Generalized osteoarthritis (OA) is a chronic joint disease that mainly affects older people. Among people over seventy years of age, pathology is detected in more than 90% of cases.
The disease has a progressive course and over time leads to massive damage to the joints. According to statistics, the disease is one of the common causes of disability in older people. As practice has shown, it worsens all indicators of quality of life and leads to significant treatment costs.
The more joints are affected, the lower a person’s quality of life and the worse his psycho-emotional state.
General information
Primary generalized osteoarthritis is the most common form of the disease. The disease occurs spontaneously, without a specific cause. It usually affects the interphalangeal, first carpal, first metatarsophalangeal, knee and hip joints. Intervertebral discs and joints may be affected.
In the generalized type, less than three joints or groups of joints are involved in the pathology process. The proximal interphalangeal joints represent one group, the distal joints the second, and the metacarpophalangeal joints the third.
When only the proximal and distal interphalangeal joints are affected, we are talking about local osteoarthritis. If any large joint (knee or hip) is also involved in the pathology, doctors make a diagnosis of “generalized osteoarthritis.”
One of the factors that provokes the development of OA is connective tissue dysplasia (CTD). It leads to hypermobility and further damage to articular cartilage.
Types of osteoarthritis
Depending on the cause of primary and secondary osteoarthritis are distinguished
Primary osteoarthritis appears for an unknown reason, and secondary joint pathology can occur after injuries, inflammatory processes (rheumatoid osteoarthritis, purulent inflammation of the joint, arthritis with systemic lupus erythematosus, etc.), endocrine diseases and metabolic disorders.
Classification by location:
- generalized osteoarthritis - inflammation of all joints of the body;
- Osteoarthritis of the spine can also affect the cervical and lumbar regions. With this pathology, a person feels pain both when moving and during prolonged standing and sitting;
- Osteoarthritis of the hip joint is characterized by pain in the thigh, buttocks and groin. The patient is limping and has difficulty moving. In advanced cases, the thigh muscles atrophy and bone tissue begins to deteriorate;
- Knee osteoarthritis occurs when the knee is injured. When moving, a person feels pain, restriction in movement, which subsequently leads to joint deformation;
- osteoarthritis of the elbow joint - a problem with bending the arm, a tingling sensation is felt in the affected joint;
- osteoarthritis of the shoulder joint is characterized by the inability to raise the arm upward, subsequently the shoulder becomes completely immobile;
- Osteoarthritis of the hands appears in women during menopause; the symptoms of the disease are swollen joints and stiffness of movement in the morning.
Don't underestimate osteoarthritis! Advanced disease can lead to impaired mobility and joint deformation. and also to complete loss of ability to work!
Only timely, qualified treatment will help your joints!
Diagnostic principles
The diagnosis is made on the basis of anamnestic data, clinical signs of damage to at least three groups of joints, and the results of laboratory and instrumental research methods.
Table 1. Main signs of deforming osteoarthritis
| Clinical symptoms | Pain | At first it appears during active movements, walking, and doing normal work. In the later stages of the disease, it persists permanently and causes a lot of suffering to the person. “Starting pain” that occurs at the beginning of movement is typical. |
| Feeling stiff | It manifests itself as difficulty in flexing/extending joints. Appears along with pain after heavy physical activity. May occur in the morning and last no more than 30 minutes | |
| Difficulty performing usual activities | Patients find it difficult to walk, do housework, and perform their professional duties | |
| Joint deformity | In later stages, the damaged joints become deformed. Dense thickenings, painful on palpation, form along the edges of the joint spaces. Bouchard's and Heberden's nodes appear in the area of the interphalangeal joints of the hands. | |
| Results of imaging studies | Radiography | At the initial stages, X-ray examination is not very informative. Later on the pictures you can see a narrowing of the joint space, bone growths - osteophytes. Severe arthrosis is characterized by the appearance of osteosclerosis and bone deformation |
| MRI | Allows you to identify the characteristic symptoms of osteoarthritis in the initial stages. MRI clearly visualizes small defects of cartilage tissue and fluid accumulated in the joint cavity in case of synovitis | |
| Arthroscopy | Makes it possible to examine changes in joints from the inside. Diagnostic arthroscopy can turn into therapeutic. This happens when doctors need to remove fragments of destroyed cartilage from the joint cavity. |
Osteoarthritis and osteoarthritis
The differences between osteoarthritis and osteoarthritis are significant. Human joints are movable joints that allow the articulating bones to move relative to each other. At the points of contact, the bone surfaces are covered with cartilage tissue, which makes the sliding process easy and painless. The inside of the joint is lined by the synovial membrane. It produces a fluid, or lubricant, that facilitates the movement of the articular surfaces.
Osteoarthritis is inflammation of the joints. The following types of osteoarthritis are distinguished:
- Reactive – develops under the influence of infectious agents;
- Rheumatoid – systemic pathology of connective tissue;
- Gouty – occurs when there is a metabolic disorder;
- Psoriatic is a chronic progressive joint disease that occurs in patients with psoriasis.
In osteoarthritis, the inflammatory process primarily affects only the synovium of the joint. It contains many blood vessels, which are important participants in the inflammatory response. The cause of the classic symptoms of osteoarthritis (pain, swelling, joint dysfunction) is synovial effusion - a fluid that is produced in large quantities by the synovial membrane during inflammation.
Osteoarthritis is a degenerative disease that is associated with the gradual and slow destruction of cartilage. Inflammation of the joint is caused by elements of the collapsing cartilage plate. The following causes of osteoarthritis are distinguished:
- Injuries;
- Frequent osteoarthritis;
- Metabolic disease;
- Degenerative age-related changes.
