Arthritis of the knee joint. Course of the disease and treatment plan

Arthrosis and arthritis: symptoms, treatment and prevention

Osteoarthritis and arthritis, although they have similar symptoms that are accompanied by damage to the joints, are different diseases. In the first case, destruction of articular cartilage and deformation of bone tissue occurs. The main indicators of the development of arthrosis (osteoarthrosis) are mechanical and biological processes. It most often appears in the arms (fingers), neck, lower back, knees and hips.

Arthritis is a collective term that refers to diseases of the joints of inflammatory etiology. Most commonly manifest as osteoarthritis (a degenerative disease) and rheumatoid arthritis. The disease is considered the most common cause of disability.

General signs of arthrosis and arthritis

The main manifestation of arthritis and arthrosis is joint pain of varying intensity. The pain intensifies from high activity and decreases as a result of rest, it is worth noting arthrosis. During arthritis, joint inflammation is accompanied by swelling, redness, difficulty moving and constant pain, even at rest.

Let us highlight the most striking symptoms of the disease:

1. Regular pain.
2. Stiffness, after rest and lack of movement.
3. Swelling and tenderness.
4. Clicking and crunching in the joint.
5. Reduced range of motion.

IMPORTANT! Often forms of arthritis are accompanied by rheumatic diseases, and therefore can cause symptoms affecting different organs. Based on this, the clinical manifestation of pathology in some patients with specific forms of the disease may include swelling of the lymph nodes, weight loss, fatigue, deterioration of well-being, and fever.

In addition to the above symptoms, symptoms of arthritis and arthrosis are quite often accompanied by the formation of Heberden’s and Bouchard’s nodes, which causes significant difficulties in further treatment.

Although they are not always painful, they do significantly limit the movement of the fingers.

Is it possible to do without surgery?

Only certain types of gonarthritis are amenable to conservative treatment: acute infectious, reactive and fresh post-traumatic, not accompanied by massive hemorrhage and damage to joint structures. In the presence of hemarthrosis, rupture of menisci and ligaments, patients require surgical intervention. In this case, arthroscopy is most often performed. With purulent arthritis, patients often require puncture of the knee joint. During the procedure, doctors remove accumulated exudate, wash the joint cavity and administer antibiotics. Rheumatoid, psoriatic and other autoimmune arthritis in the initial stages are treated conservatively. However, with late prescription of drug therapy and high disease activity, patients experience impaired knee function and chronic pain. In this case, there may be a need for endoprosthesis replacement, that is, replacing the knee joint with an artificial endoprosthesis.

Prevention of arthritis and arthrosis

It is well known that an active lifestyle improves health and prevents many diseases. Arthritis and arthrosis are no exception in this case.

It has been clinically proven that sport is extremely beneficial in combination with traditional treatment of the disease. Particularly good prevention includes strengthening joints and ligaments. Strength training will help in the fight against knee pain. Thanks to them, metabolism in the joints is activated and muscle tissue is strengthened. Moreover, physical activity helps activate the immune system, which will begin to fight the inflammatory process.

When taking preventative measures, it is extremely important to prevent unilateral stress on the joints. Therefore, sitting and standing activities should be alternated regularly.

This is interesting! Shoes play an important role in joint damage: many women suffer from osteoarthritis, which is accompanied by damage to the metatarsophalangeal joint due to inappropriate shoes. This happens especially often when wearing high-heeled shoes.

Preventing arthritis also includes proper nutrition. Here it is necessary to eliminate unhealthy foods such as fast food, as well as fried, smoked and fatty foods. While wear and tear on joints is a natural part of aging, osteoarthritis can appear earlier in life, for example due to injury. It has been clinically proven that nutrition directly affects the occurrence of the disease.

Excess weight also causes damage to cartilage. They are under constant pressure, which causes wear to occur much faster. This is why obesity and osteoarthritis are always close together.

