Hyperarthrosis of the knee joint treatment. Thyroid gland and joint diseases Hypothyroidism causes knee pain, what to do

Dysfunction thyroid gland may lead to symptoms of musculoskeletal damage. At thyroid pathology the most common are osteoporosis, adhesive capsulitis, Dupuytren's contracture, index finger syndrome, limited joint mobility, and carpal tunnel syndrome. In studies by M. Cakir (2003), adhesive capsulitis was detected in 10.9% of patients, Dupuytren's contracture - in 8.8%, limited mobility in joints - in 4.4%, index finger syndrome - in 2.9% and symptom carpal tunnel - in 9.5% of patients in a group of 137 patients with various pathologies of the thyroid gland.

Hyperthyroidism (thyrotoxicosis) is a hypermetabolic syndrome that develops when there is an excess of thyroid hormones in the body. A significant amount of data has been obtained demonstrating direct action thyroxine and T3 on bone tissue. In all areas of bone and cartilage tissue, expression of their receptors was detected in both osteoblasts and osteoclasts. A number of researchers have obtained data on the participation of fibroblast growth factor receptor 1 in T3-dependent bone tissue formation and the pathogenesis of bone tissue damage in thyroid pathology.

It has been established that in cases of manifest thyrotoxicosis, resorption processes prevail in the bone, and their speed is determined by the level of thyroid hormones. Increased level thyroid hormones leads to a negative mineral balance with loss of calcium, which is manifested by increased bone resorption and reduced intestinal absorption of this mineral. Patients with hyperthyroidism exhibit low levels of the vitamin D metabolite 1,25(OH)2D, sometimes hypercalcemia, and decreased serum parathyroid hormone levels. According to a study by E.I. Marova [et al.] (1999), a significant correlation was found between the levels of free thyroxine in the blood serum and alkaline phosphatase, as well as the content of hydroxyproline in the urine.

Clinically, all these disorders lead to the development of diffuse osteoporosis. According to BMD indicators, osteopenia in patients with thyrotoxicosis was detected more often in the proximal parts of the femur (Benevolenskaya L. I., 2003). Bone pain, pathological fractures, vertebral collapse, and kyphosis are possible. According to the results of a meta-analysis of 20 studies on bone mineral density and the risk of fractures in patients with thyrotoxicosis, a statistically significant decrease in bone mineral density and an increase in the risk of hip fracture was obtained. It has been shown that after the elimination of thyrotoxicosis, bone mineral density returns to normal even though the patient does not receive any specific treatment for osteoporosis (Vestergaard P., 2003). A history of thyrotoxicosis in postmenopausal women increases the risk of fractures by 2.4 times compared with those who have not suffered from this disease.

Arthropathy in thyrotoxicosis develops rarely, like hypertrophic osteoarthropathy with thickening of the phalanges of the fingers and periosteal reactions. Describe thyroid acral syndrome (exophthalmos, pretibial myxedema, severe thickening of the fingers and hypertrophic osteoarthropathy), which occurs in patients receiving treatment for thyrotoxicosis. More often than arthropathy, myopathy is observed with the development of muscle weakness, sometimes myalgia. Also, in patients with hyperfunction of the thyroid gland, adhesive capsulitis (17.4%), a symptom of the carpal tunnel, occurs.

Hypothyroidism- a condition characterized by a decrease in the level of thyroid hormones in the serum. An insufficient level of thyroid hormones in organs and tissues leads to a decrease in the processes of bone tissue remodeling. It has been demonstrated that hypothyroidism does not cause disturbances in calcium kinetics and is characterized by a smaller trabecular resorption surface and increased cortical bone thickness. There is evidence of a decrease in the level of calcitonin and an increase in the level of calcitrol, as well as a decrease in the levels of bone formation markers (osteocalcin and thyroid factor), a decrease in urinary excretion of pyridinoline and deoxypyridinoline, indicating a slowdown in bone resorption with a deficiency of thyroid hormones (Lukert B., 1990; Aoki Y., 1993). Systemic osteoporosis occurs only in long-term and severe cases of the disease.

Hypothyroidism leads to a slowdown in oxidative processes and thermogenesis, the accumulation of metabolic products, which leads to the development of tissue degeneration with the formation of a kind of mucous edema (myxedema) due to the impregnation of tissues with mucopolysaccharides. Quite often, arthropathy and myopathy develop with this pathology.

Arthropathy develops in 20-25% of patients with myxedema. It manifests itself as slight pain in the joints, swelling of soft tissues, joint rigidity, and sometimes the appearance of non-inflammatory effusion in the joint cavity. In a number of patients, crystals of calcium pyrophosphate or urate are found in the synovial fluid, which do not cause a clear inflammatory reaction, which is explained in such patients by a decrease in the functional activity of neutrophil leukocytes. The knees, ankles and small joints of the hands are usually affected, and radiographs reveal periarticular osteoporosis. There is information about destructive arthropathy affecting the knee joints, although progressive destruction and the formation of erosions are not typical. Cases have been described where the only complaint in patients with autoimmune thyroiditis with hypofunction was pain in the knee joints without any other clinical manifestations (Gillan M. M., 2000). There is evidence in the literature that polyarthralgia occurs in patients with chronic autoimmune thyroiditis even without dysfunction of the thyroid gland (Punzi L., 2002). M. Cakir (2003) revealed Dupuytren's contracture in patients with hypothyroidism in 21.7% of cases, limited mobility in the joints - in 8.7% and carpal tunnel syndrome - in 30.4% of cases, index finger syndrome occurred in 10% of patients.

Thus, musculoskeletal disorders often accompany thyroid dysfunction. These symptoms are common with hypothyroidism, but they also occur with thyrotoxicosis.

Joint diseases
IN AND. Mazurov

Some diseases of the endocrine glands associated with metabolic disorders in the bones are accompanied by damage to the joints. This leads to the emergence of characteristic articular syndromes, often simulating rheumatic diseases.

Pituitary arthropathy

They occur due to hypersecretion of somatotropic hormone (growth hormone), caused in most patients by the presence of eosinophilic pituitary adenoma. Due to the anabolic effect of growth hormone, such patients experience an increase in the mass of soft tissues, including joint capsules, synovial membranes, as well as cartilage and bones; body weight increases (in approximately 40% of cases). Hypertrophy of skeletal muscles and thickening of the synovial bursae, especially the ulnar, prepatellar and subacromial, are noted.

Hypertrophy of the fibrous capsule of the joints leads to hypermobility. Due to the thickening of the interarticular cartilage, in approximately 1/3 of patients, X-rays reveal an increase in interarticular spaces, especially in the proximal interphalangeal joints (normally, these interarticular spaces are 3 mm in men, 2 mm in women). The collarbones, sternum, and ribs thicken. Due to the increase in anteroposterior size, the chest becomes barrel-shaped. Cervicothoracic kyphosis and lumbar lordosis are formed. In most patients, the terminal phalanges of the fingers expand in the “drumstick” type. X-rays reveal thickening of the cranial vault, enlargement lower jaw, hyperostosis of the frontal bone, exostoses and periosteal reactions.

Clinical picture. At the onset of the disease, hypermobility of the joints and reversible effusions are noted; later, bone hypertrophy, deformation of the joints, and decreased mobility in them occur. Both large and small joints are affected, proliferation of periarticular tissues without signs of inflammation is observed. Typically, patients complain of periodic joint pain that lasts for weeks or months. Sometimes joint pain is combined with stiffness of movement. Characterized by significantly pronounced crepitus of the joints. Blood tests show high levels of growth hormone, alkaline phosphatase and phosphorus.

Diagnosis A. g. is not difficult if available obvious signs pituitary adenomas: acromegaly, changes in the sella turcica, hypertrophy of the skull bones, etc. The disease should be differentiated from deforming osteoarthritis, in which there is no hypermobility of the joints or thickening of the interarticular cartilage. In contrast to rheumatoid arthritis, synovitis is rarely observed in A. g., synovial effusion is non-inflammatory in nature, swelling of the joints occurs due to thickening of the periarticular tissues, and giant osteophytes are detected on radiographs.

Treatment Aimed at eliminating hyperproduction of somatotropic hormone: surgical removal of the pituitary adenoma, radiotherapy, injection of radioisotopes into the pituitary gland.

At Hypothyroidism Aching pain in joints and muscles appears, arthritis rarely occurs, usually symmetrically; More often the knees and ankles are affected, and less often the small joints of the hands and feet. When palpating the joints, pain and increased temperature of the skin are noted. The periarticular tissues thicken, the synovial effusion contains a small number of leukocytes (less than 1·109/l) with a significant increase in viscosity due to the presence of hyaluronic acid. In 1/3 of patients, ligamentous weakness, tenosynovitis of the wrist flexors, and carpal tunnel syndrome are observed. In more than 1/2 of patients, chondrocalcinosis and calcium pyrophosphate crystals are found in the synovial fluid; uric acid crystals are often found. However, this is not accompanied by an increase in articular syndrome, since the phagocytic function of leukocytes is reduced. Sometimes asymptomatic hyperuricemia is observed.

The first signs of the disease may be radiculitis and neuritis. Cases of severe polyneuritis with muscle atrophy, paresis and paralysis of the upper and lower extremities have been described. Damage to the cranial nerves and related disorders are noted. Characterized by an increase in the time of muscle contraction and relaxation. Hypochromic anemia, hypercholesterolemia often develop, and the content of lipoproteins in the blood serum increases. Characterized by swelling of the subcutaneous tissue of the back of the hands and feet (absence of a pit when pressed), hyperkeratosis in the area of ​​the palms and soles. The X-ray picture is nonspecific. As a result of changes in the articular ends of bones, signs of secondary osteoarthritis appear early.

Treatment. The basis of therapy is the use of thyroid hormones. Prescribe thyroidin, starting from 0.05 g 2-3 times a day (average daily dose 0.15-0.2 g) or triiodothyronine.

For hyperthyroidism An early symptom is severe muscle fatigue with varying degrees of muscle atrophy. Often patients cannot stand up from a squatting position without the help of their hands. Attacks of weakness of the thigh muscles have been described, up to the development of so-called periodic paralysis. The fingers and toes take on the shape of “drumsticks” (due to periostitis and swelling of the soft tissues). Arthralgia is characteristic, and joint pain on palpation is often noted. Humeral periarthritis is common. A decrease in cholesterol levels and an increase in the level of thyroid hormones T3 and T4 are detected in the blood. Strengthening the function of the thyroid gland is confirmed by an increase in the absorption of I131 by its tissues.

Treatment. The main direction of therapy is the long-term administration of thyreostatic drugs - diiodotyrosine (0.1-0.3 g per day) or Mercazolil (0.01-0.04 g per day). If such therapy is ineffective, the issue of surgical treatment is decided upon within 6 months.

Hyperparathyroidism

It is characterized by excessive formation of parathyroid hormone and impaired calcium-phosphorus metabolism, leading to a decrease in bone density, the formation of cysts and subperiosteal erosions. There are primary G. (caused by the development of adenoma or hyperplasia of the parathyroid gland) and secondary (primary disturbance of calcium-phosphorus metabolism leads to hyperproduction of parathyroid hormone). G. is observed more often in women aged 20-50 years.

Clinical picture. The disease develops unnoticed. Early symptoms are bone pains that get worse with movement. The resorptive effect of parathyroid hormone leads to the formation of characteristic “shaggy” type subperiosteal erosions of the middle phalanges of the fingers, mostly of the tibia and femur, and clavicles. There is rarely a clear connection between the interarticular space and erosions, since parathyroid hormone does not cause cartilage destruction. Characterized by weakness of the ligamentous apparatus, which is explained by an increase in collagenase activity. There are tendon ruptures or avulsions, vertebral subluxations, especially in cervical spine spine, formation of kyphosis with arched protrusion of the sternum and hypermobility in lumbar region spine. Weakness of the ligamentous apparatus leads to degenerative changes in the joints. 1/5 of patients have chondrocalcinosis. The deposition of calcium pyrophosphate crystals often manifests as pseudogout attacks. G. becomes one of the causes of kidney stones.

Hypercalcemia, hypophosphatemia, and increased alkaline phosphatase activity are observed in the blood; hypercalciuria is typical. X-ray examination reveals in most cases osteoporosis and cysts (sometimes large). Subperiosteal resorption of the phalanges of the fingers is often observed. In the bones of the skull, a millet-like granularity with foci of clearing is detected. A decrease in the height of the vertebral bodies and an increase in the contrast of teeth in photographs of the jaws are revealed, since the teeth do not undergo decalcification.

Treatment. In primary G., only removal of the parathyroid tumor leads to the disappearance of the symptoms of the disease. Any other treatment, including radiotherapy, is ineffective. In case of secondary G., first of all, treatment of the underlying disease should be provided. Patients with hypercalcemia and hyperphosphatemia are prescribed a diet with limited calcium and phosphorus salts. To bind and remove calcium, the disodium salt of ethylenediaminetetraacetic acid in a 5% glucose solution is injected intravenously (at the rate of 2-4 g of the drug per 500 ml of glucose). Course 3-6 days. If necessary, re-prescribe.

For diabetes Musculoskeletal involvement may manifest as destructive arthropathy, carpal tunnel syndrome, interosseous muscular atrophy, and proximal muscle weakness due to neuropathic changes. Hyperuricemia, ankylosing hyperostosis, glenohumeral periarthritis, Dupuytren's contracture, and flexor tenosynovitis are often observed. The consequence of neuropathy is severe arthropathy, observed in 0.1% of patients suffering for a long time from S. d. Destructive changes are initially unilateral, much later bilateral, more often in the bones of the tarsus, metatarsus, phalanges, as well as in the tarsometatarsal and metatarsophalangeal joints, less often in ankle and knee joints (see Neuropathic arthropathy). There is local swelling of the joints, and there is a characteristic discrepancy between minor pain and pronounced radiological changes (erosions, bone sequestration, osteolysis).

Treatment. Prescription of hypoglycemic drugs is indicated. With overproduction of glucocorticosteroids (adrenal tumor, pituitary adenoma) or as a result of therapeutic use of glucocorticosteroids, some patients develop generalized osteoporosis, avascular necrosis of the heads of the humerus and femurs, and pathological bone fractures. Porosity of the vertebrae causes severe back pain. Subsequently, the vertebrae become flattened and kyphosis forms, which significantly reduces the patient’s height.

There is a non-inflammatory myopathy with progressive damage to the muscles of the pelvic and shoulder girdle. At the same time, the content of muscle enzymes in the blood serum remains normal, but creatinuria increases.

Ovariogenic joint lesions They arise due to a decrease or loss of ovarian function due to their disease, radiotherapy or surgical removal, as well as due to menopause. Usually the interphalangeal, metacarpal and metatarsophalangeal, and less commonly knee joints are affected. Initially, arthralgia appears, intensifying after physical exertion, stiffness after a state of rest, and rarely, transient synovitis. During this period, there are no changes in X-ray examination. Subsequently, deformation of the joints occurs, fibrous changes in the periarticular tissues predominate, and signs of deforming osteoarthritis with small osteophytes appear on radiographs of the affected joints.

Treatment. Colpocytology makes it possible to determine the nature of endocrine disorders and prescribe appropriate drugs - estrogens, androgens, progesterone.

Hyperthyroidism is a pathological condition of the body that develops when there is an excess of thyroid hormones in the body, often accompanied by increased metabolism in the body. The most common causes of hyperthyroidism are:

• diffuse or diffuse nodular toxic goiter,
• thyrotropin-producing pituitary adenoma,
• toxic thyroid adenoma,
• autoimmune thyroiditis (Hashimoto's disease).

