Osteoarthritis is a group of diseases of different origin, which are based on the defeat of all components of the joint, primarily cartilage, as well as the perineal bone region, ligaments, capsule, periarticular muscles.
The prevailing age is 40–60 years.
- The discrepancy between the mechanical load on the joint and its ability to withstand this load. The biological properties of cartilage may be genetically determined or altered under the influence of acquired factors.
- Genetic factors: the role of gene type II collagen defects is discussed.
- Deficiency of female sex hormones – postmenopausal estrogens in women.
- Acquired bone and joint diseases.
- Joint injuries.
- Operations on the joints.
In general, osteoarthritis is characterized by a mechanical rhythm of pain – the occurrence of pain under the influence of daytime physical exertion and subsiding during a period of night rest, which is associated with a decrease in the depreciation abilities of cartilage and bone arthritic structures to the loads.
In osteoarthritis, symptoms such as continuous dull night pain associated with congestion of venous blood and increased intraosseous pressure are possible. Short-term “starting” pain occurs after rest and soon passes against the background of physical activity. Starting pains are caused by friction of the articular surfaces on which detritus – fragments of cartilage and bone destruction – settle. At the first movements in the joint, the detritus is pushed into the twists of the articular sac, and the pain is significantly reduced or ceases completely.
Also a symptom of osteoarthritis is the so-called “joint block” or “stiffened joint” – a pronounced rapidly developing pain syndrome due to the appearance of the “articular mouse” – a bone or cartilage fragment with infringement between the articular surfaces or penetration into the soft periarticular tissues. The intensity of the pain in this case makes it impossible for the patient to make the slightest movement in the joint.
In the presence of inflammation, in addition to pain in the joint, both during movement and at rest, morning stiffness, swelling of the joint, local increase in skin temperature are characteristic.
With osteoarthritis, the deformity and stiffness of the joints gradually develop .
Osteoarthrosis usually develops slowly and begins as a disease of one joint, but after some time other joints are involved in the process, most often those that compensated for increased mechanical stress to relieve the originally diseased joint.
Osteoarthrosis is often accompanied by diseases of the veins ( varicose veins of the lower extremities, thrombophlebitis ). The most frequently affected knee joints, hand joints, lumbar and cervical spine, hip joints, ankle joint, shoulder joint.
If osteoarthritis is suspected, the following tests and studies should be performed:
- General and biochemical blood test
- Synovial fluid examination
- X-ray examination
- Ultrasound examination of the joints
- Regimen and diet. It is important to reduce body weight in order to reduce the mechanical load on the joint. Physical overload and trauma of joints, soft chairs and pillows should be avoided; It is recommended to use chairs with a straight back and a bed with a hard wooden base, fixtures that facilitate mechanical loads on the affected joints – a corset, a cane, kneecaps, and performance of special exercise therapy complexes.
- In the treatment of osteoarthritis, “short-lived” drugs are considered the most optimal: ibuprofen, diclofenac, ketoprofen. For the rapid elimination of pain prescribed drugs with high analgesic activity: diclofenac ( Rapten Rapid). Rapten Rapid can also be recommended for introductory therapy to relieve pain and then switch to another pain medicine. Significantly better results were obtained using meloxicam and nimesulide . With an isolated articular lesion for the treatment of osteoarthritis, local remedies are used in the form of ointments, creams, thus avoiding systemic adverse reactions, especially in the elderly, and chondroitin sulfate in combination with dimethyl sulfoxide ( chondroxide ).
- In the presence of articular effusion, intra-articular injections of corticosteroids are used. Unfortunately, certain aspects of this therapy remain controversial (its relative effectiveness, potentially damaging effects and potentially structurally modifying effects), so the place of long-term use of intra-articular corticosteroid therapy for the treatment of osteoarthritis is still not clear – long-term studies are needed. Currently, it is believed that the number of intra-articular injections into one joint should not exceed 3–4 for one year.
- Chondroitin sulfate 500 mg 2-3 p. / Day ., The course of 3-6 months.
- Glucosamine 1500 mg 1 time per day course for 6 weeks, breaks between courses for 2 months.
- Alflutop 1 ml / m daily, for a course of 20 injections. Perhaps intra-articular injection of 1–2 ml into large joints, for a course of 5–6 injections, then continue with 1 ml of intramuscular injection. Repeat course after 6 months.
- Physiotherapy of osteoarthritis: electrosleep, electrophoresis with a 5% solution of novocaine according to the method of Vermel, acupuncture, microwave resonance therapy, hyperbaric oxygen therapy , diadynamic therapy , amplipulse therapy, magnetic therapy , ultraphonophoresis , laser therapy, gravitational energy. Physical factors – ultraviolet radiation, ultrasound, laser therapy, diadynamic currents – with synovitis ; paraffin and mud applications – in the absence of synovitis. Resorts with sulfuric, hydrogen sulfide, radon springs, therapeutic mud or brine.
One of the very effective preventive measures of osteoarthritis is weight loss through diet, rational physical activity. For osteoarthritis, a combination of such exercises is particularly important, which would include a combination of gradually increasing the walking time and strengthening the muscles of the lower limbs. In order to strengthen the muscles, isometric contractions of the quadriceps are shown, which can be achieved by the tension of the knee joint, flexion with the strain of the ankle joint, and also by percutaneous electrical stimulation of the nerves. The strengthening of the quadriceps muscle of the thigh for 6 months reduced pain and improved the function of the knee joints.
Equally important is the wearing of comfortable shoes with individually selected instep with flat feet.
It is also useful to wear knee pads with instability of the joint or the patient’s uncertainty in his support. Such a knee pad should also be individually selected; it should not impair blood circulation in the vessels of the lower limb, especially when combined with a disorder in the venous system.
Recently, much attention has been paid to the use of heel wedges with lesions of the knee joint.
And it must be remembered that a patient with osteoarthritis should avoid overloading the knee joints, so any physical activity should alternate with rest.