Osteoarthritis is a very common joint disease that affects about 80% of our population at the age of 50-60, but sometimes it occurs earlier, at the age of 30. Osteoarthritis primarily affects the articular cartilage. As you know, the joint is formed by the articular surfaces of the bones, covered by cartilage tissue. During various movements cartilage acts as a shock absorber, reducing the pressure on the articulating surfaces of the bones and ensuring that they glide smoothly relative to each other. Cartilage consists of fibers of connective tissue loosely arranged in a matrix.

Schematic representation of a diseased and a healthy knee joint

The matrix is a jelly-like substance formed by special compounds - glycosaminglycans. Due to the matrix, cartilage is nourished and damaged fibers are repaired. Such a structure makes cartilage similar to a sponge - in a quiet state it absorbs fluid, and when loaded it squeezes it into the joint cavity, providing a kind of "lubrication" of the joint.

Throughout life, cartilage reacts flexibly to the stereotypical, thousands of times repeated shocks of certain types of work or running, jumping, etc. This constant stress leads to aging and destruction of some of the fibers, which in a healthy joint is replaced by the synthesis of an equal number of new fibers. Osteoarthritis develops when there is an imbalance between the formation of new building material for cartilage tissue repair and the destruction.

A kind of less valuable cartilage structure emerges, capable of absorbing less water. Cartilage becomes drier, more brittle, and easily splits in response to stress. As arthritis progresses, the layer of cartilage covering the articular surfaces becomes thinner, up to complete destruction.

Together with the cartilage, the bone tissue underneath changes as well. Bony outgrowths form around the edges of the joint, as if compensating for the loss of cartilage by enlarging the articular surfaces. This is the cause of joint deformities in arthritis. People call this condition "deposition of salts", which is just an illiterate name for osteoarthritis disease.

WHAT FACTORS LEAD TO OSTEOARTHRITIS?

There seems to be no single cause for the development of this disease. There are a number of factors that weaken the cartilage in one way or another, the harmful effects of which add up over the course of a lifetime and eventually lead to the development of arthritis. The onset of the disease in this situation can be characterized as an unfavorable set of circumstances, and these circumstances are different for each person. Nevertheless, a number of factors can be identified that increase the risk of developing osteoarthritis.

THE AGING

As we age, cartilage becomes less elastic and loses its resistance to stress. This does not mean that all people develop arthritis in old age. But in the presence of other predisposing factors, the risk of getting the disease increases with age.

CONGENITAL FEATURES

Connective tissue dysplasia syndrome is now widespread. It is a congenital weakness of connective tissue, manifested by increased joint mobility, early development of osteochondrosis, and flat feet. If not following a certain motor regimen, this condition can lead to the development of arthritis at a young age.

Another fairly common congenital anomaly is total or incomplete hip dislocation (which is why preventive examinations are performed on newborns immediately after birth), which, if incorrectly repositioned or improperly treated, leads to a severe form of osteoarthritis of the hip joint with age.

GENETIC PREDISPOSITION

A predisposition to the knotty form of arthritis, which affects many of the joints, has been shown to be hereditary. Women whose mothers had this form of arthritis have a higher risk of getting it.

TRAUMAS

Severe single-step trauma accompanied by a contusion, fracture, dislocation, damage to the ligamentous apparatus of the joint, or repeated microtraumatization of the joint can contribute to the development of arthritis. Microtraumatization is the cause of the development of arthritis in a number of professions and professional athletes. Examples include the development of arthritis of the knee joint in miners, soccer players; arthritis of the elbow and shoulder joints in workers with a jackhammer; arthritis of the small joints of the hands in secretaries - typists, weavers; arthritis of the ankle joints in ballerinas; arthritis of the hands in boxers, etc.

COMORBIDITIES

Any metabolic disorders, endocrine disorders contribute to the development of arthritis. Osteoarthritis more often develops in obese people, patients with diabetes, thyroid disorders, and women during the menopause. Various circulatory disorders in the extremities, such as varicose veins and atherosclerosis, also contribute to the development of arthritis.

HOW DOES OSTEOARTHRITIS MANIFEST ITSELF?

The first symptom that makes you go to the doctor is pain in the joint. The intensity of the pain can vary from severe, limiting the mobility of the joint, to moderate, occurring only with certain movements.

