Knee arthrosis is so common that it has a separate name - gonarthrosis. Another name for this disease is deforming osteoarthritis.
Arthrosis of the knee joint worries 20% of the population, its ICD-10 code is M17. Half of knee pathologies are due to arthrosis. This is a disease in which the tissue of cartilage and articular surface degenerates - they disintegrate. The joint is poorly supplied with nutrients and oxygen, its function deteriorates, and inflammation occurs. He becomes inactive and hurts, the patient’s quality of life decreases. Complications of arthrosis lead to a wheelchair.
Let's figure out what arthrosis of the knee joint is and how to treat it. How can the disease be prevented and how dangerous it is.
The causes of arthrosis of the knee joint are different - mechanical damage, hereditary predisposition, metabolic disorders.
The occurrence of the disease is associated with excessive stress on the knees. This is an occupational injury in many sports. People with a high degree of obesity, over 60 years of age, almost always have arthrosis of one degree or another due to constant microtrauma. Arthrosis refers to occupational diseases in areas where a person has to stand or lift heavy objects for a long time. The disease can begin after rheumatoid arthritis.
The most common cause of knee arthrosis is injury. The second most common is dysplasia in childhood. Inflammation due to autoimmune pathologies is the third source of arthrosis. Usually there are several reasons, one complements the other.
Types of arthrosis of the knee joint are divided depending on the causes into primary and secondary. If the etiology is unknown, primary arthrosis is diagnosed; if the cause is determined, secondary arthrosis is diagnosed.
Cartilage is nourished due to constant changes in osmotic pressure. When the joint is loaded, the viscosity of the intra-articular fluid decreases and its quantity increases. In a calm state, the intraarticular fluid becomes viscous and the amount decreases. Normally, these processes alternate. The cartilage plate, acting as a pump, pushes fluid out of the joint when loaded, and when relaxed, sucks it in. This is how the joint tissues are nourished. The pathological process manifests itself if the joint is subjected to destructive influences:
Signs of arthrosis of the knee joint appear: it becomes inactive and pain occurs. The pain is especially severe in the morning and after prolonged immobility.
There are three degrees of arthrosis:
At the very beginning of the disease, the muscles are intact. Their function is gradually lost. In the third stage, movement is severely limited. Due to a change in the axis of movement, the muscle attachment sites change. The muscles are deformed - they contract or stretch, they can no longer contract normally. The nutrition of all leg tissues suffers.
Symptoms of arthrosis of the knee joint at the beginning of the disease do not manifest themselves in any way and do not force the patient to see a doctor. The patient notices fatigue and pain, but does not attach serious importance to them.
The classic sign of knee arthrosis is immobility and stiffness in the joint, a pulling sensation in the popliteal region, pain after exercise. It is difficult to move in the morning or after a long period of immobility. Relief comes after the patient stretches his knee, massages it, and walks around.
After some time, the intensity and duration of the pain increases. A crunch appears in the joint, it completely stops bending and unbending. A person begins to limp when walking - most patients come to the doctor with this complaint. Treatment of arthrosis of the knee joint usually begins only at the second stage.
If nothing is done, movement becomes possible only with outside help. When the patient lies down, the knee hurts less, but the pain often bothers you at night.
At the second and third stages, the knee joint is deformed - the contours of the bones are sharply outlined, the lower leg is curved. If you put your hand on your knee, you hear a crunching sound when bending and straightening. When the kneecap moves, it also crunches. Fluid collects in the cavity, the joint is swollen, and the tissues bulge.
As the disease progresses, all symptoms become more pronounced.
Diagnosis of arthrosis of the knee joint is carried out comprehensively: an anamnesis is collected, laboratory and instrumental methods are prescribed.
The doctor examines the damaged joint, takes measurements of the bones and flexion angle, and determines the degree of mobility in the joints at an angle.
The patient is sent for a general blood test, a biochemical blood test, and a general urinalysis.
An X-ray of the knee joint is the main source of information for making a diagnosis. Arthrosis of the knee joint is visible in the photo: the joint space is narrowed, the cartilage is sclerotic, the bones are damaged; there is joint deformation, salt deposition and dystrophic changes. Osteophytes are clearly visible in the image.
For arthrosis of traumatic origin, x-rays have great diagnostic value and must be performed.
Ultrasound diagnostics is an informative method. Ultrasound does not replace x-rays and does not provide a picture of the nature of the destructive process in the joint.
Magnetic resonance imaging provides a complete picture of the disease. This is a modern and accurate research method that allows you to make a diagnosis at an early stage. The disadvantage of MRI is its high cost.
Treatment of the knee joint for arthrosis is carried out on an outpatient basis; hospitalization is not required.
