Osteoarthritis of the knee joint (knee joint): diagnosis and treatment

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

Prevalence

The pathology of the articular cartilage of a degenerative-dystrophic nature with the participation of bone tissue, synovial sac, ligaments and muscles in the process is called deforming arthropathy. In terminology there are synonyms:

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

In terms of frequency, the damage to the knee comes immediately after the hip joint, so a fixed phrase has been formed: "knee joint genarthrosis". 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 older	eleven%

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

In the field of persistent disability, degenerative arthropathy of the knee joint accounts for almost 30% of all causes of disability related to joint pathology.

Classification of gonoarthrosis

For reasons of development, the disease is divided into two large groups: primary and secondary. The primary arises without visible prerequisites. Secondary is preceded by (or accompanied by) precipitating factors:

1. biomechanics disorders: injuries, excessive loads, developmental abnormalities (dysplasia), skeletal pathology (scoliosis, flat feet), obesity.
2. inflammatory processes: aseptic or infectious arthritis, frequent hemarthrosis in hemophilia.
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 postthrombovenous syndrome, obliterative endarteritis, atherosclerosis of the vessels of the lower limb.

In medical practice, classification according to the severity of pathological changes is more useful. Evaluation is done according to X-ray studies. The most popular clinical and radiological classification.

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The image shows a slight narrowing of the interarticular space (compared to a healthy joint), the beginning of hardening of the perichondrial bone tissue. Clinically - pain occurs during walking or immediately after it, with prolonged standing. More pronounced when climbing stairs. It goes into a state of rest. 1st degree gonoarthrosis does not greatly affect the function of the joint.

II stage

The joint space is 2-3 times narrower than normal. Sclerosis is more intense, osteophytes are found (spiky growths of bone tissue along the edges of the joint space and condyles). The pain is moderate, there are signs of muscle scholarship, lameness. Distortion of the knee in the frontal axis is visible. 2nd degree gonoarthrosis leads to noticeable limitation of joint mobility.

III stage

Hardening of cartilaginous elements, deformation of articular surfaces. There are areas of subchondral necrosis, local osteoporosis. Cysts in adjacent bone tissue. The joint space is critically narrow, sometimes not defined. Osteophytes of considerable size. Atrophy of the muscles of the thigh and lower leg, the joint is unstable, there is a strong deformity. Movement in the knee is sometimes impossible, a contracture is formed. When moving - severe pain, lameness.

This classification approach is convenient as it allows evaluation 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.

Development mechanism

The pathogenesis of any arthropathy goes through three stages:

1. Damage to cartilage microstructures. Under the influence of any of the harmful factors, compounds of high molecular efficiency lose their strength and are enriched with water molecules. The ability of low molecular weight collagens to assemble into macromolecules is reduced. This leads to a decrease in the strength and durability of the hyaline cartilage. Chondroprotectors neutralize such phenomena.
2. If the causative factor is not eliminated, the weakening of cartilage components (glycosaminoglycans, proteoglycans) continues. This leads to the activation of the recovery processes. Their power reserve is not particularly large, so this stage quickly passes to the next.
3. Disruption of compensatory mechanisms leads to progressive destruction of articular cartilage, death of its cells - chondrocytes. The cartilage fissures extend into the underlying bone. The degree of detachment of cartilaginous components increases, their defibrillation occurs, which leads to thinning of the vitreous membrane.

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

Diagnostics

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

Objective examination

It includes clarification of the patient's life history, circumstances preceding the development of knee joint arthrosis, collection of complaints and examination. Along the way, the presence of causative factors and their degree of influence on the development of the disease is clarified.

At this stage, it is important to know the condition of the second knee. If you skip the bilateral knee joint and focus only on the knee you are most concerned about, you can make a gross diagnostic error.

For this, functional tests should be performed on both ends simultaneously. Attention is drawn to the pain of active and passive movements, sensitivity to palpation, screaming (squealing) during extension and flexion. Chronic inflammatory processes lead to the appearance of a Becker cyst - a protrusion of the synovial sac in the popliteal fossa, which can also be detected by palpation.

Instrumental Methods

The first is X-ray. An image of the knee in two projections allows a preliminary assessment of the condition of the joint and determination of the stage of the disease. The disadvantage of the method is that radiological signs appear later than the symptoms and morphological changes that accompany arthropathy of the knee joint.

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

Direct examination of the joint cavity is possible with arthroscopy.

