ArthropathyDegenerative joint disease (commonly known as salt deposition) is a chronic disease of degenerative dystrophic joints in which destruction of articular cartilage, joint capsule and deformation of the bones themselves occur.
It is noteworthy that arthropathy is a group of joint diseases with different origins and similar mechanisms of development.The most common large joint arthropathy are:
- Deforming arthropathy (arthropathy) of the knee,
- Deformity of the hip joint (coxarthrosis),
- and arthropathy of the shoulder joint.
These are the most severe types of joint disease.
Arthritis of the facet joints is less common.More common are deformations of the interphalangeal joints of the hand and the metacarpophalangeal joint of the thumb.Patients note interphalangeal joint pain, decreased mobility, and the development of seals near the joints (Heberden's and Bouchard's nodes).This type of joint disease is more common in older people.Arthritis of the foot joints is common.
Polyarthrosis, or systemic arthropathy, is characterized by simultaneous damage to multiple joints.
ArthropathySpondyloarthropathy - spondyloarthropathy - belongs to the group of spinal diseases, although it has similar mechanisms of development to other joint diseases.
The main clinical symptoms of arthropathy are joint pain and reduced mobility.Specific symptoms are determined by the stage of the arthropathy and depend on the degree of destructive changes in the joints.
Causes of Arthropathy
ArthropathyIt is customary to divide it into primary and secondary.Primary (idiopathic) arthropathy is the result of abnormal functioning of the entire organism due to an interruption in the recovery process and increased degeneration of articular cartilage tissue.Secondary joints occur as a result of other pathological processes in the body or in joints that have been damaged by some external influence (partial destruction of the joint surface).
Most commonly, traumatic joint injuries are diagnosed in younger patients.In older patients, it is not always possible to draw a clear line between primary and secondary arthropathy.
Although the exact cause of arthrosis has not been determined, the factors that contribute to its onset and progression are well known.
The following types of causes can be identified for the development of primary and secondary osteoarthritis.
Causes of Primary Arthropathy – Genetic Factors
The following genetic disorders have been identified as causing primary arthropathy:
- Genetic disorders of the tissue components of articular cartilage, leading to accelerated destruction;
- Congenital defects of the musculoskeletal system (hypermobility of joints, dysplasia, flat feet, etc.) can cause trauma to certain areas of the articular cartilage tissue, leading to the emergence of arthropathy.
It is also noteworthy that deformative arthropathy of the interphalangeal joints of the upper extremities occurs primarily in females and is inherited through the maternal line.
Causes of secondary arthropathy
Secondary arthropathy is the result of damage to the joints.These damages can be caused by a variety of factors.
- Mechanical damage to joints.This group of factors includes various joint injuries, intra-articular fractures, resulting in destruction of the joint structure.The same result results from persistent microdamage to the joints due to excessive static and dynamic loading (e.g., athletes).Obesity can also lead to joint overload and damage.
Another factor that negatively affects joints, primarily the hip joints, is incorrect posture.
Surgery may also damage the structure of the joint. - Joint disease.Arthropathy may be the result of inflammatory diseases of the joints (acute and chronic arthritis, synovitis, primary aseptic necrosis of bone tissue, etc.).
- Metabolic disorders, endocrine system diseases, and mineral deficiencies in the body.Various metabolic disorders, deficiencies of calcium, phosphorus and other minerals, vitamins and trace elements lead to changes in the composition of bone and cartilage tissue, synovial fluid, leading to interruption of the recovery process and gradual destruction of the composition.
- autoimmune disease(Gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis),Hormone imbalance, estrogen deficiencyIn postmenopausal women, joint tissue changes and is gradually destroyed.
- vascular disease(Lower limb vascular atherosclerosis, obliterative endarteritis, varicose veins) andlack of physical activityCauses circulation disorders in the tissues around the joints and poor blood supply to the joint tissues, leading to degenerative changes.
Mechanisms of joint development
developArthropathyIt starts with the destruction of cartilage.It is believed that initially there is a circulatory disorder in the capillaries of the subperiosteal cartilage.Since the nutrition of cartilage depends on the nutrient supply of intra-articular fluid and adjacent bone tissue, poor circulation causes the cartilage to gradually lose elasticity, become thinner, and develop cracks. The smoothness of the joint surface is destroyed, and the amount of synovial fluid that ensures joint sliding is reduced.The result appearspain and crunching when moving.The width of the joint space gradually decreases and the bones form along the edges of the articular surface. Osteophytic spurs.
Eventually, the joint deforms and its range of motion is reduced.This is how degenerative joint diseases associated with aging of the body develop.This form of joint disease usually develops gradually over many years.
Other forms of large joint arthropathy, such as post-traumatic, post-infectious, metabolic, toxic, etc., have slightly different mechanisms of development, but the result is that we get similar changes in the joints.
Symptoms of joint arthritis.Stage and extent of joint disease
Classification of arthropathy based on clinical and radiological signs is considered "classical".According to this, disease development is divided into three stages.It corresponds to the classification according to the degree of preservation of working ability, distinguishing 3 levels of arthropathy:
- Grade I Arthropathy - This disease does not affect work performance, although it makes work difficult,
- Degree II Arthropathy - This condition affects work performance,
- III degree arthropathy - incapacity.
Let us consider in more detail the clinical signs and symptoms of arthropathy at each designated stage.
