Deforming osteoarthritis is a progressive dystrophic change in bone joints with primary damage to cartilage tissues and subsequent degeneration of the entire complex of the bone and joint apparatus. Disease is characterized by arthralgia, functional insufficiency of the joints and pronounced changes in their shape. Pharmacotherapy of deforming osteoarthritis is aimed at slowing the progression of degenerative processes, reducing pain and improving the functioning of joints; in some cases, joint replacement is indicated. The course of deforming osteoarthritis progresses slowly with the development of ankylosis or pathological instability of the joint.
Meaning
Deforming osteoarthritis is a frequent pathology of joints, in which a violation of the regeneration of connective tissue structures leads to premature aging of articular cartilage – its thinning, roughness, cracking, loss of strength and elasticity. The subchondral bone is exposed and compacted, osteosclerotic changes occur in it, cysts and marginal growths – osteophytes are formed.
Pathology of the primary type develops in initially healthy cartilage with a congenital decrease in its functional endurance. Cases of secondary deforming osteoarthritis occur against the background of existing articular cartilage defects caused by traumatization, inflammation of bone and joint tissues, aseptic bone necrosis, hormonal or metabolic disorders.
Classification
In accordance with the clinical and radiological picture, there are 3 stages in the development of deforming osteoarthritis:
- I – is characterized by a slight decrease in joint mobility, a slight indistinct narrowing of the articular gap, initial osteophytes at the edges of the articular planes;
- II – occurs with reduced mobility and crunching in the joint during movement, moderate muscular atrophy, noticeable narrowing of the articular gap, the formation of significant osteophytes and subchondral osteosclerosis in the bone tissue;
- III – it is characterized by joint deformation and a sharp restriction of its mobility, the absence of an articular gap, pronounced bone deformation, the presence of extensive osteophytes, subchondral cysts, articular “mice”.
The authors Kellgren and Lawrence distinguish the 0 stage of deforming osteoarthritis with the absence of radiological manifestations.
Symptoms
All types of deforming osteoarthritis are characterized by pain in the joints (arthralgia). The mechanical type of pain occurs during loads on the joint (due to micro-fractures of the trabecular bone tissue, venous stagnation and intra-articular hypertension, the irritating effect of osteophytes on surrounding tissues, spasm of the periarticular muscles) and subsides at rest or at night. The “starting” pain lasts for a short time, appears with the onset of movement as a result of the development of joint edema and reactive synovitis. “Blockade” pain in the joint is periodic, occurs during movement and “jams” the joint when a part of the destroyed cartilage (“articular “mouse”) is pinched between two articular surfaces.
Manifestations of deforming osteoarthritis include crepitation (crunch) in the joints during movement; limited joint mobility associated with a decrease in the articular gap, proliferation of osteophytes and spasm of periarticular muscles; irreversible joint deformation caused by degeneration of subchondral bones.
First of all, deforming osteoarthritis affects the supporting knee and hip joints, the joints of the spine, as well as the small phalanx joints of the toes and hands. The most severe is deforming osteoarthritis involving the hip joints – coxarthrosis. The patient is concerned about pain in the groin area, radiating into the knee, “jamming” of the joint. The development of hypotrophy of the thigh and buttock muscles, flexion-adductor contracture leads to functional shortening of the lower limb, lameness, up to immobility.
Deforming osteoarthritis with knee joint involvement (gonarthrosis) is manifested by pain during prolonged walking, climbing stairs, crunching and difficulty in performing flexion and extensor movements. With arthrosis of small joints of the hands, dense nodules appear on the edges of the interphalangeal proximal and distal joints (Geberden and Bouchard nodules), accompanied by soreness and stiffness.
In the generalized form of deforming osteoarthritis (Kellgren’s disease, polyosteoarthrosis), multiple changes in peripheral and intervertebral joints are noted. Polyosteoarthrosis is usually combined with osteochondrosis of intervertebral discs, spondylosis in the cervical and lumbar spine; periarthritis and tendovaginitis.
Complications
Long-term progression of deforming osteoarthritis may be complicated by the development of secondary reactive synovitis, spontaneous hemarthrosis, ankylosis, osteonecrosis of the femoral condyle, external patellar subluxation.
Diagnostics
During the diagnosis of deforming osteoarthritis, the patient undergoes a consultation with a rheumatologist and studies to determine the condition and degree of functional usefulness of the joint according to characteristic clinical criteria. The main data are X-ray diagnostics showing narrowing of articular gaps, proliferation of osteophytes, deformation of articular bone sections: the presence of cysts, subchondral osteosclerosis. For a more detailed assessment of cartilage changes in deforming osteoarthritis, ultrasound, CT of the spine and MRI of the diseased joint are additionally performed.
According to the indications, a puncture of the joint is performed. In difficult cases, arthroscopy is performed with targeted sampling of the material and morphological examination of biopsies of the synovial membrane, articular fluid, cartilage tissue, revealing dystrophic and degenerative changes of the joint.
Treatment
Therapy of deforming osteoarthritis includes an integrated approach taking into account the etiological circumstances, the systematic nature and duration of treatment. First of all, it is necessary to unload the diseased joint (especially the supporting one), reduce motor activity, avoid long walking, fixed poses and carrying weights, use a cane when walking.
Reduction of inflammation and joint pain in deforming osteoarthritis is achieved by the appointment of NSAIDs: diclofenac, nimesulide, indomethacin. Severe pain syndrome is relieved by intra-articular blockades with the introduction of hormonal drugs. At the risk of developing peptic ulcer disease, drugs meloxicam, lornoxicam, local anti-inflammatory ointments, gels are indicated. With slow resorption of intra-articular effusion, its puncture evacuation is performed.
In the initial stage of deforming osteoarthritis, chondroprotectors (glucosamine hydrochloride and chondroitin sulfate) are effective, helping to stop further destruction of cartilage and restore its structure. With deforming osteoarthritis, local physiotherapy is prescribed – applications of paraffin and ozokeritotherapy, high-frequency electrotherapy, electrophoresis with novocaine and analgin, magnetotherapy and laser therapy. To strengthen the musculoskeletal structures and improve the motor function of the joints, therapeutic gymnastics, kinesotherapy, regular sanatorium treatment and balneotherapy are indicated.
In case of severe disabling damage to the hip or knee joints, endoprosthetics are performed, in case of deforming osteoarthritis of the ankle joints, the operation of complete immobilization of the joint (arthrodesis) is effective. Innovative in the treatment of deforming osteoarthritis is the use of stem cells that replace damaged cartilage cells and activate regenerative processes.
Prognosis and prevention
The rate and degree of progression of deforming osteoarthritis is determined by its form, localization, as well as age and the general background of the patient’s health. Coxarthrosis can seriously disrupt the function of the limb, cause disability and even disability. With many forms of deforming osteoarthritis, the elimination of pain reaction is achieved, the joint functioning is improved, but it is impossible to achieve complete restoration of cartilage in an adult patient.
Prevention of deforming osteoarthritis consists in limiting joint overloads, timely treatment of injuries (sprains, bruises), diseases of the bone apparatus (dysplasia, flat feet, scoliosis), regular gymnastics, maintaining optimal body weight.