrosis, for example, can only complain about the appearance of pain localized from the knee joint.
If a cartilaginous or bone fragment of considerable size appears in the articular cavity, then this can cause acute sudden soreness, because of which the patient simply is not able to perform any, even the slightest, movements with this joint. In this case, we are talking about the so-called state of blockade of the joint.
The unfolded stage of arthrosis is characterized by the appearance of pain during walking and standing, which increases later in the evening, this pain is explained by a decrease in the ability to resist the joint bone surface with an acting load. At the level of anatomy, this can be explained by the fact that, due to the absence of a cartilage damper, there is a significant increase in pressure on the bone, which in turn leads to a deflection of bone bones to the spongy bone.
In addition to pain, the initial stage of manifestation of arthrosis is accompanied by a certain degree of crepitation — the emergence of a characteristic «crunchy» sound. As the disease develops, crepitation manifests itself in the form of a rough crunch. In addition to this symptom, short-term stiffness is also noted, which is preceded by a transition to active activity after a resting state, rapid fatigue can be noted in the muscles of the affected area.
The subsequent progression of the disease, with the concomitant increase in morbidity, may also initially appear as a slight mobility, which is associated with pain and reflex muscle spasm. In the future, there is an increase in the limitation of mobility, and it is then associated not only with a parallel increase in pain sensations, but also with the formation of tendon-muscular contractures in combination with osteophytosis.
In the future, the deformation of the composition gradually develops, this process progresses, which is caused by the thickening to which the capsule and the synovial membrane is exposed, and also by the formation of marginal osteophytes, the cartilage and bone are destroyed with subsequent remodulation of the joint surfaces. Deformation of the joints in osteoarthritis differs from the deformation that develops against the background of arthritis in that it arises mainly due to the joint bone component, soft tissues do not participate in the pathological process.
Periodically, some swelling may form in the joint area, which is accompanied by an increase in temperature in this area, soreness in sensation, especially marked along the course of the joint space. In some cases, the joint cavity contains a certain amount of exudate (fluid), often with synovitis there is tendo bursitis — a disease in which the tendon is affected, which is combined with the development of inflammation from the synovial bag, as well as with dystrophic transformations formed in the tendon.
Here, in the area where the tendon that has undergone the pathological process mounts to the joint, a limited type of tumor formation is formed, painful points appear and skin temperature rises (again, in the affected area). Both synovitis and tendo bursitis never develop to the same degree of intensity that is noted in arthritis, moreover, both of these conditions quickly subsided sufficiently if bed rest is properly maintained.
As for movements in the joint, they are characterized by their own soreness. As a rule, pain is increased as a result of climbing or descending the stairs. Gradually, against the backdrop of a pathological process, muscle atrophy develops.
The late stage of arthrosis is characterized by limited mobility of the joints with a pronounced degree of their disfigurement, which is especially important in case of a disease such as coxarthrosis. Meanwhile, there is no complete immobility of joints in this case.
As a frequent satellite of osteoarthritis, against the backdrop of the actual processes for it, venous diseases (phlebitis, thrombophlebitis, varicose veins, etc.) can be designated.
Osteoarthritis: symptoms of major clinical forms
Based on specific areas of localization, the disease under consideration has its own peculiarities accompanying its manifestation.
- Symptoms of coxarthrosis
The defeat of the hip joint, which, as we have already noted, corresponds to the disease «coxarthrosis», is not only the most frequently diagnosed form of osteoarthritis, but also the most severe form. On average, coxarthrosis is detected in 43% of cases of manifestation of OA, and, as a rule, the completion of its progression is accompanied by a disruption of the joint function to almost complete cessation, which, in turn, leads to disability. Against the background of the pathological processes accompanying it, in 50-70% of cases the working capacity is lost if one joint is affected, in 100% this occurs when both joints are affected.
The development of the primary form of coxarthrosis begins mainly after overcoming the age threshold of 40 years, there is also the same frequency of sexual predisposition, that is, the disease is equally often diagnosed in both men and women. With the development of coxarthrosis to 40 years of age, there is mainly joint dysplasia, in which the head of the thigh does not have enough coverage to ensure proper functionality, which occurs against the background of inferiority of the acetabular state.
More rarely, coxarthrosis provokes an idiopathic (mostly family form) protrusions in the ileal cavity. That is, it is a question of a too deep (again, most likely family predisposition) acetabulum in which the bone thinning with accompanying protrusion to the side of the hip cavity of the femoral head is simultaneously actual.
Also, coxarthrosis can cause deformation of the head of this bone against the background of osteochondropathy, at which the femoral neck is shortened and the angle anatomically present between the head and the femur is reduced. In addition to these reasons, coxarthrosis provokes a chronic form of arthritis, osteonecrosis and other types of processes in which the proportionality of the articular surfaces is to be violated. We also add that coxarthrosis can become the outcome of excessive physical exertion (for example, in athletes), a well-known fact is that about a third of patients in this case are faced with bilateral hip joint lesion.
