Knee arthrosis: symptoms, treatment

Among the diseases of the musculoskeletal system, osteoarthrosis is a frequency leader.It is believed that the majority of the planets at the age of 60 have the early signs of changes in the articular cartilage, and 14% already have manifestations of osteoarthrosis.The most common version of the disease is osteoarthrosis of the knee joint.

However, "arthrosis" or "arthritis"?

Do not mix these two concepts.Arthrosis is a process of change primarily in the structure of the joints, and arthritis is an inflammation that can occur in the background of the "un touched" structure and against the background of arthrosis.

Bone changes with arthrosis can be compared, for example, with growth fastened to the trunk, which grows close to the concrete fence and puts pressure on this fence with all its weight.

Usually, the surface of the bone facing each other is separated by two layers of cartilage and meniscus (additional cartilaginus plate).In addition to the role of "buffers" between bones, cartilage gives bone sliding and mechanical letters.Meniscus, which, because of major or small (but frequent) injuries, as well as losing their elasticity, can completely or partially break down more.

With age, and especially in the presence of hereditary tendencies, the articular cartilage is thinner.That is why the bones and lower legs, which form the knee joints with their ends, are dangerous to each other, friction may arise between them.

Usually in line with the depletion of cartilage for years, another unpleasant event occurs: the amount of intra -Articular fluid decreases.This fluid is not just a mechanical "lubrication" of the joints from the inside.It provides bone nutrition, menisci and cartilage together.The violation of "supply" of all these structures is a real disaster for joints!

If there is a physical load of the joints, then bone growth appears on the surface of the bone and begins to grow, more similar to the indicator, or spikes.For the knee joint, such advantages will lift weight (including your own body weight!), Physical work with knee emphasis (for example, garden grass), walking on the stairs, running, wearing uncomfortable shoes, flat feet and more.It is now easy to imagine what's going on in the knee joint during the development of arthrosis, and how it shows itself in appearance.

How's the work together?

Each of us has seen joint cartilage many times in the end, for example, chicken bones.It covers small areas contacting bones.Under the articular cartilage is a subcondral bone or pioneer.The human musculoskeletal system is arranged in the same way.

Most joints of people consist of bones, synovial shells (articular) and intra -articular fluid.

What happens to joints with arthrosis?

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

The cartilage cartridge product formed because microtrauma falls into the synovial liquid.It is naturally arranged that they are foreign materials for synovial shells and trigger their inflammation.The formation of synovial fluid is interrupted, which is usually a "conveyor", similar to a continuous cycle of enrichment and blood purification.In addition, the joint fluid becomes less than hyaluronic acid.It's worth telling about this acid.

Hyaluronic acid provides synovial fluid viscosity, creates "buffer effects" and "lubrication effects" between bones, reducing their friction against each other.Thanks to this material that the articular fluid in consistency resembles egg protein, not water.Another important role of hyaluronic acid is to ensure the delivery of nutrients from the articular fluid deep into the articular cartilage, as there is no place to take nutrition to it: blood vessels do not directly fit directly to the cartilage.In the same way, the "spent" material from the cartilage into the joint fluid is removed: using hyaluronic acid molecules.

Therefore, enhanced bone seals occur and unbearable conditions are made for articular cartilage.

The cartilage receives a signal to adapt to this extreme situation, and its change begins, in other ways it is called re -formation.This is mainly indicated by the decline in cartilage elasticity.

In the final stages of arthrosis, the bone becomes rigid, but at the same time more fragile, the cartilage itself is partially absorbed with calcium - calcium.

Symptom

The development of arthrosis begins with a slight pain in the knee, appearing after walking, physical activity, walking on foot.Such mild pain can appear for several months, or even years.Then they became more clear.In the early stages of the development of the disease, the knee bone is not defective, but the slightest swelling of the joints itself can be observed.

In the second stage of the development of the disease, the pain becomes more intense and occurs after a slight burden.In addition to pain, problems arise in the knee joint, which is different from the normal abuse of healthy joints with pain.In addition, the joint deformation becomes significant, the bone to the touch is wider and rough.Near the knees more than 90 degrees are a problem.

In the third stage of the disease, knee pain is severe and permanent, not even passing even during the rest.Knee mobility is minimal, often it does not bend more than 90 degrees and does not extend to the end.Bone modification of the joints is so strong that there is a valgus (X -shaped) or variation (o) foot variation.

