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Arthrosis

Arthrosis of the ankle joint

Arthosis is an entire group of dystrophic depths of the joint system with various etiology, but a similar clinical picture of pathological changes.The cartilage IALINA of the joint, therefore the drunk bone tissue, the capsule of the joint and the binding system, are exposed to destruction and deformation.The disease is progressive chronic and without adequate treatment can significantly limit the patient's motor activity.

The diagnosis and treatment of pathology are engaged in an arthrologist, rheumatologist, surgeon, orthopedist.



General information

Arthosis is diagnosed in about 1/5 of the planet's population, but the disease is more characteristic of the elderly.This demonstrates the statistics of its diffusion between different ages:

  • Young people up to 40 years, no more than 6-7 %;
  • Mature faces after 45 years at 20-25%;
  • After 70 years - up to 80%.

The disease affects the tissues that are under a constant load: small joints of the hands and more than the legs, joints of the hip and knee, the areas in the cervical and chest parts of the spine, a little less often to the ankle and the shoulder joint.

Note! The defeat of the interfaces of the hands in women takes place 10 times more often than men.

In many Western countries, the term "arthrosis" is not used, replacing it with the concept of "arthritis".This replacement is quite justified, since in most cases the inflammatory processes precede arthrosis or accompany it.In domestic medicine, the terms "arthrosis" and "arthritis" essentially mean the same disease, but with different etiology of the process.In addition, the concepts of osteoarthritis, osteoarthritis, deforming of osteoarthritis are used to designate the pathology.

Note! The difference between arthritis and arthrosis lies in the cause of the disease.In the first case, these are inflammatory processes (suffix -in means inflammation), in the disorders of the second -metabolic (protein, mineral). 

The development mechanism and the causes of osteoarthritis

The main cause of arthrosis is a violation of the balance in the processes of anabolism and catabolism of cartilage and bone tissues.If the synthesis processes normally prevail during the changes in arthrose, the processes of destruction go faster.Consequently, rapid aging and degeneration of tissue structures is observed.They begin to collapse first at cellular level, then to the organ tone.The first destructive changes appear:

  • ADBODUCTION OF CARTILLY;
  • Superficial storagity;
  • microocack and tears;
  • The focal and general thinning of the cartilage layer.

Cartilage loses natural elasticity and density and is no longer able to serve as shock absorber during movements.The mutual correspondence of the shape of the joint surfaces is disturbed, which leads to the deformation of the connection.This aggravates the development of pathological changes and triggers a series of irreversible processes.In exchange for the lost cartilage, the bone tissue begins to grow with the formation of peaks and extensions, which chain movements and subsequently can lead to a serious disability of the patient.

Reasons why scenario:

  • The violations of mineral metabolism are able to lead to gottic changes in the joints, osteoporosis, etc.
  • The disadvantage of tissue nutrition is venous stagnation and poor microcirculation slows down the flow of blood and lymphatic drainage.The mineral composition of the bone is depleted, becomes osteoporous and loses the ability of car -heal.The phenomenon is characteristic of a lack of movement, with vascular diseases, hormonal failures.
  • Inflammatory processes: a consequence of acute infectious diseases, body hypothermia, compromised hormonal background.
  • Autoimmune reactions are chronic outbreaks of inflammation, nervous stress, endocrine pathologies and other causes can cause the aggression of the body's immune system against their cells, including joint tissues.The most common autoimmune lesions with rheumatoid arthritis, scleroderma and red lupus.
  • Increase of joint wear: a failure to correspondence between functionality and loading latient slows down the synthesis processes and accelerates destruction.The phenomenon is characteristic of athletes, dancers, people with overweight, as well as for all those who are engaged in heavy physical work or is associated with long static loads (standing work).
  • Injuries - bruises, dislocations, fractures, penetrating wounds, tears - violate the structure of tissues and damage to the beginning of the deformation.
  • Genetically determined pathologies - Dysplasia of the connective tissue, a violation of the synthesis of collagen initially constitutes an unstable and low articulation.

