Arthrosis of the knee joint (gonarthrosis): diagnosis and treatment

Up to 20% of all people over the age of 25 are at risk of developing deforming osteoarthritis of the knee. The knee joint works in the mode of axial compression, therefore its articular surfaces are subject to constant loads and are subject to degenerative changes in hyaline cartilage.

Prevalence

Pathology of articular cartilage of a degenerative-dystrophic nature with the involvement of bone tissue, articular bag, ligaments and muscles in the process is called deforming arthrosis. In the terminology, there are synonyms:

• osteoarthritis;
• osteoarthritis;
• degenerative arthritis;
• osteoarthritis;
• hypertrophic arthritis;

In terms of frequency, damage to the knee occurs immediately after the hip joint, so that a stable phrase has formed: "gonarthrosis of the knee joint". The dependence of the frequency of the disease on age was studied:

26 - 44 years old	5% of adults
45 - 59 years old	16. 70%
60 - 69 years old	12. 10%
70 years and over	Eleven%

In all age groups, representatives of the fair sex predominate quantitatively. In them, arthrosis of the knee occurs 1. 2-1. 4 times more often than in men.

In the area of persistent disability, deforming osteoarthritis of the knee joint accounts for nearly 30% of all causes of disability related to joint pathology.

Classification of knee osteoarthritis

For developmental reasons, the disease is divided into two large groups: primary and secondary. Primary arises without visible preconditions. The secondary is preceded (or accompanied) by provoking factors:

1. biomechanical disorders: injuries, excessive loads, developmental abnormalities (dysplasia), skeletal pathology (scoliosis, flat feet), obesity;
2. inflammatory processes: aseptic or infectious arthritis, frequent hemarthrosis in hemophiliacs;
3. metabolic diseases: gout, hemochromatosis, Paget's disease;
4. endocrine gland disorders: acromegaly, diabetes mellitus, parathyroid gland disorders;
5. violations of adequate blood supply: varicose veins and post-thrombophlebitic syndrome, obliterating endarteritis, atherosclerosis of the vessels of the lower extremity;

In medical practice, the classification according to the severity of pathological changes is more useful. The evaluation is made according to radiographic studies. The most popular clinical and radiological classification.

I stage

The photo shows a slight narrowing of the interarticular gap (a comparison is made with a healthy joint), the beginning of sclerosis of the pericartilaginous bone tissue. Clinically - pain occurs during walking or immediately after it, with prolonged standing. More pronounced when climbing stairs. Go to rest. 1st degree knee osteoarthritis does not greatly affect the function of the joint.

II stage

The joint space is 2-3 times narrower than normal. Sclerosis is more pronounced, osteophytes (spiny outgrowths of bone tissue along the edges of the joint space and condyles) are found. The pain is moderate, there are signs of muscle hypotrophy, lameness. The deformation of the knee in the frontal axis is visible. Second degree knee osteoarthritis leads to a significant limitation of joint mobility.

Stage III

Sclerosis of cartilaginous elements, deformation of articular surfaces. There are areas of subchondral necrosis, local osteoporosis. Cysts in adjacent bone tissue. The joint space is extremely constricted, sometimes undefined. Osteophytes of considerable size. Atrophy of the muscles of the thigh and lower leg, the joint is unstable, there is a pronounced deformation. Movement in the knee is sometimes impossible, a contracture is formed. In motion - severe pain, lameness.

This approach to classification is convenient in that it allows the assessment of clinical manifestations in relation to organic changes. It gives the opportunity to choose a more effective treatment based on a comprehensive assessment of the condition of the joint.

Mechanism of development

The pathogenesis of any osteoarthritis goes through three stages:

1. Damage to cartilage microstructures. Under the influence of one of the harmful factors, high molecular weight compounds lose their strength and become enriched with water molecules. The ability of low molecular weight collagens to assemble into macromolecules is impaired. This leads to a decrease in the strength and durability of hyaline cartilage. Chondroprotectors neutralize these phenomena.
2. If the provoking factor is not eliminated, the weakening of cartilage components (glycosaminoglycans, proteoglycans) continues. This leads to the activation of recovery processes. Their power reserve is not particularly large, so this step quickly moves on to the next one.
3. Disruption of compensatory mechanisms leads to the gradual destruction of articular cartilage, the death of its cells - chondrocytes. The cracks in the cartilage extend to the underlying bone. The degree of detachment of cartilaginous components increases, their defibration occurs, which leads to thinning of the hyaline membrane.

From the side of the bone, with deforming arthrosis of the knee joint, thickening (sclerosis) occurs, cysts and areas with uneven bone density appear. Therefore, the deformation of the articular surfaces, the instability of the joint develops.

