Osteoarthritis deformans or osteoarthritis (DOA) is a chronic joint disease. In this case, a gradual destruction of the articular cartilage occurs, leading to changes in the surfaces and deformation of the joint itself.
ICD 10 code: M15—M19 Arthrosis
There are also other names for the disease that are synonymous, according to ICD 10 code: arthrosis deformans, osteoarthrosis, arthrosis, osteoarthritis.
The term “deforming osteoarthritis” is more often used in foreign terminology.
Deforming osteoarthritis (osteoarthritis) is the most common joint disease. Its symptoms occur in 20–40% of the world's population, depending on the region. Women are almost twice as likely to get sick. With increasing age, the number of sick men and women becomes approximately the same. Although the disease sometimes occurs in young people, however, it is still the lot of the elderly: among people over 50 years old, almost half are sick, and by the age of 70 – already 80–90%.
The hip joint is most often affected - about 42% of cases, followed by the knee - about 34%. The “top three” is closed by damage to the shoulder joint – in 11% of all DOAs. The share of lesions of other joints accounts for about 13%.
Deforming osteoarthritis (osteoarthritis) causes disruption of normal joint function, which often leads to disability. To understand the pathological processes that occur during the development of this disease, it is worth delving a little into the anatomy of the joint.
Joints are located in those places of the skeleton where distinct movements occur. By the way, there are 360 of them in the human body.
Deforming osteoarthritis of the extremities (DOA) is a severe degenerative disease characterized by the progressive destruction of the cartilage tissue of the joints, accompanied by the formation of bone growths - osteophytes. It is worth noting that deforming osteoarthritis has been known to mankind for thousands of years, but even now this disease has not been fully studied and can only be cured in the early stages of development. This arthrosis, listed in the international classification under ICD code 10, leads to severe degenerative changes in the joint, which is accompanied by a change in the shape of the joint and a decrease in its mobility.
Deforming osteoarthritis. having ICD code 10, is considered a disease of old age, occurring mainly in people over 50 years of age. Statistics show that approximately 10-15% of people who undergo regular examinations have signs of developing deforming arthrosis ICD 10. In fact, arthrosis ICD 10 can begin to develop at a young age, that is, up to 25 years, but there are noticeable symptoms may appear only in old age.
Arthrosis deformans, which has an ICD code of 10, is a common disease in which, first of all, there is a decrease in regeneration in connective tissue, which leads to early aging of cartilage. The process of early aging of cartilage tissue is accompanied by the appearance of roughness on its surface, thinning, as well as loss of elasticity and strength of the tissue. In this case, compaction of the subchondral bone, complete disappearance of cartilage tissue, formation of cysts and osteophytes, as well as sclerosis of surfaces are observed.
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Excludes: selected conditions occurring in the perinatal period ( P00 - P96 )
some infectious and parasitic diseases ( A00 - B99 )
complications of pregnancy, childbirth and the puerperium ( O00 - O99 )
congenital anomalies, deformities and chromosomal disorders ( Q00 - Q99 )
diseases of the endocrine system, nutritional disorders and metabolic disorders ( E00 - E90 )
injuries, poisoning and some other consequences of external causes ( S00 - T98 )
symptoms, signs and abnormalities identified during clinical and laboratory tests, not classified elsewhere ( R00 - R99 )
M95 - M99 Other musculoskeletal and connective tissue disorders
The following categories are marked with an asterisk:
M01 Direct infection of the joint in infectious and parasitic diseases classified elsewhere
M03 Post-infectious and reactive arthropathy in diseases classified elsewhere
M07 Psoriatic and enteropathic arthropathy
M09 Juvenile arthritis in diseases classified elsewhere
M14 Arthropathy in other diseases classified elsewhere
M36 Systemic connective tissue disorders in diseases classified elsewhere
M49 Spondylopathies of tissue in diseases classified elsewhere
M63 Muscle lesions in diseases classified elsewhere
M68 Lesions of synovial membranes and tendons in diseases classified elsewhere
Osteoarthritis - I Osteoarthritis (osteoarthritis; Greek osteon bone + arthritis[s] (Arthritis)) inflammation of the joint involving the articular ends of the articulating bones in the pathological process. They are a form of arthritis. The term "osteoarthritis" is sometimes incorrect... ... Medical Encyclopedia
OSTEOARTHRITIS - (Osteoarthritis), deforming arthritis, inflammation of the joint with damage to the articular bones. Observed in horses, oxen and dogs. The knee, shoulder blade, coronary, and wrist joints are most often affected. With O., periostitis, exostoses,... ... Veterinary encyclopedic dictionary develops
DOA - Osteoarthritis ICD 10 M15. M19. M... Wikipedia
Sanatorium-resort selection is a set of medical measures carried out to determine indications or contraindications for spa treatment, as well as the location, medical profile of the sanatorium, duration and season of spa treatment. The purpose of S. k.o. improvement... ... Medical encyclopedia
RHEUMATISM - RHEUMATISM. Contents: Historical sketch. 437 Chroaic rheumatism. 437 Etiology and pathogenesis. 438 General semiotics. 440 Clinical forms. 441 Prevention and treatment ... Big medical encyclopedia
Osteoarthritis (OA) is a heterogeneous group of diseases of various etiologies with similar biological, morphological and clinical manifestations and outcomes, which are based on damage to all components of the joint, primarily cartilage, as well as the subchondral portion of the bone, synovium, ligaments, capsule, periarticular muscles .
