Knee joint: symptoms, treatment

Osteoarthritis is the leader in frequency in the musculoskeletal disorders.It is believed that the vast majority of the Earth’s population by the age of 60 have the initial signs of articular cartilage changes, while 14% have already shown osteoarthritis.The most common version of this disease is osteoarthritis in the knee joint.

But, "arthritis" or "arthritis"?

Don't mix these two concepts.Arthritis is a process that mainly changes the structure of the joint, an inflammation that can occur both in the context of "untouched" structures and in the context of arthritis.

For example, changes in joint bone changes can be compared with knotted growth on a trunk that grows close to the concrete fence and applies pressure of all weight.

Typically, the surface of the bone facing each other is separated by two layers of cartilage and meniscus (other cartilage plates).In addition to the role of "buffer" between bones, cartilage also provides the sliding of bones and the mechanical correspondence between each other.Meniscus can be completely or partially broken down due to size (but frequent) damage and loses elasticity.

As we age, especially in the case of hereditary tendencies, the articular cartilage becomes thinner.This is why bones in the hips and calf make up the bones at the knee joints and ends, dangerously close to each other, and there may even be friction between them.

Usually at the same time as the thinning of the cartilage, another unpleasant event occurs: - The amount of fluid in the joint is reduced.This liquid is not only purely mechanically "lubricated" from the inside.It provides nutrition for bones, meniscus and articular cartilage.The “supply” that violates all these structures is a real disaster for the Union!

If the joint is physically overloaded, bone birth occurs on the surface of the bone and begins to grow, more similar to pointing or spikes.For knee joints, such overload will be weightlifting (including your own body’s overweight!), focusing on knees (e.g., weeding gardens), constant walking on stairs, running, wearing uncomfortable shoes, flat feet and many others.It’s easy to imagine what happens inside the knee as arthritis develops and how it manifests itself in appearance.

How does the union work?

For example, each of us sees articular cartilage multiple times at the end, such as chicken bones.It covers small areas that touch bones.Subchondral bone or cellular bone under the articular cartilage.The human musculoskeletal system is arranged in a similar way.

Most of the joints of the person are composed of bones, synovial (joint) shells, and intra-articular fluid.

What happens to joints?

Under the influence of all the already mentioned loads, therefore, compaction and growth of the slender bones increase the trauma of the articular cartilage.

The product of the cartilage cartridge formed by the microcrystals falls into the synovial fluid.It is essentially arranged so that they are foreign bodies in the synovial shell and cause inflammation.The formation of sliding fluids is disturbed, usually a "conveyor belt" that resembles a continuous circulation of enrichment and purified blood.In addition, the joint fluid becomes less than hyaluronic acid.It's worth telling about this acid.

Hyaluronic acid provides the viscosity of synovial fluid, which creates a "buffering effect" and a "lubricating effect" between bones, thus reducing their frictions against each other.Because of this substance, the consistent joint fluid is similar to egg protein, rather than water.Another important role of hyaluronic acid is to ensure that the nutrients are delivered from the joint fluid deep into the articular cartilage, because there is nowhere to bring the nutrients to it: the blood vessels are not suitable for the cartilage directly.In the same way, the "spending" substance from cartilage to joint fluid is removed: use hyaluronic acid molecules.

Thus, enhanced bone seals occur and unbearable conditions are created for joint cartilage.

The cartilage receives a signal to adapt to these extreme conditions, and its variation begins in another way called remodeling.This is mainly manifested by the reduction of cartilage elasticity.

In the later stages of arthritis, the bones become stiff but at the same time are more fragile, and the cartilage itself is partially immersed in calcium-calcification.

symptom

Arthritis develops with mild pain in the knee, which occurs after walking up the stairs, exercises physically, and walks very long.This mild pain can occur for months or even years.Then they become more obvious.In the initial stages of disease development, the kneecap bones are not deformed, but a slight swelling of the joint itself can be observed.

In the second stage of disease development, the pain becomes more intense and occurs after a slight load.In addition to pain, tightening occurs in the knee joint, which is different from the pain that usually soft abuses healthy joints.In addition, deformation of the joints becomes obvious and the bones touched become wider and rude.It becomes problematic to carry more than 90 degrees on your knees.