The main clinical manifestations of arthropathy in hyperthyroidism.

With thyrotoxicosis in bone tissue, the processes of resorption (resorption) of bone tissue and a decrease in its density mainly predominate. The speed of this process directly depends on the level of thyroid hormones in the blood. Simultaneously with the processes of bone tissue resorption in thyrotoxicosis, there is a decrease in calcium absorption in the intestine and disturbances in the metabolism of vitamin D in the body. All this leads to the development of osteoporosis - decreased bone density and increased bone fragility.

Osteoporosis in hyperthyroidism is diffuse in nature and is accompanied by symptoms of varying severity. This can include bone pain, pathological fractures, which can occur even without obvious traumatic injuries, and kyphotic deformity of the spine. The risk of developing femoral neck fractures in patients with thyrotoxicosis in old age is especially high - it increases almost 2.5 times. If hormonal levels are corrected in a timely and adequate manner in such patients, the symptoms of osteoporosis will go away on their own, even without treatment.

With hyperthyroidism, arthropathy may occur with thickening of the nail phalanges and a periosteal reaction - this is the so-called thyroid acropathy (Marie-Bamberger syndrome, or hypertrophic osteoarthropathy), in which deformation of the nail phalanges is noted in the form of drumsticks, and nails in the form of watch glasses. This is usually accompanied by muscle weakness and muscle pain (myalgia). One of the most common manifestations of damage to the osteoarticular system in hyperthyroidism is glenohumeral periarthrosis (adhesive capsulitis, shoulder-hand syndrome), observed in 17.5% of patients, and carpal tunnel syndrome.

Hyperthyroidism may be accompanied by an increase in the volume of the thyroid gland (goiter is formed), disturbances in the functioning of the heart (tachycardia, heart rhythm disturbances) and central nervous system(with thyrotoxicosis), increased fatigue, emotional instability, vegetative-vascular disorders (hyperhidrosis, hand tremors, etc.). With severe hyperthyroidism, bilateral symmetrical exophthalmos (bulging eyes) may be observed.

Diagnosis of arthropathy in hyperthyroidism

• Determination of increased levels of triiodothyronine and thyroxine, thyroid-stimulating hormone in blood serum (in case of thyrotropin-producing pituitary tumor).
• Ultrasound examination of the thyroid gland (or MRI)
• Radioisotope scanning.
• Ultrasound-guided thyroid biopsy.
• In peripheral blood (with autoimmune thyroiditis) there may be an acceleration of ESR and a positive Boyden reaction
• X-ray, computed tomography or MRI of the skull and sella turcica (to identify pituitary adenoma), as well as an extensive neuro-ophthalmological examination.
• Ultrasound or X-ray densitometry (to determine the severity of osteoporosis).
• Ultrasound of the shoulder joint, wrist and other joints (to identify glenohumeral periarthrosis, carpal tunnel syndrome, etc.).

Treatment of arthropathy in hyperthyroidism.

Treatment of the underlying disease leads to a reduction in arthropathy and osteoporosis. But at the same time, strictly differentiated treatment is necessary after conducting a full examination and identifying the cause of the disease:

• For Graves' disease, thyreostatic drugs (tyrosol, Mercazolil and other drugs) or radioactive iodine are prescribed.
• For autoimmune thyroiditis, corticosteroids or immunosuppressants are prescribed.
• Thyrotoxicosis and/or diffuse nodular goiter, thyroid tumors are treated surgically (strumectomy), pituitary tumors are treated with radiation therapy and other specific types of treatment.
• Pain in arthropathy is treated symptomatically, in osteoporosis - treatment with bisphosphonates, calcium supplements with vitamin D and other drugs.

This disease provokes pain, limits mobility and often leads to complete immobility of the joints.

Articular cartilage breaks down due to excessive stress and lack of natural lubrication in the joints. Gliding worsens with metabolic disorders, which leads to a lack or loss of quality of synovial fluid, which acts as a lubricant.

Thus, the root causes of the development of hyperarthrosis are:

• Metabolic disorders in the body;
• Violation of the circulatory system, as a result of which the nutrition of joint tissues deteriorates;
• Decreased collagen production with insufficient liver function;
• Reduced blood circulation in the knees, ankles and other joints due to impaired kidney function;
• The presence of inflammatory processes in the joints.

We try non-standard treatment:

The problem may spread to different parts of the body. The most common form is considered to be arthrosis of the knee joints, which manifests itself in the form of pain and crunching while walking up the stairs. As the disease progresses, pain and stiffness increase.

The second most common is arthrosis of the hip joint, which is accompanied by pain and crunching in the joints, lameness, and shortening of the lower limb.

Arthrosis of the 1st degree of the shoulder joint is characterized by pain in the shoulder area, which can intensify when lifting, placing behind the back and other movements of the arms. If treatment is not started in time, the disease can lead to disability, and the patient will not be able to fully care for himself at home.

The disease also has several stages, depending on the severity of the disease.

1. The first stage of the disease manifests itself in the form of pain during movement. If the patient is at rest, the pain syndrome gradually disappears.
2. In the second stage of the disease, the patient experiences more persistent and intense pain in the joints, which usually does not disappear even after a long rest.
3. The third stage is characterized by significant destruction of hyaline cartilage, which causes limited movement and complete loss of joint mobility.

Treatment of joints can be effective if the disease is diagnosed in time and the necessary measures are immediately taken to eliminate the symptoms. At an early stage, therapy is primarily aimed at eliminating the causes of the disease, eliminating inflammatory processes and restoring previously lost functions.

It is important that treatment is comprehensive and regular. The doctor prescribes the use of medicinal anti-inflammatory and painkillers. The patient is also referred for physiotherapy, which helps relieve pain and stop inflammation. Additionally, spa treatment with mineral waters and mud therapy is recommended.

During treatment, the patient must follow certain rules so that the joints heal faster.

• It is necessary to avoid excessive stress on the affected joints, and during the treatment period it is best to completely avoid heavy physical activity.
• The patient must follow a specific regimen as prescribed by the doctor.
• Every day you should devote time to physical therapy exercises.
• The treatment complex should include visits to laser and shock wave therapy, electrotherapy, and magnetic therapy.
• Once a year you need to undergo a course of treatment at a sanatorium-resort institution.
• It is important to regularly carry out intra-articular oxygen therapy so that the joints receive the necessary dosage of oxygen.
• The main method of treatment is taking medicines prescribed by a doctor.
• Additionally, it is recommended to carry out intraosseous blockade and decompression of the metaepiphysis.
• During treatment, it is necessary to follow a certain therapeutic diet and rationally approach issues of proper nutrition.

A disease of any stage is treated primarily with anti-inflammatory drugs, which can slow down the development of the disease and alleviate the patient’s condition. Non-steroidal anti-inflammatory drugs relieve pain and eliminate inflammatory processes occurring in the joints.

The greatest effect is achieved by injections administered intravenously or intramuscularly. Non-steroidal anti-inflammatory drugs are also available in the form of ointments, but they are not able to be completely absorbed, for this reason they are used only in emergency cases for quick and temporary relief from symptoms.

When the disease worsens, the doctor prescribes the use of hormonal corticosteroids, which are injected into the joint cavity. Among the most well-known such drugs are Diprospan injection and Hydrocortisone. Additionally, special pepper patches, ointments or tinctures are used to alleviate the condition.

Chondroprotectors allow you to restore cartilage tissue and improve the quality of synovial fluid. The most famous and widespread drug is Don, which contains glucosamine and chondroitin sulfate. These substances not only relieve the symptoms of the disease, but also slow down the progression of the disease. As a result, the patient feels much better, while surgery temporarily not required.

Diacerein is used to stop the destruction of cartilage tissue. However, this method of treatment requires regularity and duration. The first positive results from therapy can be seen only two to three weeks after starting to use the drug.

The role of physical activity in hyperarthrosis

A joint is a movable connection of bones. The area where the joints come into contact with each other is covered with cartilage tissue. Cartilage, in turn, allows the bones to glide smoothly and acts as a shock absorber, reducing pressure on the joints during movement. Due to these features, healthy joints are able to withstand significant stress.

During the disease, cartilage tissue is gradually destroyed, and synovial fluid loses its quality. If the joints are not freed from stress in time, the disease progresses quickly. In this regard, the first thing doctors recommend is that you avoid any increased physical activity during treatment.

During the treatment period, you should not lift weights, run, jump, squat or stay in a bent position for a long time. Additionally, it is recommended to use a cane while walking.

However, this does not mean that the patient should completely abandon any movements. On the contrary, in order for damaged cartilage to receive increased nutrition, a certain amount of physical activity is required. Only in this case can the affected area be fully supplied with blood.

In this regard, it is necessary to do special therapeutic exercises every day, take regular walks, and visit the pool. You need to spend about 40 minutes a day on physical exercise.

It is important to consider that exercise can only be done during the period of remission, when the disease subsides.

For hyperarthrosis, overweight patients are advised to lose weight. From excess weight causes additional stress on the joints, not only during movement, but also at rest. In this regard, the risk of disease progression increases.

You need to lose weight at a gradual pace, without using strict diets or fasting. As you know, during a period of fasting, the body is left without certain nutrients that are necessary for cartilage tissue, so the cells are not able to recover.

It is better to start losing weight by giving up sweets, flour and fatty foods. In particular, sausages are considered a high-calorie product, but are not among the most nutritious.

It is important to include in the diet increased amount vegetables and fatty fish, which contain omega acids necessary for cartilage tissue. You should also eat dairy products, as the calcium they contain helps strengthen bones and improve the condition of joints.

It is necessary to follow fractional nutrition - eat often and in small portions, while avoiding starvation. This method allows you to reduce your daily caloric intake by 15 percent.

It is possible to completely get rid of the symptoms of the disease only if the disease was diagnosed at the initial stage. In cases where cartilage tissue begins to deteriorate, only surgical intervention in the form of endoprosthetics can help. Replacing the affected joint with a prosthesis requires long-term rehabilitation and can have a variety of side effects.

However, not everyone is allowed to undergo the operation; for example, if you are overweight or in old age, endoprosthetics is contraindicated. Therefore, it is important not to let the disease progress and seek medical help at the first suspicious symptoms. For example, if the patient feels pain in the joints in the evening, after training or work, and after rest the pain disappears. You should also be wary if you feel stiffness in your movements in the morning, which disappears after a while.

Treatment in this case should be aimed not only at emergency relief from pain with the help of painkillers, ointments and compresses. Despite the fact that the patient forgets about the disease after some time after getting rid of the symptoms, the process of destruction of cartilage tissue continues.

Therefore, the main task is to stop inflammation and destruction. For this purpose, chondroprotectors are used to nourish cartilage, moisturize it and strengthen it, as Elena Malysheva will talk about in the video in this article.

According to statistics, every THIRD resident of the country suffers from various joint diseases (arthrosis, arthritis, etc.). And due to limited mobility, over time, concomitant diseases such as hernia, metabolic disorders (weight gain), curvature of the spine and inability to walk arise. And the worst thing is that in the very last stages, neoplasms can appear in the joints, which lead to cancer.

People, taught by bitter experience, use...

is a degenerative-dystrophic disease, a substrate (

underlies

) which is articular cartilage. Violation of the nutritional mechanisms of cartilage leads to a gradual disruption of its functioning. According to statistics, gonarthrosis (

arthrosis of the knee joint

) is in the top three in terms of frequency of occurrence among arthrosis of various localizations, along with coxarthrosis (

arthrosis of the hip joint

) and deforming arthrosis of the intervertebral joints.

Based on the causal principle, primary and secondary forms of the disease are distinguished. Primary osteoarthritis is the most common form of the disease. It is also called idiopathic osteoarthritis, which means that it develops for unknown reasons or there are so many causative factors that it makes no sense to attribute the occurrence of the disease to any one of them.

Secondary osteoarthritis of the knee joint has a clear relationship to one or another risk factor. For example, it most often occurs against the background of injuries, in athletes during excessive physical exertion, in people whose professional activities are closely related to static loads (

loaders, auxiliary workers, etc.

). Sometimes there is a clear genetic inheritance of arthrosis in each generation, then the disease is also considered secondary. It happens that secondary osteoarthritis manifests itself due to specific diseases, such as

diabetes

Hemochromatosis, congenital deformity of the lower extremities,

rheumatoid arthritis

The most common symptoms of the disease are morning stiffness in the knee and pain when moving. In more severe stages, joint deformation reaches such a level that subluxations occur,

and jamming of the joint in a certain position.

Treatment of arthrosis of the knee joint is long and sometimes quite expensive, especially in advanced stages of the disease. Speaking about costs, it should be clarified that the bulk of them is spent on medications that need to be used in courses, and some constantly for preventive purposes. In addition, if it is necessary to replace the knee joint with an artificial prosthesis, it must also be paid for, since its cost is not included in the list of services covered by a standard insurance policy.

The prognosis of the disease depends on the degree of its aggressiveness, the quality of treatment and the discipline of the patient. The earlier the first signs of the disease appear, the sooner the transition from one stage of cartilage destruction to another occurs, the more aggressive the course of the disease is considered. The patient’s discipline means his ability to adamantly follow the doctor’s recommendations regarding how to drug treatment, and maintaining the right image life.

The knee joint is formed by the articular surfaces of the femur, tibia and patella. The main load falls on the femur and tibia, while the patella, being the largest sesamoid bone of the skeleton, performs a mostly protective function.

Unlike other joints of the body, the articular surfaces of which are strictly congruent to each other (

are in close contact with each other over their entire area

) the knee joint is not congruent in the usual sense of the word. In other words, if you attach the distal (

) part of the femur and proximal (

) part of the tibia, then they will not correspond to each other at all. However, the knee joint functions very clearly, in physiologically specified planes, without deviating from them, which would not happen if the articular surfaces were not in close contact.

The missing link in the mechanism described above is the paired menisci. They are thin triangular cartilages with curved contours that occupy free space in those places where the femur and tibia do not touch. Loss of the meniscal integrity often leads to joint instability with the risk of complete dislocation when a force is applied perpendicular to the main axis of motion in the joint, in other words, when the knee is struck from the side.

The ligamentous apparatus makes a huge contribution to the coordinated functioning of the knee joint. The ligaments of the knee joint are conventionally divided into those that are in the joint cavity and those that are outside it. The most important ligaments in the joint cavity are the anterior and posterior cruciate ligaments. They are one of the most powerful ligaments of the knee. The anterior cruciate ligament prevents the lower leg from moving forward, and the posterior cruciate ligament prevents it from moving backward. Extra-articular ligaments, for the most part, are thrown over the articular capsule at various angles, intertwining with its fibers and strengthening it. Of great importance is the patellar ligament, which securely holds this bone in the knee joint.

Thus, with the help of fibers of numerous ligaments, the tendon capsule of the knee joint is formed, perhaps the most durable capsule in the entire body. On the outside, this capsule consists of multilayered dense epithelium, and on the inside, from single-layer cylindrical epithelium. The inner layer of the joint capsule, otherwise called synovial, actively produces intra-articular (

synovial

) liquid. This fluid performs two important functions - improving the mutual sliding of articular surfaces and nourishing the synovial cartilage. Zero or even negative pressure is maintained in the articular cavity in order to attract the articular surfaces with the force of vacuum and ensure better contact of the articular surfaces. This, in turn, significantly reduces the likelihood of accidental dislocation.