Statistical data . Prevalence: 20% of the world's population. The predominant age is 40–60 years. Radiological signs of OA are found in 50% of people aged 55 years and older. The predominant gender is female for gonarthrosis, male for coxarthrosis. Incidence: 8.2 per 100,000 population in 2001.
Etiology • Discrepancy between the mechanical load on the joint and its ability to withstand that load. The biological properties of cartilage can be determined genetically or change under the influence of exogenous and endogenous acquired factors • Genetic factors •• The role of type II collagen gene defects is discussed •• Autosomal dominant type of inheritance of erosive OA in women and recessive in men • Acquired factors •• Excess weight body •• Estrogen deficiency in postmenopausal women •• Acquired diseases of bones and joints •• Joint injuries •• Joint surgeries.
Deforming arthrosis of the knee joint is a severe acute disease characterized by the formation of pathological processes of destruction of cartilage tissue with subsequent intra-articular bone growths and deformations of the articular surfaces. The etiology of the development of this type of damage to the musculoskeletal system can be varied; the progression of the pathology, as a rule, depends on the cause of the disease.
ICD 10 classifies deforming arthrosis of the knee joint (gonarthrosis) under the number M17.
Statistics provided by WHO show that about 5% of all inhabitants of our planet suffer from such joint disease. This percentage is higher than that of common diseases such as tuberculosis, cancer or diabetes.
It was also found that in women the risk of developing gonarthrosis is 2 times higher than in men. Often arthrosis develops in women with the onset of menopause, with hormonal changes in the body.
The etiology (reasons) of the development of deforming arthrosis is determined by the following factors:
Deforming arthrosis of the knee joint differs from ordinary arthrosis in its constant progressive nature and high intensity of symptoms.
Deforming arthrosis develops sequentially. Depending on the characteristic pathological changes and symptoms, the patient is assigned the stage of development of the disease. Rheumatology distinguishes 4 stages of the formation of gonarthrosis, which makes it possible to determine the nature of the progression of the disease and establish an effective course of therapy.
The following symptoms indicate the development of deforming arthrosis:
Deformations often develop at later stages of this pathology. However, once a diagnosis of deforming arthrosis of the knee joint is established, the development of this pathology occurs many times faster, since the process is actively progressive.
For the disease, grade 1-2 deforming arthrosis of the knee joint, treatment involves the following intervention methods:
Since the initial stages of development of deforming arthrosis are reversible, the course of therapy does not yet require aggressive intervention in the form of surgical treatment.
Therapy for deforming gonarthrosis involves taking the following medications:
Drug therapy forms the basis for the treatment of stages 1 and 2 of the development of arthrosis of the knee joint, when deformations of the articular surfaces have not yet become pronounced and persistent.
The rheumatologist also determines the complex of special physiotherapeutic procedures that restore the natural processes of nutrition and functioning of joint tissues.
The main physiotherapy procedures in the treatment of stage 1-2 deforming gonarthrosis are the following methods:
When the late stages of the disease are established, NSAIDs or corticosteroids are taken only to reduce the intensity of pain. Taking chondroprotectors at stages 3-4 of deforming arthrosis of the knee is ineffective.
There are the following indications for surgical intervention for gonarthrosis:
If, after undergoing complete medical treatment, deforming arthrosis continues to progress, the patient is recommended to undergo surgery, which will help eliminate the product of the destructive process and prevent the development of consequences of the disease, such as disability or disability.
Surgical treatment of deforming arthrosis of the knee joints is based on the following surgical methods:
This surgical operation, regardless of its high cost, is a widespread method of treating deforming arthrosis of the knee joint.
Today, the cost of such an operation can range from 80 to 420 thousand rubles, which includes the cost of a mechanical endoprosthesis, anesthesia, the work of a surgeon and subsequent hospitalization.
The rehabilitation course consists of wearing special orthopedic devices and performing a complex of physical therapy.
Orthopedic surgery uses implants made from the following materials:
The replaced implant can serve the patient from 5 to 15 years. As the endoprosthesis wears out, it can be replaced by repeat surgery.
An operation to replace the affected joint will provide the patient with relief from constant pain and restore the functioning of the limb.
Some medical institutions in Russia operate a high-tech medical care program (HTMC), which allows patients who have a full list of tests, quotas and referrals to undergo knee replacement surgery free of charge.
You can learn more about deforming arthrosis of the knee joint from the following video:
It is important to remember that when diagnosed with deforming arthrosis of the knee joint, treatment provided in a timely manner can prevent the development of irreversible deformities requiring radical surgical intervention. However, even carrying out an operation is not a death sentence. Take care of yourself!
Deforming gonarthrosis (DOA of the knee joint code according to ICD 10 - M17) is a pathological disease that causes destruction of the cartilaginous component. The main danger of the disease is its dynamic development. If you do not seek help in a timely manner, DOA leads to a complete loss of the ability of the knees to bend.
