Osteoarthrosis is the most common disease of the joints (about 70% of all joint pathology). Like atherosclerosis of vessels, osteoarthrosis develops with age as an indicator of degenerative processes — the locomotor system (in particular, cartilage).
At the age of 40 to 60 years, the total population of osteoarosis is found in 15% of cases, and after 60 years – in 100%.
In everyday life, this disease is often known as “salt deposition”, which, of course, is erroneous in all respects. The essence of osteoarthritis is the degeneration and destruction of cartilage and secondary compensatory processes – the subchondral sclerosis.
end plates and the growth of osteophytes. Subchondral sclerosis develops due to friction of the bone ends, and marginal osteophytes increase the contact surface of the bones and thereby reduce the load on the epiphyseal unit.
Cartilage consists of the main substance of connective tissue – mucopolysaccharides (MPS) and chondroinsulfate with the inclusion of cells in them – chondrocytes, producing the main substance of cartilage. Cartilage has no blood vessels and feeds by diffusion.
MPSs are hydrophilic; they provide cartilage resilience and nutrient diffusion.
With the degeneration of cartilage, there is a decrease in the number of chondrocytes in it and, consequently, a decrease in the MPS content. The lack of MPS leads to drying out of cartilage, which further enhances the dystrophic processes, since it disrupts the diffusion of nutrients.
There are three stages of cartilage degeneration: 1. Reduction of its hydrophilicity, drying, thinning. 2. The appearance of cracks and defects. 3. Exposure of the bone surfaces of the epiphyses. When the degeneration of cartilage in it naturally increases the content
cholesterol and phospholipids, which brings together the processes of any tissue dystrophy and allows us to draw an analogy with the age-related degeneration of the vascular wall.
The causes of the pathological degeneration of cartilage are little known, apparently, they are diverse. The pathogenetic mechanisms of cartilage dystrophy are also complex. Great importance in this regard
Lies vascular, endocrine and metabolic factors. Often, osteoporosis develops on the background of menopause. Microcirculation disorder is observed in cartilage, trophicity worsens, cells break down with the release of intracellular enzymes of proteases, under the influence of which tissue destruction is further enhanced. There is a point of view that osteoarthrosis is basically a vascular disease.
Of additional importance are exogenous factors – mechanical overloads, microtraumas. In this connection, apparently, osteoarthrosis is observed in athletes, geologists, as well as in individuals with certain occupational hazards.
(vibrations, shocks, mechanical overloads, etc.). However, direct dependence of osteoarthrosis on the load on the joints does not exist.
Errors in the diagnosis of rheumatoid arthritis in the direction of osteoarthritis are not uncommon both in the initial stages and in the subsequent stage when a similar X-ray picture appears.
The fact is that the destruction of cartilage in rheumatoid arthritis creates the prerequisites for such similarity, because the destruction of cartilage, regardless of the reasons causing it, in both cases leads to the same x-ray signs: narrowing of the joint space and osteophytes. However, in rheumatoid arthritis, signs of osteoarthritis are secondary. Nevertheless, they say about the combination of two diseases – rheumatoid arthritis and osteoarthritis. However, in such cases it is more correct to speak not about the combination of these diseases, but about the “complication” of rheumatoid
arthritis osteoarthritis. The main clinical manifestation of osteoarthritis is
pain in the joints, especially during physical exertion, as well as at night, often with stiffness in joints after resting. Pain increases with changing weather. Inflammation local – expressed little, and general – always absent.
Contractures and ankylosis rarely develop, the latter can be observed in the joints of the spine. A change in the configuration of the joints is observed, as a rule. Hence the name of the disease “deforming” osteoarthritis. Particularly noticeable deformities of the terminal phalanges of the fingers in the form of “Heberden’s knots” (after the English rheumatologist who described this syndrome).
As a result, it should be noted that the most important differential diagnostic criterion between rheumatoid arthritis and osteoarthrosis is inflammatory syndrome (temperature reaction, increased ESR, leukocytosis, the appearance of C-RB, etc.), which is constantly expressed in rheumatoid arthritis and, as a rule, absent with osteoarthritis.
Osteoarthrosis, in essence, as cartilage degeneration, must be distinguished from chondrocalcinosis as focal calcium deposits in cartilage (pseudogout). Chondrocalcinosis is sometimes difficult to distinguish from RA.
Chondrocalcinosis begins slowly and flows torpidly. Deposition of calcium in the joint is accompanied by reactive inflammation in the form of both local and general inflammatory symptoms, which alter “primary” arthritis. Often affects the knee and wrist.
The diagnosis of chondrocalcinosis is resolved by X-ray detection of calcium in the cartilage (meniscus) in the form of linear or chalk scribal sediments.