The goal of treatment is to slow down the process of destruction, prevent contractures (the inability to fully bend and straighten the leg), and restore the function of the joint if possible. During the rehabilitation period, staying in sanatoriums and resorts shows good results.
Only the doctor decides how to treat arthrosis of the knee joint. You cannot select medications on your own.
Inflammation is relieved with the help of NSAIDs (non-steroidal anti-inflammatory drugs) - Diclofenac, Olfen, Diclac, Ibuprofen, Indomethacin, Ketoprofen.
Since arthritis causes severe pain, NSAID injections provide a quick effect and a feeling of relief.
Modern treatment of knee arthrosis involves the use of NSAIDs from another group - Meloxicam, Celecoxib and Nimesulide. Their effect is more pronounced.
If there is inflammation of the joint lining, the doctor prescribes corticosteroid hormones for intra-articular administration. Hydrocortisone, Kenalog, Diprospan relieve inflammation and pain, but they have many contraindications.
If necessary, antienzyme substances are injected into the joint cavity - contrical, ovamine, gordox. They can significantly slow down the destructive process.
Intra-articular injections of hyaluronic acid and its preparations are also prescribed. It restores the protective and shock-absorbing properties of synovial fluid.
Chondroprotectors are often prescribed, but there is no evidence that they help.
The newest methods of treating knee arthrosis do not exclude proper loading. The goal of physical therapy is to provide the necessary amount of movement, but not to overload the joint, maintaining balance. If the patient does not understand how to treat arthrosis of the knee joint - when it is necessary to simultaneously protect the knee and develop it, the result of other methods is sharply reduced or reduced to zero. It is possible to get rid of the disease if the patient is conscious.
Laser treatment and physiotherapeutic procedures have proven themselves to be excellent, especially if they were able to start at the first stage.
Intraosseous blockades provide a therapeutic effect, breaking the cycle of inflammation. Along with the blockade, multichannel electromyostimulation is used using a special device.
Compresses made from homemade ointments and rubs can relieve pain and swelling.
If necessary, an operation is performed - the patient is fitted with a knee joint endoprosthesis. Modern prosthetic methods allow patients to return to sports.
Proponents of the unconventional approach argue that it is possible to eliminate symptoms and treat arthrosis of the knee joint only using their methods - without resorting to drugs. This is kinesitherapy (a special set of exercises), ozone therapy (physiotherapy using ozone, which is injected into the joint), homeopathy, treatment with dietary supplements, manual therapy, massage.
When using unconventional methods, you need to remember that their effectiveness has not been proven.
There are original treatment methods, but reviews about them vary.
Only therapeutic exercises and measured load on the joint can restore the knee joint with arthrosis. If the patient follows all the doctor’s recommendations and is ready to fight for his health by all means, in most cases the answer to the question “can arthrosis of the knee joint be cured” is positive.
Prevention consists of timely assistance for injuries, active movement without overload, and maintaining an optimal body mass index.
Reviews from patients who have undergone traditional treatment are usually positive, but there are also negative ones.
I injured my knee at 14 years old. Several times the kneecap fell out later, each time it got easier. At the age of 30, I underwent treatment when my knee started to hurt. 10 years have passed, I don’t even remember.
Polina, 43 years old, Krasnoyarsk.
I was treated at home and went to the clinic to get intra-articular injections. I brought my knee to an extreme state. The effect was there and lasted a long time. On the doctor’s recommendation, I did special exercises. Now I do it from time to time, nothing bothers me.
Vasily, 34 years old, Tver.
I underwent treatment last year. I took pills and did physio. It seems to have gotten better, but in bad weather my knee still hurts.
Maria Maksimovna, 45 years old, Omsk.
When making a final decision about treatment, you should consult your doctor without forming an opinion based on reviews.
Medicine has learned to successfully treat joint diseases, the consequences of which in the last century inevitably led to disability. With arthrosis of the knee joint, it is important to seek help in time to determine the stage of the disease and the extent of treatment.
Arthrosis is a disease that develops slowly, in the first stage it is almost invisible to the patient. Few go to a medical facility when primary symptoms of diseases of the knee, hip, and other joints are detected.
Regardless of the stage of arthrosis, interviewing the patient to clarify complaints and examination is not enough. In order not to confuse arthrosis with other diseases, the symptoms of which may be similar, it is worth conducting clinical tests and studies. The results obtained allow us to establish an accurate diagnosis and prescribe correct, effective treatment for the knee, ankle, and hip joints.
