Knee arthrosis: symptoms, treatment

Among the diseases of the musculoskeletal system, osteoarthrosis is a frequency leader.It is believed that the greater part of the population on the planet by the age of 60 has the initial signs of changes in the articular cartilage, and 14% already have manifestations of osteoarthrosis.The most common version of this disease is osteoarthrosis of the knee joints.

Still, "arthrosis" or "arthritis"?

Do not mix these two concepts.Arthrosis is the process of change mainly the structure of the joints, and arthritis is an inflammation that can occur both against the background of the "untouched" structure and against the background of arthrosis.

Changes in bone with arthrosis can be compared, for example, with knitted outgrowths of a tree trunk that grows near the concrete fence and puts pressure on this fence with all its weight.

Usually the surface of the bones facing each other is divided by two layers of cartilage and meniscus (additional cartilage slabs).In addition to the role of the "buffer" between bones, cartilage ensures bone sliding and mechanical correspondence with each other.Meniscus, which, due to large or small (but frequent) injuries, and also loses its elasticity, can completely or partially disintegrate even more.

With age, and especially in the presence of a hereditary predisposition, the articular cartilage is smaller.Therefore, the bones of the hips and lower legs that make up the knee joint with their ends are dangerously approaching each other, even rubbing between them may occur.

Usually, with the thinning of cartilage over the years, another unpleasant event has emerged: the amount of intravivory fluid decreases.This fluid is not only a purely mechanical "lubrication" of the joint inside.It provides feeding of bones, menies and joint cartilage.Violating the "supply" of all these structures is a real disaster for the joint!

If there is a physical overload of the joint, then bones appear on the surfaces of the bones and begin to grow, more like targeting or spikes.For the knee joint, such overloads will be weight lifting (including the overweight of your own body!), Physical work with an emphasis on your knees (such as weeding the garden), constantly walking on the stairs, running uncomfortable shoes, flat feet and more.It is now easy to imagine what happens inside the knee joint during the development of arthrosis and how it manifests itself in appearance.

How does the joint work?

Each of us has seen joint cartilage many times at the end, such as a chicken bone.It covers small areas of bone contact.Under the articular cartilage is subchondral or fascinated bone.The human musculoskeletal system is similarly arranged.

Most of the human joints consist of bones, synovial (joint) shell and intraiortic fluid.

What happens to the joint with arthrosis?

Under the influence of all these loads already mentioned, there is a thickening and growth of the thin bone as a result, increased trauma to the articular cartilage.

Products from the cartridge of cartilage formed due to a micro -trauma enter the synovial fluid.It is so arranged by nature that they are foreign substances for the synovial sheath and cause its inflammation.The formation of synovial fluid is disturbed, which is usually something like a "conveyor", similar to a continuous cycle of enrichment and purification of the blood.In addition, the joint fluid becomes smaller than hyaluronic acid.It is worth saying about this acid.

Hyaluronic acid provides the viscosity of the synovial fluid, creates the "buffer effect" and the "lubrication effect" between the bones, reducing their friction against each other.Thanks to this substance, the joint fluid in a consistency resembles egg protein, not water.Another important role in hyaluronic acid is to ensure the supply of nutrients from the joint fluid deep to the joint cartilage, since there is nowhere to be taken to eat: the blood vessels are not suitable directly for cartilage.In the same way, the "consumed" substances of cartilage in the joint fluid are removed: using hyaluronic acid molecules.

So, an improved bone seal arises and unbearable conditions for articular cartilage are created.

The cartilage receives a signal to adapt to these extreme conditions and its change begins otherwise that it is called reconstruction.This is manifested mainly by reducing the elasticity of cartilage.

In the late stage of the development of arthrosis, the bone becomes firm, but at the same time more fragile, the cartilage itself is partially impregnated with calcium - calcified.

Symptoms

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

In the second stage of the development of the disease, the pain becomes more intensive and occurs after a slight load.In addition to the pain, a crunch appears in the knee joint, which differs from the usual soft abuse of healthy joints with pain.In addition, the deformity of the joint becomes noticeable, the bones of touch become wider and rough.Wearing the knee more than 90 degrees becomes problematic.

In the third stage of the disease, knee pain becomes severe and constant, not even passing even during the rest period.Knee mobility becomes minimal, often does not bend more than 90 degrees and does not extend to the end.Deformation of the joints of the joint becomes so strong that there is a valgus (X-shaped) or variable (O-shaped) curvature of the legs.

