Joint pathologies are among the most common among all disorders of the musculoskeletal system. Inflammatory and non-inflammatory diseases significantly worsen the quality of human life and in many cases cause disability. One of the most common diseases is osteoarthritis of the knee joint. Symptoms of pathology are more often acute and require qualified help.
Causes of disease
In medicine, the disease is also called osteoarthritis, gonarthrosis, deforming osteoarthritis (DOA). Arthrosis is the general name for all degenerative-dystrophic diseases of the articular and intervertebral joints. An injury in the area of the knee joint is called gonarthrosis.
It is characterized by damage to the cartilage in the knee joint.
The pathology consists of degenerative-dystrophic changes in the bone and cartilage tissue, which is characterized by the gradual thinning of the cartilage in the articular joint and the parallel formation of bone growths.
This becomes the body's response to friction and increased pressure. The most likely causes of symptoms of gonarthrosis of the knee joint are the following:
- Mild and severe traumatic injuries with impaired joint mobility over a long period of time. Ligament tears or severe bruises often cause the development of an inflammatory process, which as a result causes the appearance of gonarthrosis symptoms.
- Surgical intervention on the knee joint in order to remove any defect or foreign body.
- Prolonged and excessive physical activity on an ongoing basis. This may be due to a professional sport or specialty. Constant tension in the joint area leads to gradual thinning of the cartilage, which negatively affects the entire musculoskeletal system.
- Acute bursitis with the development of purulent inflammation in the joint cavity. As a rule, it is difficult to get rid of such a pathology in a conservative way, so doctors resort to minor surgical intervention, which negatively affects the cartilage tissue.
- Arthritis of various forms and severity. In this case, the inflammatory process is pronounced, continues with a sudden increase in temperature and leads to the development of arthrosis after a certain period of time.
- Gout also often leads to cartilage pathology with severe clinical manifestations and joint deformity.
- Weakened immunity, which causes the gradual dissolution of bone and cartilage tissue due to the inability of the body to cope with the pathology.
- Bad habits - alcohol abuse, smoking - often become a predisposing factor for the appearance of signs of pathology.
- Severe autoimmune diseases.
- Frequent viral and catarrhal pathologies that cause the inflammatory process and the development of degenerative-dystrophic changes.
- Overweight and severe obesity also cause a violation, because each extra kilogram increases the load on the articular joints by 10 times, which will certainly affect the cartilage tissue.
It is worth noting that all these reasons most often cause a secondary type of violation. There is also primary, which differs in that the disease becomes a consequence of the natural aging process of the organism. Bone and cartilage wear away, increasing friction and stress. The result is gonarthrosis.
Types of pathology
There are several types of pathological conditions, each of which has its own characteristics. Depending on how the joint is affected, the following types of disorders are distinguished:
- The right side is characterized by the appearance of changes in the cartilage tissue on the right side. As a rule, this becomes the initial stage of the disease.
- The signs of left-sided gonarthrosis of the knee joint by nature of the clinical picture do not differ from those of the right side. But it is noted that this type often develops in overweight patients.
- Bilateral refers to severe forms, affects the entire cartilage and is characterized by severe pain.
It is noted that the latter type is more often observed in elderly patients with primary tissue damage. Depending on the course of the pathological process, there are acute and chronic types. The first is characterized by rapid progression and the development of complications, the second occurs slowly, it cannot disturb the patient for several years.
Clinical picture
Signs of gonarthrosis of the knee joint and its symptoms largely depend on the degree of damage to the joint. Currently, there are several stages of the pathological process, each of which has its own clinical manifestations:
- The initial phase is characterized by the absence of pronounced symptoms and the inability to visually recognize the pathology. The patient gets more tired than usual, but writes it off as overwork or increased workload. He becomes lethargic, sleepy, and performance is sharply reduced. Some patients have slight stiffness in the affected joint when moving, especially in the morning. However, they often do not pay attention to it and do not turn to a specialist. If an X-ray of the joint is taken at this stage, a narrowing of the joint space can be observed, which causes a violation.
