Arthritis is a joint pathology accompanied by damage to cartilage tissue. Synonyms for arthrosis are gonarthrosis, osteoarthrosis deformation, osteoarthritis - all these terms mean the development of a degenerative process in the cartilage that covers the epiphysis of the articular bone.
Despite the fact that the lesion affects only the cartilage structure, all articular elements are affected - the capsule, synovial membrane, subchondral bone, as well as the ligaments and muscles surrounding the joint. Arthritis can affect one or several joints.
The most common localized forms of the disease have their own names: arthrosis of the hip joint is called coxarthrosis, arthrosis of the knee joint is called gonarthrosis.
Classification and causes
Knee arthrosis can be primary or secondary. The first group includes pathologies whose cause has not been established, that is, they are idiopathic. Secondary arthrosis occurs after injury, due to congenital anomalies and against the background of systemic diseases.
The following are the causes of arthrosis of the knee joint:
- autoimmune pathologies - rheumatoid arthritis, lupus erythematosus, scleroderma, etc. ;
- joint inflammation caused by certain infections (syphilis, gonorrhea, encephalitis);
- Hereditary diseases of the musculoskeletal system and joints, type 2 collagen mutations.
There are also several factors that have a negative effect on the joints and can trigger pathological changes in them:
- old age, overweight, osteoporosis;
- hormonal changes, including a decrease in estrogen synthesis during the menopause period in women;
- metabolic diseases;
- lack of microelements and vitamins in the diet;
- congenital and acquired defects of the skeleton;
- hypothermia and intoxication with toxic compounds;
- persistent injury to the joint during sports training or hard work;
- operations on the knee joint - for example, to remove the meniscus.
Symptoms and stages
Deformation of arthrosis of the knee joint is characterized by intracellular changes at the morphological, molecular, biochemical and biomechanical levels. The result of the pathological process is softening, fibers and a reduction in the thickness of the articular cartilage. In addition, the surfaces of the bones forming the joints become denser, and bone spines - osteophytes - appear on them.
DOA of the knee joint develops in 3 stages, and in the early stages it may only show minor pain and discomfort after prolonged physical activity. Sometimes one of the characteristic symptoms of arthrosis appears - morning stiffness. During this time, changes occur in the synovial membrane and the composition of the intra-articular fluid.
As a result, cartilage tissue does not receive enough nutrients, and its ability to withstand pressure begins to decrease. Therefore, with intense exercise and long walks, pain occurs.
In the second stage of arthrosis, the destruction of cartilage tissue takes place, and part of the increased load is taken by the articular surface of the bone. Since there is not enough area for support, the edges of the bones grow due to osteophytes. The pain no longer goes away during rest, as before, and bothers me even at night.
Morning stiffness also increases, and it takes a long time to "train" the legs so that you can walk normally. In addition, when the limb is bent, a cracking and clicking sound is heard, accompanied by a sharp pain. It is not always possible to fully bend the leg; it seemed stuck, and further attempts ended in cramping and rough pain.
Due to the occurrence of pain during any movement, a person tends to move less, which has a negative effect on the muscles around the joints. Changes in the size of the bone epiphysis lead to axial displacement of the limb and the development of deformities. The joint capsule becomes stiffer as the volume of fluid inside decreases. When osteophytes compress the surrounding soft tissue, synovitis and chronic inflammation appear.
When moving to the 3rd stage, the signs of arthrosis of the knee joint become very severe - the pain does not go away even at night, the motor ability practically stops, the legs seem bent and not bent. The third stage of arthrosis is characterized by an X or O-shaped deformity, which makes it very difficult to move. Advanced forms of deformed gonarthrosis can only be treated surgically.
Diagnostics
The diagnosis of osteoarthritis of the knee joint is not very difficult; a doctor can assume gonarthrosis based on existing symptoms and characteristic visual signs. To confirm the diagnosis, an x-ray is performed. Images will show narrowing of the interarticular space, bone growth and subchondral osteosclerosis of the bone.
X-rays are used to determine the cause of the disease. Bone deformation is especially evident in post-traumatic arthrosis. If cartilage degeneration is caused by arthritis, then defects along the edges of the bones are detected, as well as periarticular osteoporosis and atrophy of the bone structure. With various congenital anomalies, axial distortion of one of the bones is observed, which leads to improper load distribution and the occurrence of secondary osteoporosis.
Treatment
Treatment of gonarthrosis of the knee joint has 3 main goals - restoration of cartilage tissue, increased mobility in the joint and slowing down the progression of the disease. Great importance is attached to the elimination or weakening of symptoms - reducing the intensity of pain and inflammation. To solve this problem, drugs, physiotherapy, and exercise therapy are used. To obtain the maximum effect of therapy, dosed physical activity and compliance with the orthopedic regimen is necessary.
Drug treatment of knee arthrosis includes taking painkillers and anti-inflammatory drugs, as well as chondroprotectors that promote the regeneration of cartilage tissue. Medicines can be prescribed in the form of injections, tablets, ointments and gels.
If knee arthrosis of the first degree is diagnosed, then physiotherapeutic methods, physical therapy and massage are used in treatment. The early stages of the disease are easier to treat, and you can expect a full recovery. An important condition is to lose weight to reduce the load on the painful joints.