Diagnostics

Verification

In the early stages of the disease, the joint does not change, mobile, the muscles around it are preserved and strong enough.Only by palpation (pressure) of certain points, more often on the inner surface of the joint, is local (local) pain.The doctor asks the patient to perform several squats, bend, straighten his leg in the knee, place his face up on the sofa, and leads to an extension of flexion (this is called "passive" movements).In this case, in addition to the pain and restriction of the volume of movement, you can determine the crunching, clicking the joints.With a pronounced inflammatory component, the joint increases in size, seems to be "pumped" with fluid.With a away from the process of taking the bending in the knee, it can be partial or completely absent when examined, the surface of the joint seems uneven, tuberculosis, the limb can be curved (displacement of the axis of the limb, "created").

Laboratory and Instrumental Research

• The obligatory laboratory exploration program includesGeneral, biochemical and immunological blood tests, urine analysisSThe general blood test will pay attention: increased leukocyte levels and increased incidence of erythrocyte sedimentation, indicating inflammation.In biochemical blood analysis, metabolic metabolic metabolic indicators are important, the level of "liver" enzymes.In immunological analysis, the presence or absence of signs of systemic inflammation will be determined-this is evidenced by the level of C-reactive protein.Urine analysis will reveal the content of "sand" - uric acid crystals.
• Analysis of synovial (joint) fluidIt is prescribed in the case where this fluid is in sufficient quantities.That is, when the joint is swollen, swollen.In conditions of compliance with the sterility, the doctor breaks the capsule of the joint in a strictly defined place, puts the needle into the cavity of the joints and then removes excess fluid.Part of the material obtained enters the analysis laboratory.At the end of the procedure, the anti -inflammatory drug of glucocorticosteroid group is most commonly used in the joint cavity (eg Diprospan).
• RadiographySA photo of the two knees is a must, this is necessary to compare a diseased knee with a healthy.In the photo, attention is paid to the width of the joint precipice (it is assessed by the state of the meniscus and cartilage), the presence or absence of bone spikes-osteophytes, signs of destruction (destruction) of the bones.
• Ultrasound of the knee jointsHe will answer questions about the maintenance of the meniscus, the presence of a cockroach cyst, the severity of inflammation, the presence or absence of uric acid crystals (in the presence of gout).
• MRI (Magnetic Resonance)SThis study is prescribed if the ultrasound does not give a comprehensive answer to a specialist questions.MRI is a must for those patients who plan to have arthroscopy.
• ArthroscopySAllows you to visualize, that is, you personally evaluate the condition of the joint.The method is indispensable for contradictory diagnoses, suspected traumatic damage to meniscus and connections (then directly during the study it is possible to quickly remove the torn meniscus or connections).

Treatment of knee arthrosis joint

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

1. Patient's detailed awareness of the disease

2. The use of physiotherapy exercises that includes: specific exercises for the joints in a supine position, swimming
3. Maintain optimal body weight
4. Wearing an orthosis (soft dressing or at least an elastic bandage) during an increased load of the joint - on the road, during a walk, etc.
5. Inalous methods (physiotherapy).This type of treatment gives excellent results exactly with arthrosis of the knee joint (gonarthrosis).Obviously, this is due to the fact that the joint is available for the influence of factors such as magnetic and laser radiation.To treat the knee joint, you can use magnetic currents, UHF, cryo-exposition (translated from Greek means that the effect of cold).Physiotherapy procedures are widespread, treatment courses are usually short - 10, maximum sessions a day or any other day.It should only be remembered for possible contraindications, which include tumor processes, diseases of the thyroid gland and pelvic organs, as well as systemic (autoimmune) inflammatory diseases.
6. Drug therapy.

Osteoarthritis therapy Principles:

• Relieves pain
• delaying the increasing destruction of joint structures
• Restore the lost joint function.

Non -steroidal anti -inflammatory drugs

Nsaid Lee Nsaid drugs are used to relieve pain -no -resistant anti -inflammatory drugs.They are used in and in the form of applications (skin application).Applications (local therapy) are a very effective method, especially in terms of the early stages of the disease.Before using a gel or cream containing NSAIDs, it is necessary to make sure that there is no skin changes, whether it is a rash, pustules or cracks.The general rule of local treatment is the use of the selected cream or gel at least twice a day, and if unpleasant sensations occur - to cancel until the complete disappearance of these manifestations.At present, intramuscular administration of painkillers is not recommended, since the risk of side effects as a result of administration with the help of a syringe does not decrease, but more recently.In the case of pronounced inflammation, a large amount of fluid is allowed, intraarticular glucocorticosteroid drugs, but it should be noted that this procedure should be performed no more than 1 time every 3 months.

Chondroprotectors

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

Chondroprotectors are a collective name for a group of medicines containing at the same time chondroitin sulfate and glucosamine - "building bricks" of cartilage.Despite the apparent high -cost treatment with chondroprotectors, their convenience for patients and effectiveness is difficult to overestimate.First, these substances taken inside are perfectly absorbed by the stomach, and the losses of the drug "along the way" to 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 cartilage!Most often, they are prescribed courses because they have a rather long "Ace", which lasts for several months, and sometimes even up to six months.