In the third stage of the disease, knee pain becomes severe and constant, and does not pass even during the rest of the period.The knee has minimal mobility, usually does not bend over 90 degrees, and does not extend to the end.The deformation of the bones of the joint becomes so strong that the legs have a valgus (X-shaped) or variability (O-shaped) curvature.

diagnosis

examine

In the early stages of the disease, joints are not altered, movement is moved, and the surrounding muscles are retained and strong enough.Local (local) pain is more often identified on the inner surface of the joint through palpation (pressure) at certain points.The doctor asks the patient to do several squats, bends, straightens his legs, straightens his knees, lifts his face on the sofa, and leads the flexion to extend (this is called a "passive" movement).In this case, in addition to pain and limiting exercise, you can also determine the tightness of the joint, clicking on the joint.With obvious inflammatory components, the size of the joints increases, and it seems that the liquid is "pumped up".During remote processes, bending in the knee may be partially or completely absent, and at examination, the surface of the joint appears to be uneven, nodules, and limbs can be bent (displacement of limb axis, "joint").

Laboratory research

• Mandatory laboratory investigation plans includeGeneral, biochemical and immune blood tests, urine analysis.In general blood tests, attention will be paid to: increased levels of white blood cells and increased rate of red blood cells settle, which indicates inflammation.In the biochemical analysis of blood, metabolic metabolic indicators are important, namely the level of "hepatic" enzymes.In immunologic analysis, the presence or absence of signs of systemic inflammation will be determined - demonstrated by the levels of C-reactive protein.Urine analysis will reveal the content of "sand" - uric acid crystals.
• Analysis of synovial fluid (joint) fluidIt is specified in the case of sufficient quantity of the liquid.That is, when the joints swell, swell.In fertility conditions, the doctor pierces the joint capsule at a strictly defined position, inserts the needle into the joint cavity, and then removes excess fluid.Some of the obtained materials were entered into the laboratory for analysis.At the end of the procedure, anti-inflammatory drugs of glucocorticoid groups are usually administered into the joint cavity (eg, the diadrenal gland).
• Radiography.Pictures of both knee joints are necessary, which is essential for comparing sick knees to healthy knees.In the picture, pay attention to the width of the joint space (judged by meniscus and cartilage status), the presence or absence of bone spikes - fractures, signs of bone destruction (destruction).
• Ultrasound of the knee jointHe will answer questions about the preservation of meniscus, the presence of bread cysts, the severity of inflammation, the presence or absence of uric acid crystals (in the presence of gout).
• MRI (magnetic resonance imaging).This study is prescribed if ultrasound does not have detailed answers to the expert’s questions.For those who plan to have an arthroscopy, an MRI is a must.
• Arthroscopy.Allows you to visualize, i.e., assess the condition of the joints yourself.This approach is essential for a controversial diagnosis, with traumatic damage to menstrual flexion and ligaments suspected (and then, directly, can be removed quickly during the study period).

Treat the joints of the knee joints

The principle of comprehensive treatment should be followed, including:

1. Detailed understanding of patients' diseases

2. The use of physical therapy exercises, which include: specific exercises in joints in lying positions, swimming
3. Maintain optimal weight
4. During the period of increasing load on the joints - on the road, during walking, etc., wear an orthosis (soft bandage or at least elastic bandage).
5. Nonnuclear approach (physiotherapy).This type of treatment can be precisely effective with arthritis in the knee joint (contributing).Obviously, this is due to the influence of factors such as magnetic and laser radiation.To handle the knee joint, you can use magnetocurrent, UHF, frozen exposure (translated from Greek to cold effect).Physical therapy procedures are extensive, and treatment courses are usually short-term -10, the maximum courses per day or every other day.Only possible contraindications should be remembered, including tumor processes, diseases of the thyroid and pelvic organs, and systemic (autoimmune) inflammatory diseases.
6. Drug therapy.

Principles of treatment of osteoarthritis:

• Relieve pain
• Delayed further damage to joint structure
• Restore lost joint function.

Nonsteroidal anti-inflammatory drugs

To relieve pain, NSAID Lee NSAID's drug - a non-replacement anti-inflammatory drug was used.They are used in application and application form (applied to the skin).Application (local therapy) is a very effective approach, especially in the early stages of the disease.Before using gel or cream containing NSAID, it is necessary to make sure there is no change in the skin, whether it is a rash, pustules or cracks.The general rule of topical treatment is to use at least the selected cream or gel every day, if unpleasant feelings occur - cancel these manifestations completely disappear.Intramuscular administration is not currently recommended, as the risk of administration using a syringe will not be reduced, but rather the contrary.In the case of obvious inflammation, the accumulation of glucocorticoid drugs is allowed in the liquid with large amounts of fluid, but it should be noted that the process should be performed no more than once every 3 months.

Cartilage protector

The higher "step" anti-inflammatory effect of osteoarthritis is a preparation of chondroitin or glucose agents.Like NSAID, they fight inflammation at a thin joint structure level, but have fewer side effects and most importantly, retain their anti-inflammatory effects for several months after cancellation.

