Polyosteoarthritis of the joints

Osteoarthritis, or polyosteoarthritis of the joints, is a lesion of multiple mobile joints - both intervertebral and peripheral, small and large. The basis for the development of pathology is the process of generalized chondropathy. Against the background of changes in the mechanical resistance of cartilage tissue, multiple lesions of articular elements develop. The risks of pathology increase with age, as well as with excessive loads, injuries, surgeries, background pathologies (including endocrine and hormonal). [1]

Epidemiology

Polyosteoarthritis refers to heterogeneous pathologies with different etiologies but similar biomorphologic and clinical features. The basis of the disease is the lesion of all articular components, cartilage of several joints, as well as subchondral bone, ligamentous apparatus, synovial membrane, bursa and periarticular muscles.

The pathology is actively studied, but its prevalence is not clearly defined. The disease is believed to affect up to 20% of the world's population, with a statistical increase of at least 30-35% in recent decades.

Clinical symptoms are found predominantly in elderly people over 60 years of age (according to different data - from 55 to 70 years). A characteristic radiologic picture is detected in 35-45% of men and 25-30% of women aged 60 years, and in 80% of patients over 75 years. [2], [3]

In women, the knee joints, the thoracic and cervical spine, the joint at the base of the big toe, and the articulations of the fingers and toes are more commonly affected. In men, the hip, wrist, and ankle joints are predominantly affected, as well as the temporomandibular joint and the lumbar spine.

Polyosteoarthritis is often an indication for endoprosthesis, and polyosteoarthritis in most cases leads to premature loss of function and disability. [4]

Causes of the polyosteoarthritis of the joints

Polyosteoarthritis is considered to be a polyetiologic disease, i.e., it has not one but a number of possible causes for its development. In this case, the actual cause is considered to be disturbed biological characteristics of cartilage tissue, which is also caused by the following factors:

• general failure of regeneration processes, activation of cartilage destructive reactions, which in many cases is of idiopathic origin (the cause is unknown);
• other pathologies and pathological conditions in the body;
• excessive pressure on the musculoskeletal system, regular overload (e.g., if the person is obese);
• hormonal imbalances (e.g., menopausal women);
• trauma and joint injuries;
• joint surgery (regardless of the initial success of the surgery).

The etiologic factor may be both natural aging of tissues and the appearance of corresponding changes in young people (so-called premature aging of the organism) as a result of cartilage trophism disorders. These processes lead to rapid wear and tear of cartilage tissue. With the development of polyosteoarthritis, there is an accumulation of salts in the periarticular structures, joint distortion and inflammatory reaction of the articular bursa.

Polyosteoarthritis in most cases is combined with other degenerative pathologies of the musculoskeletal system - in particular, with osteochondrosis, deforming spondylosis. The etiology is not fully understood, but the factors that lead to the development of polyosteoarthritis are divided into hereditary and acquired factors. [5]

Risk factors

A distinction is made between primary and secondary polyosteoarthritis. The main factors that provoke the development of primary pathology include:

• excessive or repetitive strain that significantly exceeds the physical capacity of the cartilage (in particular, this includes intense sports or heavy physical labor);
• overweight.

Congenital pathology leading to a disorder of joint biomechanics and impaired adequate distribution of load vectors on joint cartilage can be presented:

• congenital dysplasia;
• with deforming diseases of the spinal column;
• with skeletal developmental defects;
• with underdevelopment and increased mobility of the ligamentous apparatus.

In addition, the structure of cartilage tissue can change as a result of microtrauma, impaired microcirculation, traumatic injuries (intra-articular fractures, subluxations and dislocations, hemarthrosis).

Secondary polyosteoarthritis is often provoked:

• inflammatory diseases (infections or traumatic inflammation);
• congenital joint dysplasia and impaired joint development;
• instability (including post-traumatic instability);
• endocrine pathologies (e.g. Diabetes mellitus);
• metabolic disorders (gout, hemachromatosis);
• bone necrosis;
• severe intoxication or rheumatologic pathologies.

For example, polyosteoarthritis is often found in patients with rheumatoid arthritis, systemic lupus erythematosus, hematologic diseases (hemophilia).

