Osteoarthrosis of the joints of the brushes

Unfortunately, osteoarthritis of the joints of the hands is not as thoroughly studied as gonarthrosis and coxarthrosis. This is probably due to the relative good quality of osteoarthritis of this localization.

Osteoarthrosis mainly affects distal (-70% of patients with osteoarthrosis of the hand), less often - proximal (-35% of patients with osteoarthrosis of the joints of the hands) interphalangeal joints and carpometacarpal joint of the big toe (-60% of women and -40% of men with osteoarthrosis of brushes) . Metacarpophalangeal joints and wrist joint are rarely affected (in women -10 and 5%, in men -20 and 20%, respectively). Osteoarthritis of the hands affects women 4 times (according to other sources, 10 times) more often than men. According to EL Radin and co-authors (1971), the above-described distribution of the frequency of the joints of the hands can be explained by the distribution of the load on them - the maximal load is accounted for by the distal interphalangeal joints. The frequency of involvement of the joints of the hands in patients with osteoarthritis is a mirror image of that in rheumatoid arthritis.

Osteoarthritis of the brushes usually begins in middle age, more often in women in the climacteric period. Oftenoarthrosis of brushes is associated with gonarthrosis and obesity (especially isolated osteoarthrosis of carpometacarpal joint of the big toe and interphalangeal joints). Isolated arthrosis of individual small joints of the hands (with the exception of the carpometacarpal joint of the 1st finger), as well as isolated arthrosis of the wrist joint, are usually secondary (for example, osteoarthritis of the wrist joint after Kinbeck's disease (aseptic necrosis of the lunate) or I posttraumatic osteoarthritis).

A distinctive sign of osteoarthritis of interphalangeal joints of the hands are Geberden nodes (distal interphalangeal joints) and Bushar (proximal interphalangeal joints). They are dense knotty thickening mainly on the upper lateral surface of the joints. The nodes are painful, often complicated by a secondary synovitis, in which there may appear a slight swelling of the soft tissues, a local increase in skin temperature, sometimes hyperemia of the skin over the joint. Patients with osteoarthritis of interphalangeal joints more often than patients with other localization complain of stiffness of up to 30 minutes in affected joints in the morning and after a rest period. In the early stages of osteoarthritis of the interphalangeal joints of the hands above the joints, cysts can be formed, which are sometimes spontaneously opened with the release of a viscous colorless gelatinous content rich in hyaluronic acid. In the late stages of osteoarthritis of interphalangeal joints, their instability, a decrease in the flexion volume, and a decrease in the functional capacity of the joints may occur, which is manifested by difficulties in the performance of small work, fine movements.

Patients with isolated osteoarthritis of the carpometacarpal joint of the first finger are concerned with pain in the base of the first metacarpal bone. Rarely the patient can complain of an indeterminate pain "somewhere in the wrist joint." A frequent complaint of patients with osteoarthritis of the carpometacarpal joint of the first finger is difficulty in folding the fingers into a pinch. Palpation of the joint is painful, sometimes you can hear and palpatorically feel crepitations when moving in the joint. In severe cases, degenerative changes of the carpometacarpal joint of the 1st finger are accompanied by reduction of the metacarpal bone and atrophy of nearby muscles, which leads to the formation of a "square brush". Osteoarthritis of the carpometacarpal joint of the 1st finger of the hand can also be complicated by a secondary synovitis accompanied by increased pain, swelling of the soft tissues, hyperemia and increased local skin temperature over the joint.

In severe cases, osteoarthritis of the joints of the hands radiographically reveals not only the characteristic for osteoarthritis symptoms (narrowing of the joint gap, sclerosis of the subchondral bone, osteophytosis, subchondral cysts), but also the intermittent nature of the white cortical line. Such osteoarthritis is called erosive. For the erosive (non-cerebral) form of the osteoarthrosis of the brushes, the recurrence of synovitis is characteristic. Histologically, synovial manifestations of inflammation without pannus, in blood tests - signs of acute phase response (hypergammaglobulinemia, increased COE, increased SRV content, etc.).

The nature of erosive osteoarthritis is unclear. It is sometimes interpreted as a cross-state between osteoarthritis and rheumatoid arthritis, although more often as a severe form of osteoarthritis of the joints of the hands.

The evolution of the osteoarthritis of the joints of the hands usually ends in a few years. The disease begins with feelings of discomfort, soreness, sometimes itching in the area of interphalangeal joints and the base of the first metacarpal bone. Within a few years (sometimes months) the symptoms periodically exacerbate and subside, often there are signs of local inflammation. Cysts can form over the joints. After a while the process stabilizes, the pain and inflammation subsides, the swelling of the joints becomes firm and fixed, acquires a nodular character; the volume of movements in the joints decreases, sometimes the instability of the joints develops.

For osteoarthritis of the joints of the hands is characterized by non-simultaneous damage to the joints. Therefore, at any given time in some joints, the changes are stable, in others - there are signs of active inflammation and the progression of morphological changes. Emerging "erosions" subsequently undergo a reverse development, leaving a typical symptom of the "gull wing". According to PA Dieppe (1995), osteoarthritis of the joints of the hands is a stage process in which each joint undergoes a period of "active" changes, followed by a stabilization of the condition.

Osteoarthritis of the joints of the hand is rarely accompanied by complications. The defeat of the wrist joint can be complicated by tunnel syndrome. In every joint, instability can develop. The consequence of an erosive (non-cerebral) form of osteoarthritis of interphalangeal joints of the hands can be a fusion of joint surfaces; this process is accelerated by intra-articular administration of long-acting corticosteroid preparations.

[1], [2], [3], [4], [5], [6]