Table of symptoms of osteoarthritis at different stages

The cause of severe pain is usually reactive inflammation of the joint (so-called synovitis) or inflammation of the surrounding tissues (muscles, tendons, joint capsule). Inflammation in the joint occurs because pieces of destroyed cartilage enter the joint cavity and irritate the synovial membrane of the joint. Inflammatory pain is quite pronounced and increases with any movement in the joint, as well as occurs at rest during the 2nd half of the day.

With inflammation of the tissues surrounding the joint (tendons, bags), the pain increases when performing certain movements, there are painful points in the joint area, "starting" pains are characteristic (after a period of rest it is difficult to start moving). With proper treatment, inflammation in the joint or surrounding tissues can be stopped, which is accompanied by the subsidence of pain syndrome, disappearance of night pains, and improvement of joint mobility.

In the absence of inflammation, the pain syndrome is mild in the initial stages of arthritis. Pain occurs only when there is significant load on the joint, such as prolonged fixation of the joint in one position (sitting in an uncomfortable position), prolonged walking or running, and carrying heavy bags. These pains go away after a short rest with relaxation of the joints. In the advanced stages of osteoarthritis, the pain syndrome is almost constant.

WHICH JOINTS ARE AFFECTED BY OSTEOARTHRITIS?

In principle, arthritis can develop in any joint. Depending on which joints are affected, there are several forms of osteoarthritis. The first form mainly affects the small joints of the hands and feet. On the fingers form dense nodules, so-called Geberden nodules. These nodules are bony growths at the edges of the joints. During the formation stage, they can be painful, and the skin above them may be red. Afterwards, the inflammation subsides, painless joint deformities persist, and the function of the hand remains satisfactory.

Schematic drawing of knee pain in osteoarthritis of the knee joint

In the form of osteoarthritis with predominant involvement of the joints of the 1st fingers of the hand, the function of the hand deteriorates markedly already in the early stages of osteoarthritis. The next form is osteoarthritis of the supporting joints. The supporting joints include the knee and hip joints. Osteoarthritis of the knee joints is called gonarthritis. Osteoarthritis of the hip joints is called coxarthritis. And finally, there is a form of osteoarthritis that affects many joints at once, then we talk about polyosteoarthritis.

WHAT EXAMINATIONS ARE NECESSARY TO DIAGNOSE OSTEOARTHRITIS?

A rheumatologist can suspect osteoarthritis based on complaints, medical history, and examination of the patient. To confirm the diagnosis, X-rays of the most bothersome joints are needed. The pictures show changes characteristic of osteoarthritis: in the early stages, the contour of the bones that form the joint is emphasized, then the joint gap narrows, and bone overgrowths form on the edges of the joint.

Depending on the severity of the changes on the radiographs, there are four stages of arthritis - from the first, with minimal changes, to the fourth, when the structure of the joint is almost completely disrupted. Thermographic (thermal imaging) and ultrasound (ultrasound) examinations of the joints can help to detect inflammation in the joints or surrounding tissues, which cannot be seen on an X-ray.

PROGNOSIS (FUTURE) FOR OSTEOARTHRITIS PATIENTS

The prognosis for osteoarthritis patients can be considered good and even good, and this is not false optimism. The opinion that this disease has a permanently progressive nature is unfounded. Total disability due to osteoarthritis is rare, and most patients have only occasional joint problems. When they say that osteoarthritis is incurable, they mean that the changes that have already formed in the joint cannot be reversed.

But usually these changes are insignificant when you first go to the doctor, and by following a certain motor mode, recommendations for rehabilitation, you can prevent further progression of arthrosis. You should also remember that with this disease, periods of exacerbation associated with reactive inflammation of the joint are replaced by periods of rest, when the joint almost does not bother or the complaints are minimal.

HOW TO LIVE WITH OSTEOARTHRITIS

The appearance of the first symptoms of arthritis should not be a reason to panic, but rather a signal to the body to change the established motor stereotypes.

First of all, you should try to limit the movements associated with increased load on the articular cartilage. In arthritis of the hip, knee and ankle joints, it is necessary to reduce such types of motor activity as running, jumping, lifting and carrying weights, squatting, fast walking, especially in rough terrain, climbing uphill, walking up stairs.

All of these activities exert a force much greater than the weight of the body on the affected joints, which is harmful to the already-altered cartilage. You should also avoid fixed postures, such as sitting or standing in one position for a long time, squatting, or bent over when working in the vegetable garden. Such postures impair blood flow to the affected joints, which also impairs nutrition of cartilage. When the joints of the hands are affected, you should limit carrying heavy objects, pressing heavy things by hand, typing on a typewriter, playing musical instruments, etc.