Arthritis statistics

Despite the fact that arthritis is a very common disease, collecting statistics on it is not easy. Many people ignore the symptoms of the disease, citing the fact that such manifestations are “natural” at a certain age. There are approximately 314 million people diagnosed with arthritis in the United States, and approximately 39-42 million cases are reported each year.

In Russia this figure is close to 143 million people. The number of registered patients per year is approaching 17 million. At the same time, a much smaller segment of the population is susceptible to arthrosis of the knee joint (for the USA - 21 million, for Russia - 1.5 million).

Interpreting these data, we can say that 1% of Russians are diagnosed with arthritis every year and the number of healthy Americans is decreasing by approximately the same amount. In developed countries, up to 90% of injuries are due to falls, and the remaining 10% are non-traumatic injuries.

The issue of rheumatoid arthritis (hereinafter referred to as RA) is particularly acute. According to statistics, about 1.3 million Americans are susceptible to this disease, which is equivalent to 41 cases per 100 thousand population. Women suffer from pathology 2-3 times more often than men, and the life risk is: 3.6% for women and 1.7% for men. The worldwide prevalence of the disease is 0.5-1% (up to 5% among the elderly population).

Methods for treating joints

After passing a clinical examination and collecting anamnesis, a diagnosis is made. Pathological changes are confirmed by X-ray diagnostics. The most typical changes are a narrowing of the space in the joints, subchondral sclerosis (an increase in bone density occurs around the joint), the appearance of the same cyst and osteophytes.

There is no direct treatment for these diseases. They are both irreversible processes that occur due to age. However, it is possible to control its progress, reducing pain and destruction of cartilage tissue and improving the patient’s well-being.

Methods for treating joints:

• Undergoing physical therapy.

It can be of several types:

1. Warm water. Here you need to do exercises in warm water with sufficient depth. For example, in the pool. The liquid will support your weight, reducing stress on your muscles and joints.
2. Physical therapy. A special set of exercises has been prepared here, based on the individual needs of the patient. Sometimes combined with pain-relieving procedures.

• Ultrasound treatment.

The body is exposed to high frequency ultrasonic waves. Thanks to this, it is possible to reduce pain. Also thanks to it, medications penetrate into the deeper layer of the epidermis.

Advantages:

Anesthetic injections for pain in the hip joint are a way to relieve severe pain in the shortest possible time. The effect of chondroprotectors and other therapeutic agents lasts for a long time. A course of intra-articular injections allows you to delay and even avoid surgery, reduce the dosage and amount of medications taken, which is very important for problems with the digestive organs. Injection therapy can be repeated many times, since adverse reactions and complications are rare. The procedures have a beneficial effect on cartilage, accelerating healing and slowing down destructive processes.

Surgically

In cases of severe arthrosis, which is accompanied by rapid destruction of cartilage tissue, surgical intervention (arthroplasty) is used. The most common procedures are hip or knee replacements. Previously, most of the operations were performed on elderly people, whose age was 60 years or older. However, with the development of technology, artificially produced implants have become much better, and therefore young patients also undergo similar operations. However, another procedure in the form of revision surgery has been prepared for them in the future. Therefore, it is important to understand this before undergoing surgery.

What is knee arthritis

Arthritis of the knee joint (gonarthritis) is a large group of inflammatory diseases. Unlike gonarthrosis, they are more common at a young age and are of an infectious-inflammatory or immune-inflammatory nature. While deforming arthrosis develops after 60 years and is characterized by degenerative-destructive changes in the knee joint. Inflammation in gonarthrosis occurs secondarily, in the later stages of the disease.

Types of gonarthritis:

• Infectious (purulent septic, viral, tuberculosis, brucellosis). They develop due to the penetration of pathogenic microorganisms into the joint cavity.
• Reactive (urogenital, postenterocolitis, poststreptococcal). They arise as a result of the formation of circulating immune complexes (CIC) in the blood, their penetration into the joint cavity and deposition on the synovial membrane.
• Post-traumatic . Occurs in athletes who engage in extreme sports. The inflammatory process in them is a consequence of mechanical damage to the structures of the knee joint.
• Rheumatoid. It develops mainly in women over 40-50 years of age. The disease affects small joints of the hands, but large joints (knee, hip) can also be involved in the inflammatory process.
• Psoriatic . Occurs in some patients with psoriasis and is usually severe.

