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

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

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Degenerative-dystrophic articular cartilage pathology with the participation of bone tissue, articular bag, ligaments and muscles in the process is called deforming arthrosis. There are synonyms in the terminology:

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

In terms of frequency, the knee injury comes immediately after the hip joint, so a stable expression has appeared: "gonarthrosis of the knee joint". Age dependence of the frequency of the disease 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, representatives of the fairer sex have a quantitative advantage. In them, knee arthrosis occurs 1, 2-1, 4 times more often than in men.

In the field of permanent disability, deforming arthrosis of the knee joint accounts for almost 30% of all causes of disability related to joint pathology.

Classification of gonarthrosis

According to the causes of development, the disease is divided into two large groups: primary and secondary. It arises without initial apparent preconditions. Preceded by (or accompanied by) secondary precipitating factors:

1. biomechanical disorders: injuries, excessive loads, developmental anomalies (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. violation of adequate blood supply: varicose veins and post-thrombophlebitis syndrome, obliterating endarteritis, atherosclerosis of the vessels of the lower extremities;

Classification according to the severity of pathological changes is more useful in medical practice. Evaluation is based on x-ray studies. The most popular clinical and radiological classification.

I scene

The picture shows a slight narrowing of the interarticular space (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, when standing for a long time. It is more obvious when going up the stairs. Takes time off. 1st degree gonarthrosis does not affect the function of the joint much.

II stage

The joint space is 2-3 times narrower than normal. Sclerosis becomes more obvious, osteophytes are revealed (spiky growths of bone tissue along the edges of the joint cavity and condyles). The pain is moderate, there are signs of muscle hypotrophy, lameness. Deformation of the knee is visible on the frontal axis. Grade 2 gonarthrosis causes significant limitation of joint mobility.

III stage

Sclerosis of cartilage elements, deformation of articular surfaces. There are areas of subchondral necrosis, local osteoporosis. Cysts in adjacent bone tissue. The joint space is critically narrowed, sometimes not defined. Large size osteophytes. Atrophy of the muscles of the thigh and lower leg, the joint is unstable, there is an obvious deformation. Movement in the knee is sometimes impossible, contracture occurs. When moving - severe pain, lameness.

This approach to classification is convenient, allowing to assess clinical manifestations related to organic changes. This makes it possible to choose a more effective treatment based on a comprehensive assessment of the joint condition.

Mechanism of development

The pathogenesis of any arthrosis goes through three stages:

1. Damage to cartilage microstructures. Under the influence of any of the damaging factors, high-molecular 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 the hyaline cartilage. Chondroprotectors prevent such events.
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 so great, so this stage quickly moves to the next stage.
3. Disruption of compensatory mechanisms leads to progressive destruction of articular cartilage, death of its cells - chondrocytes. Cartilage cracks extend to the lower bone. The degree of separation of cartilaginous components increases, their defibration occurs, which leads to thinning of the hyaline membrane.

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

Diagnostics

The diagnosis is based on a collection of data obtained as a result of questionnaire (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, conditions before the development of gonarthrosis of the knee joint, collection of complaints and examination. The presence of provoking factors in the process and the degree of their influence on the development of the disease are clarified.

At this stage, it is important to study the condition of the second knee. If you miss bilateral gonarthrosis and focus only on the knee that bothers you the most, you can make a gross diagnostic error.

For this, functional tests should be performed on two limbs at the same time. Attention is focused on pain with active and passive movements, sensitivity to palpation, crepitus (crunching) during stretching and bending. Chronic inflammatory processes cause the appearance of Becker's cyst - the protrusion of the articular bag into the popliteal fossa, which can also be detected by palpation.

Instrumental methods

The first is radiography. The image of the knee in two projections allows for an initial assessment of the state of the joint and determining the stage of the disease. The disadvantage of the method is that radiological signs occur later than the symptoms and morphological changes accompanying knee arthrosis.

In such cases, MRI (magnetic resonance imaging) 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 intra-articular ligaments and menisci. Scintigraphy for gonarthrosis of the knee joint provides information on the functional status.

Direct examination of the joint cavity is possible with arthroscopy.

The American College of Rheumatology proposed the following criteria for inclusion of diagnostic data:

• Over 50 years old.
• Stiffness in the joint in the morning lasting at least half an hour.
• Motion-defined cracking (active and passive).