Diagnostic

The diagnosis is based on a set of data obtained as a result of a survey (anamnesis), medical examination and instrumental research methods. These include radiographic examinations (scanner, MRI), radioisotopes (scintigraphy), arthroscopy.

Objective review

It includes clarification of the patient's life history, circumstances preceding the development of gonarthrosis of the knee joint, collection of complaints and examination. During the process, the presence of provoking factors and the degree of their influence on the development of the disease are clarified.

At this stage, it is important to know the condition of the second knee. If you miss bilateral knee osteoarthritis and focus only on the knee that worries you the most, you may be making a gross misdiagnosis.

For this, functional tests should be performed on two limbs at once. Attention is drawn to the pain of active and passive movements, tenderness on palpation, crackles (crunches) when extending and bending. Chronic inflammatory processes lead to the appearance of a Becker's cyst - a protrusion of the articular bag into the popliteal fossa, which can also be detected by palpation.

Instrumental methods

The first is radiography. An image of the knee in two projections allows a preliminary assessment of the state of the joint and to determine the stage of the disease. The disadvantage of the method is that the radiological signs occur later than the symptoms and morphological changes accompanying arthrosis of the knee joint.

In such cases, MRI (magnetic resonance imaging) helps. It is possible to determine the initial stages of degenerative changes in cartilaginous and bone structures, it is possible to assess the condition of intra-articular ligaments, menisci. Scintigraphy of gonarthrosis of the knee joint provides data on the functional status.

Direct examination of the joint cavity is possible with arthroscopy.

For the unification of diagnostic data, the American College of Rheumatology has proposed the following criteria:

• Age over 50 years old.
• Stiffness in the joint in the morning, which persists for at least half an hour.
• Cracking, determined by movement (active and passive).

If these symptoms are accompanied by osteophytes found on x-ray and pain, it is very likely that gonarthrosis of the knee joint is occurring.

The initial stages of the disease may not be pronounced, therefore it is necessary to carry out differential diagnostics with other joint pathologies, in which pathogenic drugs for arthrosis (chondroprotectors) will be ineffective.

Every possible measure should be taken not to confuse knee osteoarthritis with the following conditions:

rheumatoid arthritis	Onset at an early age, stiffness in the morning for more than 30 minutes, pain worse at rest and weaker on motion, rheumatoid nodules on the skin, concomitant damage to internal organs, symptoms of intoxication (fever, sweating), protein C-reactive in blood tests.
Crystalline arthritis	The pain is sharp, at night or in the morning; the skin over the diseased joint is edematous, red, hot; crystals on microscopic examination of synovial fluid, increased uric acid in the blood (with gout).
Spondyloarthropathies	Arthritis of other unrelated joints (intercostal joint, lumbar); inflammatory processes in the tendons; damage to the cornea, skin, mucous membranes.

In the International Classification of Diseases of the Tenth Revision (ICD 10), all of these diseases are assigned the index "M", but a different numerical code.

These are fundamentally different pathological processes that require a professional approach to diagnosis and qualified treatment.

Therapeutic measures

If there is a disease, there must be ways to cure osteoarthritis of the knee joint. And they exist. Help can be provided in different ways.

First of all, the achievements of traditional medicine, based on a thorough study of the causes and mechanism of the disease. Both medical and surgical methods are used here. Competent treatment requires consistent and complex use of drugs, physiotherapy methods and rehabilitation measures.

The second way is treatment with folk remedies. The effectiveness of these methods, to say the least, is questionable. But they are used, because it is possible to reduce the manifestations of the disease at home. Folk remedies can be used only as an addition to drug treatment or as part of complex therapy, it is imperative to obtain the consent of the attending physician!

medicinal aid

This type of treatment includes the use of various drugs. For medicinal effects, drugs of different groups are used:

1. nonsteroidal anti-inflammatory drugs, analgesics, opiates;
2. slow-acting symptomatic drugs (chondroprotectors);
3. glucocorticoid hormones;

NSAIDs, rapid analgesics, opiates

Drugs of this group are designed to eliminate pain. The pain syndrome pretty much spoils the life of patients with arthrosis, its elimination significantly improves the quality of human life. NSAIDs, anilides, non-narcotic and narcotic analgesics are capable of this.

A common drawback is side effects. These drugs negatively affect the kidneys, the protective mechanisms of the gastrointestinal tract. An alternative that can reduce harmful manifestations are injections. Intramuscular administration damages the stomach less and accelerates the effect.

