Osteoarthritis is a chronic progressive joint disease with gradual destruction of cartilage, increasing pathological changes in the capsule, synovial membrane, adjacent bones and ligaments. It is manifested by pain, morning stiffness and limitation of mobility. Over time, the symptomatology worsens, and in later stages there are severe impairment of the function of the limb. Diagnosis is made on the basis of anamnesis, examination data and the results of X-rays. Treatment is usually conservative, including physical therapy, anti-inflammatory drugs, physical therapy, and blockades. If the articular surfaces are destroyed, endoprosthetics is performed. Bi–Profenid may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Bi–Profenid with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Osteoarthritis is a chronic disease in which progressive degenerative-dystrophic changes develop in the joint due to metabolic disorders. It is the most common joint pathology, diagnosed in 6-7% of the population. With age, the incidence of the disease increases sharply. The disease is detected in 2% of people under 45 years of age, in 30% – from 45 to 64 years, and 65-85% – at the age of 65 years and older. Arthrosis of large and medium-sized limb joints has the greatest clinical significance due to its negative effect on patients’ quality of life and working ability.
Causes of osteoarthritis
In some cases, the disease occurs for no apparent reason and is called idiopathic or primary. There is also secondary arthritis – developed as a result of some pathological process. The most common causes of secondary arthritis:
Injuries: fractures, meniscus injuries, ligament tears, dislocations.
Dysplasias: Congenital dislocation of the hip, congenital anomalies of the knee and ankle joints, upper extremities.
Connective tissue weaknesses: diseases and conditions in which there is increased joint mobility and weakness of the ligamentous apparatus.
Autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus.
Non-specific and specific inflammation: acute purulent arthritis, tuberculosis, etc.
Metabolic disorders and some endocrine pathologies.
Degenerative-dystrophic processes: Perthes disease and other osteochondropathies, dissecting osteochondritis.
Diseases of the blood system: hemophilia, accompanied by frequent bleeding into the joint.
Risk factors for arthritis include:
Older age, endocrine imbalances in postmenopausal women.
Excessive weight (with obesity, due to increased stress, the joint is constantly overloaded and the articular surfaces “wear out” prematurely).
Excessive strain and repetitive micro-traumas due to conditions at work, improper training (especially with a history of joint injuries), certain illnesses, and the consequences of illness and injury
Intra-articular interventions, especially highly traumatic operations with removal of a large amount of tissue, resulting in incongruent articular surfaces and increased load on them.
Hereditary predisposition (presence of arthritis in the closest relatives).
Neurodystrophic disorders in the cervical or lumbar spine (scapulopathy, lumbosacral muscle syndrome).
Osteoarthritis is a polyetiological disease, which, regardless of the specific cause of its occurrence, is based on the disruption of the normal formation and repair of cartilage cells. Normal articular cartilage is smooth, elastic. This allows the articular surfaces to move freely in relation to each other.
With arthritis, the cartilage becomes rough, and the articular surfaces begin to “cling” to each other during movement. Small pieces of cartilage become detached, which get into the joint cavity and move freely in the joint fluid, injuring the synovial membrane. Small foci of calcification appear in the superficial areas of cartilage. In the deep layers, areas of ossification appear.
In the central zone, cysts are formed that communicate with the joint cavity, and ossification zones are also formed around them due to the pressure of the intra-articular fluid. Due to constant traumatization, the capsule and synovial membrane of the joint in arthritis thicken. The synovial membrane becomes tufted, and the capsule develops foci of fibrous degeneration.
Over time, the adjacent bone surfaces become deformed, and bony protrusions appear on their edges. Due to the increased stress in the ligaments and muscles, foci of fibrous degeneration arise. Increases the likelihood of damage to the ligamentous and muscular apparatus. With significant destruction of cartilage, movements are severely limited, and ankylosis may occur.
Symptoms of osteoarthritis
The disease develops gradually. In some cases, the first symptom is a crunch on movements, which is more pronounced in gonarthrosis and osteoarthritis of the shoulder joint. Many arthritis patients notice discomfort in the joint and transient stiffness in the first movements after a period of rest. But the most constant symptom of osteoarthritis is pain.
At first, patients are experiencing mild, short pains without clear-cut localization, which increase with physical exertion. Over time, the pain becomes more pronounced, and noticeable limitation of movements occurs. Because of the increased load, the joint begins to hurt on the opposite side. The most striking signs are:
Starting pain. Appears during the first movements after a resting state and passes with continued motor activity. It is caused by detritus, a film of components of destroyed cartilage that settles on the articular surfaces. When you move, the detritus moves from the cartilage to the articular joint capsule twists, so the pain disappears.
Relationship to physical exertion. Pain increases with prolonged exertion (walking, running, standing), and subsides at rest. This is associated with a decrease in the cartilage’s ability to provide cushioning during movement.