Pathogenesis

In polyosteoarthritis, the articular cartilage is the primary lesion. Joints are formed by articular bone surfaces covered by cartilage tissue. During motor activity, cartilage acts as a kind of shock absorber, which reduces pressure on the bony articulations and ensures their smooth movement relative to each other. [6]

The cartilage structure is represented by connective tissue fibers loosely localized in the matrix. This is a jelly-like substance formed by glycosaminglycans. Thanks to the matrix, cartilage is nourished and damaged fibers are restored.

In its structure, cartilage resembles a spongy substance - at rest it absorbs fluid, and in the process of loading it withdraws moisture into the joint cavity, as if lubricating it.

Over the years of life, cartilage has to react and bear a huge amount of stress, which gradually leads to changes and destruction of individual fibers. If the joint is healthy, the damaged structures are replaced in the same amount by new fibers. If the balance between the formation of new building material and destructive processes in cartilage tissue is disturbed, polyosteoarthritis develops. Damaged cartilage loses its absorption capacity, the joint becomes drier. There are also pathological changes in the bone tissue: osteophytes are formed as a reaction to the thinning of cartilage by increasing the articular surfaces. As a result of these processes, the deformity of the joint increases.

In polyosteoarthritis, several joints are affected at the same time. These can be small joints of hands and feet, supporting joints (coxarthrosis, gonarthrosis). [7]

Symptoms of the polyosteoarthritis of the joints

The disease is characterized by a slow progression. Acute periods of joint swelling are atypical. Most often, the first signs appear gradually, after which they slowly progress.

Clinical symptomatology in polyosteoarthritis is represented by joint pain mechanical frequency - that is, the pain syndrome occurs during movements due to friction between joint surfaces. Pain becomes more intense at the end of the working day, closer to the evening, sometimes in the first half of the night (prevents sleep, becomes the cause of insomnia). In the morning, after rest, painful signs practically "disappear", resuming again after physical activity.

Polyosteoarthritis of small joints and some large joints may be accompanied by the ingress of fragments of diseased cartilage or parts of marginal growths into the joint cavities, which leads to the appearance of so-called block pain - that is, a feeling of "sticking", especially during repetitive movements of the limbs.

Occasionally, patients report the presence of crunching during motor activity, although this is not a specific sign. There may be stiffness after rest, but this condition is not prolonged (no more than half an hour) and localized (in one joint or in a limited joint group), which is a distinctive sign from inflammatory pathological processes.

During the examination, a violation of the shape, contour of articulations (limb deformities) may draw attention. For example, polyosteoarthritis of the knee joint is often accompanied by the formation of O-shaped legs, which is explained by narrowing of the articular gap of the medial part. Polyosteoarthritis of the hand joints may occur with nodular growths on the anterolateral surfaces of the proximal and distal interphalangeal joints (Bouchard's and Geberden's nodes).

When determining the volume of passive and active motor skills, a pronounced limitation is detected, which worsens over time. When palpating the joints, crepitation (painful crunch) may be detected. Palpation of soft tissues near the affected joints allows you to find locally painful places in the area of attachment of the ligamentous apparatus, bursa, tendons. This symptom is explained by excessive tension of some soft tissue elements due to altered joint configuration.

In some cases, polyosteoarthritis of large joints may be accompanied by synovitis - formation of joint effusion, although there is no diffuse pain syndrome typical of arthritis. When analyzing synovial fluid, signs of inflammation can be detected (in polyosteoarthritis, the fluid is clear, the number of leukocytes is less than 2000 per 1 mm³).

Polyosteoarthritis of the hip or other loaded joints is predominantly symmetrical. Asymmetry is more often detected in patients with osteoarthritis of other etiology, or in secondary polyosteoarthritis.

The lesion usually affects the following joint groups:

• hip joint - in about 40% of cases;
• knee joint - in 30-35% of cases;
• Less frequently, interphalangeal, carpal-carpal, acromial-clavicular, metatarsophalangeal, and intervertebral joints.

Polyosteoarthritis of the fingers is characterized by these clinical manifestations:

1. Formation of compacted nodules on the lateral surfaces of the distal interphalangeal joints (so-called Heberden's nodules), on the outer-lateral surface of the proximal interphalangeal joints (Bouchard's nodules). When nodules appear, there is a burning sensation, tingling, numbness, and this symptomatology disappears after the nodular elements are formed.
2. Pain syndrome and relative intra-articular stiffness, insufficient motor volume.

