Osteoarthritis in adults

What is osteoarthritis in simple words

Osteoarthritis is a group of diseases of various origins, which are based on the defeat of all components of the joint, but, first of all, cartilage, as well as soft tissues surrounding the joint, – says Yulia Voinova, rheumatologist, candidate of medical sciences, member of the Association of Rheumatologists of Russia.

According to her, osteoarthritis most often begins after 40 years, but with age, the prevalence of the disease increases. Approximately half of pensioners in the 65+ age group suffer from osteoarthritis, and among people over 75 years old, the disease is already detected in 80%.

What is important to know about osteoarthritis

Symptoms of osteoarthritis in adults

As we understand it, it hurts badly. And painful sensations are characteristic of any arthrosis. But this is not the only symptom of osteoarthritis in adults.

“The clinical picture of osteoarthritis includes three main symptoms: pain, crepitus (crunching) and an increase in joint volume,” our expert lists.

And now more:

1. Pain in the joints does not occur due to damage to the cartilage itself, since it is devoid of nerve endings, but is associated with changes in the adjacent bone, periarticular soft tissues, etc.

   – Most often, the joints that are subjected to the greatest load (knee, hip), small joints of the feet and the spine are affected, – says Yulia Voinova. – The nature of the pain is varied, but, as a rule, the pain intensifies with physical activity, and decreases at rest. Over time, inflammatory joint pain may also join. This is evidenced by a sudden increase in pain, the appearance of night pains, morning stiffness, swelling of the joints.

2. Crepitus – these are the crackling and creaking in the joints that are familiar to most pensioners when moving – another symptom of osteoarthritis.

   – It occurs due to a violation of the congruence (that is, the ratio) of the articular surfaces, limitation of mobility in the joint or blockade of the joint, the so-called “articular mouse” – a fragment of articular cartilage lying freely in the joint cavity, – explains Dr. Voinova.

3. The increase in the volume of the joint often occurs due to osteophytes – pathological growths of bone tissue, but may also be the result of edema of the periarticular tissues. Especially characteristic is the formation of nodules in the area of ​​the interphalangeal joints of the hands. Deformities of the extremities gradually develop: deformity of the knee joints, a “square” hand, Heberden’s and Bouchard’s nodules. In other words, the most noticeable deformation in the area of ​​​​the knees and hands.
4. According to a rheumatologist, morning stiffness in patients with osteoarthritis usually does not exceed 30 minutes, which distinguishes this disease from, for example, rheumatoid arthritis and other inflammatory joint diseases.
5. “The “gel phenomenon” or “starting pain phenomenon” is also often observed, that is, the need to stretch the joints after a long stay at rest, notes Yulia Voinova. – Fortunately, unlike other inflammatory diseases of the joints, extra-articular manifestations in osteoarthritis are usually not observed.

Causes of osteoarthritis in adults

Alas, there is no specific factor that provokes the development of osteoarthritis. Otherwise, the disease would not have such a grand “popularity”, and it could be easily avoided.

– Osteoarthritis occurs as a result of a combination of many factors, among which are the so-called endogenous (internal, it is difficult to influence them), and exogenous (external, amenable to correction), – says Dr. Voinova.

Endogenous factors:

• Age is considered the strongest risk factor for developing osteoarthritis.

  – It is believed that chondrocytes (cartilaginous tissue cells) lose their ability to recover and participate in normal metabolic processes with age. On the other hand, cartilage worn out with age becomes more sensitive to microdamage. That is, the disease develops when the processes of destruction and restoration of cartilage outweigh in the direction of destruction, – explains the rheumatologist.

• Floor. Yes, it turns out that the hormone estrogen is involved in the development of arthrosis. Therefore, osteoarthritis is often diagnosed in women during menopause, when there is a hormonal imbalance.
• Features of the development of the osteoarticular system.
• Hereditary predisposition.

Exogenous factors:

• Injuries.

  “Various dysplasias, subluxations of the hip joints, not corrected in infancy and childhood, quite often lead to the development of severe osteoarthritis in these people at an older age,” says our expert. – According to some reports, about 80% of all cases of primary osteoarthritis of the hip joints are associated precisely with unrecognized congenital developmental defects.

• Professional activity and sports activity. According to Dr. Voinova, it turns out that many professional athletes suffer from osteoarthritis. Moreover, each, so to speak, has its own type of disease. So, arthrosis of the hip joints is more often observed in football players, baseball players suffer from arthrosis of the shoulder and elbow joints, basketball players – arthrosis of the knee joints, and in professional dancers the diseased area is the ankle.
• Increased weight.

  Obesity is a very powerful risk factor for developing osteoarthritis. Excess body weight increases the risk of developing osteoarthritis, primarily due to the increasing mechanical load on the joints, says Yulia Voinova. – There is a study proving that overweight women have a 4 times higher risk of developing arthrosis than women of the same age with normal weight. And for men, this risk increases even more – by 4,8 times! In addition, overweight people have an increased risk of progression of the disease and the development of its more severe forms.

Treatment of osteoarthritis in adults

According to our expert, in the case of osteoarthritis, it is important that the patient understands his disease and knows how to “manage” it, be ready to change his lifestyle, and be sure to perform physical exercises for the joints.

The therapy itself is aimed at reducing pain, preventing further destruction of the articular cartilage, protecting the joints, improving their functional state and preventing the development of joint deformity, and, ultimately, improving the quality of life of patients.