The main symptoms of coxarthrosis are reduced to the appearance of mechanical pain, localized from the side of the hip joint, because of which a frequent companion of the disease is limping. In general, the localization of pain can be different. So, the onset of the disease is accompanied by the appearance of pain not in the hip joint, but in the groin or knee joint, in the lower back, in the thigh or in the buttock. Such a spread of pain can last long enough, there is pain during exercise (when walking), disappears at rest, and resumes at the first steps after that.
The peculiarity of coxarthrosis, more precisely of pain sensations in this disease, is that with it there may be no changes on the roentgenogram during examination. The explanation for this is the actual spasm of the hip muscles, which may exclude the possibility of revealing pathological changes.
As the disease progresses, the limitation of mobility is manifested, and then the mobility limit increases, in which the internal rotation is subject to disruption, and then the withdrawal, then — external rotation, reduction and, finally, flexion / extension of the thigh. In some cases, a symptom develops, such as «blockade», accompanied by painfulness, as well as jamming the joint with the concomitant impossibility of performing any movement. This symptom disappears after some time.
- Symptoms of gonarthrosis
In this case, the course of the disease is characterized by its own variability. Initially, pain can appear in one of the joints, after the other, or at all in both. After a while, the pain can disappear altogether, and for a long time, although most of the pain is permanent and occurs on the soil of any type of load.
The functional characteristics of the joint against the background of this disease can differ. Prolonged arthrosis in its considered form can determine the free possibility for some patients to move over significant distances, while other patients face the difficulty of overcoming at least several hundred meters, and climbing the stairs for them in general becomes impossible.
The results obtained during the radiography as a method of investigation do not always correspond to the actual picture of the pathological process, and, accordingly, do not allow to determine the degree of joint damage. In the isolated form of the patellar arthrosis, disability of the patient occurs in the least way, while the greatest degree of disability is observed with a combination of femoral and spleen arthrosis.
- Symptoms of osteoarthritis of interphalangeal distal joints with a lesion of the hand
This pathology is also defined as Geberden’s nodules. On average, this pathology accounts for about 20% of cases of arthrosis, and mostly it is faced by women during the period of onset of menopause. In some cases, Geberden’s nodules manifest in combination with other symptoms characteristic of primary osteoarthritis. Nodules in the distal region can also be formed again, which is accompanied by injury and, consequently, the development of a secondary form of osteoarthritis.
The pathogenesis of this form of the disease is most closely connected with heredity as the main factor provoking it. As a rule, the nodules formed are multiple, basically they are affected by I and III fingers of the hand. A few months later (in some cases, years), other interphalangeal distal joints are also affected symmetrically. These nodules have a sufficient density, which is explained by the formation of marginal bone osteophytes, they appear one on each side of the rear surface. The process of formation of such nodules is accompanied by the appearance of tingling, burning and «goosebumps.» Completion of the formation of these nodules is accompanied by the disappearance of this symptomatology.
After that, there is limited mobility of the distal interphalangeal joints, although their work capacity is still preserved. Further, with the progression of OA, it is possible to grope bone formations from the lateral and back surfaces of the joint, and also in the joint environment (similar to the ring). Because of this, against the background of the accompanying pathological process, the fingers are seriously deformed. Simultaneously with a moderate degree of stiffness in the interphalangeal joints, their increased mobility can also be observed under the condition of passive type of movements.
There are other specific features of osteoarthritis in this form. Here it is possible to designate frequent relapses of the manifestation of reactive synovitis, which, in turn, develops, as if without any preceding reasons, accompanied by reddening of the skin, swelling and tenderness from the soft tissues of the joints, painfulness appears also during their movements.
In some cases, the Heberden nodules are combined with the appearance in the immediate vicinity of the rounded formations with the size of a pea, in the bubbles formed in a similar pattern, you can see the gelatinous type of contents. Together with them there is a pulsating soreness. If you remove such vesicles or if the contents drain from the underlying skin, the pain, like the swelling near the nodules, disappears, and the nodules themselves remain dense and painless.
Based on the inherent peculiarities of Geberden knots, they are usually identified as an independent inflammatory pathology of the joints, although some authors emphasize their appearance as a variant of the primary form of deforming osteoarthritis due to simultaneous injury and other joints in this disease. This is already evidence of the development of polyostoarthrosis.
- Symptoms of osteoarthritis of proximal interphalangeal joints
On average, 50% of patients with Heberden nodules encounter the development of a similar type of lesion from the proximal joints of the interphalangeal region, in this case we are talking about Bushehr nodules. Sometimes the existence of such a pathology in its own form is possible with the defeat of one or at the same time several joints.
The difference between these nodules and Geberden’s nodules is that they are localized from the side of the lateral surfaces of the joints of the hand, which causes the affected joints to increase at the sides. Fingers for this reason resemble a spindle in its shape. There is a certain limited movement in the joint. If the condition is combined with a reactive synovitis, the picture of the disease can be equated to rheumatoid arthritis in view of the actual similarity with it.
- Symptoms of osteoarthritis of the wrist joint
In this form of the disease, the thumb is affected, it is also defined as rizartroz. Quite often this form of the disease is diagnosed in patients with already existing arthrosis with lesion of interphalangeal joints, especially in patients with menopause.