If the formation of the above nodules is noted in the patient, then in this situation it is said about the unfavorable course of the pathology.

In most cases, the metacarpal joint is found in patients in the menopausal period. In this case, bilateral polyosteoarthrosis is more often diagnosed, which is accompanied by pain in the area of the connection of the metacarpal and trapezius bones when making movements with the thumb. In addition to pain, the motor volume is often limited, crunching appears. With a strong and neglected pathological process, the hand is curved.

As for the feet of the lower limbs, many small joints, subtalar ligaments, cuboid-femoral joint, metatarsal joint and ligaments can be affected. Polyosteoarthritis of the feet "gives itself away" by such symptoms:

• pain occurring after prolonged walking, standing, after overloading;
• swelling and redness of the skin in the affected joint areas;
• painful reaction of the joints to a sudden change in weather conditions, to exposure to cool air or water;
• crunching of the feet during movement;
• rapid leg fatigue, morning stiffness;
• the appearance of calluses on the foot.

As a result of the joint deformity, a person may experience a change in gait, thickening of the fingers, and bony overgrowths.

Polyosteoarthritis of the tarsal foot is manifested by pain and limitation of movement of the big toe. Moreover, the joint is often deformed, becomes susceptible to injury (including when wearing shoes). Inflammatory processes (bursitis) often occur.

Polyosteoarthritis of the ankle is prone to slow, gradual progression, with increasing symptoms over several years:

• pain appears, pulling, aching, with a gradual increase in intensity;
• changes in gait, limp;
• movements become stiff (especially in the morning);
• the joint is warped.

It is not difficult to notice that the main manifestations of polyosteoarthritis of any localization occur approximately the same. There is pain in the joint, felt in the depth of the structure, increasing with load, during sports training or other physical activity, and decreasing during rest. In the morning, the articulations are poorly extensible, crunching is felt. Gradually, the pain increases, and movements become more and more limited. [8]

Stages

The development of polyosteoarthritis goes through stages such as these:

• Grade 1 polyosteoarthritis is characterized by the presence of small morphological intra-articular changes - in particular, the fibrous tissue structure. There is pain during physical activity, and X-rays show narrowing of the joint gap.
• Polyosteoarthritis of the 2nd degree is manifested by a constant pain syndrome in the area of the affected joints. X-ray picture consists in a clear narrowing of the joint gap, the appearance of osteophytes. The surface of the cartilage becomes bumpy.
• Polyosteoarthritis of joints of the 3rd degree reveals itself not only with pain syndrome, but also with a violation of joint function. Cartilage is thinning, there may be a sharp decrease in the volume of synovial fluid.
• At the fourth degree of the disease osteophytes block the affected joints, movements become impossible.

Forms

Primary polyosteoarthritis is diagnosed if pathological changes in the structure of articular cartilage occur without a specific cause - that is, the pathology itself is a "starter".

Secondary polyosteoarthritis develops as a result of traumatic injury or disease (rheumatoid arthritis, aseptic necrosis, metabolic pathologies, etc.).

Deforming polyosteoarthritis is a disease that occurs with painful or painless joint deformity, against a background of satisfactory or severely impaired joint function. The deformity is usually pronounced, determined visually, and in the early stages is detected in the course of radiological diagnosis.

Polyosteoarthritis nodosa is accompanied by the formation of dense nodules - so-called Heberden's nodules. They are bony growths on the joint edges and may be painful in the initial stages. As they grow, the pain subsides but the deformity remains.

Generalized polyosteoarthritis is the most complex and severe form of the disease, which is accompanied by the lesion of many small and supporting joints. This pathology is characterized by the most unfavorable prognosis. [9]

Complications and consequences

In the absence of timely medical care, polyosteoarthritis can become a cause of disability, disability. Patients suffer from:

• from severe joint distortions;
• from loss of joint mobility;
• from limb shortening (particularly in gonarthrosis and coxarthrosis).

Often, patients have a change in posture and gait, there are problems with the spinal column, there is pain in the lower back, neck, behind the sternum.

Delaying treatment can lead to the development of:

• periarthritis (inflammation of the tissues surrounding the affected joint);
• synovitis (inflammation of the synovial membrane);
• Coxarthrosis (permanent damage to the hip joint).