DOA of the knee joints (ICD code 10 M17) is a chronic condition in which connecting tissues are partially or completely destroyed. Subsequently, in the absence of measures taken, bone tissue fusion occurs. This phenomenon, of course, leads to loss of working capacity and disability of the patient.
Hyaline cartilage, located in the interarticular space, is the main component that ensures smooth movement. With the development of gonarthrosis, cartilage tissue gradually becomes thinner, begins to deform, and ultimately collapses. The bones of the joints, left without a shock-absorbing cushion, rub against each other. This is accompanied by severe painful symptoms and an inflammatory process. To replace the missing element, the body begins to intensively build up bone tissue.
No specific cause has been identified that determines the occurrence of this pathology. Experts agree that the development of deforming osteoarthritis of the knee joint is influenced by several circumstances:
Gonarthrosis is divided into 2 types. Primary (idiopathic) is classified as a natural process of aging of the body. The second is post-traumatic, manifesting itself as a result of pathological violations of the integrity of bone tissue.
The International Classification of Diseases, 10th revision (ICD), identifies deforming arthrosis of the knee joint as a disease of the skeletal system and connective tissues. According to ICD 10, DOA is classified as an arthropathy. The disease is considered under code M17. This classification was created by WHO to maintain international records of disease control. In this way, it is possible to monitor the spread of the disease to create statistical data. This information is standard and is used by all countries of the world. For convenience, each ailment is assigned a specific code.
In most cases, diagnostic testing of DOA of the knee joint occurs in late stages. This is due to the fact that the initial degree of the disease practically does not manifest itself to the extent of causing concern. The patient may feel slight discomfort in the knee area, mainly after long walking or physical activity. Most often this is associated with fatigue and overexertion. At the second stage, stiffness, numbness, swelling, and local hyperthermia are observed. The third degree is characterized by severe pain in the area of the leg joints, partial or complete immobilization.
The examination begins in the doctor's office. The specialist assesses the person’s condition, taking into account his age, lifestyle and previous diseases of the musculoskeletal system. Laboratory tests do not provide a specific diagnostic answer. In cases of inflammation, an increased level of ESR (erythrocyte sedimentation rate) may be observed. Hardware examination makes it possible to fully assess the condition of the knee joint. X-ray images show pathological changes, including a decrease in the interarticular space and deformation of the joint itself. The presence of deforming osteoarthritis is also indicated by osteophytes and compaction of the bone structure. In addition to X-rays, computed and magnetic resonance imaging, scintigraphy and arthroscopy are used.
Based on the results of the study, the degree of the disease is determined and an effective treatment package is selected.
Before complete destruction of hyaline cartilage occurs, the disease DOA of the knee joints (ICD10 code - M17) goes through 3 stages. As it increases, the manifestations intensify, both at the level of the patient’s sensations and at the structural level.
Depending on the degree of the disease, the most relevant treatment is selected. Early stages are easier to treat and give a positive prognosis. The sooner a person seeks help, the faster and easier the recovery process occurs.
Treatment of deforming osteoarthritis (ICD code ten – M17) consists of a properly selected set of measures:
In the early stages, drug therapy is most often used. It includes taking special medications or using products for external use. Such medications are divided into groups and selected according to the degree of damage. Chondroprotectors – have an analgesic effect and nourish cartilage tissue. Non-steroidal anti-inflammatory drugs - eliminate inflammatory processes and have analgesic properties. Corticosteroids are drugs that have a quick and effective effect. At the same time, such drugs have a large number of side effects, so their use is possible only on the recommendation of a doctor.
Physiotherapy includes physical therapy, massages, swimming, manual therapy. These procedures, in combination with the main type of treatment, bring quite good results.
The diet for DOA is drawn up by the doctor, taking into account all the accompanying circumstances. A diet is necessary to enrich the body with essential elements, eliminate negative influences and reduce the patient’s weight.
Surgery is a last resort treatment. Usually it is resorted to at the last stage of the development of the disease, when other methods are useless. There are 2 types of operations - preserving the integrity of the joint, when only growths are eliminated, and radical - endoprosthetics (the right or left knee joint is completely replaced).
To prevent the development of DOA, a person should be careful about his own lifestyle. You should not subject your body to excessive physical activity; you need to monitor your body weight. Its excess leads to the development of various pathological processes. Meals should be regular and balanced. Wearing comfortable shoes, morning exercises, and swimming are a simple guarantee of the integrity of the knee joints.
Deforming osteoarthritis of the knee joints, ICD 10 code - M17, is a dangerous disease that requires timely diagnosis and treatment. You should not delay visiting the doctor, trying to cure yourself with improvised means. This may not only turn out to be a useless exercise, but lead to dangerous irreversible consequences.
Arthrosis of the knee joint (ICD-10 - M17) is a chronic progressive disease characterized by the development of degenerative-dystrophic changes in cartilage, subchondral bone, capsule, synovial membrane, and muscles. It manifests itself as pain and difficulty moving. Progression of the disease leads to disability. Osteoarthritis of the knee joints affects 8-20% of people. The frequency increases with age.