Acute infectious and reactive gonarthritis responds well to conservative treatment. Surgery for these diseases is rarely required and is usually limited to minimally invasive procedures (joint puncture or arthroscopy).

Bilateral ankylosis of the knee joint.

Rheumatoid and psoriatic gonarthritis often have a severe course. They lead to massive degenerative changes in the joints, damage to bones and periarticular tissues, and the formation of ankylosis. This also happens in people with advanced post-traumatic arthritis. Due to severe joint damage, such patients often require surgery.

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Drug therapy.

Analgesics. They are able to reduce pain, but have no effect on inflammation.

Non-steroidal anti-inflammatory drugs (NSAIDs). Will help reduce pain and inflammation.

Local anti-inflammatory drugs. They are produced as ointments or gels. The most effective drugs are those containing diclofenac or ibuprofen.

Chondroprotectors play a special role in the treatment and prevention of joint diseases. They are available in tablets and are a complex of vitamins, minerals and various elements. Their regular use allows, first of all, to avoid the risk of disease and various injuries during an active lifestyle. Secondly, chondroprotectors significantly slow down the destruction of cartilage tissue. Rheumatologists recommend paying attention to the drug "Arthra". It helps maintain the normal condition of joints in case of degenerative-dystrophic changes. The main active ingredients of the drug are glucosamine hydrochloride and sodium hyaluronate. What benefits do they bring?

Causes

Now that we know that one of the main reasons for the development of arthritis is infectious diseases, let’s talk more specifically about what organisms have a destructive effect:

• fungi;
• viruses;
• gram-negative bacteria;
• streptococci;
• staphylococci;
• gonococci;
• brucellosis;
• Reiter's disease (most often affects the hip joints, but in a proportion of cases the knee joint is also involved in the process);
• helminthic and protozoal infestations;
• chlamydia;
• syphilis;
• hepatitis.

As for non-infectious arthritis, their development is due to many factors:

1. DDI of cartilage structures (age factor).
2. Injuries of varying severity and their complications.
3. Inflammatory processes in tissues close to the joint capsule 4. Genetic
4. predisposition
5. Disorders of calcium metabolism (for example, rickets).
6. Behçet's disease.
7. Ankylosing spondylitis.
8. Cappilatotoxicosis.
9. Osteomyelitis.

Glucosamine

It acts as an amino sugar, which gives a “start” to the biochemical synthesis of glycosylated proteins. It is also a structural component of cartilage tissue. Thanks to glucosamine, the body receives “natural” materials for the development, repair and support of tendons, ligaments and other tissues. With age, the body produces less of this substance, which leads to deterioration of the musculoskeletal system.

Rheumatologists say that taking a glucosamine supplement can reduce pain and the destruction of cartilage tissue. More than 18 studies that served as the basis for the 2005 review clinically supported the substance's effectiveness and beneficial effects on osteoarthritis.

The norm for patients is 700 mg/day. If necessary, the dosage can be increased to 1500 mg.

Methylsulfonylmethane

Methylsulfonylmethane (MSM) is an organosulfur compound. Also known as methylsulfone or dimethylsulfone. Sulfur plays an important role in the formation of connective tissue. This substance is a mild analgesic that reduces pain.

According to a pilot study that involved 50 people with knee osteoarthritis, it was found that when taken at 6000 mg per day, the drug reduced severe symptoms of the disease with minimal side effects. The study was conducted in 2006. Future trials have been conducted numerous times, all of which have shown a reduction in oxidative stress and inflammation through MSM supplementation. It turned out that it protects muscles from various mechanical damage that arise from an active lifestyle.