With the appearance of inflammation, the risk of complete immobilization of the joint increases significantly, which can be the first step to the formation of severe disability. The patient loses the ability to move without aids (walkers, crutches) and sometimes even becomes immobilized.

Polyosteoarthritis, affecting medium and large joints, significantly worsens the quality of life and often leads to disability. The destructive process occurs quite quickly, the joints wear out without a chance of recovery. To prevent this and timely stop the destruction, you should not postpone visiting a specialist. For success in treatment, it is necessary to identify the disease as early as possible, which will slow down the wear and tear of joint structures and delay the need for surgical intervention. [10]

Diagnostics of the polyosteoarthritis of the joints

The diagnosis of polyosteoarthritis is established by an orthopedic traumatologist when typical clinical symptoms are detected against the background of X-ray findings. X-ray images reveal dystrophic changes in the cartilage of articulations and adjacent bones. The articular gap is narrowed, the bone surface is deformed (may be flattened), cyst-like growths appear. Subchondral osteosclerosis, osteophytes (bone tissue formations) are noted. Articular instability is possible: limb axes are distorted, subluxations are formed.

If radiologic examination does not demonstrate a complete picture of the disease, the patient is prescribed computed tomography and magnetic resonance imaging. If secondary polyosteoarthritis is suspected, consultations with other specialists such as endocrinologist, hematologist, surgeon, rheumatologist are indicated.

Analyses in the laboratory are represented by the following tests:

• general blood test with determination of the level of erythrocytes, leukocytes, platelets, hemoglobin in order to diagnose the inflammatory process;
• erythrocyte sedimentation rate - demonstrates the activity of the inflammatory reaction in the body;
• determination of rheumatoid factor - for differentiation with autoimmune pathologies;
• C-reactive protein and fibrinogen - to diagnose tissue inflammation.

Instrumental diagnostics in polyosteoarthritis is mainly represented by radiography: the degree of joint deformity and narrowing of the gap is visualized. In addition, magnetic resonance imaging or arthroscopy may be prescribed, but only in diagnostically complex and ambiguous situations. [11]

Differential diagnosis

The differences between polyosteoarthritis and inflammatory joint pathologies are summarized in the following table:

Polyosteoarthritis	Inflammatory pathologies
Pain occurs only on exertion, there may be starting pain (at first movements).	The pain syndrome is bothersome at rest, and gradually subsides during movements ("walking around").
The soreness subsides by morning.	Pain syndrome occurs in the morning, sometimes becomes the cause of early awakening of the patient.
Load bearing joints (knees, hips) are more often affected.	Synovial joints (elbows, feet, hands, etc.) may be affected.
The pain is strictly localized.	The pain is diffuse, diffuse.
The deterioration increases gradually.	The course is acute, attack-like.
Improvement comes after taking regular pain medications.	Improvement comes after taking anti-inflammatory drugs.
Morning stiffness is absent or brief (up to half an hour).	Morning stiffness is present and differs in duration (about an hour on average).
There is joint crunch, the appearance of bony growths, with normal general health.	Soft tissue edema, swelling, and general well-being are noted.
Synovitis is not intense. Radiologically, there are signs of periarticular osteosclerosis and marginal bone overgrowths, narrowing of the joint gap.	Synovitis is present, significant laboratory changes in acute phase parameters are noted. Osteoporosis, joint erosions are determined radiologically. The articular gap is narrowed or widened.

Treatment of the polyosteoarthritis of the joints

Treatment for polyosteoarthritis is long and complex. At the initial stage of the pathological process, it is often possible to slow its development with the help of medication and physical therapy. Advanced pathologies are usually not amenable to conservative effects, so surgical intervention is used to solve the problem.

In general, among the possible therapeutic interventions utilize:

• medications;
• physical therapy, physical therapy;
• surgical method.

Drug treatment is aimed at alleviating pain and restoring cartilage affected by polyosteoarthritis. It is known that the pain syndrome significantly worsens the quality of life of the patient, limiting his motor activity. Therefore, patients are universally prescribed analgesics and anti-inflammatory drugs, in particular:

• Nonsteroidal anti-inflammatory drugs (inhibit the development of inflammatory reaction, reduce pain);
• Corticosteroids (hormonal medicines that stop inflammation);
• antispasmodics (relieves muscle spasm).