Treatment of knee joint arthrosis of the second stage should include exercise therapy, wearing orthopedic devices and following a diet. To relieve pain, non-steroidal anti-inflammatory drugs, chondroprotectors and intra-articular injections of hyaluronic acid are prescribed.
Acute arthrosis is characterized by severe pain, for which conventional NSAIDs are insufficient. In this case, strong analgesics and glucocorticosteroid injections into the joint cavity are used.
If conservative methods are ineffective, an operation is performed, which can be either corrective or radical (replacing the joint with a prosthesis).
Deformative arthrosis of the knee joint of the third degree is characterized by the complete absence of the interarticular space, replaced by bony structures. This situation requires surgical intervention, because other methods are not powerful in this case.
NSAIDs and corticosteroids
To save the patient from physical and mental suffering, therapy for acute arthrosis begins with pain relief. Drugs that are part of the NSAID group and can be used in tablets or topically have proven themselves to be effective.
The analgesic effect does not always occur immediately, but after two or three days it reaches its peak, and the pain disappears. The course of treatment with NSAIDs is limited to two weeks, because longer use increases the risk of side effects. Special attention should be paid by people who have problems with the gastrointestinal tract, as well as those who suffer from high blood pressure.
If there is no result, hormonal drugs are prescribed to relieve inflammation. In the case of left-sided gonarthrosis, the drug is injected into the left knee, the right - into the right.
Hormone injections can be given once every 10 days, no more often. The indication for such treatment is a large accumulation of fluid in the joint due to inflammation. When the symptoms subside, they switch to the tablet form of the drug.
Chondroprotectors and hyaluronic acid
Chondroprotective agents work in three directions - they restore damaged cartilage tissue, reduce pain and eliminate inflammatory reactions. Taking chondroprotectors helps normalize the composition and properties of synovial fluid, nourishes cartilage and protects pain receptors from irritation.
As a result, the destruction of the cartilage structure and, as a result, the progression of the disease slows down. After taking the drug, the function of shock absorbers and joint lubrication is restored.
In the early stages of the disease, chondroprotectors can be used in the form of ointment or gel. However, intra-articular injection is the most effective. Modern methods of treating arthrosis include the use of combined agents, which contain not only chondroprotective substances, but also anti-inflammatory components and vitamins.
Hyaluronic acid is the main component of synovial fluid, responsible for its viscosity and consistency. This is, in fact, a biological lubricant that provides cartilage with elasticity, elasticity and strength.
With the development of joint pathology, the amount of hyaluronic acid can decrease by 2-4 times, which necessarily leads to excessive bone friction. With intra-articular hyaluron injection, knee function becomes normal, and the person can move normally.
Surgery
Surgery is a radical method in which joint function is partially or completely restored. The level of intervention can be different and depends on the stage of arthrosis. The most gentle operation is arthroscopy - the recovery period after its implementation is the least painful for the patient.
Important:arthroscopy can be performed not only for treatment, but also to diagnose articular pathology. This procedure allows you to identify damage that cannot be accessed by other studies.
The goal of arthroscopy is to prolong the life of the joint by removing dead and damaged tissue from the joint cavity. As a result, pain disappears, resistance to stress increases, and motor activity returns.
In the case of a significant deformity, osteotomy is indicated - creating an artificial bone fracture in a certain area. Osteotomy of the knee literally means "cutting the bone" - during the operation, the surgeon removes a wedge-shaped segment of the femur or tibia, then fuses the bones in the most physiological position. If necessary, the resulting gap is filled with bone graft. During the healing period, the structure is secured with special clamps.
Endoprosthesis replacement is an alternative method to the outdated arthrodesis procedure, the essence of which is to replace part or all of the diseased joint with a prosthesis. As a result, knee function is fully restored in more than 90% of cases, significantly improving the patient's quality of life.
Physiotherapy
Physiotherapeutic procedures play an important role in the treatment of arthrosis, because of their beneficial effects on damaged joints. Physical therapy courses accelerate the regeneration process, eliminate pain and muscle spasms. In addition, certain procedures allow the administration of drugs through the skin, thereby reducing the dose of oral drugs.
For damaged joints, the following techniques are recommended:
- magnetic therapy;
- mid-wave ultraviolet (WUV);
- infrared laser;
- UHF;
- ultrasound;
- diademic and sinusoidal modulated current (amplipulse therapy);
- Darsonval.
Effective procedures for arthrosis are also therapeutic baths - radon, hydrogen sulfide, bischofite, minerals and sage. They have anti-inflammatory, analgesic and restorative effects on the joints.
Finally
If you suspect knee arthrosis, you should consult an orthopedic doctor or traumatologist who diagnoses and treats this pathology. In order not to worsen the disease, it is necessary to avoid excessive physical activity on the legs and get rid of excess weight.
There is no special diet for arthrosis, but it is recommended to avoid thick meat and fish soups, fatty meats and smoked meats, and also reduce the use of table salt. The diet should be dominated by foods rich in vitamins and minerals and vegetable oils. In addition, once a week it is advisable to arrange a fasting day - kefir, cottage cheese or fruits and vegetables.
To strengthen the muscle corset of the lower leg and improve blood flow, it is necessary to regularly perform therapeutic exercises, which are individually selected by the physical therapy instructor.
Therefore, taking medicines, physical procedures, a balanced diet and physical exercise are the ones that will definitely help arthrosis patients. And to avoid traumatic surgery, you should seek medical help as early as possible. So healthy!