Sodium hyaluronate

Being a glycosaminoglycan, one of the main components of connective tissues, it plays an important role in the proliferation of cells that determine their division and growth. Most often it can be found in the skin and bones, synovial fluid and intervertebral discs. Hyaluronate is part of the synoval fluid, providing support for knee mobility and reducing friction of the articular surfaces. It is actively used to treat diseases of the musculoskeletal system. It reduces pain and symptoms in general.

According to 2004 statistics, osteoarthritis caused moderate and severe disability in 43.4 million patients. Osteoarthritis of the knee and hip joint ranks 11th out of 291 in the world ranking of evaluated diseases.

Hyaluronic acid

Injections with hyaluronic acid replenish the deficiency of synovial fluid characteristic of joint pathologies. It is called “synovial prosthesis”, since the consistency and composition of hyaluronic acid is identical to natural synovium. If there is a lack of it, the articulating surfaces of the bones begin to rub against each other when walking and injure the cartilaginous layer. Hyaluronic acid returns synovium to its normal qualities, at the same time relieving inflammation and stimulating the regeneration of damaged areas.

Alternative medicine

Alternative treatment will not replace medication. However, many patients tend to claim that, for example, acupuncture or reflexology helps reduce symptoms and side effects while taking medications.

It is important to note that treatment is most successful when the course begins early. Its goal is to reduce pain, support and improve skeletal functionality.

It is worth noting that you should not self-medicate. Contact a specialist, he will select the necessary medications for you according to your condition. He may also refer you to physical therapy.

Please note that walking for an hour or two in the fresh air will help prevent the disease. This is especially important with a sedentary lifestyle and low mobility. Do exercises in the morning; this will not only reduce the risk of illness, but also improve your well-being and give you strength for the whole day.

Diagnostics

At first, exacerbations appear in the form of minute attacks, and sometimes last for several days. But abnormal changes in the immune system begin to occur long before obvious signs of illness. It is very important not to miss the initial symptoms of the disease and to visit the clinic on time. Patients often ask: their joints hurt, which doctor should they see? If you don’t know which doctor to visit, you can always ask about it at the reception desk or go to an appointment with a therapist who will examine you and give you a referral to the necessary specialists: a neurologist, rheumatologist, orthopedist and surgeon. Timely detection of the disease makes it possible to slow down its development and improve the patient’s quality of life. When visiting a doctor with a patient, the following is carried out:

• a conversation during which complaints, duration and characteristics of the disease are clarified;
• external examination and palpation are performed;
• a complete anamnesis is collected.

After this, the following laboratory tests are performed to diagnose autoimmune arthritis:

• Clinical blood test - a characteristic feature is an increased erythrocyte sedimentation rate; with the development of the disease, a decrease in hemoglobin occurs.
• Biochemical blood test - nitrogenous waste is detected, the functioning of the liver, pancreas, carbohydrate metabolism is assessed, and blood clotting is checked.
• Blood test for antibodies - their presence and concentration is detected.
• C-reactive protein indicates the development of an inflammatory process.

In addition, to make an accurate diagnosis of autoimmune arthritis, the following hardware tests are prescribed:

• Radiography is one of the important diagnostic methods: determines the presence of damage due to injuries; changes associated with inflammation; joint deformation; bone tissue growth; changes in the joint cavity.

• Ultrasound is often used to identify changes in large joints.
• CT scan – allows you to see the condition of soft tissues.
• MRI is widely used to monitor changes in ligaments, intervertebral discs, and muscle structures.
• Scintigraphy - this method is often used to diagnose arthritis (ICD-10 code M05-M99) and can detect the disease in the early stages.
• Arthroscopy – often used for the knee joint.
• Puncture - performed to take synovial fluid for the purpose of its subsequent study.

After the results of all studies are ready, consultations with specialists are made, an accurate diagnosis is made and appropriate treatment is prescribed.