Medications are prescribed for both topical and general use. In case of severe pain, intra-articular injection of medicinal solutions is allowed. The dosage, duration of the treatment course and frequency of use are selected by the doctor individually.

In addition, polyosteoarthritis is treated with drugs that help to restore and slow down the destruction of cartilage tissue. In particular, medications containing chondroitin, glucosamine are used in long courses of several months. [12]

In addition, complex therapy often includes non-medicamentous procedures:

• chiropractic care;
• Physical therapy, mechanotherapy;
• joint traction;
• physiotherapy (shockwave therapy, ozone therapy, applications of drugs, electrophoresis, ultraphonophoresis, etc.).

Surgical interventions are performed when there are strong indications, primarily when conservative treatment of polyosteoarthritis is ineffective. In such cases, it is mainly about endoprosthetics. The affected joint is removed and replaced by an implant that performs the joint function. This method is particularly often applied to the hip and knee joints.

Other possible operations include:

• corrective osteotomy (removal of a bone element with further fixation of the remaining elements at a different angle, which reduces the load on the diseased joint);
• arthrodesis (fixation of the bones to each other, which eliminates the subsequent mobility of the joint, but makes it possible to lean on the limb).

Medications

Drug therapy for polyosteoarthritis is prescribed during a relapse of the pathology and is aimed at symptom control, stopping the painful reaction in the joint or periarticular tissues. As a rule, nonsteroidal anti-inflammatory drugs - in particular, Diclofenac, Indomethacin, Ibuprofen, etc. - cope well with these goals. Since these drugs adversely affect the digestive system, they are taken after meals, in short courses, against the background of other drugs that protect the gastrointestinal tract (Omez).

More modern drugs that have a somewhat milder effect on the digestive organs are Movalis, Tinoktil, Arthrotec.

Diclofenac	In polyosteoarthritis, it is administered intramuscularly at 75 mg per day, or taken orally at 100 mg per day (in 2-3 doses). Possible side effects: abdominal pain, headache, heartburn, nausea, vertigo.
Movalis (Meloxicam)	It is taken orally at 7.5 mg per day with a maximum daily amount of 15 mg. Possible side effects: vascular thrombosis, peptic ulcer, nausea, diarrhea, abdominal pain, exacerbation of colitis.

It is mandatory to carry out local therapy. Indomethacin, Butadione ointment, as well as Fastum-gel, Diclofenac ointment, Dolgit cream, Revmagel are optimally suited for patients with polyosteoarthritis. External preparations are applied to the affected joints 2-3 times a day, for a long time.

Indomethacin ointment	The ointment is rubbed lightly into the area of the affected joints up to 4 times a day. Duration of treatment - up to 10 days. Time interval between applications of the ointment - at least 6 hours.
Diclofenac Gel	Lightly rub in 3-4 times a day. It is undesirable to use for more than 14 consecutive days. During treatment, temporary mild skin reactions may occur, which pass after completion of the treatment course. Rarely allergies are detected.

Compresses with dimexide have a good therapeutic effect: the drug can be purchased in a pharmacy, after which it should be diluted with boiled water in the proportion of 1:2 or 1:3. The solution can be supplemented with novocaine or analgin with hydrocortisone. The compress is placed on the affected polyosteoarthritis joint, for about 40 minutes before going to bed. The therapeutic course consists of 25 procedures. Therapy should not be carried out without prior consultation with a specialist (arthrologist, rheumatologist).

With pronounced symptoms of polyosteoarthritis, the doctor may prescribe intra-articular injections - in particular, it is possible to inject Celeston, Diprospan, Kenalog, Flosterone, Depomedrol into the joints, a short course of 1-2 injections.

Another category of frequently used drugs is chondroprotectors. These are specific medications that help to improve and strengthen the cartilage structure. Chondroprotectors do not relieve inflammation, act cumulatively, require long-term use (at least 6-8 weeks). The main components of such drugs are glycosamine and chondroitin sulfate - the basic building blocks of cartilage tissue.

There are also chondroprotectors that are not taken orally, but are injected intramuscularly. Such drugs include Mucartrin, Rumalon, Alflutop, Arteparon. The treatment course for polyosteoarthritis consists of 20-25 injections (every 48 hours).

In addition, may be prescribed treatment with homeopathic drugs Traumel, Target T - long courses, repeated twice a year.