There is no test that can immediately determine the presence of osteoarthritis of the joint. There are studies to exclude the presence of other pathologies. These include:
X-ray examination allows us to identify arthrosis, determine the degree of the disease, and the disorders caused by it. Thanks to the image, signs indicating the presence of arthrosis and other pathologies of the knee, hip, and other joints are revealed. Signs include: a significant decrease in the gaps between the joint-forming bones, compaction of cartilage tissue, the presence of osteophytes, and the presence of bone growths. X-ray analysis is considered the main one in the diagnosis of joint diseases. There are cases when the image does not provide accurate answers and raises doubts about establishing an accurate diagnosis (at the early stage of arthrosis, it is difficult to detect destruction and deformation of the joints). In such cases, they resort to MRI examination.
Magnetic resonance imaging provides a clearer image than X-ray analysis. MRI has a cost that is several times higher than x-rays. But the study allows us to confirm or refute the presence of osteoarthritis - the image clearly shows articular bones and soft tissues (capsules, menisci, cartilage, ligaments). Regular clinics do not have the equipment to carry out such tests; if you suspect the presence of arthrosis, it is better to contact specialized clinics and centers.
Computed tomography is prescribed if an MRI examination is contraindicated for the patient (if there is a cardiac stimulator, etc.), it is not possible to conduct it. CT allows you to obtain an image of all layers of the joint. The examination is something between an X-ray and an MRI.
Using ultrasound analysis, you can assess the degree of wear and thinning of the cartilage layer, and monitor the quantitative change in the fluid accumulated in the joint. Ultrasound is rarely prescribed to diagnose arthrosis; the analysis allows us to determine the complexity of the situation. Ultrasound of the knee joint allows you to see the degree of preservation of the menisci, determine the presence or absence of a Baker's cyst, and uric acid crystals. A highly specialized doctor, an ultrasound specialist, can objectively describe the picture of the disease.
Arthroscopy is prescribed less often than ultrasound. The examination is carried out by inserting a camera into small incisions in the joint area. On the screen you can see the structural features of the affected joint. Arthroscopy is appropriate for arthrosis of the hip joints, and is applicable for the knee and other joints.
To obtain a complete picture of the disease and assess the situation, it is worth conducting a comprehensive examination, in which attention is paid to blood tests.
Tests for arthrosis are prescribed not to identify it, but to exclude other diseases, narrowing the range of possible diagnoses. Blood for arthrosis is prescribed and donated in laboratories of medical institutions of two types: clinical research, biochemistry.
The peculiarity of a clinical blood test is that in the presence of arthrosis, it has normal readings. Fluctuations in the erythrocyte sedimentation rate (ESR) - red blood cells - are often monitored.
If the ESR is elevated and pain is present, then we can talk about the presence of processes that are rheumatic in nature. The pain intensifies in the morning and at night, this indicates arthritis, rheumatism, not osteoarthritis. If the ESR is elevated to a level of 25 mm or more, this indicates the presence of inflammation in the joints. With a high level of ESR, leukocytes in the body, inflammation of an infectious nature occurs, which is reflected in the condition of the joints of the lower extremities.
When the cartilage layer in the joints of the legs is destroyed, no deviations are observed in clinical tests. All indicators remain at normal levels. In rare cases of arthrosis, which are accompanied by the accumulation of synovial fluid in the joint (synovitis), ESR may have a significantly elevated level. When the level of ESR in the blood is elevated, we can talk about the presence of inflammatory processes, the nature of which should be clarified using additional tests.
The second option for a blood test for arthritis is biochemical. Blood biochemistry (blood is taken from a vein) for arthrosis is carried out on an empty stomach (the patient should not eat for at least 6 hours, ideally 12). This will result in cleaner results. Using analysis, you can determine whether inflammation is present in the body. Allows you to distinguish arthritis from arthrosis.
With arthritis, an increased level of C-reactive protein, seromucoids, and various types of immunoglobulins is observed. All these indicators for arthrosis remain within acceptable normal limits. Therefore, taking a BAC is important if you suspect arthritis or arthrosis. Their symptoms are similar; they can be distinguished by a blood test showing the presence or absence of inflammation in the joints.
Arthrosis is a non-inflammatory disease; deviations from the norm indicate other pathologies. The presence of uric acid indicates gout, high levels of globulins and immunoglobulins indicate rheumatoid arthritis.
Using the described list of tests, doctors differentiate what problems there may be - inflammatory joint diseases, arthrosis.
The human body consists of a large number of large joints. Among them, the knee joint is important, which is subjected to significant loads when a person moves in an upright position.
And, given the nature of its functioning, many people may experience inflammation of the articular surfaces and the tissues located next to them. Usually they say about such people that they have arthritis of the knee joint. This disease cannot be ignored, since as the disease progresses it can lead to loss of ability to work.