- In the next stage, discomfort and stiffness do not disappear, but only increase. With mild and short loading, the patient develops severe pain in the knee, which disappears only after a long rest. In some cases, the joint swells and this swelling disappears at night but reappears during the day. Since the pressure on the cartilage tissue increases due to its depletion, the patient often hears a characteristic creaking sound when moving. Flexion function is also impaired, as the patient is unable to fully bend the limb. At this stage, patients usually turn to a specialist.
- The third stage is the most difficult and is characterized by a pronounced pain syndrome that accompanies the patient not only during exercise, but also at rest. In severe cases, the pain does not leave a person even at night, which significantly worsens his condition. Swelling in this phase is constantly observed. In the joint bag, the amount of synovial fluid decreases sharply, which increases the load and increases friction in the joint.
- The initial phase is characterized by the absence of pronounced symptoms and the inability to visually recognize the pathology. The patient gets more tired than usual, but writes it off as overwork or increased workload. He becomes lethargic, sleepy, and performance is sharply reduced. Some patients have slight stiffness in the affected joint when moving, especially in the morning. However, they often do not pay attention to it and do not turn to a specialist. If an X-ray of the joint is taken at this stage, a narrowing of the joint space can be observed, which causes a violation.
- In the next stage, discomfort and stiffness do not disappear, but only increase. With mild and short loading, the patient develops severe pain in the knee, which disappears only after a long rest. In some cases, the joint swells and this swelling disappears at night but reappears during the day. Since the pressure on the cartilage tissue increases due to its depletion, the patient often hears a characteristic creaking sound when moving. Flexion function is also impaired, as the patient is unable to fully bend the limb. At this stage, patients usually turn to a specialist.
- The third stage is the most difficult and is characterized by a pronounced pain syndrome that accompanies the patient not only during exercise, but also at rest. In severe cases, the pain does not leave a person even at night, which significantly worsens his condition. Swelling in this phase is constantly observed. In the joint bag, the amount of synovial fluid decreases sharply, which increases the load and increases friction in the joint.
As a rule, the pain disturbs the patient's sleep, he becomes irritable and feels constant fatigue. Appetite is weakened or completely disappears, which causes deterioration of the work of the digestive and cardiovascular systems.
Lack of normal sleep often leads to a nervous breakdown, especially in elderly patients or young people engaged in intensive physical work. Memory impairment and reduced concentration of attention also become the result of the patient's insufficient rest.
Usually, the pathology occurs without temperature, but in advanced stages, when the cartilage is completely destroyed, the friction of the bones and the pressure between them increases, which causes an inflammatory process.
The body tries to restore balance and reduce the load on the connection. For this reason, osteophytes or bone growths develop in the joint. They become the cause of deformation in the advanced stages of the pathological process.
The most dangerous complication of such violations will be the complete immobilization of the patient and disability. As a rule, this happens in the absence of proper treatment or ignoring the symptoms of osteoarthritis of the knee for a long period.
Diagnostic methods
In order to make an accurate diagnosis, the doctor suggests that the patient undergo a complete examination. This is necessary not only for identifying the cause, but also for the correct selection of drugs needed for therapy. The first step will be interviewing the patient and determining possible causes. Lifestyle, professional activities and habits play a special role. The next step will be to examine the affected limb and determine the degree of damage.
If there are no visible signs of pathology, the disease is in an early stage. The next step will be to collect anamnesis and identify chronic pathologies that could become a predisposing factor. After that, the patient gives blood for laboratory tests. Finding traces of inflammation in him in the form of an increased level of leukocytes suggests that some process caused the development of the disorder.
A mandatory moment in the diagnosis will be an X-ray examination in order to accurately determine the degree of gonarthrosis. The image usually shows areas of complete cartilage destruction, as well as the number of osteophytes and their location. This helps in clarifying the presumed diagnosis and prescribing the appropriate treatment.
