Arthritis

Arthritis – simply put, what is it?

Arthritis is a chronic disease in which gradual destruction of the cartilage occurs. Pathological changes affect the underlying bone, causing it to become more compact and develop cell growth at the edges (osteoporosis). The joint capsule reacts to events and reactive vasculitis develops.

About the disease and possible complications

The incidence of the disease depends on age. The first signs of arthritis usually appear no earlier than 30-35 years old, and by age 70, about 90% of the population suffers from this disease. OA did not show any sex differences. The only exception is degenerative lesions of the interphalangeal joints. This form of the disease is 10 times more common in women than in men. Arthritis often affects large joints in the legs and arms.

The pathological process begins in the interstitium of cartilage tissue, which consists of type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitium is maintained by balancing anabolic and catabolic processes. If the process of decomposition of cartilage tissue dominates its synthesis, it will create conditions for osteoarthritis to develop. This explains in simple terms what arthritis is.

Usually, the first signs of the disease develop in places subjected to the greatest mechanical load, with limited appearance of soft areas of cartilage. As the pathological process progresses, cartilage fragments and cracks may occur and local calcium salt deposition may occur. Following a cartilage defect, the underlying bone is exposed, loose pieces of cartilage enter the joint cavity and can lead to "joint jamming" (symptoms of "joint rat").

Damage to the cartilage lining the articular processes of the bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, when moving, the joint surface is subjected to non-physiological loads. In response to this, compensatory resynthesis is stimulated in bone tissue. The bones become denser (subchondral sclerosis develops) and irregularly shaped bone spurs (osteophytes) appear, which further changes the differences between the joint surfaces. The development of pathological changes gradually limits the range of motion of the joint and contributes to the development of complications in the form of muscle contractures (secondary muscle spasms that occur in response to pain).

Arthritis becomes the basis for the development of synovitis - inflammation of the synovial membrane of the joints. This is due to the fact that dead pieces of cartilage and bone activate leukocyte phagocytosis, which is accompanied by the release of inflammatory mediators. Over time, such prolonged inflammation is accompanied by hardening of the tissues around the joint - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthritis is pain, which over time is accompanied by limited mobility in the joints. Restrictions in mobility are due first of all to compensatory functional properties, and then to organic changes. Additional imaging methods (X-ray, ultrasound, computed tomography or magnetic resonance imaging) help determine the exact diagnosis.

Depending on the stage and extent of osteoarthritis, treatment can be performed using conservative or surgical methods. The orthopedic traumatologist will help you choose the optimal treatment program taking into account the individual characteristics of the patient.

Types of joint diseases

There are 2 types of joint diseases:

1. The main variation is a consequence of a violation of the relationship between synthetic and degenerative processes in cartilage tissue and is accompanied by dysfunction of chondrocytes - the main cells of cartilage.
2. Secondary variations occur in a previously modified joint when the normal relationship (uniformity) of the joint surfaces is broken, followed by a redistribution of loads on them and concentration of pressurein certain areas.

Symptoms of arthritis

The main symptom of arthritis is pain. It has a number of distinctive features that allow for the correct diagnosis of the disease.

1. Mechanical pain, caused by the loss of shock-absorbing properties of cartilage. Pain occurs with physical activity and subsides with rest.
2. Night pain.The cause is venous blood stagnation and increased pressure of blood flowing into the bones.
3. Starts to hurt.It is short-lived and appears in the morning when a person gets out of bed (the patient says that he needs to "disperse"). These pains are caused by debris deposited on the cartilage plates. When moving, these debris are pushed into the inverted joints so the discomfort stops.
4. Meteor dependence.The pain may increase with changes in weather conditions (increased atmospheric pressure, cold weather, excessive humidity).
5. Pain blockade.These are sudden painful sensations that are associated with the compression of a piece of bone or cartilage between joint surfaces. Against the background of "blockade", the slightest movements in the joint stop.

The nature of the pain changes slightly when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person feels uncomfortable due to stiffness. Signs of the inflammatory process are determined objectively - swelling and increased local skin temperature.

Osteoarthritis often begins gradually with pain in an affected joint. At first, the pain only bothers you during physical activity, but then it appears even at rest and at night. Over time, pain also appears in the joints on the opposite side, which is associated with an increase in compensatory load. An important distinguishing feature of arthritis is its frequency, when short periods of exacerbation are followed by periods of remission. Progression of the pathological process is indicated by shortening the time to relapse and the development of adverse consequences in the form of contractures and marked limitation of joint mobility.

