Deforming arthritis or osteoarthritis - a disease of bone and articular apparatus. Suffering from osteoarthritis of the 10 to 15% of the people and the number of patients increases with age. Deforming arthrosis can occur in almost any joint, but most often affects the joints exposed to greater stress.
Men and women suffer equally often, except for the disease osteoarthritis in small joints of hands, which are much more common in women. The disease occurs in children and adolescents. In this case, deforming arthritis usually develops after trauma or other joint diseases for which there was joint disease.
In the beginning of degenerative-dystrophic changes occur in articular cartilage tissue, then spread to the adjacent area of bone, shell replacement, it bundles the capsule. In advanced stages involved in the process, and muscles. On the lateral surfaces of the bone growth of bone occur in the form of spikes, which are called osteophytes. In the joint, there is pain and limited mobility is gradually developing joint and impaired function.
It is impossible to isolate one cause of osteoarthritis. Degenerative changes of articular cartilage usually results in a range of factors.
Due to the development of osteoarthritis is divided into
primary
the secondary.
On the primary or idiopathic osteoarthritis, say, when there are visible cause of the disease. It is believed that in this case, the central role played by the hereditary factor - a violation of the components of articular cartilage, membranes and the biochemical structure of cartilage.
In secondary osteoarthritis is characterized preferential loss of one joint, sometimes two or more. Are the following types of reasons that contribute to the development of secondary arthrosis deformans:
mechanical. This joint injuries, intra-articular fractures, which lead to a breach of the normal structure of the joint. Has a constant value mikrotravmatizatsiya joint and constant load on the rigid joint, which is common in athletes. Various developmental abnormalities of the skeleton leads to uneven load on the joints, resulting in some parts of the articular surfaces have overburdened and destroyed. Another important factor is obesity overloads the joints
diseases of the joints. For osteoarthritis can cause inflammatory joint diseases (acute and chronic arthritis), hemophilia, in which as a result of minor trauma, blood flows into the joint (hemarthrosis), primary aseptic necrosis of bone
metabolic disorders. Osteoarthritis can occur as a complication of systemic diseases - gout, chondrocalcinosis, hemochromatosis, psoriasis, rheumatoid arthritis
endocrine diseases (metabolic calcium hypo-or hyperparathyroidism, diabetes mellitus, impaired production of sex hormones and growth hormone somatostatin)
disease accompanied by circulatory disturbance of tissue replacement (atherosclerosis of the lower extremities, occlusive disease, varicose veins).
The disease develops gradually. It is believed that in the beginning there is poor circulation in the capillaries podhryaschevogo layer of periosteum. Cartilage itself has no blood vessels and cartilage nutrition is due to the supply of nutrients from the synovial fluid and the adjacent bone tissue.
As a result, reduce the power articular tissues arise in the biochemical changes. Reduced the number of proteoglycans, substances, which are the main components of the structure of cartilage collagen tissue. Decreases the amount of water content in the cartilage. This leads to a decrease in elasticity and strength of articular cartilage and cartilage mechanical load is gradually destroyed.
Initially, these processes are compensated for hard work of cartilage cells - chondrocytes, but then the reserves are depleted, the number of chondrocytes decreased, the cartilage becomes thinner, razvoloknyaetsya, there are cracks. Cracks gradually deepened, cartilaginous fibers dissolve. Reducing the thickness of the cartilage and leads to increased elasticity of the load on the subject bone. Sclerosing bone tissue (compacted), which is also a compensatory response to overload. But this growth does not stop bone and on the periphery of the articular surfaces appear bone-cartilage growth - osteophytes. This is also a compensatory reaction to the way the body tries to nagruzku.Takim expanded articular surface of the bone, for the distribution of its load.
Osteophytes lead to deformation of the joints. Thinning of the cartilage leads to a change in the shape of the joint and its instability. In the joint cavity having reactive inflammatory changes, increasing the number of synovial fluid, but its composition changes, and its function is reduced. Gradually, dystrophic changes in the tissues of the joint capsule, ligaments and muscles. The function of the joint is broken. In early disease, patients may complain of a crunch in the joint, pain at the beginning of the disease slack, aching.
Perhaps the emergence of the so-called start-up of pain, when pain in the joint increases at the beginning of the movement, and then decreases or disappears. Such pain may occur in the morning, on rising from bed. Then the patient "at odds" and the pain disappears. With the development of the disease, the pain appears after the load on the joint, and will soon become permanent. The patient may complain of lameness, difficulty in climbing stairs, stiffness in the joint.
On examination, reveal the deformation of the joint. If the joint is put out and at the same time to flick it, there is a kind of crunch, called crepitus. In the study of the traffic volume in the joint exhibit limiting or in advanced cases, a lack of joint movement. The muscles around the joint at first reflexively tense, then gradually develop their degeneration and contraction when the muscle is shortened and can not get their normal form. In the course of the disease there may be periods of exacerbation and pain subsided.
Refine the diagnosis of X-ray examination of the joint. There are three stages of development of deforming arthrosis. In the first stage revealed uneven joint space narrowing and a small seal subchondral bone sites. The second stage is characterized by the occurrence of bone growths (osteophytes) at the edges of the articular surfaces. Joint space at the same time narrowed to 2 or 3 times the norm. In the third stage of joint space becomes almost invisible, revealed extensive osteophytes, joint deformity. Clinically, this stage is characterized by almost complete loss of mobility in the joint.