Arthrosis should be understood as destructive processes affecting cartilage, which can be supplemented by other decorative degenerative caused by age, high loads, poor circulation and nutrition of joint tissues.
Arthritis is a disease that is accompanied by inflammatory processes . It is often caused by local factors. However, it can also be caused by other diseases.
Sometimes there is a condition called arthrosis-arthritis. About such patients they say that not only an inflammatory process is observed in the joint, but also degenerative changes occur.
Knee arthritis can be identified by the following signs:
Some patients may have a symptom such as morning stiffness , in which a person struggles to move his knee in the first hours of the day, but after a short warm-up everything goes away. Patients diagnosed with rheumatoid arthritis also encounter the phenomenon of morning stiffness.
Symptoms of polyarthritis in general do not differ from arthritis of the knee, but there is one feature: the inflammatory process does not spread to the joint, but to nearby tissues, for example, muscle tendons and ligaments. This type of arthritis is accompanied by slight swelling, but changes in the joint cannot be observed on an x-ray.
During polyarthritis, a person feels a symptom in the form of pain when he makes active movements of the knee. Therefore, such people need to be very careful when climbing stairs. Sometimes pain can be felt while sitting.
In this condition, the pain becomes periodic, it does not last long and disappears as suddenly as it appears. The patient complains of itching, fever, burning in the knee area . Against the background of gout, tophi develop over time, which means salt deposits of uric acid, which can break out at certain moments.
In the absence of exacerbations, the skin in the area adjacent to the joint begins to become rough, and signs of peeling appear . Over time, it becomes more difficult to move the knee as the destruction of bone tissue continues and arthrosis begins to develop.
Its own symptoms are typical for arthritis of the knee joint in children. The knee begins to bother the child mainly in the morning, and then until the evening it does not cause any discomfort to the child.
The likelihood of developing this type of arthritis increases in children who have recently had a cold or acute respiratory viral infection. Like adults, children can be affected by juvenile rheumatoid arthritis . As a result, they begin to experience joint pain and structural changes occur in them.
Treatment of knee arthritis begins with a visit to a doctor of the appropriate profile, since in order to draw up a program of therapeutic measures it is necessary to determine the nature of the disease and find out the causes of its occurrence.
Experts suggest patients undergo an in-depth examination , which includes the following procedures:
Based on the results of the examination, the doctor will begin to draw up a treatment program, based on a number of mandatory principles. For arthritis of the knee joint, which occurs in an acute form, anti-inflammatory drugs, mainly NSAIDs, are prescribed. In pharmacies these drugs are available in the form of tablets, injections or ointments.
These medications are supplemented by intra-articular injections of hormonal drugs, washing the joint cavity in the event of the development of purulent arthritis, as well as the administration of antibiotics. If the results show the presence of reactive arthritis, then treatment begins with eliminating the underlying disease.
If rheumatoid arthritis of the knee joint is detected, the main list of medications includes basic therapy medications designed to prevent the progression of the disease and deterioration of the condition.
During an exacerbation of gouty arthritis, much attention is paid to diet: the patient’s diet should not contain foods containing purine bases and uric acid salts. During this time, the patient is prescribed bed rest; the load on the sore knee will have to be limited.
The complex of recommended therapeutic measures necessarily includes taking chondroprotectors based on chondroitin sulfate and glucosamine. These drugs provide the cartilage with the necessary elements and also do not allow structural changes in the surface of the joint to progress.
Vitamin preparations may be prescribed as additional therapy to improve the quality of blood supply to the joint.
Over time, when the inflammation subsides, you can add physiotherapeutic procedures, massage and exercise therapy to the list of main activities. The recommended exercises can be performed while lying in bed or sitting on a chair.
This way you can reduce the stress on your joints and at the same time strengthen the surrounding muscles. Physiotherapeutic procedures such as magnetic therapy, paraffin therapy, ozokerite and others have proven themselves well.
to consider the possibility of treating arthritis of the knee joint surgically if a diagnosis of arthrosis-arthritis and rheumatoid arthritis is made, which requires replacement of the knee joint with an endoprosthesis. Modern models of such prostheses are highly durable and can be used for at least 10 years.
You need to start treating arthritis at home by visiting a doctor and also eliminating the slightest load on your sore knee. To quickly eliminate unpleasant symptoms, it is necessary to take exactly the medications prescribed by a specialist at home.
Over time, when the condition improves, you can add therapeutic exercises . Lifestyle plays a big role in the treatment of knee arthritis, so a person needs to consider giving up all bad habits that can slow down the healing process:
It is necessary to pay more attention to the diet by changing its daily calorie content. This will help normalize body weight, but for this you will have to give up fatty and refined foods. At home, you are allowed to take medicinal baths, which can be replaced with warm compresses on the knee .
