joint

Arthropathy – What is it in simple terms?Arthropathy is a chronic pathology in which the cartilage plates are progressively destroyed. Pathological changes affect the underlying bone, causing it to become denser and develop marginal growths (osteophytes). The joint capsule responds to the events that occur and reactive vasculitis occurs.

About the disease and possible complications

The incidence of pathology depends on age. The first signs of arthropathy usually appear no earlier than 30-35 years of age, and by the age of 70, about 90% of the population has the disease. Arthropathy did not show any sex differences. The only exception is degenerative damage to the joints between the carpal phalanges. The disease is 10 times more common in women than men. Arthropathy most commonly affects the large joints of the legs and arms.The pathological process begins in the stroma of cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial material is maintained by balancing anabolic and catabolic processes. If the decomposition process of cartilage tissue dominates its synthesis, conditions will be created for the development of osteoarthritis. This explains in simple terms what arthropathy is.Most often, the first signs of the disease appear where mechanical loading is greatest, with limited areas of softening of the cartilage plates. As the pathological process progresses, cartilage fragments and cracks, and localized deposition of calcium salts may occur. Under a cartilage defect, the underlying bone is exposed; fragments of detached cartilage enter the joint space and can cause what is called "stuck" (symptoms of "joint mice").Damage to the cartilage lining the articular processes of bones can cause the bones to lose their ideal shape, repeating each other's contours. Therefore, when moving, the joint surface is subject to non-physiological loading. In response to this, compensatory resynthetic processes in bone tissue are stimulated. The bone becomes denser (subchondral sclerosis) and irregularly shaped marginal growths (osteophytes) develop, which further alter the differences between the articular surfaces. The evolving pathological changes gradually limit the range of motion of the joints and lead to the development of complications in the form of muscle contractures (secondary muscle spasms due to pain).The joints become the background for the development of synovitis (inflammation of the synovium of the joints). This is because dead fragments of cartilage and bone activate phagocytosis of leukocytes, accompanied by the release of pro-inflammatory mediators. Over time, this long-term inflammation is accompanied by hardening of the tissue surrounding the joint—the joint capsule thickens and the surrounding muscles atrophy.The main symptoms of arthrosis are pain and, over time, limited joint movement. Limitations in mobility are first of a compensatory functional nature and then due to organic changes. Other diagnostic imaging methods (radiography, ultrasound scan, computed tomography or magnetic resonance imaging) can help establish the correct diagnosis.Depending on the stage and extent of the arthrosis, it can be treated using conservative or surgical methods. An orthopedic traumatologist will help you choose the best treatment option that takes into account the patient's individual characteristics.

Types of Arthropathy

There are two types of arthropathy:

1. The main variation is the result of a disruption of the relationship between the synthesis and degeneration processes of cartilage tissue, accompanied by dysfunction of chondrocytes (the main cells of cartilage).
2. Secondary variants occur in previously modified joints when the normal relationship (conformity) of the joint surfaces is disrupted, and subsequently the load on the joint surfaces is redistributed and stress is concentrated in certain areas.

Symptoms of Arthropathy

The main symptom of joint arthritis is pain. It has certain unique characteristics that allow for a preliminary diagnosis of the disease.

1. mechanical pain, caused by cartilage losing its shock-absorbing properties. Pain occurs with physical activity and is relieved with rest.
2. Pain at night.Caused by stasis of venous blood and increased pressure of blood flowing within bones.
3. The pain begins.It is short-lived and appears on getting up in the morning (the patient says he needs to be "dispelled"). These pains are caused by debris deposited on the cartilage plate; during movement, these debris are pushed into the joint and turn in, so the unpleasant sensation ceases.
4. Meteor dependence.Pain may worsen when weather conditions change (increased air pressure, cold weather, high humidity).
5. Lockdown pain.These are sudden painful sensations associated with the squeezing of pieces of bone or cartilage between the joint surfaces. Under the background of "blockade", the slightest movement of the joints stopped.

When secondary synovitis occurs, the nature of the pain changes. In this case, the pain becomes constant. In the morning, a person will suffer from joint stiffness. Signs of the inflammatory process are objectively determined - swelling and local increase in skin temperature.Osteoarthritis usually occurs slowly with pain starting in the affected joints. At first, the pain only bothers you during physical activity, but later it occurs even at rest and during night sleep. Over time, pain may also occur in the contralateral joint, which is associated with increased compensatory loading. An important distinguishing feature of arthropathy is its frequency, i. e. , brief exacerbations followed by periods of remission. The progression of the pathological process is manifested by a shortening of the interval between recurrences and the development of adverse consequences in the form of contractures and a sharp limitation of joint mobility.

Course of Arthropathy During Pregnancy

Arthropathy can occur in different ways during pregnancy. Usually, for up to 12-13 weeks, the pathological process may worsen, which is related to hormonal changes in the female body. The second and third trimesters are usually relatively stable. Pregnancy management is performed by obstetricians and gynecologists and orthopedic traumatologists.