There are several classifications - for reasons, for radiological signs. It is more convenient in practice to use the classification of N. S. Kosinskaya.
Deforming arthrosis of the knee joint in ICD-10 is designated M17 (gonarthrosis). Belongs to class 13 - diseases of the musculoskeletal system and connective tissue (M00 - M99). Arthrosis of the knee joint (ICD-10 code) is in the group - arthrosis M15 - M19.
The knee joint connects three bones: the femur, the tibia and the patella, which covers the joint in front. The connecting plates of the femur and tibia are uneven, so between them there is dense hyaline cartilage to absorb the load (meniscus). The bony surfaces inside the joint are also covered with cartilage. All components of the joint are held in place by ligaments: lateral medial and lateral, cruciate anterior and posterior. On the outside, all this is covered with a very strong articular capsule. The inner surface of the capsule is lined with synovial membrane, which is densely supplied with blood and forms synovial fluid. It nourishes all joint structures by diffusion, since there are no blood vessels in cartilage. It consists of chondrocytes (up to 10%), and intercellular substance (matrix), which consists of collagen fibers, proteoglycans (they are formed by chondrocytes) and water (up to 80%). Proteoglycans, represented by glycosaminoglycans and chondroitin sulfate, bind water and fibers .
The causes of destruction of cartilage tissue may be a history of infectious or crystalline arthritis (rheumatoid, reactive arthritis, gout, psoriatic arthropathy), acute or chronic overload of the joint (sports, weight), trauma, physical inactivity in older patients. All this causes metabolic disorders, decreased proteoglycan levels, and water loss. The cartilage becomes fibered, dries out, cracks, and becomes thinner. Its destruction occurs, then regeneration with loss of congruence, bone tissue begins to become exposed and grow. If left untreated, the joint space disappears and the bones come into contact. This causes acute pain and inflammation, deformation, and necrosis of the bone.
The first manifestations of the disease are pain in the knee joints during physical activity, after a long walk, during cooling, in cold wet weather, when going up and down stairs, or lifting heavy objects. The patient takes care of his leg. Lameness occurs. As the disease progresses, crunching, crepitus, difficulty moving, and joint deformation are noted. Synovitis occurs periodically. Upon examination, the joint area may be swollen, hyperemic, and painful on palpation. Deformation of the joint or the entire limb is possible.
To find the cause of the disease and determine the degree of its severity, it is necessary to prescribe:
X-rays of the knee joint are done in lateral and direct projections. Radiological signs of arthrosis include: decreased height of the joint space, bone growths, osteophytes, subchondral osteosclerosis, cysts in the epiphyses, deformation.
In the initial stages of the disease, when there are no radiological signs yet, a more informative research method will be magnetic resonance imaging (MRI). This method allows you to see changes in cartilage, its thinning, cracking, and assess the condition of the synovial membrane. Of the invasive methods, arthroscopy is informative. It allows you to visually inspect all the internal components of the joint.
Differential diagnosis is carried out in the initial stages of arthrosis, when the clinical and radiological picture is not yet expressed. It is necessary to exclude arthritis of various etiologies: rheumatoid, psoriatic, infectious, reactive, as well as gout, joint damage in ulcerative colitis (UC), Crohn's disease. With arthritis there will be general and local symptoms of inflammation, corresponding changes in the blood picture and x-ray. It is necessary to schedule a consultation with a rheumatologist.
Treatment of patients with gonarthrosis can be surgical or non-surgical, and it depends on the stage of the disease. In the first and second stages, treatment without surgery is possible. In the second, if there was no effect from conservative therapy, as well as the third, surgical treatment is indicated.
Non-operative treatment can be non-drug or medicinal. Non-drug therapy includes:
In accordance with the European guidelines (ESCEO) 2014 for the treatment of patients with osteoarthritis, a 4-step algorithm for the treatment of osteoarthritis is recommended:
With arthroscopy, it is possible: visual inspection inside the joint, removal of fragments of cartilage, inflammatory elements, resection of damaged areas, straightening of loose cartilage, removal of osteophytes. But the main purpose of arthroscopy is to make a diagnosis in order to plan further actions.
Corrective osteotomy of the femur or tibia is performed to restore the axis of the lower limb in order to relieve stress on the affected area. The indication for this operation is stage 1-2 gonarthrosis with valgus or varus deformity of the lower limb.
Endoprosthetics can be total or partial. Usually performed on patients over 50 years of age. The indications are:
Resection arthroplasty is performed on patients after endoprosthetics if there is a recurrence of surgical infection. After this operation, you need to walk in an orthosis or with support.
In the terminal stage of arthrosis, when the joint is unstable (loose), with severe deformation, acute symptoms, and if it is impossible to perform endoprosthetics due to high risks or refusal to accept an endoprosthesis, an operation is performed - arthrodesis. This method allows you to get rid of pain and preserve the limb as a support. Shortening the limb in the future causes progression of degenerative processes in the spine.