Arthritis during pregnancy

During pregnancy, arthritis can occur in many different ways. Usually, by the 12-13th week, the pathological process can worsen, which is associated with hormonal changes occurring in the woman's body. The second and third trimesters are usually relatively stable. Management of pregnancy is performed by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of arthritis

The main mechanism causing cartilage destruction is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthritis is preceded by a period of metabolic disorders, which occur covertly. This metabolic imbalance is characterized by the destruction of proteoglycans and their constituent components (chondroitin, glucosamine, keratan), accompanied by the breakdown and breakdown of the cartilage matrix. Collagen fibers are broken in the cartilage plate, the supply of metabolites necessary for life is interrupted, and the water balance also changes (first the cartilage is hydrated, then the number of water molecules decreases sharply, which causesThis further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of defective proteoglycan molecules and short collagen fibril chains. These defective molecules do not bond well with hyaluronic acid so they quickly leave the mold. With arthritis, a "burst" of cytokines is also observed - the released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate synovial inflammation.

The main causes of joint disease can be different:

• "excess" weight, which increases the load on the joints;
• wearing poor quality shoes;
• concomitant diseases of the musculoskeletal system;
• have joint injury.

Signs and diagnosis of arthritis

Based on clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are performed.

1. X-ray.In the early stages, X-ray signs of the disease are of little significance - these may be uneven narrowing of the joint space, slight compression of the underlying bones and small cysts in this area. At a later stage, radiography gives more information - growth of the marginal bone appears, the shape of the joint surface changes, joint "rats" and areas of calcification in the joint capsule can be identified. .
2. Joint ultrasound.Ultrasound scans are more informative for detecting early signs of joint disease. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate, and secondary reactions of the joint capsule, musculotendinous compartments and ligaments may be seen.
3. Magnetic or nuclear tomography.The diagnosis of this joint disease is carried out in complex clinical cases, when it is necessary to make a detailed assessment of the condition of the cartilage plate, the subchondral area of the bone and determine the volume of synovial fluid, including the joint. in joint inversion.

Expert opinion

Joint deformity is one of the most common pathologies of the musculoskeletal system, occurring in 10-15% of the world's population. The insidiousness of the disease is that it develops slowly and gradually. At first, these are short-term pain in one joint that a person usually does not pay attention to. Gradually, the severity of the pain syndrome becomes more intense, while the cyclical nature of the pain turns into continuous. In the absence of treatment, the disease continues to progress and is accompanied by severe cartilage degeneration, which no longer responds to conservative therapy and to solve this problem only joint surgery is needed - a complex and expensive intervention. poor to replace the destroyed joint with a complete one. - official implantation. However, targeted drug therapy and lifestyle modifications can help significantly delay this activity or avoid it altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Treatment of arthritis

According to clinical guidelines, the main goal of arthropathy treatment is to slow the progression of degenerative cartilage lesions. To achieve this, measures are taken to reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to prevent the development of secondary synovitis.

Conservative treatment

Joint dismantling is carried out in the following ways:

• reduce body weight (if excess);
• carry out physiotherapy excluding prolonged similar positions;
• Refusal to lift heavy objects or kneel for long periods of time (associated with some occupations).

In the early stages of the disease, in addition to physiotherapy, swimming and cycling are very useful. In later stages, to reduce the load on the joints during an exacerbation, it is recommended to walk with an orthopedic cane or use crutches.

For pain relief, incl. In the setting of secondary synovitis, nonsteroidal anti-inflammatory drugs are used, both locally and systemically. Intra-articular corticosteroid injections can be used for the same purpose.

To improve the anatomical and functional state of the cartilage plate, chondroprotector preparations and hyaluronic acid are used, which are injected into the joint cavity. They help improve the metabolism of cartilage tissue, increase the resistance of cartilage cells to damage, stimulate anabolism and prevent catabolic reactions. This allows you to slow down the progression of the pathological process and improve joint mobility.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

• Joint puncture- Indicated for severe reactive synovitis. It not only allows the removal of inflammatory fluid, but also introduces corticosteroids that interrupt the pathological chain.
• Arthroscopic surgery, involves inserting instruments into the joint cavity through small punctures and then displaying them under magnification. These interventions make it possible to wash the joint and its inversions, level the cartilage plate, remove necrotic areas, "polish" the joint surface, etc. v.
• Endoscopic– is considered a radical operation, performed in case the pathological process progresses. Often used for knee or hip arthritis.

Prevent arthritis

Prevention of joint disease is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding work with the knees, lifting heavy objects in a dosage manner and complying with a physical activity regimen.

Rehabilitation for osteoarthritis

Rehabilitation for arthritis includes a variety of procedures that can improve the functional state of joints and surrounding tissues. Physical therapy, massage therapy and health promotion exercise are used.

Questions and answers

Which doctor treats arthritis?

Diagnosis and treatment are performed by an orthopedic traumatologist.

Does X-ray always allow for an accurate diagnosis?

The severity of clinical signs of arthritis does not always correlate with radiographic changes. In practice, there are often cases when, when there is severe pain, X-rays do not show significant changes, and vice versa, when a "bad" X-ray picture is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for joint disease?

If osteoarthritis is suspected, arthroscopy is usually performed not to confirm the diagnosis but to look for possible causes of dysfunction of the joint (eg, damage to the meniscus of the joint). knee joint and ligaments in the joint).