You can resort to folk remedies only after receiving permission from your doctor, and they should be used as a supplement to the main drug treatment.
To prepare a compress, you need to take a cabbage leaf , soften it with a kitchen hammer, place it in the microwave for a few minutes, then grease it with a small layer of honey and apply it to the sore joint. Place cling film and a woolen scarf on top. You need to keep this compress until the morning. According to patients, this remedy helps relieve pain in two or three sessions.
Salt or sand will help remove the symptoms , which should be poured into a cotton bag, kept in the microwave for several minutes, and then the heated salt is kept on the affected joint. Please be aware that there is a risk of burns when using this product.
You can alleviate the condition of arthritis if you often consume jellied meat or rich broths . These dishes bring benefits due to their chondoprotective effect. You should not put too much faith in this remedy, since such dishes may cause side effects for people with certain diseases.
licorice, calamus and dandelion herbs as raw materials . All ingredients are taken in equal quantities. The infusion is prepared from one tablespoon of the mixture.
This amount should be poured into 200 ml of hot water, then left to steep for 20–30 minutes. The infusion regimen is half a glass per day before breakfast, lunch and dinner. This remedy helps reduce pain and remove inflammation.
Knee pain should not be ignored, regardless of the severity of its manifestation. If you do not notice them for too long or put up with the sensations that arise, you may develop arthritis of the knee joint, and the treatment of this disease may take longer and require referral to a specialist.
People who, due to a particular lifestyle, expose the knee to increased stress are primarily at risk of encountering arthritis of the knee joint. Therefore, they need to be especially attentive to this part of the body and immediately consult a doctor .
Attempts to use traditional methods as the main treatment may help for a while, but they are not able to completely cure the disease. In such situations, it is recommended not to expect that the pain will go away on its own.
The very fact of its presence indicates that there are some violations and urgent treatment is necessary . Only a specialist can understand what exactly we are talking about, who will definitely order an examination.
If the diagnosis is confirmed, then in addition to treatment with medications, you will have to change your lifestyle , otherwise, several months after recovery, you may again encounter unpleasant pain in the knee.
What examinations should a patient undergo with arthrosis of the knee joint - gonarthrosis?
Nowadays, to clarify the diagnosis of gonarthrosis, they most often resort to clinical and biochemical blood tests, radiography and magnetic resonance or computed tomography.
For this test, blood is taken from a finger prick. With arthrosis, a clinical blood test, as a rule, does not show any specific changes. Only in some cases may there be a very slight increase in the erythrocyte sedimentation rate (ESR or ROE): up to 20mm.
On the contrary, a significant increase in ESR (higher) in combination with night pain in the joint should prompt us to think about the possible rheumatic, inflammatory origin of these pains. If the patient also has an increased number of leukocytes, then this circumstance confirms the presence of some kind of infectious-inflammatory process in the body, which affects the joints in particular. However, in any case, a clinical blood test does not give clear answers; it only indicates trends and narrows the circle of diagnostic search.
When performing this test, blood is taken from a vein, and always on an empty stomach. A biochemical blood test can provide significant assistance to the doctor in the differential diagnosis of joint damage: arthrosis or arthritis?
Thus, with rheumatic diseases (arthritis), the level of so-called inflammatory markers in the blood increases significantly: C-reactive protein, seromucoid, some globulins and immunoglobulins. With arthrosis, these biochemical parameters, on the contrary, remain normal.
True, there are cases when certain types of arthritis also do not lead to a significant change in biochemical parameters. But still, such an analysis, as a rule, helps to make a clear distinction between inflammatory and metabolic-dystrophic diseases of the joints (between arthritis and arthrosis).
Attention! In cases where we detect “inflammatory” changes in blood parameters taken from a finger or from a vein in a patient with arthrosis, we should be wary - after all, arthrosis does not cause any changes in the tests. And if inflammation indicators are elevated, there is a high probability that we are dealing not with arthrosis, but with arthritis. Then it is necessary to continue examining the patient until the diagnosis is finally confirmed or refuted.
Radiography is the most common and one of the most important methods for diagnosing arthrosis. In most cases, even the stage of arthrosis is established solely on the basis of an x-ray: after all, x-rays clearly show changes in the shape of the joint and bone deformations; compaction of the bones under the damaged cartilage is noticeable and osteophytes (“spikes”) are clearly visible. In addition, an x-ray can be used to judge the width of the joint space, that is, the distance between the articulating bones.
But X-ray examination has a serious disadvantage: only bones are captured on the X-ray image. But we will not be able to see the soft tissues of the joint (cartilage, meniscus, joint capsule, etc.) on an x-ray. Therefore, using only X-rays, we will not be able to assess with absolute accuracy the degree of damage to the articular cartilage, meniscus and joint capsule.