Many diseases belong to the same class, but have numerous types and forms. Thus, arthrosis can be primary and secondary, affecting individual joints and articular groups. When filling out a medical history and other medical documents, all these features must be reflected in the diagnosis. It is more convenient to do this by using an alphanumeric notation system, which allows you to encode important information about the disease so that it will be understandable to any physician who uses the same system. Such a code system exists, and it is contained in the international classification of diseases - ICD-10.
The International Classification of Diseases, 10th revision, consists of 22 sections. In ICD 10, codes are assigned not only to diseases and other pathological conditions (trauma, poisoning), but also to factors influencing health status, causes of morbidity and mortality. The last, class 22, is reserved for codes that are used for special purposes, in particular, reserved for new diseases, the classification of which at this stage is difficult. Each class (section) is designated by a Roman numeral and a pair of three-digit codes, which consist of a Latin letter and two numbers. Thus, class XIII corresponds to the code range M00-M99.
The ICD 10 code starting with the letter M indicates diseases of the musculoskeletal system and connective tissue. These include diseases of the musculoskeletal system, systemic autoimmune and vascular diseases associated with damage to connective tissue. This class opens the block of arthropathy, that is, diseases of peripheral joints. It is assigned the range M00-M25, which, in turn, includes 4 blocks of diagnoses, including a block of arthrosis. ICD 10 considers arthrosis in block M15-M19. It is divided into 5 three-digit headings, each of which includes several subheadings.
The hierarchy of ICD-10 itself ends with four-digit subcategories. In subcategory codes, the fourth character is separated from the previous ones by a dot. In practice, to clarify the diagnosis, codes consisting of 5 or more characters are used; their meaning is indicated in specialized reference books for individual classes of diseases. The ICD provides the meanings of additional characters for class XIII; they are used to indicate the location of the disease.
In the ICD, arthrosis is contrasted with arthritis, acquired deformities and other joint lesions. Arthritis is inflammation of the joints, which can be infectious or non-infectious:
Arthrosis, unlike arthritis, is a disease of a non-inflammatory nature. With these arthropathy, degenerative-dystrophic changes occur in the joints, ending in their deformation. Therefore, arthrosis is usually called deforming. Since, along with cartilage tissue, bone tissue is involved in the process, the name osteoarthritis is also used. In ICD 10, osteoarthritis deformans (DOA) is not mentioned, and in the medical literature the concepts of arthrosis and DOA are equivalent. In rare cases, deforming arthrosis is contrasted with sclerosing arthrosis, in which osteosclerosis (bone tissue thickening) is pronounced, but there is practically no proliferation of osteophytes. In this scenario, in particular, arthrosis of the temporomandibular joint can develop. ICD 10 uses the terms osteoarthritis, arthrosis, and osteoarthritis as synonyms.
Joint deformities due to arthrosis usually lead to deformities of the limbs and fingers. Thus, grade 3 gonarthrosis is accompanied by valgus or varus (X-shaped or O-shaped) deformity of the legs in the knee joints. But this is an independent pathology, which in the ICD belongs to the block “Other joint lesions” along with flat feet and hammertoe deformity. The same block includes the usual dislocations and subluxations of the patella, its chondromalacia, lesions of the knee meniscus, and ankylosis. Flat feet often lead to arthrosis of the joints of the lower extremities, and arthrosis or arthritis of the 3rd degree can turn into ankylosis, but all these are not different stages of the same disease, but independent nosological units.
In ICD 10, arthrosis is divided into 5 headings in accordance with the localization and prevalence of the process.
M15 is polyarthrosis, that is, damage to more than one joint (or more than one pair). This block includes 4 subsections:
Generalized osteoarthritis covers 3 or more articular groups and can simultaneously affect large and small, peripheral and vertebral joints. It is considered primary if its development cannot be associated with an existing disease or injury.
The remaining headings (M16-M19) include monoarthrosis, unilateral or bilateral lesions of single joints:
For other arthrosis, the code usually consists of 5 characters, the 2nd digit after the dot indicates the localization:
The numbers 5 and 6 correspond to the hip and knee joints, but in this case they are not used, since arthrosis of this localization is assigned separate three-digit codes.
The ICD does not classify spondyloarthrosis as an arthropathy. Arthrosis, osteoarthritis of the spine, degenerative diseases of the facet joints are included in the heading M47 (spondylosis). They, in turn, belong to the block of spondylopathies, a class of dorsopathies (diseases of the spine and paravertebral tissues).
Four-digit codes are used to separate unilateral and bilateral monoarthrosis, as well as to indicate their cause (etiology) in the diagnosis. So, coxarthrosis can be:
In other sections, dysplastic arthrosis is not considered, since this cause is typical specifically for arthrosis of the hip joints. For gonarthrosis, coxarthrosis, rhizatrosis and other arthrosis, a division into primary, post-traumatic, secondary and unspecified is used.
Today on the Internet you can easily find online electronic directories that allow you to decipher any disease code; just enter it in a special field. You can try to do this yourself by looking for the required code in the hierarchical structure of the ICD and studying the meanings of additional symbols. Finally, you can try to “encrypt” the diagnosis, as a doctor does.