Due to the fact that this joint is a condylar joint, movements in it are carried out in three planes. The main plane is the sagittal (

posterior-anterior

), in which flexion and extension are carried out within 140 degrees. Also in the knee joint there are minor movements in the lateral plane and rotation around its axis. These movements occur only in a bent position. In the lateral plane, abduction and adduction of the tibia occurs within 5 - 7 degrees, and thanks to the rotation of the tibia around its axis, rotation of the foot by 20 - 25 degrees becomes possible.

A special description must be given to articular cartilage, since its damage leads to the disease that this article is devoted to. In a healthy person, the thickness of the cartilage in the knee joint ranges from 0.5 to 0.7 cm in various places. Articular cartilage consists of various

proteinscarbohydrates

and their complexes – proteoglycans and glycoproteins. The main protein that makes up cartilage is type 2 collagen. Interacting with similar proteins, it forms a tertiary structure, which is represented by strong fibers. These fibers are very hygroscopic. In other words, they are capable of absorbing an amount of water tens and even hundreds of times greater than the mass of the protein complex itself. Thus, healthy hyaline cartilage consists of 80 - 90% water.

The nutrition of cartilage tissue is twofold. The first way in which nutrients and oxygen reach it is the hematogenous route, that is, through the circulatory system. In the subcartilaginous layer there is a rich network of blood capillaries, which ends at the borders of the cartilage tissue. The cartilage itself does not contain blood vessels. The second way of cartilage nutrition is diffusion (

mutual penetration of molecules of one substance between molecules of another

) nutrients from the synovial fluid into the thickness of the cartilage. Therefore, the good condition of the synovial membrane, which synthesizes synovial fluid, is extremely important.

Articular cartilage has two main functions. The first function is to ensure sliding of surfaces in contact with each other. This function is provided by fluid binding to collagen. The more fluid the cartilage contains, the smoother it is. The second important function is the absorption of shocks that befall the musculoskeletal system in daily human activities. Due to its almost ideal elasticity, the cartilage restores its original shape after the received impulse.

The load during concussions is distributed to the cartilage of the entire body. However, this distribution is uneven. In this case, the rule is that the joints closest to the point of impact bear the greatest load. Thus, when jumping, the impulse is damped by the ankle, knee and hip joints and, to a lesser extent, by the spinal column. Likewise, when you fall on your hands, large loads are distributed to the wrist, elbow and shoulder joints.

Deforming arthrosis of the knee joint is a polyetiological disease. This means that there are many reasons for its development. In some cases, when the most dominant cause can be identified, gonarthrosis is called secondary. In cases where a clear cause is not determined, a diagnosis of primary or idiopathic (

unknown etiology

) arthrosis of the knee joint.

Normally, the destruction of articular cartilage occurs during the process of physiological withering of the entire organism, that is, during aging. Cartilage destruction is considered pathological when it occurs ahead of time or at a more intense rate. Middle age, at which the first signs of cartilage degeneration may legitimately appear (

periodic pain, slight stiffness after waking up, clicking during certain movements in the joint, etc.

) is a period from 40 to 50 years. With deforming arthrosis, the disease debuts in childhood with the first manifestations at 16-18 years, and in some cases even earlier.

The mechanism of disease development is a vicious circle in which the final links trigger the initial ones and so on ad infinitum. However, each turn of this circle aggravates the condition of the cartilage and leads to progression of the disease. In the case of primary (

idiopathic

) gonarthrosis, the cause that triggers the vicious circle is unknown. However, its subsequent links have been carefully studied in order to influence them and slow down the progression of the disease.

Deforming arthrosis develops approximately as follows. Every day, the articular cartilage of the knee joint experiences thousands of shocks, which they are forced to absorb in order to avoid harm to more delicate structures. human body, such as internal organs and the brain. Over time, due to these shocks, microscopic cracks form in the subchondral layer, which also after a certain period of time are filled with synovial fluid and turn into microcysts (

cavity formations

). Adjacent microcysts tend to unite and form larger cysts.

As cysts in the subcartilaginous space increase in size, they gradually begin to compress the blood capillaries that supply the cartilage tissue from the bone side. Its supply of oxygen and substances necessary to maintain vital functions deteriorates, which leads to slower synthesis of type 2 collagen. The processes of cartilage destruction very slowly begin to dominate the processes of its formation. This certainly affects the physical qualities of the cartilage. Instead of regaining its previous shape after each concussion, the cartilage slowly shrinks.

Compression of cartilage leads to two negative consequences. Firstly, it leads to a deterioration in shock-absorbing properties and more intensive formation of new microcracks in the subcartilaginous layer. Secondly, due to the compression of the cartilage, its density increases, which negatively affects the second mechanism of its nutrition - through the diffusion of synovial fluid into the thickness of the cartilage tissue. An increasing deficiency of nutrients leads to even greater “starvation” of the cartilage, progressive compression, etc., until it becomes thinner altogether.

However, on a body-wide scale, the destruction of articular cartilage does not go unnoticed. As a compensatory reaction, in the area of ​​cartilage tissue abrasion, the activity of chondroblasts, young cells synthesizing new cartilage tissue, increases. However, this compensatory mechanism is imperfect, and its imperfection lies in the fact that the bulk of cartilage tissue is formed not in the place of greatest destruction of the cartilage, but where the cartilage does not experience stress. In other words, there is little benefit from such restoration, since excess growth of cartilage tissue occurs mostly at the edges of the articular surfaces. In these places, tissue growth occurs chaotically, disorderly, in the form of a continuous heap.

As a result, cone-shaped growths of cartilage tissue – chondrophytes – form along the edges of the joint. These chondrophytes do not manifest themselves clinically until ossification processes begin in them. Ossified, chondrophytes harden and turn into

osteophytes

Which are popularly called thorns. As a rule, the appearance of thorns is always accompanied by pain and the development of inflammation in the joint. This is explained by the fact that osteophytes, when moving the joint, touch the cartilage tissue and synovial membrane, thereby mechanically damaging it.

The inflammatory process, in turn, greatly worsens the course of the disease due to the following mechanisms. Firstly, the composition of the synovial fluid changes. It becomes thicker and penetrates worse into the thickness of the cartilage, impairing the delivery of nutrients to it. Secondly, during inflammation it is formed

tissues and pressure in the joint cavity increases. Tissue swelling leads to pain. To reduce pain, the patient tries to make fewer movements in the joint, sparing it. New osteophytes soon form on the immobile joint and

Which significantly reduce the range of motion of the lower leg. Increased pressure in the joint cavity causes the articular surfaces to move further apart, increasing the risk of dislocation if the movement is unsuccessful.

As a result, each complication of deforming arthrosis (

inflammatory process, formation of adhesions, contractures, spines, etc.

) leads to an acceleration of the progression of pathological changes in cartilage. However, knowing the mechanism of development of gonarthrosis, it is possible to successfully influence some of its links in order to slow down its course and improve the long-term prognosis.

Secondary gonarthrosis differs from primary gonarthrosis in that it is known main reason, which started a vicious circle of destruction of articular cartilage. The further course of the disease occurs in exactly the same way as with primary gonarthrosis, with the peculiarity that the disease is constantly getting worse due to the influence of negative factors associated with the underlying disease. For this reason, the course of secondary arthrosis of the knee joint, as a rule, is more aggressive.

The following causes of secondary gonarthrosis are distinguished:

• injuries (acute and chronic);
• congenital varus or valgus deformity of the lower extremities;
• congenital shortening of one of the lower limbs;
• knee hypermobility syndrome;
• congenital dysplasia of the knee joint;
• chondrocalcinosis;
• osteomyelitis;
• rheumatoid arthritis;
• acromegaly;
• diabetes;
• obesity;
• hypothyroidism;
• frostbite, etc.

Injuries Post-traumatic deforming arthrosis is divided into acute and chronic. The acute form of the disease develops after one serious injury, more often a fracture, which occurs or partially extends to the articular part of the bone. The chronic form of the disease develops over a longer period of time and is usually associated with frequent and minor injury to the joint. Such conditions are created for builders, road workers, loaders, etc.

In acute gonarthrosis, the mechanism of the disease is associated with severe inflammatory changes in the joint cavity, namely lymphostasis, increased pressure in the joint cavity, and changes in the composition of the synovial fluid. Excessive acceleration of the growth of new cartilage tissue leads to deformation of the articular surface at the fracture site and the growth of osteophytes.

In chronic gonarthrosis, a pronounced inflammatory process is not observed, however, frequent and intense load on the cartilage tissue leads to its rapid compaction, the formation of microcracks and a deterioration in the supply of cartilage with nutrients both from the bone and from the joint space.

Congenital varus or valgus deformity of the lower extremities People with this pathology can be found quite often. Its essence is to change the shape of the legs. With varus deformity, the legs are bent outward in the horizontal plane. In other words, the space between the patient’s legs is greater than that of healthy people. With hallux valgus, the feet become X-shaped when the knees touch each other. Both of these pathologies can be either genetically programmed or develop during life as a result of fractures of the lower extremities.

In both cases, the load on one side of the knee joint increases; with varus deformity, on the lateral ones (

) sides, and in case of valgus deformity - on the medial (

internal

) sides. Due to the fact that the same weight of the patient presses on a smaller area, premature wear of the cartilage occurs, accompanied by inflammation, pain and morning stiffness.

Congenital shortening of one of the lower limbs Congenital shortening of one of the legs is a consequence of anomalies intrauterine development or may develop several years after birth as a consequence of birth trauma. As in the previous case, there is an uneven distribution of weight, with the normal leg taking on more of the load. As a result, the articular cartilage of the knee joint of a healthy leg undergoes structural changes that lead to deforming arthrosis.

Knee hypermobility syndrome This pathological condition is not a disease, but it may well lead to it. This syndrome refers to excessive mobility of the ligamentous-articular apparatus, in which the range of motion of the joints within the normal axes can significantly increase. Such patients almost never suspect that they have such a feature, since they live with it all their lives and believe that other people function in the same way.

A sign of knee joint hypermobility syndrome is the formation of an obtuse angle between the anterior surfaces of the thigh and lower leg with maximum straightening of the leg. In other words, the knees bend backwards, and the legs take on an arched shape. Also, such patients can easily reach their forearm with their thumb, reach their shins with their head and, in principle, have innate flexibility.

However, unfortunately, such patients are at risk of deforming arthrosis, since the frequency of dislocations in them is many times higher than that among other people. Frequent dislocations lead to inflammation, which, in turn, accelerates the destruction of cartilage tissue.

Congenital dysplasia of the knee joint Dysplasias are certain defects of organs or systems, during which they develop in the wrong direction. Often dysplasia is combined with hypoplasia, that is, with tissue underdevelopment.

With dysplasia of the knee joint, the following structural changes in nearby bones can occur - shortening of the femur and tibia, changes in the shape of the articular surfaces. Shortening of the bones leads to shortening of the entire limb and disruption of equal distribution of weight on both legs. Changes in articular surfaces are often associated with smoothing of restrictive structures - grooves, condyles, etc. This, in turn, leads to increased instability of the joint, an increase in the frequency of dislocations and the development of post-traumatic gonarthrosis.

Chondrocalcinosis This disease is associated with premature deposition of calcium pyrophosphate and hydroxyapatite salts in the cartilage of the body. Since the disease is systemic, its manifestations are also systemic. In other words, damage to the cartilage of the knee joint is usually combined with similar damage to other joints.

Due to the fact that the above crystals are formed in cartilage tissue, it gradually transforms into bone tissue. X-ray shows foci of petrification (

ossification

) are presented in the form of dark islands (

seals

) in the thickness of the articular cartilage. As cartilage tissue transforms into bone tissue, the elasticity of which is practically zero, the shock-absorbing function of the articular apparatus is reduced to nothing. In addition, friction between the articular surfaces increases significantly and an inflammatory process occurs, which, as is known, aggravates the course of deforming arthrosis.

Osteomyelitis Osteomyelitis is an inflammation of the bone marrow. Typically, development of this disease always leads to a multiple increase in pressure in the medullary canal due to the abundant formation of purulent masses. Purulent masses corrode the surrounding tissues, and high pressure accelerates this process. As a result, a fistula or pathological passage is formed, through which purulent masses spread beyond the bone into the surrounding tissue.

The opening of a fistula is almost always associated with a temporary decrease in

temperature

and pain intensity. However, after the free space between the muscle fascia is filled with pus and pressure in the soft tissues increases again, the temperature and pain return as the amount

toxins

Entering the blood increases again. After the pus finally breaks through to the surface of the skin, the disease enters a chronic phase with periodic exacerbations.

In some cases, when osteomyelitis develops near the knee joint, and its fistula tract opens directly into the articular cavity, so-called purulent arthritis is formed. Also, such arthritis is possible when the joint capsule is corroded from the outside, when it forms one of the walls of phlegmon (

diffuse accumulation of pus in soft tissues

). According to the previously stated mechanism, the inflammatory process destroys articular cartilage, leading over time to deforming arthrosis.

Rheumatoid arthritis This disease damages articular cartilage in a similar way to the previous ones through the development of an inflammatory process. However, in this case, the inflammatory process is not microbial in nature, but autoimmune. In other words, antibodies formed by the body to protect against a bacterium called beta-hemolytic streptococcus cross-attack the body's own structures that have a similar antigenic composition. Such tissues are the synovium of the joints and the heart muscle. That is why very often, along with the articular manifestations of rheumatoid arthritis, the patient also experiences symptoms of acute heart failure.

Acromegaly This disease is one of the endocrine diseases, that is, those that develop due to disruption of the endocrine glands and the occurrence of hormonal imbalance. Acromegaly, in particular, occurs when a hormone called somatotropin, otherwise known as growth hormone, is present in excess in the body. As a rule, the cause of an increase in the concentration of this hormone is a benign hormone-producing tumor of the anterior pituitary gland. When this hormone is increased from birth or early childhood, a person grows much taller than his relatives and looks quite proportionate. In this case, deforming arthrosis develops in them no more often than in others.

When the concentration of this hormone increases during adolescence, pronounced internal changes develop, leading to the formation of a specific physique. Such patients are dwarfs with prominent cheekbones, chin and brow ridges. As a rule, there is no intellectual lag. This appearance is a consequence of the fact that under the influence of excessive concentrations of the hormone, a pronounced growth of bone and cartilage tissue occurs. The growth of bone tissue gives patients the above-mentioned features. The growth of cartilage tissue leads to a change in the shape of the joints. The first to react to such a change are the joints that bear the main load of the body, that is, the ankles, knees and hips. Loss of congruence of the articular surfaces leads to a change in the axis and the appearance of joint instability, accompanied by subluxations and dislocations. All these changes together negatively affect the condition of cartilage.

Diabetes Diabetes mellitus is one of the most common diseases, leading to numerous complications from the organs of vision, kidneys, brain, cardiovascular system, etc. In particular, the negative impact of this disease on the knee joint and joints in general is as follows. Due to insufficient production of insulin, the hormone of the endocrine pancreas, which is responsible for the absorption of glucose by the body, its level in the peripheral blood increases. High value glucose negatively affects the trophism of blood vessels, which is why microscopic cracks form on them.

In large vessels, these cracks serve as a substrate for the formation

and a significant deterioration in the blood supply to the corresponding part of the body. In small vessels, microcracks also cause disruption of blood supply, increasing their fragility. As a result, there is a disruption in the nutrition of the articular cartilage of the knee, both globally - due to

thrombosis

femoral arteries, and locally - due to the fragility of the capillaries of the subchondral space. Worsening cartilage nutrition is one of the links in the vicious circle of the pathogenesis of deforming arthrosis.