“In addition, it is important to avoid side effects of therapy and exacerbation of concomitant diseases,” says Yulia Voinova. – In the treatment of osteoarthritis, it is imperative to take into account the patient’s risk factors, and, if possible, correct and eliminate them. As for the methods of treating osteoarthritis, special attention should be paid to non-pharmacological methods, many of which any patient can master on their own.

But more on that below.

Diagnostics

– Diagnosis of osteoarthritis, taking into account the knowledge of the diagnostic criteria by the doctor, usually does not cause difficulties, – says Dr. Voinova. — Nevertheless, each clinical situation must be analyzed in terms of the possibility of a secondary origin of osteoarthritis.

There are a number of diseases that are similar in symptomatology, which must be excluded in the diagnosis of osteoarthritis. These include:

• ankylosing spondylitis (Bekhterev’s disease) and other diseases from the group of spondyloarthritis,
• gouty arthritis,
• rheumatoid arthritis,
• infectious arthritis,
• rheumatic polymyalgia,
• post-traumatic synovitis,
• congenital deformities of the joints,
• diabetic arthropathy,
• paraneoplastic arthropathy (against the background of a tumor process) and others.

It turns out that there are no laboratory signs characteristic of this particular disease, and, nevertheless, it is necessary to pass tests to make a diagnosis. Firstly, to distinguish osteoarthritis from other joint problems, and secondly, to identify contraindications for subsequent treatment.

– To detect inflammation, it is also necessary to determine the level of C-reactive protein. A moderate increase is characteristic of secondary synovitis on the background of osteoarthritis. A pronounced increase in these indicators indicates another disease and requires additional diagnostics, – says Yulia Voinova.

The most reliable method currently is x-ray.

– X-ray examination reveals narrowing of the joint space, marginal bone growths – osteophytes and sharpening of the condyles of the tibia, subchondral sclerosis, – explains the rheumatologist. – According to indications, ultrasound of the joints, MRI, CT can be prescribed. Often radiological signs do not correlate with the clinical signs of osteoarthritis and more often only more pronounced radiographic changes are accompanied by clinical symptoms.

And in patients with suspected osteoarthritis, synovial fluid (a kind of intra-articular “lubricant”) is sometimes examined – but only in the presence of synovitis – effusion in the joints, in order to distinguish one disease from another.

Modern treatments

“The treatment of osteoarthritis should be comprehensive and include non-pharmacological, pharmacological and surgical methods of therapy,” says our expert.

Non-pharmacological include: patient education, weight loss, exercise therapy, use of orthopedic devices, physiotherapy.

Patient education, according to Dr. Voinova, should be a mandatory component of all (!) therapeutic programs in the treatment of osteoarthritis. Of course, the attending physician must take into account the individual characteristics of the patient, make recommendations for lifestyle changes, weight loss (especially for patients with a body mass index of more than 25 kg / m2), and the need for exercise.

By the way, do not neglect exercise therapy. It turns out that there is evidence that regular exercise for 6-8 months reduces pain, and in this case, physical education can compete with non-steroidal anti-inflammatory drugs (NSAIDs) in effectiveness.

But – it should not be abused. The intensity and duration of the physical rehabilitation program for each patient should be developed individually, taking into account not only indications, but also contraindications.

Also, doctors often recommend various orthopedic devices (orthoses, insoles) that reduce the load on the joints, and hence pain, and also improve joint function. In addition, in order to “unload” diseased joints, doctors often “prescribe” walking with a cane. And there is absolutely nothing to be ashamed of!

Medication

In this case, the main goal is pain relief. And there are many options here.

As our expert notes, the following can be used as painkillers in the treatment of osteoarthritis at home:

• simple analgesics (paracetamol, if the pain is not the worst),
• non-steroidal anti-inflammatory drugs (NSAIDs),
• local (local) therapy,
• opioid analgesics – rarely, only for a very short period and in the presence of very severe pain,
• hormonal drugs (glucocorticosteroids) administered intraarticularly.

Of the drugs for long-term use in Russia, the following are prescribed:

• chondroitin sulfate and glucosamine,
• diacerein,
• piascledine,
• hyaluronic acid preparations.

“The effectiveness of these drugs is rather controversial, in a number of countries they are not included in the protocols for managing patients with osteoarthritis,” emphasizes Yulia Voinova.

Surgery

As with other diseases, sometimes doctors are forced to resort to extreme measures. Now we are talking about endoprosthetics.

“Arthroplasty is indicated for osteoarthritis with a severe pain syndrome that is not amenable to conservative treatment, in the presence of a serious dysfunction of the joint: the development of significant joint deformities, joint instability, contractures and muscle atrophy,” says our expert. — The best results of arthroplasty were observed in patients aged 45–75 years, weighing <70 kg, with a high social standard of living.

Prevention of osteoarthritis in adults at home

Prevention is discussed here, first of all, with regard to risk groups. And if no one is able to influence a person’s age, then everyone, if desired, can keep weight under control, not push the sofa endlessly and engage in physical education – without overworking the body.

Is it possible to prevent the development of osteoarthritis by 100%?

“Unfortunately, there is no “magic pill” that would reverse all joint damage accumulated over the years, so the prevention of osteoarthritis should be systematically carried out virtually throughout life,” notes Yulia Voinova.

Popular questions and answers