Fortunately, in recent years, magnetic tomography has become increasingly widespread.
The research uses, as the name implies, magnetic waves. They are able to reflect the smallest details of the joint in the resulting image. The magnetic resonance imaging method is very accurate: it helps to detect the earliest changes in cartilage tissue (which are not yet visible on a regular x-ray), and also allows you to see damage to the menisci and ligaments of the knee.
Therefore, I often recommend that my patients, in addition to X-rays, carry out magnetic resonance imaging of the joint to clarify the diagnosis.
Although here one thing must be kept in mind. Usually, having received tomographic examination data, doctors are so confident in their infallibility that they do not consider it necessary to double-check the research results and conduct a personal examination of the patient. It is not right.
Firstly, the specialist in the tomography department who interprets the images is also a person and can make mistakes. In particular, I have repeatedly encountered situations where ordinary age-related changes or other diseases similar in picture to arthrosis were mistaken for arthrosis. This happens very often.
In general, even after receiving a “full package” of patient examinations (X-rays, tests, tomogram), the doctor must still first conduct a personal examination of the patient and only then prescribe treatment.
In addition to magnetic resonance imaging, some hospitals still use computed tomography. In essence, computed tomography is the most advanced version of x-ray: computed tomography uses the same x-rays as in a conventional x-ray examination. The only difference is that with computed tomography, the tomograph “shreds” the joint with a series of x-rays, and as a result, the image is more voluminous and detailed than with x-rays. But it is still an order of magnitude inferior in information content to a magnetic resonance imaging scan. Therefore, CT should be used only in cases where for some reason we cannot perform magnetic resonance imaging on the patient (for example, if the patient has a pacemaker, a pacemaker, and magnetic waves can disrupt its operation).
In recent years, ultrasound has been actively used to diagnose joint diseases. After all, ultrasound, like magnetic resonance imaging, allows you to see changes in the soft tissues of the joint - for example, using ultrasound you can detect thinning of cartilage tissue in arthrosis or an increase in the amount of joint fluid in arthritis; it is possible to detect damage to the menisci in the knee, etc. However, the method has a significant drawback - it is very subjective, and the data obtained depend entirely on the qualifications of the specialist conducting the study.
Of course, this does not mean that joint ultrasound specialists are always wrong. But even if such an accurate method as tomography leaves room for discrepancies in the interpretation of the data obtained and disagreements in the diagnosis, then the data from ultrasound examination of joints raises questions especially often.
Article by Dr. Evdokimenko© for the book “Pain in the Legs”, published in 2004.
The diseases arthritis and arthrosis are often confused due to the similarity of names. And both diseases affect the joints (for example, there is both arthritis and arthrosis of the knee joint). Joints affected by disease become inflamed, swollen and painful. Otherwise, these are completely different diseases. Let's try to figure out how arthritis differs from arthrosis?
Arthritis is accompanied by inflammation of the articular joints, which, in turn, leads to impaired motor functions. The patient experiences discomfort, he experiences sharp or aching pain, both during physical activity and during rest, especially in the morning. The skin in the joint area swells, turns red and becomes tense. Body temperature often rises.
Arthrosis is a disease in which degenerative processes occur in articular cartilage. The changed cartilages no longer cope with the load falling on them and gradually collapse. Pain that occurs during exercise usually goes away with rest. The tissues around the joint become swollen and inflamed. The progressive disease leads to the destruction of cartilage and severe deformation of the joints.
The difference between arthrosis and arthritis lies in the causes of the disease. Arthrosis happens:
Predisposing factors for the development of arthrosis are:
Arthritis is inflammatory in nature. There are such causes of the disease as:
To quickly diagnose diseases affecting the musculoskeletal system, a specialist needs to collect a complete medical history. The patient is asked to undergo the following tests and carry out the specified examinations:
Arthrosis is a rather insidious disease that develops slowly and at the first stage is almost imperceptible to the patient. Few people go to a medical facility when they detect primary symptoms of diseases of the knee, hip and other joints.
Regardless of the stage of arthrosis at which the patient turned to specialists, one interview with the patient, clarifying complaints and examination is not enough. In order not to confuse arthrosis with a number of other diseases, the symptoms of which may be similar, it is necessary to conduct a series of clinical tests and studies. The results obtained allow us to establish the most accurate diagnosis and prescribe the most correct and effective treatment for the knee, ankle and hip joint.