Obesity Obesity is truly the scourge of at least a third of the world's population. An increase in body weight can occur due to a huge number of reasons, such as a sedentary lifestyle, unhealthy diet, various organic and mental diseases, etc. For deforming arthrosis, the very fact of an increase in body weight above established normal guidelines is a direct trigger factor. With an increase in weight, there is an excessive load on the articular cartilage, their compression, abrasion, deterioration of blood supply and nutrition from the synovial fluid, which causes pain, stiffness and other signs of the disease. The knee joints, as one of the most massive and complex, are the first to be affected by liquefaction.

Hypothyroidism Hypothyroidism is an endocrine disease in which, for one reason or another, there is a lack of thyroid hormones. In this case, the patient gains weight due to the accumulation of fluid in the subcutaneous fat layer. In addition, the patient becomes apathetic, moves little and rarely. Both of these factors lead to increased wear of the cartilage of the knee joint due to an increase in the static load on them.

Frostbite (frostbite) Frostbite develops as a result of prolonged local exposure to low temperatures on living tissue. With this pathology, ice crystals form in frostbitten tissues, which completely destroy the body's cells from the inside, causing their death. When frostbite occurs in cartilage, germ cells that have a high division potential are often affected. Thus, even after the frostbitten knee joint is externally restored, the processes of internal molecular restoration in it are irreversibly disrupted, which leads to its slow and inevitable destruction.

The symptoms of gonarthrosis are (in the classic order of occurrence):

• crunching, clicking of a joint during a certain movement;
• pain;
• stiffness of movements;
• decreased range of motion;
• increase in joint volume;
• jamming of a joint in a certain position;
• dislocations and subluxations.

Crunching, clicking of a joint in a certain movement This symptom, as a rule, goes unnoticed for a long time, and if attention is paid to it, it is interpreted as insignificant. Unfortunately, this approach is frivolous, since the crunch indicates that the congruence of the articular surfaces is disrupted due to the formation of grooves, osteophytes, and small ulcers of the cartilaginous surface.

In order to determine whether this symptom is present in a particular patient or not, you should place your hand on the patella (

kneecap

) and slowly bend and straighten the knee. Crunching or clicking is usually quite easily felt if cartilage degeneration occurs.

Pain Pain in the joint is initially almost unnoticeable and may slightly intensify after prolonged and intense physical activity. Moreover, it is important to note that it is the static load that matters, that is, lifting weights. Dynamic load on the joint leads to pain much less often and, on the contrary, improves the nutrition of the cartilage, as well as the prognosis of the disease as a whole.

The pain is usually associated with exposure of nerve endings when the top layer of cartilage is worn away. After several hours of rest, such as sleep, the pain goes away due to the fact that these nerve endings are covered with a thin layer of fibrin and are less irritated.

As the disease progresses, the pain becomes more protracted, and its disappearance requires a longer period of rest. This is due to the fact that the depth of cartilage wear increases. In addition, the destruction of articular cartilage is accompanied by an inflammatory process, in which edema forms in the synovial membrane and subchondral base, further compressing the nerve fibers. A feature that allows us to indirectly judge the attachment of the inflammatory process to deforming arthrosis is the appearance of pain at rest. Classically, pain in gonarthrosis without an inflammatory process appears only when moving the joint.

Stiffness in movement This symptom is important in the differential diagnosis of deforming arthrosis from other diseases of the musculoskeletal system, for example, rheumatoid arthritis. Stiffness of movement is observed after waking up in the morning and lasts no more than 30 minutes from the moment you start walking. Stiffness lasting up to one hour may be a sign of the addition of an inflammatory process to deforming arthrosis. Stiffness that lasts several hours is more likely to indicate other diseases.

The mechanism of stiffness is usually associated with the formation of fibrin films that envelop exposed nerve fibers during joint inactivity. They mechanically impede the movement of the joint until they are partially worn out. The addition of an inflammatory process is always associated with worsening stiffness, as changes occur in the synovial fluid. It becomes cloudy due to the presence of a large number of

leukocytes

In this case, the inflammatory process often spreads to the internal ligaments of the joint, which, swelling, shorten. The shortened ligaments directly hold the joint in a certain position, but when movements begin, their swelling subsides, and the ligaments restore their previous length, and the joint regains mobility.

Decreased range of motion A decrease in the range of motion is manifested by the patient’s inability to fully bend the leg at the knee. The mechanism of this phenomenon is due to the fact that the patient, trying to reduce the intensity of pain, moves his leg as little as possible, since it is movements that provoke pain. After some time, the ligamentous apparatus of the joint adapts to a small range of movements in such a way that both the internal and external ligaments of the knee joint are shortened. Similar changes occur in any joint that has been without movement for a long time. A striking example is the shortening of the ligamentous apparatus when applying plaster immobilization due to a fracture or dislocation. A shortened ligament in this case is called contracture and requires long-term development through daily gymnastics.

Increase in joint volume An increase in joint volume can occur for several reasons. The first reason is swelling of the soft tissues surrounding the joint, as well as its capsule itself. This occurs in advanced stages of the disease, when inflammation does not completely disappear and becomes chronic. The second reason may be osteophytes - spiny growths along the edges of the articular surfaces, which in the terminal stages of the disease can reach impressive sizes and even form single masses.

Joint jamming in a certain position Jamming refers to a condition in which a joint is locked in a certain position, and any attempt to displace it causes pain. The most common cause is a change in the articular surfaces of the knee, in which its internal ligaments can extend beyond the natural protrusions of the epiphyses (end parts of the bone) of the tibia and femur and become stretched like a string. In this case, the joint is fixed in a certain position and is released only when the ligament is reversely displaced.

More rare causes of knee joint locking can be foreign bodies entering the joint space. Such foreign bodies can be fragments of osteophytes and parts of menisci.

Dislocations and subluxations Both dislocations and subluxations of the knee joint are a consequence of extremely pronounced changes in the shape of the articular cartilage during the terminal stages of gonarthrosis.

A dislocation of the knee joint is a pathological condition in which the distal epiphysis of the femur does not contact the proximal epiphysis of the tibia and completely extends beyond the joint. In this case, the joint completely ceases to function, and the axis of the leg shifts significantly away from the normal one. A dislocated knee joint is usually very painful and difficult to reduce. However, the good news is that its incidence is low enough that you don’t have to think about it even with severe gonarthrosis. The reason for this is the powerful ligamentous apparatus of the knee and the large area of ​​​​contact of the articular surfaces.

Subluxation of the knee joint is a partial displacement of the articular surfaces relative to their normal position. In this case, the functional impairments are significant, the pain syndrome is also pronounced, but the deviation of the tibia to the side from the normal axis is less. Subluxations of the knee joint are more common than dislocations and are usually treated with external reduction followed by external fixation with orthoses.

Methods for studying arthrosis of the knee joint are conventionally divided into instrumental and laboratory. Among instrumental diagnostic methods, conventional radiography is of paramount importance, since it is simple and cheap to use, and also provides the researcher with almost all the necessary information to identify and determine the severity of the disease. Less often, mainly in unclear cases, they resort to using other instrumental methods.

Additional information is provided by laboratory tests that can indicate the cause of the development of deforming arthrosis, determine the effectiveness of treatment and promptly suspect its possible side effects. However, you should not rely completely on laboratory tests, since they are of value only in conjunction with the clinical picture and the instrumental methods mentioned above.

• simple radiography in two projections;
• arthroscopy;
• Ultrasound (ultrasound examination);
• computed tomography (CT);
• magnetic resonance imaging (MRI);
• scintigraphy;
• thermography, etc.

Simple radiography in two projections Since the introduction of the X-ray machine into everyday practice, the main task for which it was used was the diagnosis of pathology of the musculoskeletal system. Only after some time did X-rays begin to be used to diagnose pneumonia, tuberculosis, pericarditis, sinusitis, etc. Thus, over the past decades of using this method, a lot of information has accumulated about the signs of one or another bone pathology on film.

In particular, an x-ray of the diseased knee should be performed in two projections - lateral and postero-anterior. It is often necessary to take a picture of the second healthy knee in order to compare the diseased one with it. Signs of deforming arthrosis of the knee joint are conventionally divided into direct and indirect.

Direct signs of gonarthrosis are:

• narrowing of the distance between the epiphyses of the femur and tibia;
• subchondral sclerosis;
• osteophytes;
• microcysts in the subcartilaginous layer.

Indirect signs of gonarthrosis are:

• dislocation or subluxation;
• residual bodies in the articular cavity (osteophyte fragments);
• foci of ossification in cartilage tissue;
• change in synovial tissue.

Arthroscopy Arthroscopy is an invasive endoscopic instrumental method, in which an LED conductor is inserted through a small hole on the side of the knee into the joint cavity. In this case, what is located directly in front of the conductor is displayed on the monitor screen. Thus, the researcher sees with his own eyes all the structures of the knee joint.

The undoubted advantage of this method is that it can be used not only for diagnostic purposes, but also for treatment. In particular, it can be used to endoscopically remove synovial polyps, chondrophytes, correct the shape of the meniscus, and the like. Also, all tissue fragments obtained during the operation can be sent for histological examination if a malignant bone or cartilage tumor is suspected. Considering that the knee joint is one of the largest joints in the human body, examination of its cavity is most convenient and allows us to diagnose a large number of diseases.

However, this method also has negative side, which, in fact, is its essence. This disadvantage is the depressurization of the joint cavity and the entry of microbes into it. In this regard, purulent arthritis is the most common complication of arthroscopy.

Ultrasound (ultrasound examination) Ultrasonography internal organs has been used in medicine since the mid-80s of the last century, however, the potential of using ultrasound in traumatology and, in particular, in the diagnosis of deforming arthrosis of the knee joint was discovered relatively recently. This method is absolutely harmless and therefore can be performed as many times as desired, which distinguishes it favorably from x-rays, in which the body receives a certain dose of radiation. In addition, ultrasound clearly visualizes the soft tissues of the joint, such as cartilage, subchondral tissue, synovial membrane, blood vessels, cysts, X-ray negative tumors, etc. In connection with the above, it is expected that in the future medicine will gradually move away from the use of X-rays in the diagnosis of cartilage pathology (deforming arthrosis) to the use of ultrasound. However, at the moment, unfortunately, we have to admit that only a small number of clinics have specialists capable of performing high-quality ultrasound of joints.

Computed tomography (CT) Computed tomography belongs to the X-ray research methods, however, the most advanced of this series. The essence of this method is to create a large number of images of a certain segment of the body along its entire circumference. The information from all the images is then fed into a computer and processed to create a single 3D image.

Of course, the radiation dose with this method is slightly higher than from conventional radiography, but the amount of information is many times greater. The resolution of modern tomographs is amazing. With their help, you can detect objects with dimensions not exceeding 2 mm. Moreover, the abundance of contrast agents (

water-soluble and fat-soluble

) allows the use of CT in pneumology, cardiology, oncology, surgery, gastrology, hepatology, etc.

Despite all the advantages of this method, in fairness, it should be noted that the use of CT in the diagnosis of arthrosis of the knee joint is very rarely resorted to. The reason for this is the abundance of other, less expensive research methods. The same rare case when CT turns out to be necessary is differential diagnosis with more complex and rare diseases, as well as the impossibility of carrying out other studies for one reason or another. Contraindications to CT may occur

allergy

for contrast agent or patient weight more than 160 kg.

Magnetic resonance imaging (MRI) This research method is based on recording photons with a certain wavelength emitted by hydrogen atoms, which return to their original position after being exposed to a strong magnetic field. The definition seems cumbersome, but each of its components is important. Since hydrogen atoms are capable of emitting only photons, which carry much less energy than radium or plutonium atoms, their radiation is absolutely harmless to the human body. This fact determines the advantage of MRI over CT.

The second difference between MRI and CT is that MRI visualizes soft tissue much more clearly than hard tissue, as in CT. This is explained by the fact that soft tissues contain more water, the main component of which is the above-mentioned hydrogen ions.

It is believed that the greater the power of the tomograph, the more powerful the force field the device can create, the clearer the resulting image. Today, the most advanced clinics in the world use tomographs with a power of at least 3 - 5 Tesla (

). Already at this stage, the resolution of MRI makes it possible to detect objects a fraction of a millimeter in size, which is several times greater than the resolution of CT.

However, MRI, like CT, is rarely used to diagnose arthrosis deformans, even though it can provide comprehensive information about the structure of articular cartilage and all other components of the joint. The reason lies in the price, which is on average 2 - 3 times higher than the price of CT. A contraindication for MRI is the presence of metal objects in the patient’s body (

dental crowns, wires, plates, etc.

), as well as the patient’s weight more than 120 kg.

Scintigraphy Scintigraphy is one of the representatives of radiological methods. In this study, a certain contrast agent is intravenously injected into the patient’s body, which has a tropism (certain reaction) to the required type of tissue. In the case of deforming arthrosis, the contrast agent can be monosphonates and bisphosphonates labeled with technetium-99, which have a tropism for growing cartilage tissue. After contrast is administered, the whole body is scanned. The concentration of the contrast agent in one of the joints will indicate a cartilaginous tumor, with which gonarthrosis sometimes has to be differentiated.

Like previous radiological methods, this one carries little risk associated with exposing the patient to radiation. However, non-invasiveness and the ability to localize small tumors with questionable clinical data justify the value of this research method. The cost of the study depends on the type of contrast agent and its quantity, but usually it is quite high for a patient with average income.

Thermography This examination method is based on recording thermal radiation from the surface of the body. As a rule, the foci of increased temperature are inflammatory foci and malignant tumors. Like previous methods, thermography can be prescribed only for the purpose of differential diagnosis. In addition, this study is only available in large medical centers.

Osteoarthritis of the knee joint is a long-term disease that periodically worsens. During periods of remission, laboratory tests are rarely useful, since often all indicators are within normal limits. However, during the period of exacerbation, signs of inflammatory-intoxication syndrome appear, which is laboratory manifested by the changes listed below.

General blood analysis This screening analysis allows one to assess the severity of the inflammatory process and sometimes suggest a possible causative agent.

The following changes are observed in the general blood test:

• an increase in the total number of leukocytes, in accordance with the severity of the inflammatory process (normal range from 4 to 9 x 109/l);
• a shift in the leukocyte formula to the left, that is, an increase in the fraction of band neutrophils (normal - less than 6%);
• an increase in the number of lymphocytes (the norm is from 19% to 37%) may indicate the viral or autoimmune nature of arthritis;
• an increase in ESR (erythrocyte sedimentation rate) is proportional to the intensity of the inflammatory process (the norm is from 2 to 10 mm/hour in men, from 2 to 15 mm/hour in women);
• with a pronounced inflammatory process, thrombocytosis may be present (the norm of platelets is from 180 to 320 x 103/l).

General urine analysis A general urine test is performed in order to exclude damage to the kidneys and urinary tract as sources of the inflammatory process. In addition, kidney damage in combination with arthrosis may indicate an autoimmune nature of the disease.

The most common deviations from the norm of a general urine test for gonarthrosis are:

• changing the urine environment (pH) in favor of reducing acidity;
• impaired urine clarity;
• appearance of protein (normal value less than 0.033 g/l);
• presence of leukocytes (normal 1 - 2 per field of view);
• the appearance of deformed red blood cells and pigment cylinders (normally completely absent).

Blood chemistry A biochemical blood test consists of a huge number of individual tests, which can be divided into:

• general markers of inflammation;
• markers of dysfunction of internal organs;
• tumor markers;
• qualitative and quantitative reactions to the presence in the body of antibodies of the supposed causative agents of arthritis or the disease within which arthritis developed.