If these symptoms are accompanied by osteophytes detected on X-ray and pain, there is a high probability of gonarthrosis of the knee joint.

The initial stages of the disease cannot be pronounced, so it is necessary to carry out differential diagnosis with other articular pathologies, in which pathogenetic drugs (chondroprotectors) for osteoarthritis will be ineffective.

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

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

In the International Classification of Diseases of the Tenth Revision (ICD 10), all these diseases are given the index "M", but a different numeric 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 treat arthrosis of the knee joint. And they exist. Help can be provided in a variety of ways.

In the first place are the achievements of traditional medicine based on the deep study of the causes and mechanism of the disease. 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 is questionable, to put it mildly. But they are used because it is possible to reduce the manifestations of the disease at home. Folk remedies can be used only in addition to drug treatment or as part of complex therapy, it is important to get the consent of the attending physician!

medical assistance

This type of treatment involves the use of various drugs. Drugs from different groups are used for drug effects:

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

NSAIDs, rapid analgesics, opiates

Medicines of this group are designed to relieve pain. Pain syndrome greatly 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 have a negative effect on the kidneys and the protective mechanisms of the gastrointestinal tract. Alternative injections that can reduce adverse effects. Intramuscular administration causes less damage to the stomach and accelerates its effect.

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

The main advantage of NSAIDs is many forms for local 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 due to the ineffectiveness of the other two groups. The most popular opiate is prescribed during exacerbations, more often with bilateral gonarthrosis. These drugs are addictive. You can't take them alone!

Slow-acting symptomatic drugs

The effect of these substances is two-fold: they have the ability to reduce pain (like NSAIDs) and help restore hyaline cartilage. Often they are called chondroprotectors.

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

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

The most studied and popular chondroprotectors (chondroitin sulfate and glycosaminoglycans) are ready-made components of articular cartilage. It is well absorbed into the blood, forming high concentrations in the joint space. To accelerate the effect, injections can be made directly into the joint.

It has been proven that chondroitin sulfate taken in a daily dose of 800 mg for two years has a stabilizing effect on the joint cavity in 2nd grade knee gonarthrosis.

Avocado/soy combinations are anti-inflammatory. Due to the inhibition of collagenase (a decomposing enzyme), it significantly slows down the destruction of cartilage, increases the synthesis of "own" collagen. They are also very well tolerated.

Hyaluronic acid derivatives are used in the form of articular injections. These agents, like chondroprotectors, improve the functional condition of the knee joint.

The mechanism of action of different drugs with a slow symptomatic effect is slightly different, so their joint use is recommended. A high level of safety allows you to take chondroprotectors for a long time without causing serious harm to the body.

Glucocorticosteroids

The main action is anti-inflammatory. These funds are prescribed in cases where NSAIDs are ineffective. Tablet forms also damage the lining of the stomach. There are forms for intra-articular injection.

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

Group name	Advantages	Defects
NSAIDs, analgesics, opiates	Fast effect, many forms for topical application.	Side effects, unstable effect, dangerous for age-related patients, addiction occurs.
Chondroprotectors	They have pathogenetic activity, have a permanent effect, are non-toxic, and have forms for external and intra-articular use.	Slow development of the effect.
Hormones	Rapid action where NSAIDs are insufficient; 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 here are a few:

• no clinical studies have been conducted;
• it is impossible to determine the exact dose of the medicinal substance;
• signs 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 use of biologically active substances (gum, bile, infusions of medicinal plants).

In addition, competent treatment with folk remedies begins with following a diet, losing weight. Only this method, 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 capacity). Healthy nutrition itself stimulates the body's regenerative abilities. Diet includes: light hunger, vegetables, freshly squeezed juices. It is recommended to add low-fat jelly and jelly to the diet.

External means are very diverse. They are mainly irritating and warming. The most studied components are bile, dimethyl sulfoxide and bischophyte. Bile should not be removed independently from the animal's carcass and should be used medically. Dimethyl sulfoxide is an analogue of the chemical warfare agent, mustard gas. Bishofite is a derivative of petroleum. That is the difference of origin.

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

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 trust the apparent simplicity and cheapness of folk remedies. If you decide to try them, pay more attention to the painful joint. The development of the disease against the background of treatment with folk remedies is a reason to reconsider the approach to therapy.

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