Arthropathy is the most common joint disease. According to experts, 6, 43% of the population of our country suffers from it. Men and women suffer from arthritis just as often, however, among young patients there is a slight predominance of men and among the elderly - women. An exception to the general picture is arthropathy of the interphalangeal joints, which develops in women 10 times more often than in men.
With age, the incidence increases dramatically. According to studies, arthropathy is detected in 2% of people under 45 years, in 30% of people from 45 to 64 years and in 65-85% in people aged 65 and over. Arthropathy of the knee, hip, shoulder and ankle joints has the greatest clinical significance due to its negative impact on the standard of living and the ability of patients to work.
Causes
In some cases, the disease occurs for no apparent reason, such an arthropathy is called idiopathic or primary.
There is also a secondary arthropathy - which developed as a result of some pathological process. The most common causes of secondary arthritis are:
- Injuries (fractures, meniscus injuries, ligament ruptures, dislocations, etc. ).
- Dysplasia (congenital developmental disorders of the joints).
- Degenerative-dystrophic processes (Perthes disease, osteochondritis dissecans).
- Diseases and conditions in which there is increased mobility of the joints and weakness of the joint.
- Hemophilia (arthropathy develops as a result of frequent hemorrhage).
Risk factors for developing arthritis include:
- Old age.
- Overweight
- Excessive pressure on the joints or a specific joint.
- Joint surgeries,
- Hereditary predisposition (presence of arthropathy in the closest relatives).
- Endocrine imbalance in postmenopausal women.
- Neurodystrophic disorders of the cervical or lumbar spine (shoulder arthritis, lumbar-pelvic muscle syndrome).
- Repeated micro-injury of the joint.
Pathogenesis
Arthropathy is a multifaceted disease, which, regardless of the specific causes of its occurrence, is based on a violation of the normal formation and repair of cartilage tissue cells.
Normally, the articular cartilage is smooth and elastic. This allows the articular surfaces to move freely with each other, provides the necessary shock absorption and, therefore, reduces the load on adjacent structures (bones, ligaments, muscles and capsule). With arthropathy, the cartilage becomes rough, the articular surfaces begin to "stick" together during movement. The cartilage relaxes more and more. From this small pieces are separated, which fall into the joint cavity and move freely in the synovial fluid, injuring the synovial membrane. Small foci of calcification appear in the superficial zones of the cartilage. Osteoporosis areas appear in the deep layers. In the central zone, cysts form that communicate with the joint cavity, around which, due to the pressure of the intra-articular fluid, ossification zones are formed.
Pain syndrome
Pain is the most persistent symptom of arthritis. The most striking signs of joint pain are the connection with physical activity and the weather, night pains, initial pains and sudden acute pains combined with joint blockage. With prolonged exertion (walking, running, standing), the pain intensifies and they calm down. The cause of nocturnal pain in arthritis is venous congestion, as well as an increase in intraosseous blood pressure. The pain is aggravated by adverse weather factors: high humidity, low temperature and high atmospheric pressure.
The most characteristic sign of arthropathy is the initial pain - pain that appears during the first movements after a state of rest and disappears while the motor activity is maintained.
Symptoms
Arthropathy develops gradually, gradually. Initially, patients worry about mild, short-term pain without clear localization, exacerbated by physical exertion. In some cases, the first symptom is stinging during movement. Many patients with arthritis report joint discomfort and transient stiffness during the first movements after a period of rest. Then the clinical picture is complemented by nocturnal and weather pains. Over time, the pain becomes more and more intense, there is a noticeable restriction of movement. Due to the increased load, the joint on the opposite side begins to ache.
Periods of exacerbations alternate with recessions. Exacerbations of arthritis often occur against a background of increased stress. Due to the pain, the muscles of the limbs break reflexively, muscle contractions can form. The stinging in the joint becomes more and more stable. At rest, muscle cramps and muscle and joint discomfort occur. Due to the increasing deformity of the joint and the severe pain syndrome, lameness occurs. In the later stages of arthropathy, the deformity becomes even more intense, the joint bends, the movements in it are significantly limited or absent. Support is difficult; when moving, a patient with arthritis must use a cane or crutches.
Diagnostics
The diagnosis is made based on the characteristic clinical signs and the x-ray of the joint. X-rays are taken of the affected joint (usually in two projections): with knee arthroplasty - knee joint radiograph, with coxarthrosis - hip joint radiograph, etc. X-ray of the joint consists of signs of dystrophic changes in the area of articular cartilage and adjacent bone. The clearance of the joint narrows, the position of the bone is deformed and flattened, cystic formations, hypochondriac osteosclerosis and osteophytes are revealed. In some cases, with joints, signs of joint instability are identified: curvature of the limb axis, subluxation.
Taking into account the radiological points, specialists in the field of orthopedics and traumatology distinguish the following stages of arthropathy (Kellgren-Lawrence classification):
- Stage 1 (doubtful arthropathy) - suspected narrowing of the joint space, osteophytes are absent or present in small numbers.
- Stage 2 (mild arthropathy) - a suspicion of narrowing of the joint space, osteophytes are clearly defined.
- Stage 3 (moderate arthropathy) - clear narrowing of the joint space, there are clearly strong osteophytes, bone deformities are possible.
- Stage 4 (severe arthropathy) - 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 the joint. For the study of bone structures, a computed tomography of the joint is performed, for the evaluation of the condition of the soft tissues - MRI of the joint.
Treatment
The main goal of treating patients with arthritis is to prevent further cartilage destruction and to maintain joint function.
During the period of remission, a patient with arthritis is sent to physiotherapy. The totality of the exercises depends on the stage of the joint.
Drug treatment in the exacerbation phase of arthropathy involves the appointment of non-steroidal anti-inflammatory drugs, sometimes in combination with sedatives and muscle relaxants.
Long-term use of arthropathy includes chondroprotectants and synovial fluid prostheses.
To relieve pain, reduce inflammation, improve microcirculation and eliminate muscle spasms, a patient with arthritis is referred for physiotherapy. In the exacerbation phase, laser therapy, magnetic fields and ultraviolet radiation are prescribed, in the remission phase - electrophoresis with dimexid, trimecaine or novocaine, phonophoresis with hydrocortisone, induction heat, thermal processes (ozokerite, paraffin, paraffin). Electrical stimulation is performed to strengthen the muscles.
In case of destruction of articular surfaces with severe joint dysfunction, arthroplasty is performed.