Almost all common markers of inflammation are increased in arthrosis complicated by arthritis. These markers include thymol test, C-reactive protein, mercuric test, fibrinogen, etc.

Markers of dysfunction of internal organs may increase in the presence of a single disease that simultaneously affects this organ, when side effects from the treatment of arthritis or in case of combined damage to this organ by another disease. Increases with kidney damage

urea

creatinine

Increases with liver damage

bilirubin

and its factions,

transaminases

AlAT and AsAT

gamma-glutamyl transpeptidase

) and alkaline phosphatase. When the pancreas is damaged, amylase increases and, in parallel, urine diastasis. With brain damage, the MM-CPK fraction increases (

creatine phosphokinase

). When the heart muscle is damaged, the fraction of MB-CPK and LDH increases (

lactate dehydrogenase

Tumor markers can be extremely useful in identifying malignant neoplasms, however, unfortunately, tumor markers for osteosarcoma (

malignant bone tumor

) and chondrosarcomas (

malignant tumor of cartilage tissue

), which are the causes of secondary osteoarthritis, do not exist today.

The most narrow and specific biochemical tests that can clearly indicate the cause of arthrosis are the following studies. In cases of rheumatoid nature, rheumatoid factor and ASL-O are increased (

antistreptolysin - O

), as well as the previously mentioned C-reactive protein and fibrinogen. With the autoimmune nature of the disease, the CEC increases (

number of circulating immune complexes

), globulin fraction. To identify specific pathogens of arthritis in the blood, the titer of IgG and IgM is determined (

immunoglobulins G and M

sexually transmitted infections

mycoplasma, ureaplasma and chlamydia

). The above tests are performed most often, however, due to the fact that arthrosis deformans is a polyetiological disease and the causes that cause it can be rare and varied, the range of studies performed can be significantly expanded.

There are several classifications of arthrosis of the knee joint. Some of them are understandable only to doctors because they require the ability to read x-rays. Some classifications are also understandable to patients, since they are based on the clinical manifestations of this disease.

The most common radiological classification of deforming arthrosis of the knee joint is the Kellgren-Lawrence classification, which distinguishes 4 degrees of destruction of articular cartilage. This classification is easy to remember because it is based on only three key points - the width of the interarticular space, osteophytes and the severity of bone deformation.

Degrees of gonarthrosis according to Kellgren-Lawrence:

• slight narrowing of the joint space, indirect signs of the presence of small osteophytes;
• slight narrowing of the joint space, reliable signs of the presence of small osteophytes;
• pronounced narrowing of the joint space, moderate osteophytes, indirect signs of bone deformation;
• pronounced narrowing of the joint space up to its absence, large multiple osteophytes, reliable signs of bone deformation.

In addition to the above classification, the Kosinskaya classification of gonarthrosis is still popular in the post-Soviet countries, due to the fact that each stage of the disease is described in more detail.

Degrees of gonarthrosis according to Kosinskaya:

• mild narrowing of the joint space(less than a third of the norm), small single osteophytes along the edges of the articular surfaces;
• moderate narrowing of the joint space(more than half of the norm), sclerosis of the subchondral space, multiple osteophytes;
• pronounced narrowing of the joint space(more than two-thirds of the norm), cysts in the subchondral layer, multiple large osteophytes, sometimes forming a continuous mass.

There are many clinical classifications of deforming arthrosis, but all of them in one way or another divide the disease into three stages - mild, moderate and severe.

Clinical stages of gonarthrosis:

• Mild disease The following symptoms correspond. There is a crunching sensation when moving in the knee joint, a barely noticeable feeling of stiffness in the knee joint in the morning. Pain occurs only when the knee is fully bent.
• Moderate disease The following symptoms correspond. The pain is periodic and appears only when moving. The appearance of pain at rest is preceded by intense physical activity. Reducing the range of knee flexion by 10 - 15 degrees. Morning stiffness lasts from 5 to 15 minutes, after which it disappears without a trace.
• Severe disease The following symptoms correspond. Constant aching pain that intensifies with movement. Morning stiffness lasts no more than half an hour during periods of remission and more than half an hour during periods of exacerbation, which is associated with the addition of an inflammatory process. Marked narrowing of the range of active and passive movements in the knee joint.

Thus, in order to properly treat gonarthrosis, a fairly strong financial foundation and discipline are required. An important role is played by how seriously the patient takes treatment, since often, in order to reduce the frequency of exacerbations of the disease, the patient is forced to change his daily activity, favorite profession, engage in joint development, quit smoking and drinking alcoholic beverages, etc.

There are three main stages in the treatment of deforming arthrosis of the knee joint. The first stage involves the treatment of patients with mild manifestations of the disease, the second - with moderate manifestations and the third, respectively, with severe ones.

The first stage of treatment includes:

• communicating to patients the essence of their disease, risk factors and measures secondary prevention;
• daily gymnastics with stretching elements;
• cold and hot shower;
• swimming in the pool 2 - 3 times a week;
• weight loss.

The second stage of treatment includes:

• external fixation of the joint using calipers, bandages, elastic bandages and orthoses;
• the use of ointments and creams based on non-steroidal anti-inflammatory drugs to relieve inflammation and pain;
• the use of drugs from the group of chondroprotectors to reduce the rate of cartilage destruction.

The third stage of treatment includes:

• course use of NSAIDs orally;
• intra-articular injections with hormonal anti-inflammatory drugs;
• additional use of drugs with a pronounced analgesic effect;
• surgical replacement of a diseased joint with an implant.

• non-steroidal anti-inflammatory drugs;
• glucocorticoid hormones;
• analgesics (painkillers);
• chondroprotectors.

Nonsteroidal anti-inflammatory drugs Drugs in this group have an anti-inflammatory effect by blocking an enzyme called COX (cyclooxygenase). Since this enzyme ensures the formation of prostaglandins (biologically active substances that provoke the development of inflammation), its blocking will lead to a gradual decrease in the intensity of the inflammatory process.

Due to the fact that prostaglandins are responsible not only for the development of the inflammatory process, but also perform many other functions in the body, blocking their synthesis can lead to serious side effects. The most common side effect is the formation of erosions and ulcers of the stomach and duodenum due to a decrease in the protective role of the mucus covering it.

At particular risk for development peptic ulcer stomach and duodenum after taking NSAIDs include:

• aged people;
• patients with concomitant pathologies (diabetes mellitus, arterial hypertension, heart failure, liver cirrhosis, etc.);
• patients simultaneously taking glucocorticoid hormones and anticoagulants;
• smokers and alcohol abusers.

In patients at risk, it is recommended to use drugs to protect the mucous membranes of organs along with NSAIDs. gastrointestinal tract, such as proton pump inhibitors (pantoprazole, esomeprazole, lansoprazole, omeprazole, etc.) and antacids (almagel, maalox, phosphalugel, etc.).

Also, in order to reduce the likelihood side effect NSAIDs are recommended to use selective representatives of this group, such as nimesulide, meloxicam, rofecoxib, etoricoxib, celecoxib, etc. Drugs of this group block only type 2 COX, which is active only at the site of inflammation.

However, it is important to note that the above recommendations are necessary only for those forms of the drug that are indicated for oral administration. NSAIDs for external use do not create high concentrations in the blood, so they can be used for a long time without fear of side effects from the stomach and duodenum. Drugs in this group include

diclofenakibuprofen

Fastum gel, etc. Also, lotions with a 50% solution of dimethyl sulfoxide are extremely effective.

The duration of treatment depends on the severity of the disease, however, as a rule, it is at least two to three weeks and no more than two to three months. Creams, ointments and compresses based on NSAIDs can be used for as long as desired, provided they do not cause local allergic reactions or banal

dermatitis

Glucocorticoid hormones Glucocorticoid hormones have the most pronounced anti-inflammatory effect among all existing ones medicinal substances. This is due to the fact that they immediately affect all parts of the mechanism of development of the inflammatory reaction. Since mediators (biologically active substances that ensure the development of a particular process in the body) of inflammation and immune reactions largely overlap, their blocking can lead to a pronounced decrease in immunity.

Corticosteroid hormones for gonarthrosis are used when the anti-inflammatory effect of non-steroidal drugs is not enough. It is important to note that hormonal drugs for arthrosis deformans are never prescribed orally, that is, systemically, but are used only locally in the form of ointments and intra-articular injections.

Unlike NSAID-based ointments, which can be used for a long time without any serious side effects, hormonal ointments have strict limitations on the duration of use. Hormonal ointments can be used on average for no more than 7 to 10 days in a row, since otherwise they lead to atrophy of the skin at the site of application. There is a wide variety of hormonal-based ointments on the pharmaceutical market, but they are all based on the same active substances - betamethasone, hydrocortisone, dexamethasone, prednisolone, etc.

The introduction of hormones into the joint cavity is carried out when the analgesic and anti-inflammatory effect of NSAIDs and hormonal ointments is not enough. As a rule, the effect of intra-articular hormone injections is very pronounced. Patients feel relief literally after half an hour. Inflammation and pain disappear without a trace.

The duration of the effect of one intra-articular injection depends on how long the drug is in the joint cavity. The duration of his stay there is influenced by several factors. The first factor is the amount of substance administered. Since the cavity of the knee joint is one of the largest articular cavities in the body, 2 to 5 ml of the drug can be safely injected into it, depending on the patient’s constitution. To ensure that the injected medicine does not leak out of the joint cavity, after the injection the patient is recommended not to stand on his leg for 24 - 48 hours and to make a minimum amount of movements in the knee. In this case, the pressure in the joint cavity does not increase, and the drug does not leak into the subcutaneous space. After the above time has passed, the injection hole is closed.

The second factor influencing the duration of the effect of an intra-articular injection is how quickly the medicine is consumed. It is believed that the more damaged the cartilage, the more medicine is needed to provide an anti-inflammatory effect, and the sooner it is used up.

The following hormonal drugs are used for intra-articular administration:

• betamethasone (2 - 4 mg);
• triamcinolone (20 - 40 mg);
• methylprednisolone (20 - 40 mg).

It is important to add that, despite the fact that the effect of hormonal intra-articular injections is very pronounced, and patients insist on repeating it as many times as they like, there are also restrictions on its use. According to international guides, no more than 2 - 3 injections are allowed into one joint throughout life. A larger number of injections significantly increases the risk of microbes entering the joint cavity and the development of purulent arthritis with serious complications, including leg amputation.

Analgesics Pain with gonarthrosis is chronic, varying in intensity. In the initial stages of the disease, the pain is mild and intermittent. Later, as the articular cartilage deteriorates, pain occurs more and more often and eventually accompanies the patient constantly, sometimes intensifying, sometimes subsiding. Patients, tired of taking mountains of medications, simply come to terms with the pain and endure it as an inevitability.

This approach is fundamentally wrong. A fundamental principle in the treatment of chronic pain is that all pain, regardless of its intensity, should be controlled. The reason lies in the fact that pain not only causes discomfort, but also negatively affects the emotional sphere, changes the patient’s psyche, making him very irritable and hot-tempered. Moreover, it has been scientifically proven that pain triggers a cascade of reactions in the body, which ultimately aggravate the course of all existing diseases, including the deforming arthrosis of the knee joint itself.

All the problems of patients are due to the fact that they treat pain incorrectly. Sometimes doctors themselves prescribe painkillers incorrectly because they cannot accurately assess its intensity. In order to treat pain as effectively as possible, the World Health Organization has developed a treatment regimen for chronic pain. This scheme consists of three levels. At the first level, pain of low intensity is treated, at the second – medium and at the third – high.

Practically this system works as follows. When a patient consults a doctor with chronic pain, first level pain medications are prescribed. These include all NSAIDs, but selective NSAIDs are preferable because they have fewer side effects with long-term use. Selective NSAIDs include nimesulide, meloxicam, rofecoxib, etoricoxib and celecoxib. They need to be used in minimal doses to ensure a constant analgesic effect. If pain persists at the maximum permissible dose of the drug, it is necessary to proceed to the second level of pain treatment.

The second level of pain treatment involves switching to drugs with more pronounced analgesic (

painkillers

) action. In particular, we are talking about weak opiates (

tramadol, codeine, oxycodone

). It is important to note that first-level drugs are not canceled, but continue to be prescribed in medium doses. It has been experimentally proven that when weak opiates are used together with NSAIDs, the dose of weak opiates required to relieve pain is prescribed several times lower than when pain is controlled only with weak opiates without NSAIDs. In other words, NSAIDs enhance the effects of weak opiates. Thanks to this effect, the patient will be able to remain at the second level of pain treatment for a longer time without moving to the third and final level.

As the disease progresses and pain intensifies, the doses of weak opiates and NSAIDs are increased to the maximum permissible. When pain persists against this background, the patient moves to the third level of treatment for chronic pain. Third level drugs are strong opiates, that is, classic narcotic analgesics (

morphine, promedol, fentanyl, etc.

). Due to the fact that these drugs cause physiological dependence, their dosage must be extremely careful. By analogy with weak opiates, strong opiates are prescribed in parallel with first-level drugs, that is, NSAIDs. The goal of such therapy is to minimize the dose of narcotic analgesics in order to avoid the patient becoming addicted to them. It is important to note that once tier 3 drugs are started (

strong opiates

), second level drugs (

weak opiates

) are canceled because they have a single point of application, and their effect will not be noticeable against the background of strong opiates.

As a rule, patients who are transferred to the third level of treatment for gonarthrosis are gradually prepared for surgery to replace the knee joint with an artificial graft.

Chondroprotectors Chondroprotectors are a relatively new group medicines, which has proven itself in the treatment of deforming arthrosis in general and gonarthrosis in particular. The mechanism of action of these drugs is associated with the delivery of building substances necessary for its regeneration to the articular cartilage. Thus, the cartilage does not need to independently synthesize substances for its own restoration, which saves energy and time in order to speed up the processes of this very restoration.

Unlike the above groups of drugs, the effect of which appears relatively soon after the start of use, chondroprotectors act unnoticed by the patient. In other words, their effectiveness can only be assessed after several months of daily treatment with them. According to long-term clinical studies of drugs in this group, it was found that they can significantly slow down the progression of deforming arthrosis and delay the onset of complications, improving the long-term prognosis.

Among the drugs in this group there are:

• glucosamine hydrochloride;
• glucosamine sulfate;
• chondroitin sulfate;
• derivatives of hyaluronic acid;
• Wobenzym.

The only disadvantage of these drugs today is their high cost. Long-term use of these drugs, which is an essential condition proper treatment, can significantly hit the wallet of the average patient.

Gymnastics and physical exercises for arthrosis of the knee joint are of utmost importance in the treatment of this disease. Only the patient who most carefully follows all the necessary instructions outlined below every day has every chance of improving his health.

Physical exercises are designed to warm up and strengthen the muscles surrounding the knee joint, and gymnastics are designed to stretch the heated ligaments to increase knee mobility and prevent contractures.

An important condition for the exercises is to carry them out only with small weights, up to a maximum of 10 kg on both legs, that is, 5 kg on each. In those exercises where the use of additional weight is allowed, there will be a corresponding mention.

On average, the patient should spend 1 - 1.5 hours training 2 - 3 times a week. Each workout consists of three stages - warming up, strength exercises and stretching.

Warm-up exercises are:

• rolling from toes to heels;
• raising legs bent at the knee;
• "bicycle" in the air;
• running in place.