Sometimes it is impossible to see the exact picture and degree of joint damage on an X-ray. In this case, an ultrasound examination of the joint is recommended.
In extreme cases, the patient is prescribed a CT scan. This is usually enough to get a complete picture of the disease.
Medical therapy
Conservative treatment of the pathological condition is possible only in the 1st and 2nd stages, when the formation of osteophytes has not yet begun. The therapy is mainly aimed at slowing down the destruction of cartilage and restoring it. The classic scheme includes the use of the following drugs:
- Means from the group of painkillers that help relieve pain. Make the patient feel better, improve night sleep. In the hospital, effective injections are given 1 to 3 times a day under the supervision of a specialist. It is not recommended to use the means for a long time, because they do not affect the course of the pathological process, but only relieve acute pain.
- Nonsteroidal anti-inflammatory drugs. Means are available in the form of tablets and injections, they can not only eliminate acute pain, but also slow down the progression of pathology, relieve local temperature and swelling, improve motor function. With regular intake for 7-10 days, a constant concentration of the active components of the drug is observed in the patient's blood, which ensures a prolonged effect. Long-term use of drugs is not recommended, as they often have a negative effect on the digestive system. For this reason, they should not be taken by patients with severe peptic ulcers or other disorders.
- Chondroprotectors help restore cartilage in the affected joint and increase the amount of synovial fluid. As a rule, such drugs contain glucosamine and chondroitin. It is recommended that you take them for a long time. A course of 8-12 weeks is usually prescribed with regular visits to a specialist to detect improvement. Longer reception is possible with clear indications.
- Glucocorticoids. They are used to treat advanced cases when the pain syndrome is not eliminated by conventional means. It helps to relieve swelling and reduce pain. It is allowed to be used only in the hospital in the form of intramuscular or intravenous injections.
- Nonsteroidal anti-inflammatory drugs. Means are available in the form of tablets and injections, they can not only eliminate acute pain, but also slow down the progression of pathology, relieve local temperature and swelling, improve motor function. With regular intake for 7-10 days, a constant concentration of the active components of the drug is observed in the patient's blood, which ensures a prolonged effect. Long-term use of drugs is not recommended, as they often have a negative effect on the digestive system. For this reason, they should not be taken by patients with severe peptic ulcers or other disorders.
- Chondroprotectors help restore cartilage in the affected joint and increase the amount of synovial fluid. As a rule, such drugs contain glucosamine and chondroitin. It is recommended that you take them for a long time. A course of 8-12 weeks is usually prescribed with regular visits to a specialist to detect improvement. Longer reception is possible with clear indications.
- Glucocorticoids. They are used to treat advanced cases when the pain syndrome is not eliminated by conventional means. It helps to relieve swelling and reduce pain. It is allowed to be used only in the hospital in the form of intramuscular or intravenous injections.
In addition to such means, the patient is prescribed a course using an external means in the form of ointment, cream or gel. The last option is the most preferable because it quickly penetrates into the joint cavity and has a therapeutic effect. They are allowed to be used within 14 days. It is not recommended to independently extend the course, as the risk of complications increases.
In the most severe cases, the patient is injected directly into the joint cavity. You can drive conventional analgesics, but the best therapeutic effect is achieved with the introduction of hyaluronic acid preparations. Injections are given once every 7 days. 3-5 injections are enough to completely remove the pain. After such therapy, the effect lasts for 6 months. The patient is able to move normally, and the pain syndrome almost completely disappears.
If none of the methods bring the expected result, and the patient's condition worsens, a surgical operation is performed to replace the joint with a prosthesis. Replace the entire joint or its individual parts. It is usually indicated in arthrosis, caused by a severe knee injury. The operation is performed under general anesthesia, and the recovery period is quite long and difficult.
Gonarthrosis is a severe degenerative-dystrophic pathology that, if not treated, leads to disability of the patient. It is recommended to consult a doctor immediately when the first signs of violation appear.