As a rule, in medical documentation, the verbal formulation of the diagnosis and the ICD code are used in parallel. Although for some delicate diseases only a code can be indicated that is understandable only to specialists. But the main thing is that thanks to the use of codes, the systematization of data, their accumulation and analysis, and the collection of medical statistics, including on a global scale, are simplified. If a patient is sent for treatment or surgery to a foreign clinic, incorrect interpretation of the diagnosis due to translation difficulties is excluded. The codes are used in medical histories, epicrises, sick leave certificates, and are used as a guide when conducting a medical and social examination when the question of assigning disability is raised.
Many of us sometimes experience painful sensations in our knees after hard physical labor and long periods of standing, but few people pay attention to such a “trifle.” We begin to think about the nature of this pain only when it becomes unbearable and does not leave us even after rest. One of the main causes of knee pain is knee osteoarthritis (DOA).
DOA of the knee joints or gonarthrosis is a chronic, progressive, degenerative-dystrophic disease that leads to the destruction of all components of the knee joint, especially the hyaline articular cartilage, which leads to loss of function of the lower limb and disability. The disease is very common, its symptoms can be found in more than 40% of the population aged 40 years and over. For gonarthrosis, a special category is allocated in the International Classification of Diseases (ICD 10) - M17.
Pathological changes that lead to damage to the knee joint begin in the hyaline cartilage. This structure covers the articular surfaces of the bones that form the knee joint and performs a number of very important functions. Cartilage tissue does not have its own blood vessels, so its nutrition is provided by nutrients found in the synovial fluid (lubricant inside the knee).
The impetus for the beginning of the process of destruction of intra-articular cartilage is any reason that leads to disruption of the metabolic process in it. This leads to the fact that cartilage loses substances that provide its elasticity, strength and resistance to constant stress. Its structure becomes loose, microcracks appear in it and gradually the cartilaginous layer is destroyed. If the cause of the pathology is not eliminated at this stage, then in the future this will lead to complete destruction of the intra-articular cartilage tissue.
As a result of such pathological changes, DOA of the knees leads to the development of joint instability. The body reacts to this with a kind of protective reaction - the proliferation of osteophytes. These are marginal bony outgrowths that are designed to stabilize the knee joint. But their appearance only aggravates the situation. When they reach large sizes, they increase pain; in addition, osteophytes can break off and remain freely in the cavity of the knee joint. Such fragments can cause blockage of the joint in DOA (“joint mouse”) - sharp and unbearable pain develops in the knee, the person cannot take a step. Often, to eliminate this condition it is necessary to resort to surgery.
Over time, osteophytes occupy the entire cavity of the knee joint and lead to various deformities or ankylosis (complete loss of mobility). At this stage, except for knee replacement surgery, nothing can relieve a person of chronic pain and restore the joy of movement.
DOA of the knee joints ranks second after damage to the hip joint. It is these structures that bear the greatest burden. The knees often suffer also because they are highly susceptible to various injuries, since these joints are located superficially and are little protected by the muscles from traumatic influences.
Depending on the reasons for the development of DOA of the knees, it happens:
Factors that predispose to damage to the knees by the degenerative process:
Signs and symptoms of DOA of the knees depend on the stage of the disease. As a rule, at the beginning of the disease, nothing particularly bothers the patient, which leads to the fact that the diagnosis is made already in the second, and sometimes in the third stage of osteoarthritis, when conservative treatment methods cannot achieve positive dynamics.
All existing methods of treating osteoarthritis can be divided into conservative and surgical.
The basis of conservative treatment of DOA is medications. Anti-inflammatory and painkillers come first. Although these drugs do not affect the course of the disease and its progression, they significantly improve the patient’s quality of life, relieving him of chronic pain.
The second place among the drugs prescribed by doctors for deforming arthrosis is taken by chondroprotectors. These medications are designed to restore intra-articular cartilage. It should be noted that they do not act immediately. The effect of taking such medications can be noticed after 3-6 months of regular use. Positive dynamics can be observed in the initial stages of the disease. When the cartilage layer is already destroyed, these medications are useless.
Vasodilator medications are prescribed in the complex treatment of patients. They increase blood flow to the cartilage tissue and lead to normalization of its nutrition, which has a positive effect on the course of the disease.
Today, intra-articular injections of hyaluronic acid are actively used. This substance is a structural component of cartilage and promotes its hydration. The disadvantage is the difficulty of performing injections, the development of complications, and the high cost of a course of such therapy. It is also effective only in the initial stages of pathology.
Corticosteroid hormonal drugs are used only for exacerbation of osteoarthritis as an emergency aid. They quickly eliminate swelling, pain and other signs of inflammation, but have many side effects.
Not a single course of therapy for gonarthrosis can do without such conservative treatment methods as massage, manual therapy, physiotherapeutic procedures, physical therapy, a special diet, and orthopedic devices.
As a rule, surgical treatment is necessary in stage 3 of osteoarthritis, when all other methods are ineffective. All operations on the knee joint for gonarthrosis can be divided into 2 groups:
As already mentioned, surgery becomes the patient’s only chance to restore limb function and eliminate constant pain.