An analysis that can immediately determine whether a person has osteoarthritis of the knee or any other joint does not yet exist. But there are a number of studies that make it possible to exclude the presence of other pathologies in the body. These include:
X-ray examination allows us to identify arthrosis and determine the extent of the disease and the disorders caused by it. Thanks to the image, the main signs can be identified that indicate the presence of arthrosis, and not other pathologies of the knee, hip and other joints. These signs include: a significant reduction in the gaps between the joint-forming bones, compaction of cartilage tissue, the presence of osteophytes, the presence of bone growths and other symptoms of arthrosis. It is believed that X-ray analysis is the main thing in diagnosing joint diseases. But there are cases when the image does not give accurate answers and raises doubts about establishing an accurate diagnosis (at the early stage of arthrosis it is very difficult to identify destruction and deformation of the joints). In such cases, they resort to MRI examination.
MRI for arthrosis
Magnetic resonance imaging provides a clearer image than X-ray analysis. However, MRI is also distinguished by its cost, which is several times higher than classical X-rays. But it is precisely such a study that makes it possible to confirm or refute the presence of osteoarthritis in a patient, since the image clearly shows not only the articular bones, but also all the soft tissues (capsules, menisci, cartilage and ligaments). Regular clinics, unfortunately, do not have the equipment to conduct such tests, so if you suspect the presence of arthrosis, it is better to contact specialized clinics and centers.
Computed tomography is usually prescribed if an MRI examination is contraindicated for a patient (if he has a cardiac pacemaker, etc.) or it is simply not possible to conduct it. CT also allows you to obtain an image of all layers of the knee and any other joint. This examination is a cross between an X-ray and an MRI.
As for ultrasonic analysis, it can be used to assess the degree of wear and thinning of the cartilage layer, as well as to monitor the quantitative change in fluid accumulating in the joint. Ultrasound is rarely prescribed specifically for diagnosing arthrosis. This type of analysis makes it possible to simply determine the complexity of the situation. For example, an ultrasound of the knee joint allows you to see the degree of preservation of the menisci, determine the presence or absence of a Baker's cyst and uric acid crystals. It should be noted that only a highly specialized doctor, an ultrasound specialist, can objectively describe the picture of the disease.
Arthroscopy is prescribed even less frequently than ultrasound. The examination is carried out by inserting a camera into small incisions in the joint area. At this time, all the structural features of the affected joint can be seen on the screen. Arthroscopy is more appropriate for arthrosis of the hip joints, although it is also applicable to the knee and other joints.
Thus, to obtain a complete picture of the disease and assess the situation, it is necessary to conduct a comprehensive examination, in which special attention should be paid to blood tests. Only after collecting enough information can treatment begin.
As already mentioned, tests for arthrosis are prescribed not to identify it, but to exclude other diseases in a person, narrowing the range of all possible diagnoses. Blood for arthrosis is usually prescribed and donated in laboratories of medical institutions of two types: clinical research and biochemistry.
The peculiarity of a clinical blood test is, first of all, that in the presence of arthrosis it has normal readings. But in quite frequent cases, fluctuations in the erythrocyte sedimentation rate (ESR) - red blood cells - can be monitored.
If the ESR is elevated and at the same time there is also pain in the patient, then we can talk about the presence of processes that are rheumatic in nature. The pain is usually worse in the morning and at night, and this already indicates arthritis and rheumatism, but not osteoarthritis. If the ESR is elevated to a level of 25 mm or more, this may indicate the presence of inflammation in the joints. With a high level of ESR and leukocytes in the body, inflammation of an infectious nature can occur, which is reflected in the condition of the knee and other joints of the lower extremities.
Consultation with a doctor
That is, when the cartilage layer in the joints of the legs is destroyed, no deviations are observed in clinical tests. All indicators should remain at normal levels. Only in rare cases of arthrosis, which are accompanied by the accumulation of synovial fluid in the joint (synovitis), the ESR may have a level that is significantly elevated. Whenever the level of ESR in the blood is elevated, we can talk about the presence of inflammatory processes in the human body, the nature of which must be clarified using additional tests.
The second option for a blood test for arthritis is biochemical. Blood biochemistry (blood is taken from a vein) for arthrosis should be carried out on an empty stomach (the patient should not eat for at least 6 hours, ideally 12). This will result in cleaner results. Using this analysis, it is also possible to determine whether an inflammatory process is present in the body or not. And, therefore, makes it possible to distinguish arthritis from arthrosis.
As practice shows, with arthritis there will be an increased level of C-reactive protein, seromucoids and various types of immunoglobulins. All these indicators for arthrosis remain within acceptable normal limits. This is why taking a BAC is so important if you suspect arthritis or arthrosis. After all, their symptoms are quite similar and can only be distinguished by a blood test showing the presence or absence of inflammation in the joints.
