The symptoms and treatment of osteoarthritis of the joints: the causes, the diagnosis, as a cure — description of the disease

Osteoarthritis pathology is chronic, that affects connective tissue in the structure of the locomotor apparatus. For the disease characteristic is the progressive course of the gradual destruction of the cartilage tissue. Osteoarthritis is revealed the majority of patients after the age of 65, as well as one of the causes of its development becomes the natural aging of the body.

The emergence of a and on the other hand, degenerative pathology is carried prior to the injury, endocrine and inflammatory diseases, excessive physical activity or, on the contrary, the sedentary life style. The main symptoms of osteoarthritis are joint pain, swelling, limitation of movements.

For the diagnosis of pathology is conducted are with instruments of inquiry — the x-ray, arthroscopy, magnetic resonance imaging, computed tomography. Osteoarthritis of 1 and 2 degree of severity of the treated conservatively course of the intake of medications, physiotherapy and massage service, physiotherapy. When destructive and irreversible changes in the joints is shown a surgical procedure — arthrodesis, arthroplasty.

Pathogenetic mechanisms of

Osteoarthritis occur expressed to the changes in the interior of connective tissue structures. In the cartilage tissues are formed by deformation of the erosion, which becomes the cause of the destruction of the collagen fibers, as well as proteoglycans, composed of proteins (5-10%) and of the glycosaminoglycans (90-95%). As a result of the mesh of collagen lose stability, begin to break free of metalloproteinases, destroying all the types of proteins of the extracellular matrix. Their destruction is accelerated by the increase of the biosynthesis of collagenase and stromelysin. Usually normal quantitative values of the enzymes control the cytokines are small peptide information of the molecule. But when the progression of osteoarthritis, the concentration of these proteins is reduced, which leads to the national liberation of large amounts of enzymes that damage the cartilage, the tissue.

The proteoglycans with the new structure begin to absorb the water molecules, which are not able to retain. Therefore, the excess of liquid enters in the fibers of collagen. Is "swell", they lose their strength and elasticity. Qualitative and quantitative composition of the synovial fluid is also produced negative changes. Osteoarthritis it reduces the concentration of hyaluronic acid. To hyaline cartilage no longer work sufficient for the regeneration of the amount of nutrients and oxygen. In the cartilage tissue forming foci of softening, and then appear cracks, specific to necrotic growth. Bone of the head naked, and to begin to microtraumatic move relative to one another.

Causes and triggers of the

The causes of the development of primary (idiopathic) osteoarthritis still have not been established. It occurs in the absence of the factors that cause, for what they propose theories about the hereditary predisposition to degradation and premature cartilage. Secondary osteoarthritis develops as a consequence of other diseases of the joints, or previous injuries. What can cause and on the other hand, the degenerative disease:

• injuries to the joint or surrounding connective tissue structures — fractures, dislocations, injury to the meniscus to partial rupture of muscles, ligaments, tendons, or the complete separation of the bone marrow of the foundation;
• innate dysplastic disorder of the development of the joint;
• malfunction of the endocrine glands, the disorder of the metabolic processes;
• rheumatism, or rheumatic fever;
• rheumatoid, reactive, metabolic, psoriatic or arthritic rheumatoid arthritis;
• arthritis, purulent, caused by streptococci, epidermal or golden staph;
• tuberculosis of any localization, brucellosis, chlamydia, gonorrhea, syphilis;
• and on the other hand, degenerative disease, for example, the dissection of the Legg.

The development of osteoarthritis predisposes the hypermobility of the joints, subject to the special formulation of collagen. This condition is diagnosed 10% of the inhabitants of the planet and not considered a pathology is. But the hypermobility is accompanied by weakness tendon-ligamentous apparatus, which leads to frequent injuries, especially of the ankle joint (sprains and rupture of ligaments, separations).

The reason for the occurrence of osteoarthritis are sometimes converted in violation of hematopoiesis, for example, hemophilia. Hemarthrosis, or bleeding into the joint cavity, causing the deterioration of the trophic cartilage and its destruction.

To predisp factors include advanced age, the frequent load on the upper limbs to the limits of their endurance, the excess weight, the surgery, the subcool.

In the group of risk are women during the menopause, the people living in the unfavourable environment or material in contact with toxic chemical compounds. In case of deficiency in the diet of foods with vitamins and micronutrients, to create the preconditions for the progressive destruction of hyaline cartilage.

The clinical picture

The risk of osteoarthritis consists of in the absence of symptoms in the first stage of its development. Pathology is clinically manifested gradually, the first symptoms occur in the context of significant destruction of cartilage tissue. In the beginning, the man feels weak and the pain, which has no clear localization. She appears after exercise — weightlifting, sports training. Sometimes, the first clinical manifestation becomes a crunch, clicks in flexion or right extension of the joint. The person begins to realize that some of the movements are given with the job. However, in the initial phase of the stiffness of osteoarthritis occurs in the morning hours and soon disappears.