To unify diagnostic data, the American College of Rheumatology proposed the following criteria:

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

If these symptoms are accompanied by osteophytes detected on X-ray and pain, it is very likely that knee joint gonarthrosis occurs.

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

All possible measures should be taken not to confuse gonoarthrosis with the following conditions:

Rheumatoid arthritis	Onset at a young age, stiffness in the morning for more than 30 minutes, pain worse at rest and weaker on movement, rheumatoid nodules on the skin, concomitant damage to internal organs, symptoms of poisoning (fever, sweating), C-reactive protein in blood tests.
Crystalline arthritis	The pain is sharp, at night or in the morning. the skin over the affected joint is swollen, red, hot. crystals in microscopic examination of synovial fluid, increase in uric acid in the blood (with gout).
Vertebral arthropathies	Arthritis of other, unrelated joints (intercostal, lumbar joint). 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 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 specialized treatment.

Therapeutic measures

If there is a disease, there must be ways to treat arthropathy of the knee joint. And there are. Help can be provided in a number of ways.

In the first place are the achievements of traditional medicine, based on a deep study of the causes and mechanism of the disease. Medical and surgical methods are used here. Appropriate 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 put it mildly, is doubtful. But they are used, because it is possible to reduce the manifestations of the disease at home. Folk remedies can only be used as an addition to drug treatment or as part of complex treatment, it is imperative to obtain the consent of the attending physician!

Medical Assistance

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

1. non-steroidal anti-inflammatory drugs, analgesics, opiates.
2. slow-acting symptomatic drugs (chondroprotectors).
3. glucocorticoid hormones?

NSAIDs, rapid pain relievers, opiates

Medicines of this group are designed to eliminate pain. The pain syndrome slightly spoils the life of patients with arthropathy, its removal 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 is injections. Intramuscular administration damages the stomach less and accelerates the effect.

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

The main advantage of NSAIDs is the many forms of topical treatment (ointments, gels). It allows you to control the manifestations of the disease at home.

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

Symptomatic slow-acting drugs

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

The effect develops in several weeks (2-8) and remains 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 chondroprotectants (chondroitin sulfate and glycosaminoglycans) are ready components of articular cartilage. It is well absorbed into the blood, forming high concentrations in the joint cavity. To speed up the result, injections can be made directly into the joint.

Chondroitin sulfate, taken in courses for two years at a daily dose of 800 mg, has been shown to have a stabilizing effect on the joint space in 2nd degree knee osteoarthritis.

Avocado/soy compounds have an anti-inflammatory effect. Due to the inhibition of collagenase (a decaying enzyme), they significantly slow down the destruction of cartilage, increase the synthesis of "their" 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 condition of the knee joint.

The mechanism of action of various drugs of slow symptomatic action 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 effects, so you should not abuse hormonal drugs for deforming arthropathy of the knee joint.

Team name	Advantages	Defects
NSAIDs, pain relievers, opiates	Fast result, many forms for local application.	Side effects, unstable effect, dangerous for age-related patients, addiction occurs.
Carboprotectors	They act pathogenetically, have a lasting effect, are non-toxic, there are forms for external and intra-articular use.	Slow development of the effect.
hormones	Quick result where NSAIDs are not enough. forms for intra-articular administration.	Side effects, unstable effect, long-term use is impossible.

ethnoscience

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 large selection for external use. Homemade compresses and tinctures, ointments are popular.

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

In addition, proper 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 osteoarthritis of the knee joint of the 1st degree (the condition is young age, sufficient compensatory abilities). A healthy diet, in itself, stimulates the body's regenerative abilities. The diet includes: a slight feeling of hunger, vegetables, freshly squeezed juices. It is recommended to add low-fat jelly, jelly to the diet.

The external means are very different. They mainly have an irritating and warming effect. The most studied components are bile, dimethylsulfoxide and discofite. Bile should be used medicinally and not independently extracted from an animal's corpse. Dimethyl sulfoxide is an analogue of a chemical warfare agent, mustard gas. Bischofite is an oil derivative. This is the difference in origin.

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.

We must not forget the placebo effect in the treatment of folk remedies.

The last thing I want to convey is that a person has a health. You should not completely rely on the apparent simplicity and cheapness of folk remedies. If you have already decided to try them, increase your attention to the painful joint. The progression of the disease in the context of treatment with folk remedies is a reason to reconsider the approach to treatment.

If you are diagnosed with osteoarthritis of the knee joint grade 2 or higher, it is better not to engage in traditional medicine. Or postpone it for a period of recession. Unsatisfactory treatment is an indication of complicated surgery.