Since arthrosis is a non-inflammatory disease, deviations from the norm of certain indicators indicate other pathologies. The presence of uric acid indicates gout, high levels of globulins and immunoglobulins indicate rheumatoid arthritis.
Thus, by carrying out the described list of tests, doctors can easily distinguish between what problems there may be - inflammatory joint diseases and arthrosis.
Clinical blood test. For this test, blood is taken from a finger prick. With arthrosis, a clinical blood test, as a rule, does not show any specific changes. Only in some cases may there be a very slight increase in the erythrocyte sedimentation rate (ESR or ROE): up to 20 mm.
On the contrary, a significant increase in ESR (higher) in combination with night pain in the joint should prompt us to think about the possible rheumatic, inflammatory origin of these pains. If the patient also has an increased number of leukocytes, then this circumstance confirms the presence of some kind of infectious-inflammatory process in the body, which affects the joints in particular. However, in any case, a clinical blood test does not give clear answers; it only indicates trends and narrows the circle of diagnostic search.
Blood chemistry. When performing this test, blood is taken from a vein, and always on an empty stomach. A biochemical blood test can provide significant assistance to the doctor in the differential diagnosis of joint lesions: arthrosis or arthritis?
Thus, with rheumatic diseases (arthritis), the level of so-called inflammatory markers in the blood increases significantly: C-reactive protein, seromucoid, some globulins and immunoglobulins. In arthrosis, these biochemical parameters, on the contrary, remain normal.
True, there are cases when certain types of arthritis also do not lead to a significant change in biochemical parameters. But still, such an analysis, as a rule, helps to make a clear distinction between inflammatory and metabolic-dystrophic diseases of the joints (between arthritis and arthrosis).
Attention! In cases where we detect inflammatory changes in blood parameters taken from a finger or from a vein in a patient with arthrosis, we should be wary - after all, arthrosis does not cause any changes in the tests. And if inflammation indicators are elevated, there is a high probability that we are dealing not with arthrosis, but with arthritis. Then it is necessary to continue examining the patient until the diagnosis is finally confirmed or refuted.
X-ray of joints. Radiography is the most common and one of the most important methods for diagnosing arthrosis. In most cases, even the stage of arthrosis is established solely on the basis of an x-ray: after all, x-rays clearly show changes in the shape of the joint and bone deformations; compaction of the bones under the damaged cartilage is noticeable and osteophytes (spines) are clearly visible. In addition, an X-ray image can be used to judge the width of the joint space, that is, the distance between the articulating bones.
Magnetic resonance imaging - MRI, or NMRI. The research uses, as the name suggests, magnetic waves. They are able to reflect the smallest details of the joint in the resulting image. The magnetic resonance imaging method is very accurate: it helps to detect the earliest changes in cartilage tissue (which are not yet visible on a regular x-ray), and also allows you to see damage to the menisci and ligaments of the knee.
Secondly, arthrosis detected on a tomogram may not be the patient’s only disease. And the main cause of pain, even in the presence of arthrosis, may be another disease: for example, arthritis or meniscus damage. And these diseases will need to be treated first (in parallel with the treatment of arthrosis).
In general, even after receiving a complete package of examinations of the patient (X-ray, tests, tomogram), the doctor must still first conduct a personal examination of the patient and only then prescribe treatment.
Computed tomography - CT. In addition to magnetic resonance imaging, some hospitals still use computed tomography. In essence, computed tomography is the most advanced version of x-ray: computed tomography uses the same x-rays as in a conventional x-ray examination. The only difference is that with computed tomography, the tomograph seems to shred the joint with a series of x-rays, and as a result, the image is more voluminous and detailed than with x-rays. But it is still an order of magnitude inferior in information content to a magnetic resonance imaging scan. Therefore, CT should be used only in cases where for some reason we cannot perform magnetic resonance imaging on the patient (for example, if the patient has a pacemaker, a pacemaker, and magnetic waves can disrupt its operation).
Ultrasound of joints (ultrasound examination). In recent years, ultrasound has been actively used to diagnose joint diseases. After all, ultrasound, like magnetic resonance imaging, allows you to see changes in the soft tissues of the joint - for example, using ultrasound you can detect thinning of cartilage tissue in arthrosis or an increase in the amount of joint fluid in arthritis; it is possible to detect damage to the menisci in the knee, etc. However, the method has a significant drawback - it is very subjective, and the data obtained depend entirely on the qualifications of the specialist conducting the study.
Therefore, I am not inclined to blindly trust the diagnosis obtained by ultrasound of the joints, and I always double-check such conclusions (through a personal examination of the patient, as well as using X-rays or magnetic resonance imaging).
Article by Dr. Evdokimenko for the book Leg Pain, published in 2004. Edited in 2011 All rights reserved .