Knee arthrosis: symptoms, treatment

Among the diseases of the muscular system, osteoarthrosis is a frequency leader.It is believed that the majority of the planet's population up to the age of 60 has the initial signs of articular cartilage changes, and 14% already have manifestations of osteoarthrosis.The most common version of this disease is the osteoarthrosis of the knee joints.

Still, "arthritis" or "arthritis"?

Do not mix these two concepts.Arthrosis is the process of changing mainly joint structure, and arthritis is an inflammation that can occur both against the background of the "intact" structure and against the background of arthritis.

Changes in the arthritis bone can be compared, for example, with the growth of the knot in a tree baggage, which grows near the concrete fence and pressures on this fence with all its weight.

Normally, the bone surface opposite one another is separated by two layers of cartilage and meniscus (additional cartilaginous plates).In addition to the role of the "tampon" between the bones, the cartilage provides the bone slide and mechanical correspondence with each other.Meniscus, which, due to large or minor (but frequent) injuries, and also lose their elasticity, can be completely or partially broken.

With age, and especially in the presence of an inherited predisposition, the articular cartilage is thinner.That is why the bones of the buttocks and lower legs, which make up the knee joint with their edges, are approaching each other dangerously, and even the friction between them may arise.

Usually parallel to the thinning of the cartilage over the years, another unpleasant event occurs: the amount of intra -articular fluid decreases.This fluid is not just a purely mechanical "lubrication" of the joint from the inside.It provides bone, meniscus and joint food.Violation of "supplying" all these structures is a real disaster for union!

If there is a physical congestion of the joint, then bone outputs appear on the bone surfaces and begin to grow, more similar to the story or points.For the knee joint, such overloads will be lifting weights (including overweight of your body!), Knee accent physical work (for example, barking the garden), walking constantly on the stairs, running, wearing unpleasant shoes, flat feet and many more.It is now easy to imagine what is happening inside the knee joint during the development of arthrosis, and how it manifests itself in appearance.

How does it work together?

Each of us has seen the joint cartilage many times at the end, for example, chicken bone.Covers small bone contact areas.Under the articular cartilage is a subcondrial bone or anticipated.The human musculoskeletal system is regulated in a similar way.

Most persons of the person consist of bones, synovial (articular) shells and intra -articular fluid.

Happens what happens with joining arthritis?

Under the influence of all those loads that are already mentioned, there is a compression and increased bone growth, as a result, the increase in articular cartilage trauma.

The cartilage cartridge products formed due to the microtra fall into the synovial fluid.It is regulated by nature how many foreign substances are for the synovial shell and provoke its inflammation.The formation of synovial fluid is disturbed, which is usually a type of "carrier", similar to a continuous cycle of enrichment and blood purification.In addition, joint fluid becomes less than hyaluronic acid.It is worth telling about this acid.

Hyaluronic acid provides the viscosity of the synovial fluid, creates the "buffer effect" and "lubrication effect" between the bones, reducing their rubbing against one another.Thanks to this substance that the articular fluid in consistency resembles egg protein, not water.Another important role of hyaluronic acid is to ensure the distribution of nutrients from the articular fluid deep into the articular cartilage, as there is nowhere to take food in it: blood vessels are not directly suitable with cartilage.In the same way, the "spent" substances are removed from the cartilage to the joint fluid: using hyaluronic acid molecules.

So an enlarged bone seal occurs and unbearable conditions for articular cartilage are created.

The jump receives a signal to adapt to these extreme conditions, and its change begins, in another way it is called remodeling.This is mainly manifested by a decrease in cartilage elasticity.

In the late stage of arthrosis development, the bone becomes stiff, but at the same time more fragile, the jumps itself is partially saturated with calcium calcium.

Symptoms

The development of arthrosis begins with slight knee pain, appearing after walking the stairs, physical activity, walking long standing.Such a mild pain can occur for several months, or even years.Then they become more pronounced.In the initial stage of development of the disease, the knee bones are not deformed, but a slight swelling of the joint may be observed.

In the second stage of developing the disease, the pain becomes stronger and occurs after a slight load.In addition to the pain, a crisis appears in the knee joint, which differs from the usual gentle abuse of a healthy pain with pain.In addition, deformation of the joint becomes visible, the bones on the touch become wider and rude.Kneeing more than 90 degrees becomes problematic.

In the third stage of the disease, knee pain becomes severe and persistent, not even going through the rest period.Knee mobility becomes minimal, often does not bend more than 90 degrees and does not extend to the end.The deformation of the bones of the joint becomes so strong that there is a curvature of the valgus legs (X -shaped) or variability (in O form).