Cartilage protectors are the collective name of a group of drugs containing chondroitin sulfate and glucosamine - the "building brick" of cartilage.Despite the high cost of cartilage protectants, their convenience and effectiveness to patients are difficult to overestimate.First, these substances are received internally, absorbed completely from the stomach, and the drug loss “follows the road” to the cartilage is minimal.Secondly, they are able to suppress inflammation in the joints, and furthermore, reliably slow down the destruction process of joint cartilage!Mostly, they are prescription courses because their "trump card" is quite long and lasts for several months, sometimes even six months.

A drug based on hyaluronic acid is what SO calls hyaluronate.These funds are sold in the form of prepared syringes for intra-articular administration.Hyaluronic acid is an artificial synovial fluid.The effect of treatment with this method can last up to 12 months.

Surgery treatment of knee joints

Like articulation of the hip joint, it operates in the event of severe changes and persistent loss of function.With the contribution of experience, two interventions are currently underway: arthralgation (restationary compounds) and endophytes.According to special instructions, when the installation of the chapter is impossible for any reason, the first operation is rarely performed.The result of this surgery is that the knee becomes motionless.But that doesn't hurt.In terms of function, the operation of the internal op worm is more profitable.Recall that if you weigh a lot, you didn't do this - the risk of postoperative complications is too high.From removing damaged parts of the joint and installation of the prosthesis to fully recovering function, no more than three weeks.

How does ridiculous osteoarthritis threaten?

Over time, osteoarthritis does not look back, but only intensifies, especially while maintaining the outrageous factors.Consider the main source of risk to the health and life of patients with osteoarthritis.

• Chronic pain of various intensities- A very important risk factor, especially among the elderly.Unpleasant sensations that are frequently experienced can lead to sleep disorders, reduced emotional background and even depression.It is difficult to predict which chain of adverse events pulls the listed phenomenon.
• Intravenous pathology.Constant inflammation in the knee area, bone spikes - The growth of bone plants may mechanically damage pop bone blood vessels, which can lead to the development or progression of veins in the legs.Sometimes, an orthopedic doctor refuses to operate the knee until the varicose lymph nodes are removed, but venous biologists (venous experts) do not start venous surgery unless there is a significant change in the knee joint.
• Decreased limb function.During remote processes, joints can completely lose their ability to move, which in most cases is a sign of disability.
• Participate in other joints.We have discovered such a seemingly common phenomenon, such as a flat foot, that can "pull" the knee joints and lead to the development of osteoarthritis.In the same way - along the chain - participate in the painful process of the knee from the other side.If the patient ignores the advice, refuses to wear sugar cane, and prefers to "lim feet", arthritis in the hip joints will soon appear.The legs are twisted and the gait becomes a "duck".
• Stay still.This serious complication of disease occurs when the bones of the joint are greatly damaged, without cartilage, severe pain in the joint movement or simply impossible due to the fusion of the bones (called "ankylosis").In this case, only surgery can help the patient, but only if it is technically feasible.In a general sense, overcoming is dangerous: it can lead to the rapid development of obesity, osteoporosis, muscle atrophy, internal organ diseases.Furthermore, of course, a fixed person is constantly in need of taking care of himself.
• Not working.Unfortunately, there are many states that make the surgery impossible, with one state being ignored far away, with “neglected” osteoarthritis among patients with more than 80 severely related diseases.

prevention

• Exclude joint damage.It seems: Nothing is easier than this.For a while, it wasn't difficult to give up jumping, running, walking, dancing, and high heels.In fact, it turns out that it is this that has caused the most protests among patients.A person, if he suffered recently, is usually not ready for the fact that there are some important points in his daily life.However, if you do not follow these tips, there is a danger of quality of life and disability.
• Losing weight and maintaining weight within the optimal range is a very important advice!No matter how miraculous the tool works, fat people will not be able to appreciate it.Because when the joint is overweight, the micro-curves are repeated once a day.This can reduce all efforts to "no".In addition, obesity is a direct contraindication for certain treatments.
• Walk under support.The common rule for unloading joints with support support is that the crutch, crutch or handrail should be opposite to the affected limb.That is, if the right knee is injured, the cane should be placed on the left and vice versa.
• Correct flat feet.It seems, how do you connect the flat feet of the knee joint to arthritis?The facts are direct.If the foot is improperly mounted (now we are talking about longitudinal or mixed flat feet, not transverse), then the load is redistributed in the knee joint.In this case, the severity of the body does not fall at the center of the joint, but on its right or left.Therefore, the right or left meniscus suffers more pain, and because it suffers more pain, we wear out faster.Next is the "cohort" of articular cartilage, and the meniscus cannot cope with its function.This process ends with the formation of a typical “joint” change in the knee joint (the appearance of bone birth).