Prevention of a disease such as arthrosis deformans is nonspecific and includes the following main measures:
If pain appears in the arm, you can assume the presence of arthrosis of the elbow joint, the symptoms and treatment of which depend on the stage of development. A visit to the doctor at the first signs of illness increases the chances of recovery. However, many people ignore discomfort, postponing visiting a medical facility. Over time, irreversible changes appear in the joint. The sick person loses the ability to perform usual activities and suffers from pain. At a late stage of the disease, it is impossible to completely restore the function of the elbow joint.
Osteoarthritis is a disease in which the cartilage tissue inside the joint is destroyed. The World Classification of Diseases assigned arthrosis an international code according to ICD 10 M15 - M19.
Cartilage tissue can be compared to a sponge located between the hard surfaces of the heads of bones. When the joint does not move, the “sponge” is saturated with articular (synovial) fluid. During movement, the bones exert pressure on the “sponge”. The articular fluid released from it ensures soft sliding of the articular cartilage between the heads of the bones, even under significant physical exertion. After the cessation of motor activity, all synovial fluid is absorbed into the “sponge”.
Healthy cartilage tissue is smooth, elastic and shiny. It not only allows the bones to glide during movement with virtually no friction, but also performs shock-absorbing functions. Cartilage cushions impacts, protecting bones from damage. It takes on one part of the pressure, and distributes the other over the area of the bones.
In order for cartilage tissue to cope with its task, its shape must be perfectly adjusted to the curves of the adjacent bones. The strength of a healthy joint is superior to that of metal bearings.
With arthrosis, the structure of cartilage tissue changes. She becomes:
The cartilage decreases in size and changes its shape, deforming the joint. Its surface becomes rough and covered with cracks.
The changed cartilage tissue peels off from the surface of the bone in the form of scales. In this case, a product of its breakdown is formed - cartilaginous detritus (pieces of cartilage). Cartilage particles move inside the joint and get between the rubbing surfaces. They damage the cartilage and synovium of the joint capsule, like sandpaper.
The amount of joint fluid decreases. Easy sliding of bone surfaces becomes impossible. Movements begin to be accompanied by pain and creaking. Their amplitude decreases.
Joint deformation changes the load on the tendons, ligaments and muscles involved in the motor process. They weaken, stretch or atrophy. Trying to compensate for the functions of cartilage tissue, bone tissue grows, forming bone deposits (osteophytes). Osteophytes further limit human movement.
Deforming arthrosis of the elbow joint can be triggered by trauma. Destructive processes in cartilage tissue are triggered by bone fractures, cracks, ruptures and sprains of ligaments, tendons, dislocations and severe bruises. Even minor impacts from the elbow can cause damage to the superficial layers of cartilage.
Changes in the structure of cartilage occur due to its wear and tear. Excessive or monotonous physical activity destroys cartilage tissue. The disease is often diagnosed in people whose professional activities involve constant stress on the elbow joint:
In addition, the disease manifests itself in athletes:
The disease develops in people suffering from metabolic disorders, deficiency of vitamins and microelements. Arthrosis of the elbow joint can be triggered by chronic illnesses, rheumatoid arthritis, endocrine diseases, dehydration, frequent infectious diseases, hypothermia, excess weight, and intoxication of the body.
A common cause of dysfunction of cartilage tissue is the aging of the body. The disease can cause inflammation in the joint. People who have close relatives with arthrosis are at risk.
The stage of the disease can be determined by the symptoms of arthrosis of the elbow joint.
Because articular cartilage has no nerve endings or blood vessels, its destruction may not cause any discomfort at first. Arthrosis of the elbow joint 1st degree sometimes manifests itself in minor pain and muscle stiffness. There may be difficulty moving the forearm.
A characteristic sign of developing arthrosis is an unpleasant sensation that occurs when trying to move the arm back behind the thigh, as well as when flexing and extending the elbow. The patient often mistakes such symptoms for residual effects after an injury or explains them as muscle overstrain.
It is very difficult to detect changes in cartilage tissue at the initial stage of the disease. During an X-ray examination, a barely noticeable narrowing of the joint space can be seen. If the patient suspects something is wrong in time and immediately consults a doctor, complete restoration of the functions of the elbow joint is possible.
Arthrosis of the elbow joint 2nd degree is manifested by intense pain with increased load on the arm. It is pain that most often forces the patient to see a doctor. A diseased joint bothers a person even at rest, significantly reducing his quality of life.
It is very difficult for the patient to move his arm back or bend it at the elbow. He cannot keep the hand clenched into a fist in a flexed position (Thomsen's sign). When you try to rotate and flex the forearm at the same time, the pain intensifies (Welsh's symptom). The movements are accompanied by creaking.
When examined on X-ray photographs, changes in the cartilage tissue are clearly visible. Its outline becomes uneven. Bone growths are clearly visible. An external examination may reveal swelling.
Exacerbation of the disease occurs due to the accumulation of synovial fluid. Excessive activity of the synovial capsule is caused by inflammation of its injured membranes (synovitis). Swollen tissue is hot to the touch. Damage to the capsule is accompanied by severe pain.
Treatment of stage 2 arthrosis is carried out with medications in combination with physiotherapeutic procedures.