Troubleshooting

Inspection

In the early stages of the disease, the joint is not changed, removable, the muscles around it are stored and quite strong.Only by the palpation of certain points, most often on the inner surface of the joint, is defined local (local) pain.The doctor asks the patient to perform several meetings, bend, direct his leg, place his face up in the bed, and directs flexion-extensions (this is called "passive" movement).In this case, in addition to the pain and restriction of the volume of movements, you can determine the crisis by clicking the joints.With a pronounced inflammatory ingredient, the joint is increased in size, it seems to be "pumped" with liquid.With a remote removal process, the knee bending can be partially or completely absent, when examined, the surface of the joint looks uneven, tuberous, limbs can be curved (limb axis displacement, "conjurious").

Laboratory and instrumental research

• Compulsory Laboratory Study Program includesGeneral, biochemical and immunological blood tests, urine analysis.In the overall blood test, attention will be paid: increased leukocyte level and increased rate of erythrocyte resolution, which indicates inflammation.In biochemical blood analysis, metabolic metabolic indicators are important, the level of "liver" enzymes.In immune analysis, the presence or absence of signs of systemic inflammation will be determined - it is evidenced by the level of the reactive protein C. Urine analysis will detect the "sand" content - uric acid crystals.
• Synovial (articular) fluid analysisIs described when this liquid is in sufficient quantity.That is, when the knot is swollen, swollen.In conditions of compliance with sterility, the doctor drills the joint capsule to a strictly defined location, inserts the needle into the joint cavity and then removes excess fluid.Part of the obtained material enters the laboratory for analysis.At the end of the procedure, the anti -inflammatory drug from the glucocorticosteroid group is most often administered in the joint cavity (for example, diprospan).
• radiograph.A picture of both knee joints is mandatory, this is necessary to compare a diseased knee to a healthy one.In the picture, attention is paid to the width of the common gap (judged by the state of the meniscus and cartilage), the presence or absence of bone spikes-osteofites, signs of bone destruction.
• Ultrasound of knee jointsIt will answer questions about the maintenance of the meniscus, the presence of a baker's cyst, the severity of inflammation, the presence or absence of uric acid crystals (in the presence of gout).
• MRI (magnetic resonance imaging).This study is described if an ultrasound does not provide an exhaustive answer to the questions of a specialist.MRI is mandatory for those patients who are planning to perform arthroscopy.
• arthroscopy.It allows you to visualize, that is, to personally evaluate the state of union.The method is essential for controversial diagnosis, suspicion of traumatic meniscus damage and ligaments (then directly during the study, it is possible to quickly remove the meniscus or torn ligaments).

The treatment of arthrosis of the knee joint

The principles of comprehensive treatment should be followed, which include:

1. Detailed patient awareness of the disease

2. Using physiotherapy exercises, which includes: specific exercises for nodes in lie position, swimming
3. Maintaining optimal body weight
4. Wearing an orthosis (soft bandage or at least an elastic bandage) during an increased load on the joint - on the road, during a walk, etc.
5. Non -producer methods (physiotherapy).This type of treatment gives excellent results precisely with arthritis of the knee (gonarthrosis).Apparently, this is due to the fact that the union is available for the influence of factors such as magnetic and laser radiation.To treat the knee joint, you can use magnetic currents, UHF, exposure to criticism (translated from Greek means the effect of cold).Physiotherapeutic procedures are widespread, treatment courses are usually short - 10, maximum sessions daily or other day.It should only be remembered for potential contraindications, which include tumor processes, thyroid gland diseases and pelvic organs, as well as systemic inflammatory diseases (autoimmune).
6. Medication therapy.

Principles of osteoarthritis therapy:

• Relieve pain
• delay further destruction of common structures
• Restore the lost joint function.

Nonsteroidal anti -inflammatory drugs

To relieve pain, medicines from NSAID Lee NSAID are used -non -steroidal anti -inflammatory drugs are used.They are used in and in the form of applications (applying to the skin).Applications (local therapy) are a very effective method, especially when it comes to the early stages of the disease.Before using a gel or cream containing NSAIDs, it is necessary to make sure there are no changes in the skin, whether it is redness, pustules or cracks.The general rule of local treatment is to use the cream or gel selected at least twice a day, and if unpleasant sensations arise - to be canceled in the complete disappearance of these manifestations.Intramuscular management of sedatives of sedatives is currently not recommended, as the risk of side effects as a result of administration using a syringe does not decrease, but on the contrary.In the case of pronounced inflammation, the accumulation of a large amount of intraarticular glucocorticosteroid drugs is allowed, but it should be noted that this procedure should be performed no more than 1 time every 3 months.

Chondroprotectors

A higher effect "step" anti -inflammatory with osteoarthritis are chondroitin preparations or glucosamine.They, like NSAIDs, fight inflammation at the level of thin structures joint, but have fewer side effects, and, most importantly, maintain their anti -inflammatory effect a few months after cancellation.