In any case, it is necessary to develop a rhythm of motor activity, so that periods of load alternate with periods of rest, during which the joint must be unloaded. A typical rhythm is 15-20 min. load, 5-10 min. rest. Unload the joints of the legs should be in a lying or sitting position. In the same positions you can perform several movements in the joints (bending, unbending, cycling) to restore blood circulation after the load.

Secondly, in spite of a number of restrictions, it is necessary to lead an active lifestyle by increasing motor activity, which does not have a negative impact on the cartilage. It is necessary to make yourself do special exercises every day, some of which are listed below. A common feature of these exercises is that when they are performed, the load on the articular cartilage is minimal, and more work the muscles surrounding the joint. This allows you to form a good muscular corset around the joint, maintain normal mobility and sufficient blood circulation in the limb.

In addition, this exercise strengthens the cartilage itself, which needs movement for normal nutrition. Regular practice of these exercises should turn from an unpleasant duty into a useful habit, which is the best way to preserve the normal function of the joints. Must exercise at least 30-40 minutes a day, better to divide this time into several times a day for 10-15 minutes. A noticeable effect occurs after 2-3 months - pain syndrome decreases, vitality increases, and the hidden reserves of the body are released.

SOME TYPES OF EXERCISES FOR OSTEOARTHRITIS PATIENTS

It is always best to start exercising under the guidance of a rehabilitation specialist (physical therapist), preferably in health groups specialized for this localization of arthrosis. Once you have completed the group, you should continue exercising at home, using the skills you have learned. The main principle is to repeat the exercises frequently during the day for a few minutes at a time. Exercises should be performed slowly and smoothly, gradually increasing the amplitude. It is better to focus on the painful joint, think about how during the movements blood flows to the joint, brings with it nutrients that when the limb relaxes nourish the cartilage, and when you move squeeze into the joint cavity, providing a good "lubrication" of the joint.

OTHER OPPORTUNITIES TO IMPROVE PHYSICAL FITNESS

Walking on level ground at a moderate pace is a good way to maintain muscle tone. Try to walk for 20-30 minutes every day. The main thing is not to walk in a hurry, because when you walk fast, the load on the joints begins to exceed your body weight by 1.5-2 times. Walking to the stores with heavy bags also does not contribute to the improvement of physical fitness.

Swimming is the optimal sport for diseases of the musculoskeletal system. In the water you can maximize the amount of movement in the joints without the weight load, which is optimal for the articular cartilage. If you do not know how to swim, you can do aqua-gymnastics groups.

Exercise on simulators is more effective in forming a muscular corset. The same applies to the bicycle trainer. It is important to fit the exerciser correctly (the leg in the lower position should be straightened), and to make sure that the exerciser is firmly fixed on the floor.

Riding a bicycle is not only good for your joints, it is also emotionally stimulating. You should avoid riding on uneven terrain (bouncing is bad for the joints), as well as falling off the bike. If you have difficulty keeping your balance, weakness, vision problems or you are not very confident in the saddle, it is better to exercise at home on a exercise bike. It is also important to choose the right bike. You should choose between sport and semi-sport types, as they are lighter and faster than road bikes. Because sport bicycles have handlebars that are down and road bicycles are usually horizontal or raised, it is more convenient to raise the handlebar grips to the top on a sport type bicycle. The biggest problem is when the saddle height is set incorrectly. It should be set so that when the pedal is fully depressed in the lower position, the leg is fully straightened out. If the knee is bent in this pedal position, it causes joint and muscle pain. Just as important is the distance to the handlebars - the elbows should be slightly bent. A cyclist, unlike a pedestrian, puts strain on other muscles. Therefore, 15-20 minutes of riding is enough to start with, later, depending on capabilities, the duration can be extended to 30-40 minutes.

In winter, skiing is useful because the weight load is reduced by sliding.

OTHER REHABILITATION METHODS

MASSAGE improves the general well-being, relieves painful muscle spasm, improves blood circulation, transmission of nerve impulses, thereby improving nutrition of articular cartilage. Massage should be done by an experienced specialist in the absence of exacerbation of arthritis. The area above the joint is massaged with minimum intensity. More intensive massage is performed on the spine where the nerves that feed the joint and the adjacent muscles come out. If there are no contraindications, the massage is repeated twice a year.