Relationship with the weather. Pain increases under the influence of adverse weather factors: high humidity, low temperature and high atmospheric pressure.
Nocturnal pain. Caused by venous congestion, as well as increased intraosseous blood pressure.
Joint blockages. Accompanied by sudden sharp pain. The cause of the blockage is impingement of the joint mouse, a piece of cartilage or bone lying loosely in the joint cavity.
Periods of exacerbations alternate with remissions. Exacerbations of osteoarthritis often occur against a background of increased stress, in this phase synovitis is revealed, accompanied by another pain – constant, aching, rasping, not dependent on movements. The pain causes reflex spasm of the limb muscles, which leads to limitation of mobility.
Other symptoms of arthritis
As the disease progresses, there is an increase in the already existing manifestations and the emergence of new symptoms due to the gradual destruction of the joint:
The crunching becomes more and more constant over time.
Muscle cramps and muscle and joint discomfort occur at rest.
Because of the growing deformity and pronounced pain syndrome, lameness develops.
At the late stage of coxarthrosis, the patient cannot sit because of restricted hip flexion.
When examining in the early stages, visual changes are not detected. The joint is of normal shape, and slight edema is possible. On palpation, mild to moderate tenderness is detected. Movement is almost complete. Later the deformity becomes more and more noticeable, palpation reveals pronounced soreness, and the patient, as a rule, clearly marks the most painful points.
The edge of the articular cleft is thickened. Movement is restricted, and instability in the joint is detected. Curvature of the limb axis can be detected. When reactive synovitis develops, the joint is enlarged, has a ball-shaped appearance, the soft tissues look “bulging”, fluctuation (sagging) is determined on palpation.
The main goal of treatment of patients with osteoarthritis is to prevent further destruction of cartilage and preserve the function of the joint. Therapy is long-term, complex, and includes both local and general measures. Usually carried out as an outpatient. In the period of exacerbation, especially in the later stages and in the development of persistent recurrent synovitis hospitalization is possible.
One of the main objectives of the orthopaedic doctor in the treatment of patients with arthrosis is to optimise the load on the joint. It is necessary to exclude prolonged walking, repetitive stereotypic movements, a long stay on your feet, prolonged stay in a fixed position and carrying heavy loads. Reducing body weight in case of obesity plays a huge role in minimizing the load on the articular surfaces.
During the remission period, the patient is referred to therapeutic physical training. The complex of exercises depends on the stage of arthritis. In the initial stages, swimming and cycling are allowed, with severe arthritis it is necessary to perform a specially designed set of exercises in a lying or sitting position. During the exacerbation of arthritis is prescribed half-bed rest mode. In later stages, walking with crutches or a cane is recommended.
Drug therapy is carried out in the acute phase of arthritis, selected by a specialist. Self-treatment is inadmissible because of the possible side effects (for example, the negative effect of non-steroidal anti-inflammatory drugs on the mucosa of the stomach). Therapy includes:
NSAIDS. Patients are prescribed diclofenac, ibuprofen and their analogues, sometimes in combination with sedatives and muscle relaxants. The dose is chosen individually, taking into account the contraindications. Along with oral medications, intramuscular injections and rectal suppositories are used.
Hormonal means. When reactive synovitis performed puncture of the joints with subsequent introduction of glucocorticosteroids. The number of GCS injections should not exceed 4 times during the year.
Chondroprotectors. Refers to drugs for long-term use. Injection of drugs into the joint is carried out according to a certain scheme. For local application, warming and anti-inflammatory ointments are used.
To relieve pain syndrome, reduce inflammation, improve microcirculation and eliminate muscle spasms, a patient with arthritis is referred to physical therapy:
In the acute phase. Laser therapy, magnetic therapy and ultraviolet irradiation are prescribed,
In the remission phase. Electrophoresis with dimexide, trimekaine or novocaine, phonophoresis with hydrocortisone are indicated.
In addition, use thermal procedures, sulfide, radon and sea baths. To strengthen the muscles, electric stimulation is carried out. In the remission phase may also apply gentle massage.
Surgery for arthritis is performed in the late stages of the disease, when severe complications develop, limiting the ability to work of the patient. They can be radical or palliative:
Radical interventions. If the articular surfaces are destroyed and the function is severely impaired, the joint must be replaced with an artificial implant. Most often endoprosthesis of the hip joint is performed, which allows to avoid severe disability of patients.
Palliative techniques. They are used for unloading the joint. In coxarthrosis, pervertebral osteotomy and fenestration of the broad fascia of the femur is performed; in gonarthrosis, arthrotomy of the knee joint with removal of nonviable sections of articular surfaces in combination with osteotomy and correction of the tibia axis is performed.
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