Rolling from toes to heels

One cycle includes slowly rising onto your toes, hovering in this position for 2 - 3 seconds, after which, bypassing the starting position, you need to move your body weight onto your heels, raising your toes up as much as possible. All movements are carried out slowly, without jerking. The duration of the exercise is 8 - 12 cycles.

Raising legs bent at the knees Starting position - feet shoulder-width apart, arms along the body or resting on the back of a chair.

One cycle includes raising one leg to waist level, returning it to its original position, and then performing the same manipulations with the second leg. Movements are performed slowly, without jerking. The duration of the exercise is 12 - 16 cycles.

"Bicycle" in the air Starting position - lying on your back.

Before starting the exercise, you need to raise your legs above you and bend your knees. Next, each leg performs rotational movements similar to pedaling a bicycle. The legs rotate in one direction for the first 30 seconds, and in the opposite direction for the second 30 seconds. Rotations should be slow. The purpose of the exercise is to develop the knee joint.

Running in place Starting position - feet shoulder-width apart, arms bent at the elbows, back straight.

With this exercise, you need to move your body weight from one leg to the other, similar to running. It is important that when running the patient does not touch the ground with his heels and moves exclusively on his toes. Arms bent at the elbows should move forward and back in time with the legs. The duration of the exercise is 2 - 5 minutes.

Strength exercises are:

• straightening legs bent at the knees;
• bending your knees while lying on your stomach;
• squats;
• raising your legs while lying on your stomach.

Straightening legs bent at the knees Starting position - sitting on a support, legs hanging freely without touching the floor.

One cycle includes straightening one leg at the knee, returning it to its original position, then making the same movements with the other leg. Straightening the leg and returning it to its original position is carried out slowly. The duration of the exercise is 12 - 16 cycles. The exercise can be done either alternately with each leg or together with both legs at once. The use of additional weight on the shins is encouraged, however, no more than 10 kg in total. The goal of the exercise is not to lift the heaviest weight, but to perform as many movements as possible.

Bend your knees while lying on your stomach Starting position - lying on your stomach or on an inclined board with your head up.

One cycle involves bending the knee and returning it to its original position. Then the same action is performed with the second leg. You can perform the exercise as indicated above, that is, alternately or otherwise, that is, together with both legs. The use of additional weight at the level of the ankle joints is encouraged, not exceeding 10 kg in total. The duration of the exercise is 12 - 16 cycles.

Squats

One cycle includes squatting while simultaneously putting your arms forward and lifting to the starting position with returning your arms to the starting position. An important condition for the exercise is to firmly press the foot to the floor. In other words, when squatting, it is recommended not to lift your heels off the floor. Unlike previous exercises, additional weight is not recommended, since the initial body weight is more than enough. The duration of the exercise is 8 - 10 squats.

Leg raises while lying on your stomach Starting position - lying on your stomach on a horizontal surface, hands on the floor above head level.

One cycle includes a smooth lifting of one leg up 10 - 15 cm and the same smooth return to its original position. Then the second leg rises and falls in the same way. It is important that your legs do not bend at the knees and remain straight. The use of additional weight in the projection of the ankle joints is encouraged, in total no more than 6 kg. The duration of the exercise is 8 - 10 cycles.

Stretching exercises are:

• flexion of the torso (2 options);
• pulling the legs back (2 options);
• pulling your socks towards you.

Torso flexion1 option Starting position - feet shoulder-width apart, arms along the body.

One cycle includes maximum bending of the torso at the waist, and then returning to the starting position. In this case, the knees should remain unbent. The goal of the exercise is not to bend as low as possible, but to bend just enough so that the tension of the ligaments is felt at the level of the popliteal fossa. The duration of the exercise is 6 - 8 cycles.

Option 2 Starting position - sitting on the floor, legs apart in front of you.

One cycle involves bending the torso forward, trying to reach first the left leg, then to a point approximately halfway between the feet, and then to the right leg, followed by a return to the starting position. As with the first exercise, it is important to keep your knees straight and feel the tension underneath. The duration of the exercise is 6 - 8 cycles.

Pulling the legs back1 option Starting position - legs together, arms along the body.

One cycle involves bending the leg at the knee and grabbing it with the hand on the same side. After grabbing, the leg relaxes as much as possible, and the hand moves the leg as far back as possible. In this position, you need to freeze for 5 - 10 seconds, and then do the same movements with the second leg. This exercise stretches the anterior thigh muscles. The duration of the exercise is 4 - 6 cycles.

Option 2 Starting position - lying on your stomach on a horizontal surface, arms along the body.

One cycle involves grabbing your bent knees with both hands and pulling them in for 5 to 10 seconds. Then the grip is loosened for 5 - 10 seconds and the cycle is repeated. The duration of the exercise is 4 - 6 cycles.

Pulling your socks back Starting position - sitting on the floor, legs brought together in front of you, arms along the body.

During this exercise, maximum bending of the torso occurs forward while gripping the toes. Then, the toes are pulled back while the knees remain extended. The duration of being in this position is from 15 to 30 seconds.

Sometimes patients, for one reason or another, cannot treat gonarthrosis with medications. One reason may be the exorbitant cost of drugs, another may be contraindications associated with concomitant diseases or individual intolerance. One way or another, such patients are forced to resort to alternative methods treatment of this disease, that is, to

folk medicine

Most important aspects Treatments for deforming arthrosis of the knee joint at home are:

• normalization of body weight (if necessary);
• change of type of activity (if necessary);
• stopping the inflammatory process.

Normalization of body weight With a disease such as deforming arthrosis of the knee joint, it is extremely important that the patient does not have excess weight. Body weight directly affects the load that falls on the knee joints in Everyday life. In this regard, the patient must lose weight to a level at which he would feel good. In other words, you can’t lose too much weight so that weight loss doesn’t affect your overall health.

In order to determine what weight is ideal for a particular patient, there is a formula for determining body mass index (

BMI = weight in kilograms / (height in meters)2

The result is a value between 10 and 40, and even higher in very obese people. For deforming arthrosis, the optimal BMI value is 18.5 - 20.0.

Most patients have to lose weight in order to reach the required weight. Many people play sports intensively, as a result of which pain due to arthrosis intensifies and disorders of the cardiovascular system appear. The rest plunge headlong into

They strive to lose a kilogram a day and get very upset that they can’t do it, after which they break down and eat twice as much.

In fact, there is a way out and it is not difficult. This solution is an integrated approach and, most importantly, patience. You need to lose weight gradually, no more than 2 - 3 kg per month. This rate of weight loss is the most optimal, does not cause severe metabolic disorders in the body and is well tolerated.

Regarding nutrition, it must be said that the following recommendations are not a diet, since they do not eliminate any foods from the diet, but only advise how to eat properly.

Proper nutrition involves the following points:

• maximum variety of diet;
• reduction, but not elimination of foods rich in animal fats and carbohydrates;
• the main share of fats should be of vegetable origin (various oils - olive, sunflower, etc.);
• sea, lake and River fish contains a huge amount of useful substances, so it should be on the table at least 1 - 2 times a week;
• the amount of food per meal should be such that it fits in clasped hands;
• the number of meals should increase to 5 - 6 times a day;
• at the end of each meal you must eat one fruit or vegetable;
• while eating, you need to think only about food, and not about extraneous things (reading, watching TV, etc.);
• Each bite of food must be chewed thoroughly;
• the last meal should take place between 19.00 and 20.00, and not at 18.00, as is commonly believed;
• the daily volume of fluid consumed in summer should be 3 - 4 liters, and in winter - at least 1.5 - 2 liters;
• It is recommended to drink a glass of water 20-30 minutes before each meal;
• To normalize the peristalsis of the gastrointestinal tract, every morning, 10 - 15 minutes after waking up, it is recommended to drink a glass of juice, well or mineral water.

In addition to nutritional recommendations, adequate physical activity will help you lose weight. Physical activity should be adequate and not excessive. In other words, spending the night at the gym or spending hours on the treadmill is not necessary. Just one hour of calm, leisurely walking per day or half an hour of jogging is sufficient. When walking, the nutrition of the cartilages improves, which cannot but affect their condition. More intense exercise will certainly lead to weight loss, but most likely at the cost of disrupting the functions of other organs and systems.

As an alternative, swimming, contrast showers, which increase the tone of the periarticular muscles, and the physical exercises mentioned earlier are welcome.

Changing the type of activity By changing types of activity we mean avoiding work associated with heavy lifting, irregular schedules and unfavorable working conditions. All of these factors negatively affect the condition of the cartilage and often lead to an exacerbation of the disease. Work in which dynamic loads replace power static loads is considered more favorable. In other words, patients with gonarthrosis need a job in which they would have to move a lot.

In the same way, you need to reorganize your home life. Instead of carrying something heavy at once, it is better to break it into several parts and make several walks. Knee injuries should be prevented as much as possible, since it is injuries that most quickly lead to exacerbation of deforming arthrosis.

Relief of the inflammatory process As stated earlier, inflammation is one of the reasons that aggravates the course of this disease. Therefore, in order to keep the development of gonarthrosis under control, it is recommended to promptly treat the inflammatory process.

The following plants have a pronounced anti-inflammatory effect:

• thyme;
• St. John's wort;
• burdock;
• white cabbage leaves;
• horseradish leaves and root;
• leaves, flowers and dandelion root, etc.

Infusions, decoctions and extracts are made from the above plants, which are then applied to a bandage and applied to the sore joint in the form of compresses. The use of plant decoctions internally is also allowed, but more often leads to one or another side effects.

In general, folk remedies for the treatment of arthrosis deformans can be useful to some extent, but at a certain stage their effect becomes insufficient and patients sooner or later resort to traditional treatment.

Drug treatment is intended to delay as much as possible the moment when the only way to restore the integrity of the joint and return the patient to the previous level of quality of life is an operation to replace the diseased joint with an artificial one. As a rule, such a decision is made in the last stages of the disease (

Stage 4 according to Kellgren-Lawrence and stage 3 according to Kosinskaya

The decision on the possibility and advisability of the operation is made by the surgeon or a council of surgeons if conflicting opinions arise regarding this issue. If the decision is made in favor of surgery, then the patient prepares for it for some time. During this time, the necessary measurements are taken and the prosthesis is made. The patient's concomitant diseases are compensated so that he can successfully undergo the operation.

The operation itself is quite invasive (

traumatic

) and is technically complex, so it requires at least two surgeons - an operating surgeon and an assistant, as well as an experienced surgical nurse. The operation is performed under general anesthesia.

The postoperative period takes several weeks. At this time, the patient gets used to the new joint, despite the fact that it completely repeats the previous one in shape and size. After the rehabilitation period, the patient almost completely restores the previously lost function of the leg as the most important element of the musculoskeletal system.

Preventive measures for gonarthrosis are divided into primary and secondary. Primary measures are aimed at identifying patients at risk and reducing the intensity of risk factors leading to the development of this disease. Secondary prevention measures are aimed at reducing the rate of development of existing arthrosis of the knee joint.

Primary prevention measures include:

• avoiding knee injuries;
• strengthening of periarticular muscles;
• maintaining body weight within the BMI range of 18.5 - 20.0;
• avoiding heavy lifting;
• swimming procedures 1 - 2 times a week, etc.

Secondary prevention measures include:

• conducting courses of treatment with chondroprotector drugs 1 - 2 times a year;
• timely, fast and high-quality treatment of arthritis as complications of deforming arthrosis.

In most cases, general practitioners, family doctors and general practitioners are the first to encounter this disease. This is due to a fairly high incidence rate among the population. Subsequently, patients are referred to other doctors, who are involved in diagnosis and treatment. However, treatment control and correction are usually carried out by family doctors.

The following specialists treat deforming arthrosis of the knee joint:

• Traumatologist. Traumatology is a field of medicine that deals with the treatment of pathologies resulting from exposure to various traumatic factors. However, this specialty is not limited to this, but also includes the treatment of a huge variety of congenital and acquired diseases of the musculoskeletal system. Traumatologists are the specialists who perform surgery and also block the knee joint. In addition, only doctors in this specialty have sufficient experience and skills to carry out intra-articular injections of drugs.
• Rheumatologists. Rheumatology is a field of medicine that studies, diagnoses and treats diseases of the connective tissue and joints. Specialists in this particular field are the doctors you should contact first, since they are the ones who are able to accurately diagnose the cause of the disease and prescribe the correct treatment.
• Physiotherapists. Doctors in this specialty do not directly diagnose or provide medical and surgical treatment for deforming arthrosis of the knee joint. However, they are able to prescribe an adequate set of exercises to maintain joint function, as well as its postoperative rehabilitation. In addition, their competence includes a huge range of various physical procedures (ultrasonic influence, electromagnetic influence, thermal irradiation, electrophoresis and others), which can eliminate a number of unfavorable symptoms and ensure good tissue regeneration (restoration).

In addition to the specialties listed above, the process of treating and diagnosing this disease involves many doctors from other specialties who interact with the patient at one stage or another.

Doctors of the following specialties are involved in the treatment and diagnosis of knee arthrosis:

• radiologist– diagnoses radiological changes in the knee joint;
• orthopedic doctor– performs knee joint prosthetics;
• surgeon– performs operations in the presence of surgical pathologies associated with this disease;
• anesthesiologist– provides adequate pain relief during and after surgery.

It is thanks to the joint, teamwork of these specialists that timely and correct treatment of arthrosis of the knee joint is possible.

A knee joint block is a medical procedure during which special pharmacological drugs are introduced into the joint cavity and periarticular tissues, the action of which is aimed at eliminating pain and treating the original disease. This therapeutic method is quite widely used and in most cases is quite effective.

Knee blocks are usually performed by injecting local anesthetics (

locally acting painkillers such as novocaine, lidocaine, etc.

) in combination with a number of other medications directly into the joint cavity. As a result, the pain syndrome is eliminated for approximately 2–3 weeks, but the duration of action is largely individual and depends on the severity of the pathology, as well as on the condition of other body systems.

Knee blockade is indicated in the following situations:

• arthrosis of the knee joint in combination with active inflammatory process;
• non-infectious nature of joint damage;
• joint inflammation after injury or surgery;
• with inflammation of periarticular tissues, joint capsule, tendons, meniscus.

Knee block is contraindicated in the following situations:

• chronic inflammatory process in the joint cavity;
• in the presence of infectious foci in the injection area;
• in the absence of effect from the three previous injections.

The following medications can be injected into the joint cavity:

• Lidocaine or other local anesthetics (painkillers). Lidocaine and other local anesthetics block the nerve endings in the joint cavity, thereby eliminating pain. However, it should be understood that in this case the pathological process is not treated, but only one of the symptoms of the disease is eliminated.
• Steroid drugs. Steroid drugs (hormonal drugs) have a pronounced anti-inflammatory effect, which slows down the process of destruction of cartilage tissue in the joint cavity. In addition, these drugs enhance and prolong the effect of local anesthetics.
• Chondroprotectors. Chondroprotectors are substances that, to varying degrees, protect the cartilage tissue of the joint and promote its regeneration.

It should be noted that before the procedure, it is necessary to conduct an allergy test to the injected local anesthetic, since the expected time of its presence in the joint is sufficient for the development of sensitization (hypersensitivity) and the occurrence of serious allergic reaction. However, the drugs used today (lidocaine) are less dangerous and toxic than the drugs used in the past (novocaine).

During the procedure, the doctor, under sterile conditions, treats the knee with antiseptic solutions, and then uses a thin needle to apply local anesthesia. After this, the skin and joint capsule are punctured and the required amount of medication is injected, followed by application of a sterile bandage. After this procedure, it is recommended to limit movements in the joint for some time in order to avoid “leakage” of drugs through defects in the joint capsule, and also to reduce the chance of infection.