PHYSIOTHERAPHY

It also improves the nutrition of the cartilage. Soft methods of treatment such as magnetotherapy, laser therapy, electrophoresis with dimethoxide and brine, EHF therapy, laser therapy are indicated. If there are no contraindications - physical therapy courses are repeated twice a year.

SPA TREATMENT

It allows for comprehensive rehabilitation, including the positive effects of therapeutic mud, baths, sauna, physiotherapy, massage, therapeutic exercise. An important role is played by a change of scenery, the removal of stressful influences, exposure to fresh air. Remember that spa treatment can be carried out only outside of exacerbation of the disease.

ORTHOPEDIC REMEDIES

These are special devices that allow you to reduce the load on the joint. These include orthopedic shoes to be worn when the limb is short; supinators, prescribed for flat feet; and kneecaps, which can reduce the looseness of the knee joint, thereby reducing injury to the cartilage when walking. Instead of kneecaps, elastic bandages can be used.

MEDICAL THERAPY

Medicinal treatment for arthritis is prescribed during exacerbation of the disease and is aimed at relieving inflammation in the joint or surrounding tissues. For this purpose, anti-inflammatory drugs such as Diclofenac, Ibuprofen, etc. are prescribed. It should be remembered about the possibility of the negative effects of these drugs on the gastrointestinal tract, so they should be taken after meals, short courses - 10-15 days.

INTRA-ARTICULAR INJECTION OF DRUGS

Prescribed by a doctor to relieve inflammation in the joint more quickly and effectively. The drugs used are Kenalog, Dipropane, Celeston, Depo-Medrol, Flosterone. Many patients experience a significant improvement already after the first intra-articular injection, and subsequently require this procedure even if there is little discomfort. I repeat that this procedure does not cure arthritis, but allows you to buy inflammation, and if often unreasonably prescribed, is harmful to the joint.

USE OF CHONDROPROTECTORS

Chondroprotectors are drugs that improve the structure of cartilage. Taking these drugs is not aimed at relieving inflammation in the joint, but they help to slow the progression of arthritis and strengthen the cartilage tissue. Chondroprotectors can be taken internally, intramuscularly, and intraarticularly. The course usually requires 6-10 injections.

For a good effect, chondroprotector treatment courses should be repeated twice a year for several years.

Following all of the above recommendations will allow you to maintain satisfactory joint function for a long time in your life.

Stem cells in the treatment of osteoarthritis of the knee joint

Currently, stem cells are an opportunity for patients to repair cartilage defects, joint pain and bone fusion disorders. Combined surgical therapy (most often arthroscopy) and stem cells are increasingly an alternative to alloplasty (endoprosthetics) of joints. Cell therapy combined with properly chosen rehabilitation can restore patients, to effectively perform daily activities, and professional athletes to top form. The use of our own cells to treat diseases in the body is one of the most innovative therapeutic methods in orthopedics, with broad horizons for further development.

injection of mesenchymal stem cells into the knee joint for osteoarthritis

Mesenchymal stem cells

  • Mesenchymal stem cells (MSC) are widely used in the clinic for tissue regeneration and repair because they can transform into fat, bone, cartilage and muscle cells (in vitro).
  • Sources of own MSC (mesenchymal stem cells)
  • One source is the bone marrow stroma, which contains several cell populations, including mesenchymal stem cells (MSCs)
  • But autologous bone marrow harvesting has potential limitations, such as significant pain and risk of serious side effects
  • An alternative source of autologous adult stem cells is human adipose tissue, which can be obtained in large quantities under local anesthesia and with minimal discomfort
  • In Ukraine, mesenchymal stem cells are obtained from the placenta, which is obtained by caesarean section, with the consent of the woman giving birth. It is completely legal and ethical.
MEDICAL DISCLAIMER

This content is for informational and educational purposes only. It is not intended to provide medical advice or to be a substitute for such advice or treatment by a personal physician. All readers of this material are advised to consult their own physicians or qualified health care professionals. UAmedTOURS is not responsible for the possible health consequences to any person or persons reading or following the information contained in this educational content. All readers of this content, especially those who take prescription or over-the-counter medications, should consult their physicians before making any changes in their diet, lifestyle, taking pills, or other facts that may affect your physical and psychological health.

 


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