Hyaluronic acid -based drugs are So -Callyed Hyaluronates.These funds are sold in the form of prepared syringes for internal articular administration.Hyaluronets are an artificial synovial fluid.The effect of treatment with this method can last up to 12 months.

Surgical treatment of knee arthrosis joint

As with arthrosis of the hip joints, in case of serious changes and constant loss of function, it leads to surgery.With gonarthrosis, two types of interventions are currently underway: arthrodesis (fixed compound) and endoprothetics.The first surgery is rarely performed, according to special indications, when the installation of endoprosthesis is impossible for some reason.The result of this operation is that the knee becomes stationary.But it doesn't hurt.The endoprotetic work is much more boss in terms of function.Remember that with a high body weight this surgery is not performed - the risk of complications in the postoperative period is too high.From the time of the damaged areas of the joint and the installation of the prosthesis until the function is completely restored, no more than three weeks pass.

How can the ridiculous osteoarthrosis threaten?

Over time, osteoarthrosis does not go back but only worsens, especially while maintaining provocative factors.Consider the main sources of hazard and life of a patient with osteoarthritis.

• Chronic pain of varying intensity- A very important risk factor, especially in the elderly.Constantly experienced unpleasant sensations can lead to sleep disorders, reduced mood background and even depression.It is difficult to predict which chain of adverse events is pulling the phenomena listed.
• Vein pathologySContinuous knee inflammation, bone growth of spikes-osteophytes, which can mechanically injure the poppy vessels, can lead to the development or progression of varicose veins of the veins of the legs.Sometimes orthopedists refuse to manage their knees as the extended nodes are removed, but phlebologists (vein specialists) do not start surgery in veins until changes in the knee joints are highly manifested.
• Reduced limb functionSWith the long -term collection process, the joint can completely lose the ability to move, and in most cases is a sign of damage.
• Participation of other jointsSWe have already learned how a seemingly ordinary phenomenon, such as flat legs, can "pull" the knee joint together and lead to the development of osteoarthrosis.In the same way - along the chain - there is a participation in the painful process of the knee joint on the opposite side.If the patient neglects the recommendations, refuses to wear a cane by prefering to "limp on both his / her," hip arthrosis is developing very soon.The legs are twisted, the gait becomes a "duck".
• immobilitySThis serious complication of the disease occurs in cases where the bones of the joint are severely destroyed, there is no cartilage, the movement in the joint is abruptly painful or impossible at all due to the merger (this is called "ankylosis") of the bones with each other.In this situation, only surgery can help the patient, but only if it is technically feasible.Overcoming is dangerous in the general sense: it causes obesity, osteoporosis, muscle atrophy, the rapid development of diseases of the internal organs.In addition, an immobilized person, of course, must constantly take care of himself.
• NeedSUnfortunately, there are a number of conditions that make surgery impossible, and one of them is far away, "neglected" osteoarthritis in patients over 80 with severe related diseases.

Prevention

• Turn off the joints injury.It looks: there is nothing easier.For a while, abandonment of jumps, running, walking up the stairs, dances, high heels is not difficult at all.In practice, it turns out that it is this point that causes the most protests on the part of patients.A person, if he has recently suffered, is usually not ready for the fact that some important point in his daily routine will be missed.But if you do not follow these tips, there is a risk of rapidly reducing quality of life and damage.
• Reducing weight and maintaining it within optimal limits is an extremely important recommendation!No matter how miraculous the effect of this or that tool, fat people will not be able to appreciate it.As while the joints are overwhelmed with overweight, the micro -traumas are repeated daily.This can reduce any effort to no.In addition, for some methods of treatment, obesity is a direct contraindication.
• Walking with support.The universal rule for unloading the joint with the help of support is the following: a cane, crutch or railing should be in the hand opposite to the affected limb.That is, if the right knee hurts, the cane should be kept to the left and back.
• Flat leg correction.It seems how can flat legs and arthrosis of the knee joint connect?Turns out to be directly.If the leg is installed incorrectly (now we are talking about longitudinal or mixed flat legs rather than the transverse), the load is redistributed in the knee joint.In this case, the weight of the body does not fall on the center of the joint in a step, but on the right or to the left of it.Accordingly, right or left meniscus suffers more and as we suffer more, we wear more quickly.This is followed by the "tail" of the articular cartilage, where the meniscus cannot cope with its function.This process ends with the formation of typical changes in "arthrosis" in the knee joint (the appearance of bone growths).