It should be noted that in addition to the knee block procedure described above, if necessary, knee pain relief can be achieved by blocking the major nerves of the leg. When placing a catheter (

thin tube

) in the area of ​​the femoral or sciatic nerve (

or both

) you can completely or partially anesthetize the knee area, and the administration of local anesthetics is possible without repeated injections. This method is unacceptable if long-term (

more than 1 week

) for pain relief and at home, but it has proven itself well in a hospital setting for the period of surgery and subsequent rehabilitation.

Physiotherapeutic methods of treatment are methods of physical influence on the body, which under certain conditions have a significant beneficial effect. The main condition for successful physiotherapy is the competent selection of the necessary procedures and careful adherence to all instructions. The effectiveness of treatment in most cases is individual and largely depends on the effectiveness of the main therapy.

Today, there is a huge variety of various physiotherapeutic procedures, each of which has its place in medicine. It should be understood that some of these methods, if used incorrectly, can have adverse and even harmful effects.

Physiotherapy procedures used for deforming arthrosis of the knee joint

Physiotherapeutic method	Physiological effects	Recommendations for use
Electrophoresis of drugs	Under the influence of constant electric field movement of charged particles occurs (negative towards the positive electrode, positive towards the negative electrode). As a result, it is possible to deliver some drugs into deep tissues without the use of invasive techniques. Most often, local anesthetics and chlorine preparations are used during electrophoresis.	The course of treatment is for two weeks, half an hour daily.
Ultraphonophoresis	It is a combination of the effects of ultrasound and medications, which, under the influence of ultrasonic vibrations, become more active and are able to penetrate deeper into the tissue. Typically used in combination with hormonal agents, painkillers and anti-inflammatory drugs.	The course of treatment is 10 days - two weeks. Duration – no more than 10 minutes.
Laser irradiation	Under the influence of a narrow beam of intense light radiation, a number of specific molecules are activated, which stabilize the cell charge and activate metabolic and regenerative processes in tissues.	Treatment lasts for two weeks. The recommended duration of exposure is about 7 – 10 minutes.
Infrared radiation	Under the influence of infrared radiation, tissues are deeply heated with an increase in temperature by one to two degrees. In this case, substances are formed that trigger a cascade of protective and reduction reactions at the cellular and tissue level.	Treatment lasts for one week. Treatment time is up to 10 minutes per joint.
Pulse magnetic therapy	Under the influence of a high-frequency pulsed magnetic field, changes occur in cells and tissues. The permeability of the cell membrane is stabilized, metabolic processes in tissues are normalized, and redox reactions are stimulated.	The course is prescribed for one week. The exposure time per joint is about 5 – 8 minutes (total time – 10 – 20 minutes daily).
Local cryotherapy (exposure to low temperatures)	Under the influence of low temperatures, a compensatory strengthening of the functions of the main body systems occurs with gradual adaptation to unfavorable conditions and stimulation of regenerative and protective processes.	The treatment lasts for ten days by exposing the affected area to a cold air stream with a temperature of about -30 degrees for 10 minutes.

It should be borne in mind that none of the proposed methods of physiotherapy can replace full-fledged medical or surgical treatment.

Deforming arthrosis of the knee is a gradually progressive destruction of the cartilage tissue of the joint. In the first stages, this disease can manifest itself as periodic pain, limited mobility in the joint, and crunching. However, over time, without special treatment, the situation worsens significantly. The joint gradually loses its functions, and the disease can lead to serious complications.

If left untreated, the following complications of knee arthrosis may develop:

• Joint deformity. As a matter of fact, joint deformation is more likely not a complication, but the last stage of the disease. The destruction of cartilage causes hypertrophy of bone tissue. The body seems to be trying to strengthen a weak area. The patient experiences severe pain, the kneecap moves, and dense formations are felt in the joint area. Sometimes the leg begins to gradually bend at an unnatural angle. All this leads not only to cosmetic defects, but also to complete loss of joint function. The person can no longer bend the leg or walk using it.
• Infection in a joint. Infection usually occurs due to microtrauma. They can be considered small cracks in the cartilage tissue. Pathogenic microorganisms are introduced into the joint through the flow of blood or lymph from other areas. This often occurs after infectious diseases. There is a high risk of infection after a diagnostic puncture or arthroscopy, since foreign objects (needle, arthroscope) are introduced into the joint cavity. Of course, they are sterilized first, but the risk still increases. Infection can lead to avascular necrosis. In this case, the proliferation of bacteria causes accelerated tissue breakdown. This complication is quite rare, but poses a serious threat to the patient’s health.
• Dislocations and fractures. These complications are explained by dysfunction of the knee joint. With arthrosis, there is no uniform distribution of load from the femur to the bones of the lower leg. The ligaments that normally strengthen the joint also weaken. Because of this, at a certain moment (even during normal walking) the bones of the lower leg may be subject to excessive stress, which will lead to a fracture or dislocation. To avoid this, people with severe structural and functional impairments in the knee joint should move with the help of a crutch or cane.
• Ankylosis. Ankylosis is the fusion of two bones where a joint once existed. This complication is perhaps the most severe, as the joint simply disappears. The tibia and femur gradually fuse, and the tibia is fixed in one position. Movement, of course, is impossible.

It should be noted that all these complications appear mainly in cases where the patient starts the disease or does not follow the course of treatment prescribed by a specialist. Nowadays, there are quite a lot of surgical and conservative treatment methods that can maintain the functionality of a knee joint affected by arthrosis for a long time. Preventative examinations with a doctor will help prevent complications, since they take quite a long time to develop (for ankylosis, this is usually years).

In general, arthrosis of the knee joint (

gonarthrosis

) is a disease with a poor prognosis. This is explained by the fact that the degradation of cartilage tissue in the joint and its deformation are progressive. Gradually, in some patients sooner and in others later, the joint will completely lose its function. Although the prognosis is generally unfavorable and the process cannot be reversed, there are many factors that can affect the course of the disease. Their knowledge allows doctors and patients to more accurately plan treatment and predict the course of the disease.

The long-term prognosis of gonarthrosis is influenced by the following factors:

• Patient age. It is believed that the later the first signs of the disease appeared, the more favorable the prognosis for arthrosis. This is explained simply. It takes time for the disease and complications to develop. In older people, tissue metabolism slows down. That is, arthrosis for them is, in some way, a physiological stage of aging. In young people, joint destruction goes through more stages, so by old age serious complications of the disease develop, and the patient’s general condition is much more severe.
• Type of arthrosis. It is of great importance whether the arthrosis is primary or secondary. Primary arthrosis affects only the joint. Its causes are not precisely established, and the course is usually slowly progressive. Secondary arthrosis develops as a consequence of other diseases. If this disease is cured, the pathological process in the knee can slow down significantly. However accurate forecast however, it depends on the specific pathology and may be different in each individual case.
• Compliance with doctor's orders. This factor is perhaps the most important, although many patients do not give it of great importance. The prescribed treatment and recommendations are aimed at slowing down the pathological process and delaying severe complications. Patients need to use a cane or crutch, try not to put stress on the joint, and come regularly for preventive examinations, even if their condition has not changed. Failure to comply with doctor's instructions is the most common reason why the disease begins to progress rapidly and the prognosis worsens.
• Taking medications regularly. For arthrosis, most medications have to be taken for a very long time (months, years). This course of treatment is explained by the fact that the disease cannot be cured completely. We have to constantly help the body fight it. Cartilage tissue, unlike many others, does not have blood vessels. Metabolism in it is slowed down, as it occurs due to diffusion. Therefore, medications (chondroprotectors, anti-inflammatory drugs) should be taken constantly according to the regimen prescribed by the doctor. An unscheduled interruption of treatment, even for a few weeks, will lead to irreversible changes inside the joint, and the general condition will worsen, even if the course is then resumed.
• Weight loss. Excess body weight puts serious stress on the knee joints. Because of this, articular cartilage breaks down faster than in people with normal body weight. That is why people suffering from obesity are advised to urgently lose excess weight. Otherwise, the prognosis for them worsens significantly, and complications that will develop in others in 10–20 years may appear in their case within 2–3 years.
• Presence of concomitant diseases. The prognosis always depends on other diseases (mostly chronic). It is inevitably worsened by hypertension, diabetes mellitus, liver disease and other systemic pathologies. With these diseases, metabolism throughout the body is disrupted, which means that the nutrition of the articular cartilage also deteriorates.
• Occupation. The patient’s profession is also important when assessing the prognosis of the disease. If the patient works as a messenger, a loader, or plays sports professionally, the development of complications will not take long to occur. In these cases, to improve the prognosis, it is recommended to change your occupation to avoid excessive stress on the legs.

Taking into account the above factors, each patient with gonarthrosis can fight the disease more effectively. There are other factors that influence the prognosis. To fully assess the situation and draw up a rough treatment plan, you should contact a specialist.

Unfortunately, even complex treatment involving the most advanced pharmaceuticals and surgical interventions cannot completely restore the functioning of the knee joint in this disease. The problem lies in the pathogenesis (

development mechanism

) of this pathology. The cartilage of the knee joint is constantly exposed to heavy stress. Moreover, in this case, load means not only running, jumping or lifting weights, but also a normal standing position. In order to withstand this load, constant nutrition of the tissues is necessary. If it is disturbed for any reason, at least temporarily, the balance disappears and it is very difficult to restore it.

With deforming gonarthrosis (arthrosis of the knee joint), the following pathological changes are observed:

• reduction in the amount of intra-articular (synovial) fluid;
• thinning of cartilage tissue;
• the appearance of cracks in the cartilage;
• inflammatory process under the cartilage tissue and in the area of ​​the joint capsule;
• softening of bone tissue under cartilage.

All these processes develop in the form of a pathological chain (the so-called vicious circle). Some violations lead to others. The main difficulty is that all these changes occur at the structural level, that is, the death of cells and tissues takes place. In their place, normal cartilage does not have time to recover. As a result, the disease progresses.

Thus, it is impossible to completely cure arthrosis deformans. However, you can try to delay the disease at a certain stage and prevent it from progressing. In this case, some symptoms will disappear or become less intense. The general condition of the patient will depend on the stage to which the disease has reached.

To slow down the destruction of cartilage, the following groups of drugs can be used:

• Chondroprotectors. These drugs are a source of nutrients for joints. They promote tissue regeneration, although they cannot completely restore their original structure. Of the drugs in this group, the most common are chondroitin sulfate, hyaluronic acid derivatives, and glucosamine sulfate.
• Nonsteroidal anti-inflammatory drugs (NSAID). These drugs eliminate the inflammatory process in tissues and reduce pain. This improves joint movement and the patient's quality of life. Meloxicam and etoricoxib are most effective for arthrosis.
• Glucocorticoids. These are hormonal anti-inflammatory drugs that are used for intense inflammation in the later stages of the disease. Sometimes they are used intra-articularly (injected directly into the cavity of the knee joint). The most common are betamethasone and methylprednisolone.

At the same time, patients are recommended to engage in therapeutic exercises, limit the load on the affected joint and reduce body weight (if it is excessive). All this taken together will not restore the original functions of the knee joint, but will significantly improve the patient’s condition and slow down the development of arthrosis.

Osteoarthritis of the knee joint occupies a leading position in the frequency of occurrence in the group of diseases of arthrosis lesions of the joints. In terms of severity, the disease is in second place after coxarthrosis.

Every fifth person on the planet suffers from gonarthrosis. People over 40 years of age are especially predisposed to this disease and, as noted, the incidence in women is almost 2 times higher than in men. According to statistics, 7-22% of people in the world suffer from gonarthrosis.

We can say that with this disease, the articular cartilage cracks, becomes thinner, losing its fibrousness and shock-absorbing properties, which, in principle, does not make it possible to soften the periodic impacts of the knee joint and body during movement.

Today we will look at arthrosis of the knee joint, find out what it is, what the symptoms of this disease are, and also tell you effective treatment methods, including at home.

For what reasons does arthrosis of the knee joint develop, and what is it? Every day, our knee joints are subjected to physical stress while walking, supporting the weight of the entire body. Cartilage wears down over the years, causing changes in the joint. Therefore, older people experience arthrosis of the knee joints.

People at risk for gonarthrosis include:

• with excess body weight;
• those suffering from osteoporosis;
• with hereditary disorders;
• elderly;
• with specific professions;
• with metabolic disorders in the body;
• with micronutrient deficiency;
• those who received injuries to the spine;
• involved in some sports.

The disease develops gradually; it is very important to seek qualified help from a doctor in time to avoid restriction of joint movement and disability in the future.

With arthrosis of the knee joint, certain symptoms are observed. Nature of pain:

• discomfort after waking up, when trying to get up after prolonged sitting;
• knee pain when standing for a long time;
• burning and irritation when climbing stairs;
• pain at night, as well as after physical activity;
• weakness in the legs, “weaving” of the limbs.

The most important symptom indicating the occurrence of gonarthrosis is pain in the knee joint area. In this case, the disease does not occur suddenly; the pain will increase over many months and even years. At first they will bother the patient only with increased loads on the legs, and then even at rest.

Arthrosis of the 1st degree occurs with virtually no visible symptoms. This phase of development is characterized by:

• tired legs;
• a slight decrease in mobility, which is usually observed immediately after sleep.

Painful symptoms, if they occur, appear to a minor extent. At this point, knee arthrosis appears on an x-ray as small irregularities on the cartilage tissue and bone surface.

A slight narrowing of the space between the bones may also be observed. At this stage, it is extremely difficult to diagnose pathology, so radiography is mandatory.

With grade 2 arthrosis of the knee joint, the symptoms are more pronounced. Pain occurs from minimal exertion or immediately after it. In the affected part of the leg, pain is caused by almost any movement. After a long enough rest it usually goes away completely. However, the next physical actions immediately cause pain.

Approximately at the second stage of development of the disease, the following pain sensations are added:

• crunching in the knee joint when moving;
• reduced ability to bend the leg normally at the knee;
• changes in the bones of the joint;
• progressive synovitis.

Rough arthritic crunching of joints, as a rule, is barely audible at first, but as the disease progresses it becomes very loud and distinct. When you try to bend your leg, a sharp pain occurs at the knee. In some cases, this can only be done up to an angle of 90 degrees, and then only with difficulty and overcoming pain. A change in the shape of the joint also becomes obvious, which is further aggravated by the accumulation of pathological fluid in it.

Characteristic features of grade 3 arthrosis are severe pain, regardless of the amount or intensity of physical activity. The joint bothers a person even at night, causing significant inconvenience.

The mobility of the knee joint is impaired and the person is no longer able to independently bend the leg at the knee. There is sensitivity to weather changes, to which the affected area reacts very sensitively.

An x-ray can show global changes in cartilage tissue, joint surface, and uncharacteristic growths. An O-shaped or X-shaped curvature leads a person to disability.

The doctor, after listening to the patient’s complaints, during the examination first of all pays attention to visible changes in the structure of the limb (coarsening of the bones, deformation), decreased mobility in the joint. Palpation is accompanied by pain when moving kneecap a crunch is heard.

The main method for diagnosing gonarthrosis is radiography of the joint (at the same time, at the first stage, the pathology may not be detected). There may be several such images to track the dynamics of the disease. In addition to X-rays, an MRI or computed tomography may be prescribed.

All these studies are necessary to correctly determine the causes of the disease, as well as to differentiate gonarthrosis from other joint diseases.