Some reasons are strictly echoed together and form a complex pathological complex.

Attention! Hormonal deviations play a particularly important role in the violations of the metabolism of bone tissues.A failure in the thyroid gland, in menopause, in the taking of contraceptives, in corticosteroids - all this is a direct path for osteoporosis and arthrose changes in the skeleton.

Classification of changes

In the systematic of osteoarthritis, several criteria that define: causes and etiology, localization, coverage area are used.

For etiology:

  • Primary arthrosis - develops independently, with damage to completely healthy joints, without the participation of previous pathologies;
  • Secondary people are formed against the background of a disease (gout, psoriasis, rheumatism), as well as in the presence of deformations or existing joint injuries.

From the degree of coverage:

  • Local forms with damage to a limited number of joints: monoartrosis-1 articulation, oligoartrite-2-3;
  • Generalized forms are various types of polyartrosis, when 3 large structures and others are involved in the pathological process.

According to the location of the process, the names of the arthrosis of each articulation are given separately:

  • Coksartrosis: disable the hip connection;
  • Spondilartrosis - affects intervertebral discs, mainly cervical, chest and lumbar;
  • Gonartrosis - with alteration of the knee;one of the most common species;
  • Cruzartrosis - with the involvement in the pathological process of the ankle.

Arthosis can be quickly or slowly progressive, compensated or decompened.

The main symptoms and signs

Arthosis is a complex disease.Conventionally, it can be divided into different pathologies combined with each other:

  • Condrite and Condro - inflammatory and degenerative injury of the cartilage tissue;
  • Osteoporosis is also osteoporosis - a pathological process in bone structures;
  • Sinovite - the involvement of the coating shell of the joint capsule;
  • Bursit - General inflammation of the joint bag;
  • They reactive to soft fabrics in the adjacent area - affects the muscles, ligaments, fiber.
Stock and pain in the arthrosis of the joints of the hands

Depending on the stadium, degree and form, they are observed simultaneously or selectively.With this in mind, a complex of symptomatic changes is formed.Among them:

  • Pokhrutzhazing is a symptom of a violation of mineral metabolism and the first sign of the disease.It can happen at any age.
  • Stock: Intensely manifested in the morning.It is short and can be expressed by the Jaming effect of the joint.
  • Limit mobility - reduce the amplitude of movements in the Commission of active or passive actions.
  • Pain-has a different manifestation, starting from unpleasant and painful, which, after intense loads, acquire a background character and end with acute and sharp movements.The "starting pains" so called are particularly characteristic, which occur after a long period of rest and last until the articulation is completely developed.
  • SPERAZZA - With inflammation of the soft tissues, synovitis, Borsite.
  • Deformation - It is observed with the complete degeneration of the cartilage and the lack of a shock factor.

Note! The nodules of Bushara and Geberden are a characteristic sign of the deformation of the clay of the hands.They are bone growths with osteophytes processes.

Phase and degree of arthrosis

In terms of intensity of the changes in arthrose, 4 phases of the disease are distinguished:

  • 1st stadium - with a slight ri -fluttutante of the cartilage (violation of the structure and functionality in the collagen fibers).In the X -ray, the image is not practically visible.
  • PHASE 2 - The burning of the cartilage tissue in the articulation lumen is up to 50%.It is covered by crepe, it appears a slight pain in the area of the damaged compound.Osteophytes complexes appear on the X -ray;The joint gap slightly reduces its size.
  • PHASE 3 - The cartilage injury reaches almost the bone base, the joint gap is strongly reduced.
  • 4 stadiums: the cartilage is completely damaged, which leads to partial or complete degeneration of the synovial fluid, abrasion of bone tissues on each other and the deformation of the compound.In some areas, changes of sclerosis develop.The extreme manifestation of arthrosis is the fusion of joint tissues with the ossification of the structures and a complete loss of mobility.