First-grade arthropathy (early stage of arthropathy)
At the early stage of the disease, after resting in the morning, the joints will become stiff and difficult to move, which will gradually disappear after a period of time after starting to move.There may be some limitations in the joint's mobility."Starting" pain (pain when starting to move after a long rest) occurs periodically.The joints may creak when moved suddenly, but there is no pain when moving.Pain in this stage of arthrosis occurs only with significant and prolonged stress and subsides with rest.Pain-free at rest and with light activity.At this stage of the disease, patients rarely see a doctor.
In X-rays of patients with grade 1 arthropathy, no special changes are seen in the joints; sometimes small osteophytes are seen at the edges of the joints, and the joint spaces are slightly narrower.
Arthropathy 2nd degree (second stage of arthrosis)
As the joint progresses further, the pain becomes more pronounced and becomes severe.Any movement will cause obvious tightness in the joints, obvious limitation of joint mobility (contracture), functional shortening of the limbs, and disturbance of movement biomechanics, but the mobility of the joints is still retained.During this stage, the initial pain increases significantly, becoming more severe and lasting longer.Under the influence of daily physical activities, the shock-absorbing ability of articular cartilage tissue decreases, resulting in continued fatigue and pressure on the joints, and the so-called "mechanical pain".
The damage to the joints has been quite severe and the joints have begun to partially deform.
X-rays show obvious osteophytes, joint spaces that are 2-3 times smaller than normal, subchondral bone sclerosis, and cystic cavities in the epiphyseal area.
Second degree arthropathy is characterized by a reduced ability to work and the inability to perform certain types of work.
Arthropathy 3rd degree (arthrosis third stage)
ArthropathyStage III is the severe, advanced stage of the disease.The following was observed during this phase:
- Significant deformation of the joint (due to bone growth and fluid accumulation in the joint cavity);
- Vigorous restriction of movement until only rocking motion is maintained;
- Severe pain occurs not only when moving, but also in a state of complete rest - persistent pain associated with reflex spasms of nearby muscles, as well as the development of reactive synovitis;
- joint inflammation,
- Joint sensitivity to weather changes.
- Muscle spasm and atrophy around the knee;
The axis of the limbs is deformed, and the legs are obviously turned in or out (that is, in the shape of a letter "O" or "X").
On radiographs of grade 3 arthropathy, almost complete disappearance of the joint space, marked deformation of the articular surface, and extensive multiple marginal osteophytes are observed.Calcification of articular mice and para-articular tissues can be detected.
By the third grade, the disease has become so severe that it has often become the cause of permanent disability.It is displayed as follows:
- The pain becomes constant and painful: walking, especially up and down stairs, is a difficult ordeal for the patient;
- Any movement makes a loud crunching sound that can be clearly heard by others;
- The joints are severely deformed, and the range of motion is limited to a small range or even impossible;
Photographs show the destruction of intra-articular structures (ligaments and menisci), as well as signs of complete wear and hardening of the cartilage (replacement of functional organs and structures by connective tissue).
Joint 4 degrees
A state of complete destruction of the jointsArthropathyWhen a joint completely stops functioning, it is usually classified as isolated fourth degree arthropathy.There is a so-called "joint block" - an acute pain syndrome in which even limited movement of the affected joint is impossible.Fourth degree arthropathy is associated with excruciating pain in the joints that cannot be relieved even with powerful painkillers and intensive physical therapy.Complete ankylosing (fusion of the joints) or neoarthrosis (pseudoarthrosis between the displaced ends of the bones) is possible.In both cases independent movement is almost impossible.
Photographs show rough and sclerotic joint surfaces with marked cystic spaces and fusion of connecting bones in the joint space area.Progression of the disease to this stage almost always means disability, which can only be prevented by implanting an artificial joint prosthesis.
Treatment of Arthropathy
Early treatment of joint disease
It’s best to start treating joint disease as early as possible at the first symptoms (creeping joints, difficulty moving).Medications are useful at this stage - chondroprotectants that improve the structure of cartilage tissue, as well as vitamin and mineral complexes.
Physical therapy, proper nutrition and preventive measures are important.It is worth noting that preventing joint disease is very important to prevent the condition from getting worse.
Treat joints 2-3 degrees
Although complete cure of grade 2-3 arthropathy is no longer possible, its progression can be significantly slowed down.Treatment of arthrosis at this stage includes the following steps:
- relieve or lessen pain
- Relieve joint inflammation.
- Improves the recovery of cartilage tissue and slows down its degeneration process.
In the acute phase, treatment of arthropathy begins with pain relief.For this purpose, non-hormonal anti-inflammatory drugs (NSAIDs) and analgesics are used.Intra-articular injection of corticosteroids is possible.The load on the joints needs to be reduced; it is not advisable to walk or stand for long periods of time, nor to lift heavy objects.
After relieving an acute pain syndrome, the main task is to ensure as much as possible the activation of recovery processes in the joint itself and in the tissues surrounding the joint: improving blood circulation, increasing metabolism, eliminating inflammatory processes.Doctors may prescribe chondroprotectants, vasodilators, as well as therapeutic exercises and physical therapy.
Treatment of fourth degree joint disease
At this stage of the disease, the joints are almost completely destroyed.In this case, there is only one way out - surgery and replacement of the diseased joint with an endoprosthesis.Endoprostheses significantly improve joint mobility, allowing patients to return to an active life, at least without pain.