At the beginning of the development of deforming arthrosis, the amount of intra-articular fluid decreases. Then the cartilage loses elasticity, becomes covered with cracks, and, if no measures are taken, completely collapses. Rheumatologists at the Yusupov Hospital carry out a differential diagnosis (determine the differences between osteoarthritis and osteoarthritis) by analyzing the clinical picture and medical history, laboratory data, radiography and magnetic resonance imaging. Patients are consulted by a traumatologist-orthopedist, phthisiatrician, infectious disease specialist, and cardiologist. Only after making sure that the diagnosis is correct, leading specialists in the field of rheumatology draw up an individual treatment plan. A multidisciplinary approach can achieve significant results in patient treatment.
Laboratory diagnostics
Standard laboratory research methods are of no value in the diagnosis of deforming osteoarthritis.
However, scientists have recently discovered an interesting connection between an increase in oxidized low-density lipoproteins in the blood and the development of osteoarthritis. Elevated levels of oLDL are usually detected in individuals with mono- and oligoarthrosis. And in people with high levels of antibodies to sLDL, generalized arthrosis with a rapidly progressive course or concomitant synovitis is more often diagnosed.
Low-density lipoproteins have an atherogenic effect and play a key role in the development of metabolic syndrome. Their level increases in individuals with obesity, atherosclerosis, coronary heart disease, and type II diabetes mellitus.
Prevention of osteoarthritis
To prevent osteoarthritis, you need to lead a healthy lifestyle. Compliance with an orthopedic regimen, physical therapy, proper nutrition, rest and sleep patterns - all this will help keep your joints healthy for many years.
The MedicCity clinic pays special attention to the diagnosis and treatment of osteoarthritis, gout, osteoporosis, lupus erythematosus and other rheumatoid diseases.
We take a comprehensive approach to maintaining the health of patients: after treating the underlying disease, you can take courses in massage, manual therapy, physical therapy, etc.
Easy movement for you and your joints!
Possibilities of early diagnosis
Today, scientists are beginning to develop methods for early diagnosis of osteoarthritis. Their essence is to identify genetic markers of OA and DST. Studies allow us to predict the risk of developing diseases of various localizations. But so far, genetic diagnostics are practically not used in clinical practice.
Defects in the GDF5 and VDR genes are associated with an increased risk of developing generalized arthrosis. This once again confirms that osteoarthritis deformans is a disease with a genetic predisposition.
Diagnosis of osteoarthritis
Osteoarthritis of the joints is detected using the following studies:
- X-ray diagnostics;
- Ultrasound of joints;
- MRI of joints;
- blood tests: general and biochemical;
- diagnosis of synovial fluid.
1 MRI of joints
2 Diagnosis of osteoarthritis
3 Consultation with a rheumatologist
Treatment of primary generalized osteoarthritis
The first step in the fight against arthrosis should be to unload the affected joints. A sick person should avoid heavy physical activity, running, and walking long distances. If interphalangeal joints are involved in pathology, you need to stop doing monotonous manual work.
Drug treatment is necessary to relieve pain and inhibit degenerative processes. The main goals of such therapy are stimulation of metabolic processes, improvement of intraosseous and regional circulation, and inhibition of joint inflammation.
Drugs prescribed for illness:
- immediate action (NSAIDs, corticosteroid hormones). They help quickly relieve pain and inflammation, remove stiffness, and improve joint function. These medications have only a symptomatic effect, but do not in any way affect the development of the disease itself;
- structure-modifying action (chondroprotectors). Stimulate the synthesis of proteoglycans and hyaluronic acid, slowing the progression of osteoarthritis. They have a noticeable effect only with long-term use.
To combat osteoarthritis of large joints, hyaluronic acid preparations are also used. They are introduced intrasynovially, that is, directly into the articular cavity. These medications are called synovial fluid grafts.
Symptoms of osteoarthritis
Osteoarthritis can develop over a long period of time, sometimes unnoticed. Pay attention to the following signs of joint pathology:
- localized periodic pain in the joint, which appears during exercise and subsides again at rest;
- morning stiffness in the joints;
- the appearance of inflammation in joint tissues;
- swelling in the joint, cracking noise when moving;
- decreased range of motion in the joint;
- loss of mobility and joint deformation.
Degrees of osteoarthritis
Osteoarthritis stage 1 . Pain during exercise and at rest, joint mobility is slightly limited.
Osteoarthritis grade 2 . The pain intensifies, and a crunching sound is heard when moving the joints. Limitation of mobility in the joints, the appearance of restrictions in the range of motion. Treatment is conservative, without surgery.
Osteoarthritis grade 3 . Constant pain in the joints, which intensifies with movement, persistent contractures. Significant limitation of joint mobility. If the legs are affected, a person can move only with the help of a cane, crutches, or walker.
1 General blood test
2 Diagnosis of osteoarthritis
3 Consultation with a rheumatologist
Osteopenic syndrome
In old age, osteoarthritis is often associated with oligosymptomatic or asymptomatic osteopenia. The development of the latter is associated with increased loss of calcium and active resorption of bone tissue. Osteopenic syndrome can be detected using densitometry. In cases of massive osteoporosis, pathological changes are visible on plain radiographs.
Since osteopenia aggravates the course of the pathology, combating it is an important part of the treatment and prevention of the latter. Therefore, patients with OA are prescribed drugs that suppress pathological bone resorption. Alendronate is most widely used in clinical practice.
Causes of the disease
A number of reasons can contribute to the appearance of the disease:
- injury or overstrain of joints due to increased physical activity;
- decrease in the amount of estrogen in women during menopause;
- elderly age;
- joint surgery;
- excess body weight;
- hereditary predisposition;
- disruption of the activity of endocrine organs;
- osteoporosis, etc.