In some sources, stadium 1 and 2 are combined in one.

With the progress of symptoms, the motor activity of a person suffers.Given the violations of the functional performance of the joint, 4 degrees of possible development of the pathology are distinguished:

  1. 0 degrees: mobility and performance are preserved in full;
  2. 1 degree: the patient maintains the ability of cars -service and manifest social activity, but is unable to engage in work;
  3. 2 degrees - The difficulties in the manifestation of social activity are added to a violation of the activity of work;
  4. 3 degrees: all types of activities are limited or completely impossible: work, social and self -service;The patient needs constant care.

What are the possible complications

Stilling the treatment, you can cause a series of unpleasant consequences:

  • constant pain syndrome;
  • zoppa;
  • vertebrates (with spondylartosis);
  • Pronounced joint deformation;
  • Complete immobility with the ossification of the structures.

What the survey procedure includes

For the diagnosis of arthrosis, a medical examination is sufficient with the collection of aamnesis.To determine the degree of damage, an instrumental examination is carried out.The main ways to obtain a clear picture of the disease:

  • X -ray;
  • CT, MRI;
  • ultrasound;
  • scintigraphy;
  • Diagnostic arthroscopy with biopsy of cartilage tissue and synovial fluid.

In an acute inflammatory process, the doctor prescribes additional analyzes: a general blood test, reumen, biochemistry (glucose level, protein compounds, electrolytes).

Treatment

It is impossible to completely eliminate the disease.The timely treatment of arthrosis allows to maintain the functionality of the joint, normal motor activity and preventing pain.To exclude complications, it should start at the first stadium.

Drug therapy Includes:

  • Anti -inflammatory drugs, mainly fans;
  • blocks of intra -articular steroids of pain and inflammation (with pronounced synovitis, Borsite);
  • Proteolysis inhibitors: slow down and suspend the process of destruction of bones and cartilage;
  • Antispasmodic: prevent muscle cramps;
  • Angioprotectors and drugs to improve blood microcirculation in the fabrics concerned;
  • chondroprotectors;
  • Synthetic substitutes for synovial fluid;
  • Vitamin and mineral compositions.
Physical exercise therapy for the treatment of arthrosis of the joints

A physiotherapy complex prescribed in parallel to improve the effect of drugs.Main physiotherapy: 

  • magnetotherapy;
  • electrophoresis;
  • Uhf;
  • mud;
  • bathrooms;
  • massage;
  • Exercise therapy and kinesiotherapy with special simulators.



Surgery - The only way to treat in the following stages, when the cartilage fabric is completely destroyed.The following solutions to the problem are possible:

  • Endoscopy - with a partial or complete replacement of the joint from an artificial analogue;
  • Artroscopy: a minimally invasive operation to remove osteophytes or partial replacement of cartilage;
  • ARTRODESI: the closure of the joint and the fixing in the most convenient position;The joint surfaces connected properties grow over time.

Forecast 

Arthosis does not threaten the patient's life, but the lack of treatment can significantly limit freedom of movement and worsen the quality of life.Timely and competent therapy in the early stages can restore the articulation in a healthy state.In other cases, only a slowdown in the degeneration process is possible with the help of conservative treatment and compensation for the lost functions due to prostheses.

Disease prevention

A complete recovery is almost impossible, therefore, prevention should be paid to particular attention.The main requirement is a healthy lifestyle and complete treatment of inflammatory processes:

  • Do not allow hypothermia and treat infectious diseases in a timely manner;
  • Avoid physical overload and long static loads;
  • maintain normal body weight;
  • Adhering to the right diet: the balanced composition of vitamins and minerals is very important for the health of the musculoskeletal system;
  • Completely (if possible, up to complete recovery), treat any damage to the joints;
  • Practice systematic physical exercises to stimulate blood circulation (bicycle, excursions, light jogging, Scandinavian walk).

If you are at risk (elderly age, poor inheritance, physical overload) be sure to undergo a regular radiographic examination.