As a rule, rizartroz manifests itself in the bilateral form of lesion, accompanied by pain sensations, noted from the inner edge of the wrist, arising as a result of the preceding movements of the thumb. The thumb is limited in mobility, a crunch appears.
In some cases, the development of the disease leads to deformation of the brush, which is explained by the formation of osteophytes. The restriction of mobility against this background is so strongly pronounced that it deprives the patient of work capacity, which is especially critical in professional activities, accompanied by thumb movements and, in general, the joints of the hand.
In general, the course of the disease in this form can be designated as favorable, without pronounced pain and mobility limitations, only with concomitant deformation of the hand.
- Symptoms of osteoarthritis of other joints of lower and upper extremities
This development of OA is rarely diagnosed. Osteoarthrosis of the elbow joint is accompanied by pronounced bone growths around the joint surface of the elbow. Because of the formation of osteophytes, there may be a restriction of mobility, which, first of all, concerns the extension of the elbow. Also for the same reason, there is a need for taking a forced position of the joint (some flexion).
Deforming osteoarthritis of the shoulder joint is accompanied by soreness, marked when trying to divert the shoulder to the side. Actual for many forms of osteoarthrosis deformation in this case does not occur. A slight degree of muscle atrophy can develop in the environment of the muscles nearby. The lesion is mainly affected by the second shoulder joint, arthrosis of the right shoulder joint is rarely diagnosed. Primary arthrosis, accompanied by a symmetrical lesion of the shoulder joint region, is a rare form of the disease, as well as it relates to its form such as arthrosis of the acromioclavicular joint.
Osteoarthrosis of the sternoclavicular joint is diagnosed in frequent cases, it is often manifested in combination with the humerus of the periarthritis. A similar course of the disease is accompanied by swelling, further joint deformity develops, painfulness appears during its movements.
- Symptoms of deforming osteoarthritis with ankle injury
This form of the disease rarely appears as a primary OA, it is mostly secondary, being the result of previous traumatization of the indicated area. In this case, there are violations in walking, often there is a need for taking the joint by a joint position.
Often the first metatarsophalangeal joint is affected, which is mainly caused by a violation of statics, which is actual for longitudinal or transverse flatfoot, single injury or constant trauma (for example, due to the peculiarities of professional activity). As a rule, such a defeat manifests itself in a two-sided form. Clinical manifestations of arthrosis are reduced to pain, difficulty walking and restriction of mobility in the area of the big toe.
- Symptoms of arthrosis (polyostearthrosis)
This variant of the manifestation of the disease is diagnosed quite often, it is accompanied by multiple lesions of the intervertebral and peripheral joints. Arthrosis can be both primary and secondary, that is, due to certain factors (trauma, etc.). In general, secondary polyostoarthrosis develops in patients with already existing pathologies in the form of metabolic polyarthritis, in particular, ochronic disease, gout, arthropathy, etc.
The basis of the disease is a generalized form of chondropathy, in which the total resistance (resistance) of the cartilage is subject to reduction with respect to the factors influencing it that cause pressure. As an additional factor in its basis is also indicated weakness of the ligamentous apparatus, due to the degradation of proteoglycans.
The appearance of this form of the disease is mainly associated with a hereditary predisposition to it, despite the unclear nature of such heredity. Women are mainly affected by the disease, and, as is often the case with OA, those of them who are menopause. On this basis, one can also identify a leading role in the pathogenesis of endocrine factor disease.
With minor functional loads, the development of multiple chondropathy occurs in a latent (latent) manner. If there is a certain overload, which occurs on the cartilage, then polyosteoarthrosis develops. Against the background of changes in the resistance, which is subject to the intervertebral cartilage under load develop degenerative changes affecting the nucleus pulposus, leading to the appearance of cracks in the fibrous ring and lead to the development discopathy (herniated disc). Against the background of the same cause, multiple tendons are also subject to tendon, in particular this applies to those of them that are located in the areas of attachment to the bone.
When arthritic joint disease mainly affects symmetrically and bilaterally, and above all the defeat of leg joints shall be subject to load (hip, knee, distal interphalangeal joints). The joints of the hand are slightly less likely to be affected, in the region of the thumb on the foot and the ankle joints.
The main diagnostic methods for osteoarthritis are the following diagnostic procedures:
- blood test (general, biochemistry)
- joint ultrasound;
- synovial fluid research
Treatment of osteoarthritis is based on the following basic principles in it:
- providing the affected joint with the required blood volume for normal functionality
- decrease in the intensity of manifestation of the inflammatory process
- elimination of excess exposure caused by a certain mechanical load
- preventing the progression of the disease.
An important role is given to the regimen and a certain diet, in particular this is important in the presence of a problem of excess weight. Avoids the excessive exercise, used devices, which decreases due to exposure to mechanical stress on the joints (cane, corsets, etc. -., Depending on the lesion area). Anesthetics are prescribed (diclofenac, ibuprofen, etc.). When there is joint effusion, corticosteroids are used. Separately, examines the impact of the measures of physiotherapy (electrophoresis, acupuncture, magnetic therapy, laser therapy, etc.).
If symptoms appear that indicate osteoarthritis, a rheumatologist should be consulted.