Due to side effects, drugs of this group are prescribed during exacerbations, careful selection of the dose is required.

The main advantage of NSAIDs is the multiplicity of forms of local treatment (ointments, gels). Allows you to control the manifestations of the disease at home.

Analgesics of central action are prescribed for a short period, with the ineffectiveness of the other two groups. The most popular opiate is prescribed during an exacerbation, most often with bilateral gonarthrosis. These drugs are addictive. You can't take them alone!

Slow acting symptomatic medications

The action of these substances is twofold: they have the ability to reduce pain (like NSAIDs) and contribute to the restoration of hyaline cartilage. They are often called chondroprotectors.

The effect develops over several weeks (2-8) and persists after cancellation for 2-3 months.

In addition to chondroitin sulfate and glycosaminoglycans, this group includes preparations based on hyaluronic acid, compounds derived from avocado and soy.

The most studied and popular chondroprotectors (chondroitin sulfate and glycosaminoglycans) are ready-to-use components of joint cartilage. Well absorbed into the blood, forms high concentrations in the joint cavity. To accelerate the effect, injections can be made directly into the joint.

Chondroitin sulfate, taken as a course of treatment for two years in a daily dose of 800 mg, has been proven to have a stabilizing effect on the joint space in gonarthrosis of the knee joint of the 2nd degree.

Avocado/soy compounds have anti-inflammatory effects. Due to the inhibition of collagenase (a decomposing enzyme), they significantly slow down the destruction of cartilage, increase the synthesis of "their own" collagen. They are also very well tolerated.

Hyaluronic acid derivatives are used in the form of intra-articular injections. These funds, like chondroprotectors, improve the functional state of the knee joint.

The mechanism of action of various slow-acting symptomatic drugs is somewhat different, therefore their combined use is recommended. A high level of safety allows you to take chondroprotectors for a long time without tangible harm to the body.

Glucocorticosteroids

The main action is anti-inflammatory. These funds are prescribed when NSAIDs are ineffective. Tablet forms also damage the stomach lining. There are forms for intra-articular injections.

They have many side reactions, so you should not abuse hormonal drugs to deform arthrosis of the knee joint.

group name	Advantages	Defaults
NSAIDs, analgesics, opiates	Fast effect, many forms for topical application.	Side effects, unstable effect, dangerous for patients age-related, addiction occurs.
Chondroprotectors	They act pathogenically, have a long-lasting effect, are non-toxic, there are forms for external and intra-articular use.	Slow development of the effect.
Hormones	Rapid effect where NSAIDs are not enough; forms for intra-articular administration.	Side effects, unstable effect, long-term use is impossible.

ethnosciences

At home, you can reduce the manifestations of the disease with folk remedies. There are many recipes, but there are a few but:

• no clinical studies have been conducted;
• it is impossible to accurately dose the medicinal substance;
• the indications are not clearly defined;
• individual tolerance of folk remedies is not taken into account;

The advantages include a wide therapeutic range, a wide choice for external use. Homemade compresses and tinctures, ointments are popular.

The effectiveness of home treatment can be justified by the fact that biologically active substances (gum, bile, infusions of medicinal plants) are used for the preparation.

Also, competent treatment with folk remedies begins with adherence to a diet, weight loss. This method alone, aimed at reducing the load on the joint, can reverse arthrosis of the knee joint of the 1st degree (the condition is young age, sufficient compensatory abilities). A healthy diet, in itself, stimulates the regenerative capacities of the body. The diet includes: a slight feeling of hunger, vegetables, freshly squeezed juices. It is advisable to add low-fat jellies, jellies to the diet.

The external means are very diverse. They mainly have an irritating and warming effect. The most studied components are bile, dimethyl sulfoxide and bischofite. Bile should be used for medical purposes and not independently extracted from the corpse of an animal. Dimethyl sulfoxide is an analogue of a chemical warfare agent, mustard gas. Bischofite is a petroleum derivative. This is the original difference.

All three drugs have an anti-inflammatory effect, however, at home they should be used only after consulting a doctor. These substances also have contraindications and features of application.

One should not forget about the placebo effect in the treatment of folk remedies.

The last thing I want to say is that a person only has one health. You should not completely rely on the seeming simplicity and cheapness of folk remedies. If you have already decided to try them, focus more on the painful joint. The progression of the disease against the background of treatment with folk remedies is a reason for reconsidering the therapeutic approach.

If osteoarthritis of the knee joint grade 2 or higher is diagnosed, it is better not to mess with traditional medicine. Or postpone it for a period of remission. Unsatisfactory treatment is an indication for complex surgical intervention.