Diagnostics

Checkup

In the early stages of the disease, the joints were unchanged, the mobile, the muscles around it was preserved, and strongly strong.Only with certain palpation (pressure) of certain points, more often on the inner surface of the joints, is the local (local) pain.Doctors ask the patient to do some squats, bend, straighten their feet on the knees, put their face on the couch and lead their own relaxation (this is called "passive" movement).In this case, in addition to pain and limit the amount of movement, you can determine the problem, click the joints.With clear inflammation components, the joints increase in size, apparently "pumped" with fluid.With a remote process, bending on the knee can be partially or completely absent, when examined, the surface of the joint appears to be uneven, tuberous, curved limbs (axis displacement, "raised").

Laboratory and Instrumental Research

• The Laboratory Survey Program must includeGeneral blood tests, biochemistry and immunology, urine analysis.In general blood tests, attention will be paid: increased leukocyte levels and increased erythrocyte solution rate, which indicates inflammation.In blood biochemical analysis, metabolic metabolic indicators are important, the level of "liver" enzyme.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 contents of "sand" - uric acid crystals.
• Synovial fluid analysis (articular)It is prescribed in cases where the liquid is in sufficient quantity.That is, when the joints are swollen, swollen.In compliance with infertility, the doctor penetrates the capsule together in a tight place, inserting a needle into the joint cavity, and then removing excess fluid.Some of the materials obtained enter the laboratory for analysis.At the end of the procedure, the anti -inflammatory drug from the glucocorticosteroid group is most commonly administered into the joint cavity (for example, Diprospan).
• Radiography.The second picture -two knee joints are mandatory, this is necessary to compare the sore knees with a healthy one.In the picture, attention is paid to the width of the joint gap (it is evaluated by the condition of the meniscus and the cartilage), the presence or absence of bone -STeophytes spikes, signs of destruction (destruction) of the bone.
• Ultrasound of the knee jointHe will answer questions about the preservation of meniscus, presence of baker cyst, severity of inflammation, presence or absence of uric acid crystals (in front of gout).
• MRI (magnetic resonance imaging).This study is set if the ultrasound does not provide a complete answer to the expert questions.MRI is mandatory for patients planning to perform arthroscopy.
• Arthroscopy.Allows you to visualize, that is, personally assessing the condition of the joints.This method is essential for controversial diagnosis, suspicion of traumatic damage to meniscus and ligaments (then directly during the study, possibly eliminating meniscus or torn ligaments).

Treatment of arthrosis of the knee joint

The principles of comprehensive treatment should be followed, including:

1. Detailed awareness of the patient about the disease

2. The use of physiotherapy exercises, which includes: specialized exercises for joints in positioning, swimming
3. Maintain optimal weight
4. Wear orthosis (soft wrap or at least elastic bandage) during increased load on joints - on the road, during walking, and so on.
5. Non -Conservation Methods (Physiotherapy).This type of treatment provides excellent results with knee joint arthrosis (gonarthrosis).Apparently, this is due to the fact that joints are available for the influence of factors such as magnetic and laser radiation.To treat knee joints, you can use magnetic current, UHF, Cryo exposure (translated from Greek means cold effect).Physiotherapy procedures are extensive, the course of treatment is usually short - 10, maximum sessions daily or daily.It should only be remembered about the possibility of contraindications, including tumor processes, thyroid gland disease and pelvic organs, as well as systemic inflammation (autoimmune).
6. Drug therapy.

Principles of Osteoarthritis Therapy:

• Relieves pain
• slows down the destruction of the shared structure further
• Restore the missing joint function.

Anti -Nonsteroidal Anti -Medicine

To relieve pain, medicines from NSAIDs Lee NSAID -The anti -anti -non -Ssteroid medication is used.They are used in and in the form of applications (applications to 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 ensure that there is no change in the skin, whether it is rash, pustules or cracks.The general rule of local treatment is to use the selected cream or gel at least twice daily, and if an unpleasant sensation arises - to cancel the complete loss of this manifestation.Intramuscular administration of painkillers is not recommended, as the risk of side effects due to administration using the syringe is not reduced, but vice versa.In the case of inflammation mentioned, the accumulation of large amounts of fluid, intraarticular glucocorticosteroid drugs are allowed, but it should be noted that this procedure should be performed no more than 1 time every 3 months.

Chondroprotectors

The higher anti -inflammatory effect with osteoarthritis is the preparation of chondroitin or glucosamine.They, like NSAIDs, fight with inflammation at the level of thin joint structure, but have fewer side effects, and, most importantly, maintain their anti -inflammatory effects a few months after cancellation.

