Arthrosis is the most common joint disease. According to experts, 6, 43% of the population of Hungary suffers from this. Men and women are equally prone to arthrosis, but there is a slight predominance of men and the elderly - women - among young patients. An exception to the general picture is arthrosis of the interphalangeal joints, which is 10 times more common in women than in men.
As you age, the incidence increases dramatically. Thus, studies show that arthrosis is seen in 2% of those under 45, 30% of those aged 45-64, and 65-85% of those aged 65 and over. Arthrosis of the knee, hip, shoulder, and ankle joints is of greatest clinical significance due to its negative impact on patients ’living standards and ability to work.
Cause
In some cases, the disease occurs for no apparent reason, and such arthrosis is termed idiopathic or primary.
There is also a secondary arthrosis - it is the result of some pathological process. The most common causes of secondary arthrosis are:
- Injuries (fractures, meniscus injuries, ligament tears, dislocations, etc. ).
- Dysplasia (congenital joint development disorders).
- Degenerative-dystrophic processes (Perthes' disease, osteochondritis dissecans).
- Diseases and conditions in which there is increased mobility of the joints and weakness of the tape apparatus.
- Hemophilia (arthrosis is caused by common hemarthrosis).
Risk factors for developing arthrosis include:
- Old age.
- Overweight
- Excessive strain on the joints or a particular joint.
- surgical procedures on the joints,
- Hereditary predisposition (presence of arthrosis in close relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (shoulder joint inflammation, lumbar-iliac muscle syndrome).
- Repeated microtrauma of the joint.
Pathogenesis
Arthrosis is a polyethiological disease that, regardless of the specific causes of its occurrence, is based on a violation of the normal formation and regeneration of cartilage tissue cells.
Normally, the articular cartilage is smooth and supple. This allows the joint surfaces to move freely relative to each other, provides the necessary shock absorption, and thus reduces the load on adjacent structures (bones, ligaments, muscles and capsules). In arthrosis, the cartilage becomes rough, and the joint surfaces begin to "stick together" as you move. Cartilage is losing more and more. Tiny pieces become detached from it that fall into the joint cavity and move freely in the joint fluid, damaging the joint. Small foci of calcification appear in the superficial zones of the cartilage. Bone areas appear in the deep layers. Cysts that communicate with the joint cavity are formed in the central zone, around which ossification zones also develop due to the pressure of the intraarticular fluid.
Pain syndrome
Pain is the most constant symptom of arthrosis. The most prominent signs of pain in arthrosis are the association with physical activity and weather, nocturnal pain, initial pain, and sudden sharp pain combined with joint blockade. With prolonged exertion (walking, running, standing), the pain intensifies and subsides at rest. Nocturnal pain in arthrosis is caused by increased venous congestion as well as an increase in intraosseous blood pressure. The pain is exacerbated by adverse weather conditions: high humidity, low temperature and high atmospheric pressure.
The most common symptom of arthrosis is the onset of pain - pain that occurs during the first movements after rest and disappears while maintaining motor activity.
Symptoms
Arthrosis develops gradually. Initially, patients are concerned about mild, short-term pain without clear localization that is exacerbated by physical exertion. In some cases, the first symptom is cracking while moving. Many patients with arthrosis report discomfort in the joints and temporary stiffness during the first movements after a rest period. Thereafter, the clinical picture is complemented by nocturnal and weathering pains. Over time, the pain becomes more pronounced, with limited mobility. Due to the increased load, the joint on the opposite side starts to ache.
Periods of exacerbations alternate with remissions. Exacerbation of arthrosis often occurs in the context of increased stress. Due to the pain, the muscles of the limb cramp reflexively, and muscle contractures may develop. The cracking in the joint becomes more and more permanent. At rest, muscle cramps and discomfort occur in the muscles and joints. Lameness occurs due to increasing deformity of the joint and severe pain syndrome. In the later stages of arthrosis, the deformity becomes even more pronounced, the joint bends, and movements are significantly restricted or absent. Support is cumbersome, a patient with arthrosis must use a stick or crutch when moving.
Diagnostics
Diagnosis is based on characteristic clinical symptoms and an X-ray of the arthrosis. An X-ray is taken of the patient's joint (usually in two projections): X-ray of the knee joint in the case of gonarthrosis, X-ray of the hip joint in the case of coxarthrosis, etc. An X-ray of arthrosis consists of signs of dystrophic changes in the articular cartilage and adjacent bone. The joint gap narrows, the bone site is deformed and flattened, and cystic formations, subchondral osteosclerosis, and osteophytes are revealed. In some cases, in the case of arthrosis, signs of joint instability are observed: curvature of the axis of the limb, subluxation.
Based on radiological signs, orthopedic and traumatologists distinguish the following stages of arthrosis (Kellgren-Lawrence classification):
- Stage 1 (dubious arthrosis) - joint space is suspected, osteophytes are missing or present in small numbers.
- Stage 2 (mild arthrosis) - suspected joint space narrowing, osteophytes clearly defined.
- Stage 3 (moderate arthrosis) - clear narrowing of the joint space, clear osteophytes, bone deformities possible.
- Stage 4 (severe arthrosis) - severe narrowing of the joint space, large osteophytes, severe bone deformities and osteosclerosis.
Sometimes X-rays are not enough to accurately assess the condition of a joint. To study the bone structures, we perform a CT of the joint, to assess the condition of the soft tissues - an MRI of the joint.
Treatment
The main goal of treating patients with arthrosis is to prevent further cartilage death and to keep the joint functioning.
During the remission period, the patient with arthrosis is referred for physiotherapy. The series of exercises depends on the stage of arthrosis.
In the stage of exacerbation of arthrosis, medication involves the appointment of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of arthrosis includes chondroprotectors and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation, and eliminate muscle cramps, a patient with arthrosis is referred to physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet irradiation are prescribed, in the remission phase - electrophoresis with dimexide, trimecaine or novocaine, phonophoresis with hydrocortisone, inductothermia, baths, radidotin, paraffin, thermal processes. Electrical stimulation is performed to strengthen the muscles.
In case of destruction of joint surfaces, arthroplasty is performed with pronounced joint dysfunction.