Physiotherapy treatment

The following physical therapy treatments are indicated for polyosteoarthritis:

• Electrophoresis - allows you to deliver the drug directly to the affected tissues, combining the effect of galvanization and drug action.
• Galvanization - promotes activation of local blood flow, enhances the synthesis of bioactive substances. Provides anti-inflammatory, analgesic, anti-edematous effect.
• Electrical stimulation - helps restore sensitivity of nerve fibers and contractile activity of muscles, increases the rate of oxygen uptake by tissues, which leads to the activation of metabolic processes, improves blood circulation in the affected area.
• Diadynamic therapy - helps to eliminate pain syndrome, reduce muscle tension.
• Magnetotherapy (constant, pulsed) - increases tissue metabolism, has trophic, vasodilating, immunomodulatory effect.
• Thermal applications (means to stimulate cartilage regeneration, paraffin, therapeutic muds)

Schemes of physical therapy are selected by a specialist, taking into account the stage of the pathological process, the leading expressed symptom, the age of the patient, the presence of other diseases, except for polyosteoarthritis.

Most of the physiotherapies offered by doctors have proven effectiveness and have been used in practice for many decades, preserving patients' quality of life, range of motion and ability to work. Some techniques have been improved over time: in particular, specialists have created devices that can be used at home (for example, for magnetotherapy).

Additionally, patients are shown climatotherapy:

• hydrotherapy (mineral, hydrogen sulfide baths);
• mud treatment, naphthalan treatment;
• manual therapy, kinesiotherapy.

Such methods play an auxiliary role in polyosteoarthritis, and in combination with other effects slow down pathological reactions in the joints, preserve mobility and performance.

Herbal treatment

Polyosteoarthritis requires comprehensive drug treatment. However, folk remedies can often be an effective addition, which are especially effective at an early stage of pathology development. There is a whole list of herbal remedies, such as decoctions, ointments, tinctures, recommended for use in polyosteoarthritis.

• Prepare an infusion based on calendula, bark and willow bark, as well as elderberry, nettle, horsetail, juniper berries. All ingredients are taken in equal amounts, mix well (it is convenient to use a coffee grinder or a meat grinder). Take 2 tbsp. Of the mixture, pour 1 liter of boiling water and insist in a thermos for several hours. The resulting drink is filtered and take 100 ml several times a day (3-4 times) for 2-3 months. Upon completion of treatment, the patient should feel stable relief and reduction of pain.
• Prepare an infusion of 4 parts of lingonberry leaves, the same amount of succession, 3 parts of the shoots of Ledum and the same amount of grass and the same amount of turfgrass, 3 parts of tricolor violet. Also take 2 parts of St. John's wort herb, mint leaves, poplar buds and linseed. The mixture is well grinded (you can run through a meat grinder or coffee grinder). Two tablespoons of the resulting mass pour 1 liter of boiling water, insist in a thermos for 3-4 hours. Then the remedy is filtered and take 100 ml 3-4 times a day. Duration of reception - 2-3 months.
• Prepare ointment based on the flowers of melilot, hop cones, flowers of St. John's wort and butter. Plant components are crushed, well mixed, select 2 tbsp. Add 50 g of butter and again mix well, leave for a few hours for "binding". Then the resulting ointment is applied to a clean gauze or cotton cloth, applied to the affected joints, wrapped with a piece of cellophane and a warm scarf. It is good to do such procedures at night, and remove the bandage early in the morning.
• Prepare a tincture based on the plants bear ear, lilac, wormwood, valerian. All ingredients are mixed in equal amounts. Three tablespoons are poured into a jar, pour 0.5 liters of vodka, cover with a lid. Infuse for one month, periodically shake. Then on the basis of the resulting tincture make compresses on the affected joints.
• Make a water compress: prepare a mixture of equal amounts of burdock leaves, mother and stepmother, white cabbage and horseradish. Plant mass is crushed, mixed with water to obtain a thick mass, which is spread on a piece of gauze or cloth, and then apply it to the affected joint (preferably overnight). Treatment is carried out daily for 2 weeks.

In addition to folk treatment, it is important to follow all the recommendations of doctors: in no case should not neglect taking medications, therapeutic exercises, correction of diet and lifestyle. Only with a comprehensive approach, the manifestations of the disease will be much reduced, and the process of inhibition of the pathological process will go faster.