Chondroprotectors are the collective names of a group of drugs that contain at the same time chondroitin sulfate and glucosamine - "construction bricks" of cartilage.Despite the high cost treatment with chondroprotectors, their facilities for patients and their effectiveness are difficult to assess.First, these ingredients, which are accepted in it, are absorbed perfectly from the stomach, and the drug loss "along the way" to the cartilage is minimal.Second, they can suppress inflammation in the joints, and, in addition, certainly slow down the process of destroying the cartilage together!They are usually prescribed courses, as they have a relatively long "ace" that lasts for several months, and sometimes up to six months.

Hyaluronic acid -based drugs are called hyaluronates.The fund is sold in the form of a syringe provided for intra -articular administration.Hyaluronets are artificial synovial liquids.The effects of treatment with this method can last up to 12 months.

Surgical treatment of knee joint arthrosis

Like hip joint arthrosis, in the case of serious changes and continuous loss of function, it comes to surgery.With gonarthrosis, two types of interventions are now performed: arthrodesis (unpleasant compound) and endoprosthetics.The first operation is rarely performed, according to special guidance, when the installation of endoprosthesis is impossible for any reason.The result of this operation is that the knee becomes moving.But it doesn't hurt.Endoprosthetics operation is much more profitable in terms of function.Keep in mind that with large weight, this operation is not performed - the risk of complications during the postoperative period is too large.From the time the removal of the damaged parts of the joints and the installation of the prosthesis until the function is fully restored, no more than three weeks passed.

How does an absurd osteoarthrosis be threatened?

Over time, osteoarthrosis does not turn away, but only worsens, especially when maintaining provocative factors.Consider the main source of harm to the health and life of patients with osteoarthritis.

• Chronic pain with a variety of intensity- Very important risk factors, especially in the elderly.Experienced sensations can cause sleep disorders, reduced mood backgrounds and depression.It is difficult to predict the chain of bad events that are interesting to the listed phenomena.
• The pathology of the veins.Persistent inflammation in the knee area, the growth of bone -STeophytes spikes, which can mechanically injure the popliteal vessel, can lead to the development or development of varicose veins.Sometimes orthopedis refuses to handle the knee until the varicose node is removed, but the phlebologist (veins) does not begin the surgery in the veins until there is a clear change in the knee joint.
• Reduced limbs function.With a long process, the joints can completely lose the ability to move, and this, in most cases, is a sign of defect.
• Involvement of other joints.We have learned how the usual phenomenon, such as flat feet, can "pull" the knee joint together and lead to the development of osteoarthrosis.In the same way - along the chain - there is involvement in the process of painful knee joints from the other side.If the patient ignores the suggestion, refusing to wear a stick, preferring to "drown on both", the arthrosis of the hip joint develops soon.The feet are twisted, walking into "ducks".
• immobility.Serious complications of the disease occur in cases where the bones -the joints are very destroyed, there is no cartilage, the movement in the joints is very painful or impossible due to the combination (this is called "ankylosis") of the bone.In this case, only surgery can help the patient, but only if it is technically possible.Overcoming is dangerous in the general sense: it causes obesity, osteoporosis, muscle atrophy, rapid development of internal organ disease.In addition, people who do not move, of course, always need to take care of themselves.
• Disability.Unfortunately, there are several states that make the operation impossible, and one of them is far away, "ignored" osteoarthritis in patients over 80 with severe related diseases.

Prevention

• Excludes joint injuries.Apparently: nothing is easier.In the meantime, leaving jumps, running, walking on stairs, dancing, high heels is not difficult.In practice, it turns out that it is the point that causes the most protests in the patient.Someone, if he is recently suffering, is usually not ready for the fact that some important points in his daily life will be missed.But if you do not follow these tips, there is a rapid decline in quality of life and defects.
• Losing weight and maintaining it in the optimum limit is a very important suggestion!No matter how magical this is or the tool, fat people will not be able to appreciate it.Because while the joints are burdened with excess weight, microtraumas are repeated daily.This can reduce all efforts to "no".In addition, for several methods of treatment, obesity is a direct contraindication.
• Walk with support.Universal rules for unloading joints using support are these: sticks, sticks or hands should be in the hand opposite the affected member.That is, if the right knee hurts, the stick should be kept on the left, and vice versa.
• Flat foot correction.Apparently, how are the flat feet and knee joint arthrosis connected?It turned out directly.If the feet are installed incorrectly (now we are talking about longitudinal or mixed feet, not about horizontal) the load is distributed in the knee joint.In this case, the severity of the body with the steps does not fall in the middle of the joint, but on the right or left.In this regard, right or left meniscus suffer more, and as it suffers more, we wear faster.Next comes the "turn" of the articular cartilage where the meniscus cannot accommodate its function.This process ends with the formation of common "arthrose" changes in the knee joint (appearance of bone grow).