For diagnosed arthrosis of the knee joint, treatment may include the following methods:

• drug therapy;
• massage and manual therapy;
• surgical intervention;
• restorative therapy (physical therapy, physiotherapy and other methods).

Goals of treatment of gonarthrosis:

• eliminate pain;
• if possible, restore damaged cartilage and ligaments;
• increase the range of motion in the joint.

Massage procedures, physical therapy and proper balanced nutrition (diet) are very important. If contacting a doctor is too late or no method has given any results, then surgery on the joint can be performed: surgical intervention is called installation of an endoprosthesis.

The main groups of medications used to treat arthrosis include the following categories:

1. NSAIDs – non-steroidal group of anti-inflammatory drugs;
2. Chondroprotectors;
3. Therapeutic creams, ointments and rubs;
4. Products used for compresses.

The drugs used as NSAIDs are diclofenac, ketoprofen, piroxicam, butadione, indomethacin, ibuprofen, nimulide, Celebrex and their derivatives.

For arthrosis, non-steroidal, i.e. non-harmonic, anti-inflammatory drugs are traditionally used to eliminate inflammation and pain, since due to severe pain it is not possible to begin treatment. Only after the pain is eliminated with anti-inflammatory drugs can you proceed to massage, a complex of therapeutic exercises and physiotherapeutic procedures.

In cases where NSAID treatment is not enough and the disease continues to progress, the doctor may prescribe hormonal injections. They belong to the “heavy artillery” means and help to quickly eliminate pain, relieve inflammation and swelling of surrounding tissues.

Commonly used hormonal drugs:

1. Hydrocortisone;
2. Diprospan;
3. Kenalog;
4. Celeston;
5. Flosteron.

Due to the large number of side effects, hormonal drugs are prescribed in short courses, only during the acute period of the disease, when inflammatory fluid accumulates in the joint cavity. The drug is administered into the joint space no more than once every 10 days.

They are the only medications that directly affect the cause of joint arthrosis. Especially on early stages and especially those containing chondroitin and glucosamine sulfate.

Chondroprotectors include:

1. Don;
2. Chondrosamine;
3. Arcoxia;
4. Alflutop;
5. Teraflex;
6. Structum;

The action of these drugs is based on restoring the normal production of synovial fluid and damaged cartilage tissue.

Quite effective in the initial stages of arthrosis of the knee joint. Injected intra-articularly.

The procedure is not cheap. Helps reduce abrasion of joint cartilage surfaces. The main thing is that the medicine does not penetrate into the bloodstream, there is a risk of embolic complications.

There is a large list of ointments and gels aimed at relieving pain and reducing inflammation.

This list includes ointments for arthrosis of the knee joint:

1. Fastum gel;
2. Heparin ointment;
3. Ferbedon;
4. Arthroactive;
5. Dolobene;
6. Traxivazin;
7. Diclofenac;
8. Dolgit.

The list of ointments for knee joints is quite large and is not limited to those listed by us, and the composition of the medications included in the ointments is sometimes similar to each other.

How to treat knee arthrosis at home? Some prescriptions can supplement drug therapy traditional medicine.

1. Treatment with dandelion flowers. Every day you need to eat 5 dandelion flowers, washed boiled water. You can make an infusion. For these purposes, take 5 dark glass bottles and fill them half with flowers, and fill the remaining space with triple cologne. Leave in a dark place for 1 month and rub on your knees before going to bed. For treatment, you need to dry the leaves, which are then poured with boiling water. Every day 1 tbsp. This mixture must be chewed for as long as it takes to complete 3 thousand steps. This treatment folk remedies quite effective.
2. Rubbing is a product that needs to be rubbed into the area of ​​the knee joint for arthrosis. It's quite simple to do. To do this, take the yolk of a chicken egg and mix it with a small spoon of turpentine. A large spoonful of apple cider vinegar is poured in there. Everything is mixed and applied overnight. Before going to bed, apply this medicine to the knee and wrap it in a woolen scarf, which is removed only in the morning. After opening the scarf, you will need to thoroughly rinse the area where the product was rubbed. In order to treat arthrosis with this recipe, you need to use it regularly for several weeks. Although, the first results will already be noticeable on the 3rd day of using the product.
3. Burdock. According to folk recipe you need to take 2-3 young burdock leaves and apply it to the sore knee, wrapping it with a bandage. To achieve the effect, you should insulate the knee with a warm scarf and leave the compress overnight. The procedure should be repeated every day for a week. This will relieve swelling and reduce pain. To enhance the effect, it is recommended to pre-lubricate the knee with cinquefoil oil. In this case, the burdock must be applied to the knee with the back side, and a plastic bandage and insulation with a woolen scarf should be made on top of it.
4. Celandine juice is effective for arthrosis. The fabric soaked in it is applied to the sore joint. After 50 min. The joint is lubricated with vegetable oil. Duration of treatment is a week. Break - 10 days, and repeat everything.
5. Two tablespoons of dried harpagophytum root should be poured into a thermos, pour 1 liter of boiling water and leave for at least 2 hours. To successfully treat arthrosis, you must drink 3-4 glasses of the resulting drug in a warm form per day.

Many patients with arthrosis of the knee joint note a significant improvement in their condition and a decrease in painful and unpleasant sensations after using traditional medicine intended for external or external use.

A positive result is not possible without a course of therapeutic exercises, which can be performed at home. It strengthens muscles and improves blood circulation in the joint. To get the desired effect, you need to forget about intense joint tension.

• You can lie on your back and, raising your leg, hold it straight and suspended. Or raise your legs alternately from the same position lying on your back 10 to 15 times.

The main rule when treating with gymnastics is slow and measured movements without any jerks.

Proper nutrition is an important component of successful treatment for knee arthrosis.

Sample menu:

1. Breakfast: oatmeal with water without butter or sugar, fruit juice, boiled egg.
2. Second breakfast: a glass of low-fat natural yogurt.
3. Lunch: steamed meat or fish vegetable stew, tea without sugar.
4. Afternoon snack: cottage cheese casserole with nuts, a glass of fruit juice.
5. Dinner: vegetable salad, apple, tea without sugar.
6. Second dinner: a glass of low-fat kefir.

You should eat more often, eating small portions. This will speed up your metabolism, which will lead to weight loss. Between main meals, if hunger pangs occur, snacks are allowed. Fruits, with the exception of grapes and bananas, and whole grain breads can be used for them.

Many people wonder what gonarthrosis is? Gonarthrosis of the knee joint is a serious disease that is characterized by dystrophy and degenerative processes in the joint. Often the pathology is not inflammatory, but the friction of bones against each other can trigger this process. If the symptoms of damage to the knee joint are not detected in time and treatment is not started, then the person may become disabled. Gonarthrosis of the knee is a very common disease.

It is important to know! Doctors are shocked: “An effective and affordable remedy for ARTHROSIS exists...” ...

Gonarthrosis is characterized by the destruction of cartilage tissue. In the first stage of development, changes occur at the molecular level, so the symptoms remain invisible. Upon examination, the cartilage appears cloudy, begins to thin, and cracks. Gonarthrosis leads to the cartilage being completely destroyed. This exposes the underlying bone.

Due to constant irritation of its surface, the body turns on a protective reaction and begins to grow an additional layer of bone tissue, which turns into spines (osteophytes). That is why the last stages of development are characterized by severe visible deformations of the joint. Important! If the symptoms are not noticed in time, the person becomes disabled, unable to move normally.

Gonarthrosis of the knee joint does not develop overnight. The process happens gradually. The following sequence of pathological changes can be distinguished:

1. Initially, metabolic processes in the knee occur under the influence of osmotic pressure. That is, when the knee bends, lubricant is released, and when it is extended, it is absorbed. If any reasons contributed to the disruption of this process, then the cartilage begins its destruction and becomes thinner.
2. Next, destructive processes occur in the collagen fibers, which are responsible for the shock-absorbing properties of the joint. In this case, the stability of the knee and the elasticity of the cartilage tissue are lost.
3. Since the synovial membrane of the joint is constantly under abnormal load, it begins to become irritated and an inflammatory process appears. This, in turn, leads to limited mobility of the knee.

Gonarthrosis of the inner part of the knee is considered more common. The problem occurs more often in athletes and older people.

So, gonarthrosis of the knee joint is complex and potentially dangerous disease, which can be completely cured without surgery only if the degree of its development is initial. This disorder of the knee has a deforming type of development, and can be provoked by the following factors:

• Injuries or broken bones;
• Mechanical damage to the menisci and cartilage tissue;
• Rupture of ligaments or muscle tissue in a joint;
• Too big physical activity on the knee;
• Lifting excessively heavy objects;
• Overweight;
• Abnormal structure of the knee joint;

In addition, there are other reasons for the development of gonarthrosis:

1. Varicose veins.
2. Inflammation of the knee joint caused by infectious pathologies.
3. Hereditary weakness of the ligamentous and muscular apparatus of the knee.
4. Disruption of the normal innervation of the knee joint.
5. Diseases of the endocrine system.

Classification of pathology

This disease can be classified as follows:

According to the development mechanism:

• Primary gonarthrosis. It develops without any preliminary damage to the knee joint by the inflammatory process. That is, the knee is completely healthy. The reason for this is metabolic disorders, hereditary predisposition, and long-term use of hormonal drugs. Primary gonarthrosis is often found in older people.
• Secondary. It is already developing due to injuries to the knee joint and surgical intervention. In most cases, the lesion process is one-sided. This disease develops at almost any age.

By the nature of the lesion:

1. Right-handed. It is typical for athletes and people who engage in heavy physical labor.
2. Left-handed. It most often occurs in overweight people.
3. Double-sided. This disease is characterized by damage to the knees of both legs. Bilateral gonarthrosis of the knee is the most severe disease that can impair mobility. Elderly people are most susceptible to this pathology.

From the beginning of the development of pathology, signs may not appear. However, the destructive process intensifies. Symptoms of gonarthrosis depend on the degree of its development:

1. Grade 1 gonarthrosis is characterized by increased fatigue of the limb. The bone at this stage does not undergo significant changes, however, a barely noticeable restriction of movement is still present. This degree is also characterized by some narrowing of the joint space, which can only be seen on an x-ray.
2. Gonarthrosis of the 2nd degree is accompanied by painful sensations after loading the joint. While walking, the patient hears a crunching sound in the knee. He cannot bend or straighten the joint completely. Pain may be observed before the start of movement (starting). The image shows flattening of the edges of the bones.
3. Grade 3 gonarthrosis is characterized by severe pain that is felt even if the person is at rest. Swelling and fever may occur in the affected area. The joint becomes unstable and can suddenly jam.

Important! Some signs may be optional, such as swelling.

Diagnostic features

Before starting treatment for gonarthrosis, it is necessary to undergo a thorough examination. It includes the following steps:

• Visual examination by an orthopedist and palpation of the affected area. The patient must describe his symptoms in detail. In addition, the specialist takes measurements of the bones, determines the degree of mobility and the angle of bending of the joint.
• Clinical studies of blood and urine. These tests make it possible to obtain erythrocyte sedimentation parameters and fibrinogen levels. Also an important parameter is the level of urea in the urine, because it can also negatively affect cartilage tissue.
• X-ray of the joint. Here you can see the degree of narrowing of the joint space, damage to cartilage and bone, the presence of accumulation of salt deposits and osteophytes.

• Ultrasound of the knee.
• MRI. This study allows not only to determine the most microscopic changes in the knee joint, but also to find out the possible causes of the development of the disease. However, this research is unsafe and expensive.
• CT. Computed tomography makes it possible to visualize the knee.
• Arthroscopy. This technique for examining the knee from the inside is also very informative. It is carried out through small punctures in the joint area.

Before treating gonarthrosis, it is necessary not only to find out the symptoms of the disease, but also the possible causes of its development. Eliminating them will allow you to prescribe effective treatment.

In the first stages, it is enough to use drug therapy. That is, the patient will have to take the following medications:

1. Non-steroidal analgesic and anti-inflammatory drugs: Nimesil, Voltaren. In addition, deforming gonarthrosis may be accompanied by muscle spasms. You can remove them using: “Tizalud”, “Drotaverine”.
2. Chondroprotectors: “Artron”, “Chondroitin”, “Teraflex”. They help not only restore cartilage tissue that has not yet been damaged, but also restore damaged ones. Please note that you will have to take such medications for quite a long time. The dosage of the drug is determined by the doctor.
3. Vasodilator drugs that make it possible to reduce muscle tone: Trental, Ascorutin. This improves blood circulation and metabolism in the knee joint.
4. Anti-enzyme agents: “Gordox”, “Kontrikal”. These medications neutralize the action of certain enzymes that contribute to the development of degenerative processes in the knee joint.
5. Intra-articular injections of "Hydrocortisone". They can be used infrequently, however, they can quickly relieve inflammation and severe pain.
6. Preparations based on hyaluronic acid. They are injected into the joint. However, the procedure is applied only after the acute manifestation of the disease has been eliminated.
7. Warming compresses with Dimexide on the knee joints. They make it possible to improve blood circulation in the affected knee joint.

You should not use these drugs on your own. Otherwise, the patient may worsen his condition.

Treatment of gonarthrosis of the knee joint with the help of physiotherapeutic procedures can give the best possible effect. The following procedures are used for this:

1. Electrophoresis and phonophoresis with novocaine.
2. Diadynamic currents.
3. Magnetotherapy.
4. Laser therapy.
5. Paraffin and ozokerite applications.
6. Mud therapy.

The presented disease of the knee joint involves reducing the mechanical load on the affected area. For this purpose, orthoses, knee pads or a cane, and orthopedic insoles are used.

Physical therapy is very beneficial for the knee joint. Exercises for gonarthrosis of the knee joint should contribute to the development of normal mobility of the joint. Their type and intensity should be determined by the doctor. It is best to perform the complex in a supine position. The first time you do the exercises you need to do no longer than 10 minutes. Next, every day you need to increase the time by 2 minutes. The complex excludes squats and flexion-extension of the joint, as well as those exercises that provoke pain.

If traditional therapy does not produce a positive effect or the disease is already advanced, then surgery cannot be avoided. There are several types of interventions:

• Arthrodesis. In this case, not only the deformed tissue is removed, but also the joint. That is why the mobility of the limb is practically not preserved. Due to the serious consequences for humans, such an operation is performed extremely rarely.
• Arthroscopy of the knee joint. This intervention makes it possible to get rid of the affected cartilage tissue, while the joint remains intact. The whole process is carried out through small punctures through which a special device is inserted - an arthroscope and other instruments. Due to the minimal trauma of the operation, the patient can fully recover in a fairly short period of time. Despite the fact that this type of surgery is not complicated, its effect will last only a few years.

• Periarticular osteomia. This operation is considered very complex and is therefore performed in rare cases. It involves filing the bones in some places and then connecting them at the required angle. This makes it possible to redistribute the load. The effect after surgery lasts no more than 5 years. However, it is effective only in the early stages of development. In addition, this intervention requires a long recovery period.
• Endoprosthetics. This operation is performed if the joint or its elements require complete replacement. The prosthesis is made of a metal alloy – titanium. Despite the fact that the operation requires a long recovery period, its effect is very long - up to 20 years.

The operation is not a panacea, especially since it may be accompanied by some complications: necrosis of skin tissue, paresis of the peroneal nerve, vascular thrombosis. In addition, the risk of rejection of foreign material cannot be excluded.

Gonarthrosis is a complex disease that can be prevented. To do this, you need to follow some recommendations from doctors:

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