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 osteoarthritis of the knee. The knee joint functions in the mode of axial compression, due to which its articular surfaces are subjected to constant loads and undergo degenerative changes in the hyaline cartilage.

Distribution

The pathology of the articular cartilage of a degenerative-dystrophic nature with the participation of bone tissue, joint 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, damage to the knee comes immediately after the hip joint, so a stable phrase is formed: "gonarthrosis of the knee joint". The dependence of the frequency of the disease on age has been studied:

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

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

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

Classification of gonarthrosis

For reasons of development, the disease is divided into two large groups: primary and secondary. The primary arises without apparent prerequisites. Secondary is preceded (or accompanied by) provoking 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. disorders of adequate blood supply: varicose veins and post-thrombophlebitic syndrome, obliterating endarteritis, atherosclerosis of the vessels of the lower limb;

In medical practice, classification according to the severity of pathological changes is more useful. The assessment is based on x-rays. The most popular clinical and radiological classification.

I stage

The photo shows a slight narrowing of the interarticular space (a comparison is made with a healthy joint), the beginning of sclerosis of the pericartilaginous bone tissue. Clinically - the pain appears during walking or immediately after it, during prolonged standing. More pronounced when walking up stairs. Goes to rest. Gonarthrosis of the 1st degree does not significantly affect the function of the joint.

II stage

The joint space is 2-3 times narrower than normal. Sclerosis is more pronounced, osteophytes (sharp growths of bone tissue on the edges of the joint cleft and condyles) are found. The pain is moderate, there are signs of muscle hypotrophy, lameness. A knee deformity is visible in the frontal axis. Gonarthrosis of the 2nd degree leads to a noticeable limitation of the mobility of the joint.

III stage

Sclerosis of cartilaginous elements, deformation of joint surfaces. There are areas of subchondral necrosis, local osteoporosis. Cysts in adjacent bone tissue. The joint space is critically narrowed, sometimes ill-defined. 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. When moving - severe pain, lameness.

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

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 are 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 counteract such 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 stage quickly passes into the next.
3. Violation of compensatory mechanisms leads to progressive destruction of articular cartilage, death of its cells - chondrocytes. Cartilage cracks extend to the underlying bone. The degree of separation of cartilage components increases, their defibration occurs, which leads to thinning of the hyaline membrane.

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

Diagnosis

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

Objective research

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

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

For this, functional tests should be performed on two limbs at once. Attention is paid to pain during active and passive movements, sensitivity to palpation, crepitus (crunching) during extension and flexion. Chronic inflammatory processes lead to the appearance of Becker's cyst - a protrusion of the joint bag in the popliteal fossa, which can also be detected by palpation.

Instrumental methods

The first is radiography. A photograph 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 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 connections, menisci. Scintigraphy in gonarthrosis of the knee joint provides data on the functional status.

With arthroscopy, direct examination of the joint cavity is possible.

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

• Age over 50 years.
• Stiffness in the joint in the morning, lasting at least half an hour.
• Motion-induced cracking (active and passive).

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

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

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

Rheumatoid arthritis	Onset at an early age, stiffness in the morning for more than 30 minutes, pain, stronger at rest and weaker with movement, rheumatoid nodules on the skin, concomitant lesions of the internal organs, symptoms of intoxication (fever, sweating), C-reactiveprotein in blood tests.
Crystal 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 the synovial fluid, increase in 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 assigned an "M" index, 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 treat osteoarthritis 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 a thorough 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, physiotherapeutic methods and rehabilitation measures.

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

medical assistance

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

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

NSAIDs, rapid analgesics, opiates

Medicines from this group are designed to eliminate pain. The pain syndrome significantly 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 the side effects, drugs from this group are prescribed during exacerbations, careful selection of the dose is required.

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

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

Slow-acting symptomatic drugs

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 withdrawal 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 researched and popular chondroprotectors (chondroitin sulfate and glycosaminoglycans) are ready-made components of articular cartilage. Well absorbed into the blood, they form high concentrations in the joint cavity. To speed up the effect, 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 gap in knee gonarthrosis of the 2nd degree.

Avocado/soy combinations have anti-inflammatory effects. Due to the inhibition of collagenase (degrading enzyme), they significantly slow down the destruction of cartilage, increase the synthesis of "own" collagen. In addition, they are very well tolerated.

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

The mechanism of action of different drugs with slow symptomatic action is slightly different, therefore their combined use is recommended. The high level of safety allows you to take chondroprotectors for a long period of time without noticeable harm to the body.

Glucocorticosteroids

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

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

Group name	Advantages	disadvantages
NSAIDs, analgesics, opiates	Fast effect, multiple forms for local application.	Side effects, unstable effect, dangerous for age-related patients, addiction occurs.
Chondroprotectors	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	Fast effect where NSAIDs are not enough; forms for intra-articular administration.	Side effects, unstable effect, long-term use is impossible.

ethnic female

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;
• the exact dosage of the medicinal substance is impossible;
• indications are not clearly defined;
• the individual affordability of public funds is not taken into account;

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

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

In addition, competent treatment with folk remedies begins with adherence to a diet, weight loss. Only this method, aimed at reducing the load on the joint, can cure knee arthrosis 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 jellies, jellies to the diet.

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

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

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

The last thing I want to convey is that one has one health. You should not completely rely on the obvious 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 against the background of treatment with folk remedies is a reason to reconsider the approach to therapy.

If knee arthrosis of 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.