Chondroprotectors are a collective name for a group of medicines that at the same time contain sulfate chondroitin and glucosamine - "construction bricks" of cartilage.Despite the significant treatment of high cost with chondroprotectors, their convenience for patients and effectiveness is difficult to overestimate.First, these substances, accepted inside, are perfectly absorbed by the stomach, and drug losses "along the road" in the cartilage are minimal.Second, they are able to suppress inflammation in the joint, and, in addition, reliably slow down the process of destruction of the joint joke!Most often they are prescribed courses because they have a fairly long "ace" that lasts several months, and sometimes even up to six months.

Hyaluronic acid -based drugs are so -called hyaluronates.These funds are sold in the form of syringes prepared for intra -articular administration.Hyaluronets are an artificial synovial fluid.The effect of treatment with this method can take up to 12 months.

Surgical treatment of knee joint arthrosis

As with the arthrosis of the hip joints, in the case of serious changes and constant loss of function, it comes to surgery.With gonarthrosis, two types of interventions are currently performed: arthrodesis and endoprosthetic components.The first surgery is rarely performed, according to special indications, when installing an endoprostese is impossible for some reason.The result of this operation is that the knee becomes stationary.But does not hurt.The endoprosthetic operation is much more profitable in terms of function.Recall that with high body weight, this surgery is not performed - the risk of complications in the post -surgery period is very high.Since removing damaged sections of the joint and installing the prosthesis until the function is completely restored, no more than three weeks pass.

How can ridiculous osteoarthrosis threaten?

Over time, osteoarthrosis does not turn back, but only deteriorates, especially preserving the provocative factors.Consider the main sources of risk to a patient's health and life with osteoarthritis.

• Chronic pain of varying intensity- A very important risk factor, especially in the elderly.Unpleasant sensations with experience can constantly lead to sleep disturbances, a reduced background of mood and even depression.It is difficult to predict which chain of side events attracts listed phenomena.
• Vein pathology.Continuous inflammation in the knee area, increased bone spikes-osteofites, which can mechanically damage popliteal vessels, can lead to the development or progression of varicose veins of the foot.Sometimes orthopedists refuse to operate the knees until the varicose joints are removed, but phlebologists (vein specialists) do not begin surgery in the veins until there are significant changes in the knee joints.
• Reduction of limb function.With a removal process, the union can completely lose the ability to move, and this, in most cases, is a sign of disability.
• The inclusion of other nodes.We have already discovered that such a seemingly common phenomenon, like flat feet, can "pull" the knee joint together and lead to the development of osteoarthrosis.In the same way - along the chain - there is an involvement in the painful process of the knee joint from the opposite side.If the patient neglects the recommendations, refuses to wear a cane, preferring to "paint in two", arthrosis of the hip joints develops very quickly.The legs are twisted, the walking becomes a "duck".
• stickiness.This serious complication of the disease occurs in cases where the bones of the joint are greatly destroyed, there is no cartilage, the movement in the joint is severely painful or impossible at all due to the merging (this is called "ankilosis") of the bones with each other.In this situation, only surgery can help the patient, but only if it is technically possible.Overcoming is dangerous in the general sense: it causes overweight, osteoporosis, muscle atrophy, rapid development of diseases of the internal organs.Moreover, a person immobilized, of course, must constantly take care of himself.
• Non -functioning.Unfortunately, there are a number of states that make the surgery impossible, and one of them is very good, osteoarthritis "neglected" in patients over 80 with serious related illnesses.

PREVENTION

• Exclude common damage.It seems: There is nothing easier.For a while, abandoning jumps, jogging, walking the stairs, dancing, high heels is not at all difficult.In practice, it turns out to be this point that causes more protests by patients.A person, if he recently suffers, is usually not ready for the fact that an important point in his daily life will be missing.But if you do not follow these tips, there is a risk of a rapid reduction in quality of life and disability.
• Reducing weight and maintaining it within optimal limits is an extremely important recommendation!No matter how wonderful the effect of this or that tool, fat people will not be able to appreciate it.Because while the joints are overweight overweight, the microtraumas are repeated daily.This can reduce all efforts for "no".Moreover, for some methods of treatment, overweight is a direct contraindication.
• Walking with support.The universal rule for discharge of the joint using the support is this: a cane, crutch or handrail must be in hand in front of the affected limbs.That is to say, if the right knee hurts, the cane should be kept to the left, and vice versa.
• Correction of flat feet.It would seem, how can flat feet and knee joint arthritis tied?Results directly.If the foot is improperly installed (now we are talking about flat longitudinal or mixed feet, not the transverse) the load is redistributed to the knee joint.In this case, one -step body severity does not fall into the center of the knot, but to the right or left of it.Therefore, the right or left meniscus suffers more, and as it suffers more, we wear faster.Next comes the "turn" of the articular cartilage, where the meniscus cannot withstand its function.This process ends with the formation of typical unilateral "arthrosis" changes in the knee joint (display of bone results).