Surgical treatment

Surgical interventions are performed when indicated, using gentle techniques at different stages of the disease - but only if drug treatment does not lead to the desired result. [13]

The main methods of surgical treatment for polyosteoarthritis are considered to be:

• Arthroscopy is an operation to remove the upper affected (worn out) joint layer. The appropriate qualifications of the surgeon are important: the operation is performed with jewel-like precision to avoid damage to normal healthy tissue. The head of the joint is partially prosthetized, which eliminates motor limitations and allows the patient to lead a normal life without pain.
• Endoprosthetics (joint replacement) is indicated in case of severe bone destruction. Artificial joints exactly replicate the anatomical configurations of the real joints and are manufactured using safe and strong materials.

Physical therapy for polyosteoarthritis

Patients are advised to pay attention to the performance of smooth, gentle exercises that improve blood flow in the area of the affected joints, increase their mobility and eliminate stiffness. Provided that regular exercises are performed, it is possible to maintain adequate motor volume and amplitude for a long time.

The most recommended aerobic exercises include light running, walking, swimming, cycling. The selection of exercises should be done by a doctor based on which joint groups are damaged and the degree of pathology. For example, cycling is more indicated for patients with gonarthrosis, and swimming will be useful for people with osteoarthritis of the hip joint.

Important: in the acute period of the disease exercise is not carried out. Return to gymnastics only after the elimination of inflammatory reaction and disappearance of pain syndrome (about 4 days after pain relief).

The standard set of exercises for patients with polyosteoarthritis includes working out the joints, strengthening periarticular muscles, training the vestibular apparatus.

For optimal therapeutic effect, a light massage should be performed before each workout to help tone the muscles, eliminate spasm and improve tissue nutrition. Each exercise should be repeated 5-6 times.

1. The patient lies on his back on the floor, stretches out his arms and legs. Alternately lift the limbs 15 cm off the floor and hold for 5 seconds. The limbs must not be bent: the muscles must be in a state of comfortable tension.
2. The patient lies on the right side, stretching as much as possible. Pulls the left limbs in opposite directions without bending the knees and elbows. Repeats the exercise by turning to the left side.
3. The patient sits on a chair, tries to pull the left elbow in front of the chest to the opposite shoulder. Repeats the exercise with the right arm.
4. The patient folds the fingers in a "lock", effortlessly raises the upper extremities above the head, turning the palms upward. It is normal to feel tension in the shoulders and upper back.
5. The patient lies on his back with his legs stretched out. Bend the knee, wrap the arms around it and pull it up to the chest. The back and head must not come off the floor.
6. The patient stands behind the chair, holding the back of the chair with his hands. Slowly bend the right leg at the knee joint and bring the left leg back, keeping it straight. The heel should not come off the floor. Bends the right knee, keeping the back straight.
7. Holds back of chair with left hand, rests on right foot. Wraps the foot of the left leg with the right hand. Slowly pulls the left heel to the gluteal region, repeats the exercise with the other leg.
8. The patient sits down on a mat with their legs straight out in front of them. Put a long scarf or plume over the feet, bend the arms at the elbows and pull the body to the feet. The exercise should be performed slowly, emphasizing tension on the inner thighs.
9. With hands on the back of the chair, the patient puts his feet shoulder-width apart, bends the knee of the right leg and holds it in a position parallel to the floor. Attempts a squat on the left leg, holding in a "squat" for a second. Then smoothly returns to the starting position and repeats the exercise with the other leg.
10. Holding the back of the chair with hands, spread legs shoulder-width apart. Keeps back straight, shoulders apart. Pulls the heels off the floor, staying on the toes for a second.
11. The patient sits on a chair (back straight). Raises the right leg and tries to hold it without bending it at the knee for a second. Repeats the exercise with the other leg.

To enhance the effect of treatment, it is recommended to adjust the diet and drink enough clean water throughout the day.

Nutrition in polyosteoarthritis

Correction of nutrition is not the main, but quite significant factor that contributes to strengthening and maintaining the health of the musculoskeletal system. In polyosteoarthritis, nutritionists recommend:

• balance the diet in terms of vitamins and minerals;
• eliminate unhealthy foods, convenience foods, alcoholic beverages;
• normalize the amount of salt in dishes;
• Ensure adequate fluid intake throughout the day;
• reduce the amount of simple carbohydrates in your diet.

