Osteoarthritis

Osteoarthritis is a disease of the joints, in which primary changes in a primarily degenerative nature occur in the articular cartilage. In osteoarthritis, in contrast to arthritis, the inflammatory component is unstable, takes place in the form of episodes and is not highly expressed.

Etiology is diverse. There are primary (idiopathic) and secondary osteoarthritis. The latter is caused by dysplasia of the joints and bones, joint trauma, metabolic (eg, ochronosis), endocrine (eg, hypothyroidism) and other articular cartilage-damaging diseases and factors. In those cases when they are not found talking about primary osteoarthritis.

The pathogenesis is approximately the same for both forms of the disease. Primary degeneration of cartilage leads to changes in other joint tissues: subchondral bone - with its densification (osteosclerosis) and growths (osteophytes), synovial membrane - with the development of reactive hyperemia, focal inflammation (synovitis) and subsequent fibrosis. All these changes are interdependent, which leads to the progression of the disease.

Symptoms, the course depends on the localization of the disease. The most common injuries are metatarsophalangeal joints, toes, knees, hip joints, as well as distal and proximal interphalangeal joints of the hands. The defeat of other joints for osteoarthritis is uncharacteristic.

Otoarthritis of the metatarsophalangeal joint of the foot often develops due to various anomalies of the anterior part of the foot. Characterized by pain during prolonged walking, subsiding at rest. Over time, there may be restrictions in the movement of the joint (hullux rigitus), its thickening and deformation, the development of bursitis from the outside, which creates the prerequisites for more permanent and intense pain.

Osteoarthritis of the knee joints (gonarthrosis) is in many cases secondary and is caused more often by violations of the anatomical axis of the shins - varus or valgus deformity. For osteoarthrosis of the femuropatellar articulation (between the patella and the femur), pain is typical when walking on a ladder and any other loads on this joint: kneeling, squatting, etc. For osteoarthritis of the femurotibial (between the femur and the tibia), pain is typical, It occurs after a long walk and stops at rest. When viewed at this stage of the disease, there is usually no external change of the joint, only painful sensations are revealed with extreme passive movements in the joint. As gonarthrosis progresses, walking time decreases without pain. In case of synovitis joining, the rhythm of pain changes: there is starting pain, pain at standing and at rest, including at night. During examination, a small effusion or only hyperthermia of individual joint zones can be determined, palpation reveals common soreness, often also in the field of periarticular tissues. In the late stages of the disease, synovitis usually becomes permanent, although its severity remains, as before, small, often the deformity of the joint, its flexion contracture, pain becomes almost constant.

Osteoarthrosis of the hip joint (coxarthrosis) in 50 - 60% of cases is secondary, most often a consequence of joint dysplasia; The most prognostically unfavorable localization of osteoarthritis. The nature of pain and clinical dynamics with progression of the disease are similar to that observed in gonarthrosis.

Osteuroarthrosis of the mwfalangovyh joints of brushes in the overwhelming majority of cases is an example of the primary form of the disease. In many patients, only nodular deformation of the distal and proximal interphalangeal joints of the hands and a certain restriction of movements in them are observed for a long time, and the pain either is absent or appears only after considerable loads on these joints. Persistent bolt sensations, as well as swelling and pereperthermia of the periarticular tissues appear when a secondary synovitis is attached, which may have a different duration, recurs. Its persistent presence leads to a considerable deformation of joints, pronounced disturbances in their mobility, the appearance of radiologic signs of dessication (the so-called erosive osteoarthrosis). In addition to interphalangeal, in this form of osteoarthritis, the metacarpophalangeal joint of the first finger and the first wrist joint are often affected.

X-ray picture of osteoarthritis of any localization consists of a narrowing of the joint gap (mandatory for the diagnosis of the symptom), sclerosis of the subchondral bone and osteophytes.

Changes in blood and urine indicators for osteoarthritis are not characteristic.

Treatment. Radical methods of treatment of osteoarthritis have not yet been developed. Of great importance are preventive measures: timely detection and elimination (or reduction of severity) of factors contributing to the development of the disease, such as correction of orthopedic defects, reduction of excess body weight, etc.

With osteoarthritis of the lower limbs, which is manifested only by pain after a long walk, the main importance is the reduction of the load on the affected joint, shortening the duration of walking, standing. For certain types of labor (lifting and carrying heavy loads, long standing on legs, etc.), it is desirable to change the profession.

Patients with early stages of the disease use rumalone or other similar drugs (mukartrin, arteparan), which, given by some authors, can slow the progression of osteoarthritis. When prescribing these drugs, one should keep in mind that to achieve the expected effect, at least two courses of IM injections per year should be carried out for many years. A valuable treatment is synovitis. When gonarthrosis or coxarthrosis, patients should be temporarily released from work, observe the home regime. They are prescribed non-steroidal anti-inflammatory drugs (naproxen, indomethacin, orthophene). A week later, in the absence of sufficient effect, intraarticular administration of corticosteroids (hydrocortisone, metipred - 1 to 3 injections after 5 to 7 days) is performed. It should be borne in mind that long-term therapy with non-steroidal anti-inflammatory drugs, as well as frequent administration of corticosteroids in the joint cavity with osteoarthritis, is inappropriate. Gonarthrosis and coxarthrosis are often accompanied by changes in the periarticular soft tissues of these anatomical areas (periarthritis), which increase pain and require appropriate treatment (see Rheumatic diseases of the periarticular soft tissues). With frequent recurrences or persistent synovitis (in the early stages of gonarthrosis), arthrascopy is indicated and, if chondroma is detected, frequent causes of these phenomena are the removal of them.

LFK with coxarthrosis and gonarthrosis is carried out only in the supine or sitting position, the physical load on these joints should be reduced. Running, long walking is contraindicated; It is advisable to ride a bicycle, swimming. In the early stages of the disease, in the absence of synovitis, balneo- or mud therapy may be useful.

With significant violations of the function of the affected joint, persistent pain sensations are performed by various surgical operations.