Causes of joint arthritis

The main mechanism that causes cartilage destruction is the destruction of proteoglycan molecule synthesis by cartilage tissue cells. Arthropathy is preceded by a period of hidden metabolic derangement. This metabolic imbalance is characterized by impairment of proteoglycans and their constituent components (chondroitin, glucosamine, keratin), accompanied by disintegration and breakdown of the cartilage matrix. Collagen fibers in the cartilage plate break, the supply of metabolites necessary for life is disrupted, and the water balance changes (first the cartilage is hydrated, then the number of water molecules decreases sharply, further stimulating cracking). The main pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in chondrocyte mass characteristics lead to the synthesis of defective proteoglycan molecules and short-chain collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they leave the matrix quickly. In arthropathy, a cytokine "boom" is also observed - the released cytokines disrupt collagen and proteoglycan synthesis and stimulate synovial inflammation.The main causes of joint disease are diverse:

• "Excessive" weight increases the load on joints;
• wearing poor quality shoes;
• Concomitant diseases of the musculoskeletal system;
• Joint injuries.

Signs and Diagnosis of Arthropathy

Based on clinical symptoms, radiologists make a preliminary diagnosis. To confirm this, additional imaging tests were performed.

1. Radiography.In the early stages, X-ray symptoms of the disease mean little - these may be uneven narrowing of the joint space, slight compaction of the underlying bone, and small cysts in the area. In later stages, radiography can provide more information - the presence of marginal bone growth, changes in the shape of the joint surface, joint "mice" and areas of calcification in the joint capsule.
2. Ultrasound examination of joints.Ultrasound scans are more informative for detecting the first symptoms of arthropathy. Signs such as intraarticular effusion, changes in cartilage plate thickness and structure, and secondary reactions in the joint capsule, tendon, and ligament compartments may be seen.
3. Computed tomography or magnetic tomography.The diagnosis of joint arthritis is made in complex clinical cases, when a detailed assessment of the condition of the cartilage plates, subchondral areas of the bones and determination of the volume of synovial fluid, including the amount of synovial fluid, is required. Especially handstands.

Expert Opinion

Arthrodeforming arthropathy is one of the most common disorders of the musculoskeletal system, affecting 10-15% of the world's population. The insidious thing about this disease is that its progression is slow and gradual. At first, these are just short-term pains in a joint that people usually don't notice. Gradually, the severity of the pain syndrome becomes more severe, while the cyclical nature of the pain transforms into constant. Without treatment, the disease continues to progress with severe cartilage degeneration, which no longer responds to conservative treatment. To solve this problem, only a joint replacement is required - a complex and expensive procedure. Interventions to replace damaged joints with intact joints. -Proven implants. However, targeted medications and lifestyle changes can help significantly delay or avoid this surgery entirely. Therefore, if you develop joint pain, it is important to see your doctor as soon as possible.

Treatment of Arthropathy

According to clinical guidelines, the primary goal of arthropathy treatment is to slow the progression of cartilage plate degeneration. To achieve this, measures are needed to reduce the load on the damaged joints and promote their recovery, as well as treatments to halt the development of secondary synovitis.

Conservative treatment

Unloading of joints is achieved in the following ways:

• weight loss (if excessive);
• Carry out physical therapy to exclude prolonged periods of similar postures;
• Refusal to lift heavy objects or kneel for long periods of time (associated with some occupations).

In the initial stages of the disease, in addition to physical therapy, swimming and cycling are also useful. In the later stages, in order to reduce the load on the joints during the exacerbation of the condition, it is recommended to walk with an orthopedic cane or crutches.Pain relief, incl. For secondary synovitis, use topical and systemic NSAIDs. Intra-articular corticosteroid injections may also be used for the same purpose.To improve the anatomical and functional status of the cartilage plate, chondroprotective agents and hyaluronic acid preparations are injected into the joint space. They help improve the metabolism of cartilage tissue, increase the resistance of cartilage cells to damage, stimulate anabolic processes and prevent catabolic reactions. This allows you to slow down the progression of pathological processes and improve joint mobility.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

• joint puncture– For severe reactive synovitis. It not only removes inflammatory fluid, but also introduces corticosteroids to interrupt the pathological chain.
• Arthroscopic surgery, which involves introducing the instrument into the joint space through a small puncture and then visualizing it under magnification. These interventions can clean the joint and its inversion, flatten the cartilage plates, remove necrotic areas, "polish" the joint surface, etc.
• endoprosthesis– Considered a radical surgery, performed in cases of advanced pathological processes. Typically used for arthropathy of the knee or hip joints.

Prevent joint disease

The aim of preventing arthrosis is to maintain a normal body weight, wear orthopedic shoes, avoid knee work, lift heavy objects in a regular amount and adhere to a physical activity regime.

Arthritis Rehabilitation

Rehabilitation from arthrosis involves a series of procedures that improve the functional status of the joints and surrounding tissues. Physiotherapy, therapeutic massage and health gymnastics are used.

Questions and Answers

Which doctor treats joint disease?

Diagnosis and treatment are performed by an orthopedic traumatologist.

Does radiography always make the correct diagnosis?

The severity of clinical symptoms of arthropathy does not always correlate with radiographic changes. In practice, it often happens that radiographs show no obvious changes when accompanied by severe pain, or vice versa, that is, "bad" radiographs are not accompanied by obvious symptoms.

Is diagnostic arthroscopy used to treat arthropathy?

If arthropathy is suspected, arthroscopy is usually performed not to confirm the diagnosis but to look for possible causes of disruption of the functional status of the joint (for example, damage to the menisci and intra-articular ligaments of the knee).