Collagen and omega-3 fatty acids have a positive effect on the condition of mobile joints and, in particular, cartilage tissue. To ensure their residual intake into the body, it is necessary to include in the diet such products:

• bone broth, beef and chicken broth (the optimal daily portion for patients with polyosteoarthritis is 200-300 ml);
• Salmon (150 g per week is recommended);
• Greens (prevents premature collagen breakdown in the body, it is recommended to consume 100-150 g of fresh greens daily);
• Citrus (2-3 fruits daily);
• tomatoes (as an option - 200 ml of tomato juice daily);
• avocado (or avocado oil);
• berries (strawberries, strawberries, currants, raspberries, cranberries - up to 100 g daily);
• Eggs (no more than two eggs per day);
• pumpkin seeds (2 tbsp. Daily, can be added to salads, baked goods, porridge).

In addition, it is recommended to include cabbage, sea fish and shellfish, red vegetables and fruits, bananas, beans and garlic, flaxseed, soy and nuts in the weekly menu. Patients with polyosteoarthritis should completely eliminate sugar from the diet, which contributes to the gradual loss of elasticity of cartilage tissue.

Prevention

Polyosteoarthritis can be prevented and prevented by paying attention to joint health and the condition of the body as a whole from childhood.

• It is important to be physically active, exercise, excluding two extremes - hypodynamia and excessive physical activity.
• It is important to watch your own weight. Obesity puts increased strain on the musculoskeletal system: knee, hip and ankle joints are particularly affected.
• You should minimize the chance of injury by avoiding lifting and carrying heavy objects, prolonged standing or walking, and vibration.
• It is necessary to learn the correct distribution of load on the joints, as well as timely consult specialists for any injuries and inflammatory diseases that can cause the development of secondary polyosteoarthritis.
• It is necessary to eat a proper and nutritious diet, do not allow the deficiency of vital vitamins and minerals in the body, drink enough clean water throughout the day.

Forecast

Polyosteoarthritis is a complex disease with quite specific symptoms and complicated treatment. The success of treatment measures depends on many factors - both on the age of the disease, and on the patient's continued good lifestyle and adherence to all medical recommendations.

To improve the prognosis, you should eliminate the use of alcoholic beverages and harmful products, quit smoking. It is equally important to drink enough water per day. Every day you should take time for simple exercises that strengthen the musculoskeletal system.

In general, polyosteoarthritis, although progressive, responds well to most therapies. Complete disability is rarely awarded, as most patients experience exacerbations only occasionally, sporadically. Of course, intra-articular changes can not be reversed, but it is quite possible to stop further progression of the disease. It is important to follow all rehabilitation recommendations, avoid movements associated with excessive load on the affected joint, reduce certain types of physical activity (jumping, carrying heavy weights, squatting, etc.). Periods of moderate load should be alternated with periods of rest, regularly unloading the musculoskeletal system. Complete lack of physical activity is not welcome: mechanical joint inactivity leads to weakening of the already disturbed muscle corset, which in time becomes the cause of slow blood circulation, deterioration of trophism and loss of mobility.

Disability

Polyosteoarthritis is a serious progressive pathology that can negatively affect many of the patient's life plans. However, disability is not always assigned to patients, but only under certain conditions, such as:

• If the disease has been progressing for three years or more, and exacerbations occur at least 3 times a year;
• If the patient has already undergone surgery for polyosteoarthritis and there are some limitations in terms of work capacity at the end of treatment;
• if, as a result of pathological intra-articular processes, support and mobility have become severely limited.

During the expert assessment, specialists carefully review the medical history, listen to complaints, and evaluate clinical manifestations. The patient may be asked to demonstrate his or her mobility and self-care abilities. Attention is also paid to the degree of working capacity, and indicators of social adaptation. If appropriate indications are found, the patient will be assigned a disability group:

• Group 3 may be prescribed if there is moderate or slight motor limitation in the affected joints;
• Group 2 is assigned when a person is able to move partially independently, sometimes requiring the help of strangers;
• Group 1 is assigned to people who have completely lost joint mobility and are unable to maintain themselves in the future.

Increasing polyosteoarthritis of the joints with frequent recurrences, combined with other musculoskeletal disorders (e.g., osteochondrosis) is an immediate indication for disability.