As the progression of the disease, pain that is felt and in the night, causing not only the sleep disorder, but also the onset of chronic fatigue. The intensity of the pain syndrome in the second stage increases when the time changes, the worsening of chronic pathologies, such as acute respiratory infections. Significantly reduces the amount of movement. The cause of the stiffness becomes in the thinning of the cartilage, as well as aware of the limitation of the movements of the person in an attempt to avoid the onset of pain. This leads to an increase of the load on the opposite joint, which causes further damage. For oa are characteristic and other specific symptoms:

• the pain causes spasms of the skeletal musculature and the development of muscle contractures (restrictions of passive movements in the joint);
• the popping in the joints, clicks, pops when the move become permanent, occur almost every time you move bones in relationship to each other
• often produce painful muscle cramps;
• the joints become deformed, leading to violation of posture and gait;
• in the third stage of osteoarthritis, the deformation is expressed so clearly that the joint are bent, and the amount of movement in them decreased a lot or not;
• osteoarthritis of third degree of knee, ankle, hip, sick at the movement uses a cane or crutches.

In the absence of treatment of the pathology is progressing, and in its current of the remission will relapse, and the relapse rate increases all the time. Stiffness in the morning, now not go away for a long period of time, it becomes permanent.

Walking the patient with osteoarthritis) 1 degree, the doctor sees only a small swelling of the joint and the integrity of the full range of motion. When the pathology is of grade 2 identifies by palpation the pain and evil expressed by the deformation. In the area of the joint of the slit is observed the formation of bone swelling.

For osteoarthritis it is characteristic of the development of the synovitis — inflammatory processes in synovial shells of the hip, knee, ankle, shoulders, joints. Its main symptom becomes the education rounded board in the area of the joint, when you are depressed you are feeling the movement of fluid (fluctuation). Acute during the synovitis may be accompanied by the rise of temperature to 37-38°C, headache, violation of digestion.

The diagnosis

The diagnosis is negotiated on the basis of the results of research tools, the clinical features, the history, the complaints of the patients. The general analysis of blood and urine informative — all the values remain within the standard, if the osteoarthritis is not modified in the pathology is. During the development of synovitis increases the erythrocyte sedimentation rate (30 mm/hour), in the blood increases the level of leukocytes, fibrinogen. This indicates that flows in the body acute or chronic inflammatory process. The change of biochemical and immunological indicators occurs when secondary forms of osteoarthritis.

The news of a diagnosis method and on the other hand, degenerative pathology is the x-ray direct and lateral projection.

The stage of osteoarthritis according to the classification of Kellgren-Lawrence (1957)	X-rays for signs of pathology is
Initial	The absence of radiological signs of
The first	Indistinct, uneven narrowing of the joint cleft. A slight flattening of the bone edges of the disks, the initial formation of osteophytes, or the lack of
The second	Expressed by the narrowing of the joint cleft, is greater than the value of the norm in 2-3 times, the formation of a large number of osteophytes, subchondral osteosclerosis. The appearance of kistevidnyj the lighting in the epiphysis
The third	The appearance expressed subchondral osteosclerosisy and large provincial osteophytes, a significant narrowing of the joint cleft
The fourth	The formation of serious massive osteophytes, almost total fusion of the joint of the slit, the deformation and the board of epiphyses of the bones that make up the joint

If after studying the x-ray images to the doctor in doubt as to the placement of diagnostic, designated by the tc. And for the evaluation of the state located near the joint connective tissue structures is performed by a magnetic resonance imaging. When you use the contrast in the dynamics of to assess the blood flow to the tissues, to adjust the phase of the inflammatory process to the development of the synovitis.

The main methods of the therapy

The osteoarthritis is still an incurable disease, because there are no drugs for the regeneration of the cartilage tissue. The main task of the therapy becomes a warning of the progression of the pathology is, the preservation of the mobility of the joint. The long-term treatment, complex, with the use of local and systemic medications. Patients should avoid serious of the charges of the joint, if it is necessary to limit the amount of movements orthopedic accessories — clamps, flexible, and bandages. Patients with excess weight it is necessary to make adjustments in the diet for gradual reduction of weight and follow a diet.

After sustainability of the remission of the patients are shown daily of the most important lessons of the physical culture medical. The first trainings are performed under the supervision of a physician physical therapy and then the patient performs a series of exercises in the home. Physical therapy can be supplemented with swimming, yoga and riding a bike.

To reduce the severity of the pain syndrome were assigned different medications clinical-pharmacological groups:

• the nonsteroidal anti-inflammatory drugs in the form of ointments, tablets, solutions for parenteral injection with active ingredients;
• the injection in the articulation of the solutions of anesthetics in combination with corticosteroids;
• the muscle relaxers for the solution to the muscle spasms and restrictive contractures.

In therapeutic schemes include the B-group vitamins, sedatives, if necessary, tranquilizers and antidepressants. Always impose chondroprotectors much of the reception. It is the only group of drugs that possess the ability to partially restore the cartilage, the tissue.

To improve your clinical of the activity of physical therapy are performed are procedures — lazeroterapiya, magnetic fields of the uhf-therapy.

Any joint pain should be a signal for immediate attention to the doctor. The therapy carried out at the initial stage of the osteoarthritis, to stop the destruction of cartilage, preventing the loss of functioning and disability.