At stage 3 of the disease, aching pain haunts the patient even at night. The range of motion of the elbow joint is significantly reduced. Simple everyday actions are given to a person with great difficulty. Trying to reduce pain, he instinctively tries to keep his hand in a fixed position.
On X-ray images, stage 3 arthrosis can be detected by destroyed cartilage, absence of joint space and multiple bone growths. The joint deformity sometimes becomes so severe that the affected arm becomes shortened. If an advanced form of arthrosis is diagnosed, treatment will not help completely restore the function of the elbow joint.
The patient is prescribed chondroprotectors. Chondroprotectors stimulate the regeneration of cartilage tissue and stop its destruction. Most often, a traditional combination drug is used containing:
It regulates metabolism in chondrocytes (the main cells of cartilage tissue) and in the intercellular substance of cartilage (matrix), in addition, it increases the resistance of chondrocytes to enzymes that cause the destruction of cartilage tissue.
To stimulate the process of regeneration of cartilage tissue, B vitamins (B1, B2, B3, B6, B9 and B12) and vitamins C, A and E are also prescribed. To increase blood flow and improve cell nutrition, vasodilators are used (Pentoxifylline, Xanthinol nicotinate) .
To reduce pain and inflammatory syndromes, non-steroidal anti-inflammatory drugs (Flamax, Ketoprofen) are used. Antioxidants (Dihydroquercetin Plus, Mexidol) suppress the processes of lipid peroxidation, reduce the formation of free radicals and inhibit the destruction of cartilage. Lipid peroxidation plays a major role in the development of arthrosis.
In case of severe pain and swelling, local anesthetics (Novocaine, Lidocaine) or hormonal drugs (Diprospan, Celeston, Kenalog, Flosteron) are injected into the affected area. During the injection, a needle is inserted into the cubital canals.
For arthrosis of the elbow, hyaluronic acid preparations (Ostenil, Fermatron, Crespin gel, Duralan) are injected into the joint. They are called "liquid prostheses". After being introduced into the joint cavity, they act as joint fluid. Medicines lubricate the surfaces, stimulate the restoration of cartilage and improve its nutrition. The drugs form a thin film on the cartilage surface, protecting it from friction and destruction.
If drug therapy does not give the desired result, surgery is prescribed.
For arthrosis of the elbow joint, ultraphonophoresis, electrophoresis with the lysine salt of ketoprofen (Flamax for injection) and vascular drugs, laser therapy, inductothermy, magnetic therapy, ultraviolet irradiation, balneotherapy, and UHF on the affected elbow joint are prescribed. In addition, applications of coolant fluids are shown.
During the period of exacerbation and subsequent recovery, the patient’s affected elbow joint is fixed with a special orthosis - a bandage.
Massage and therapeutic exercises give good results. Massage and therapeutic exercises should not be prescribed after injuries, dislocations and sprains, during exacerbation of the inflammatory process, at elevated body temperature (above 37.5? C) and during infectious diseases. Before treating arthrosis, you must wait for complete recovery. At least 3 months must pass after surgery on the elbow joint.
First, the diseased joint is pressed to the stomach, the hand is lowered down, turning it to the side opposite the patient. With a healthy hand, lightly press the hand until a slight painful sensation appears. Then you should try to lift the sore palm up, resisting the hand. The actions alternate 3 - 5 times, holding each position for 5 - 7 seconds. For the first time, it is better to hold your hand for no more than 5 seconds.
During the second exercise, the hand remains pressed to the stomach, but the hand is tilted back. The sore hand is carefully rotated with the healthy hand, trying to point it to the shoulder on the sore side. Then they try to provide resistance to the sore hand in the direction from the shoulder. Actions alternate 3 - 5 times.
For the next exercise, you need to cross your legs and place your straightened sore arm on top, palm up. With a healthy hand, grab the sore hand from the outside and twist it away from you until slight pain appears. After this, the diseased hand resists for 5 - 7 seconds, but the healthy hand does not allow it to turn.
Remaining in the same position, the palm of the affected hand is turned down and away from you, and with the healthy hand, the inversion of the hand is increased until slight pain appears. The sore hand resists for 5-7 seconds, then the movement is repeated another 3-5 times.
For the last exercise, the painful elbow joint is placed on the knee, with the hand turned palm up. With your healthy hand, move your fingers back towards you. During resistance, you should try to lift your hand up and bend your elbow joint. The tension must occur in two directions. Abduction and tension alternate 3 to 5 times. Between movements you need to relax your hand.
Exercises for arthrosis of the elbow joint should be done daily 1 - 2 times a day for 3 - 4 weeks. When performing movements, you need to avoid sudden pain. Moderate tolerable pain caused by tendon strain is acceptable. The load should be increased gradually.
Treatment of arthrosis of the elbow joint with folk remedies gives good results, especially in the early stages of the disease. Traditional healers use rubbing to restore motor function of the elbow. To prepare propolis ointment, the bee product is simmered in a water bath until completely dissolved. Then add the same amount of vegetable oil to the propolis and mix the ingredients thoroughly.
When the product has cooled, it is rubbed into the sore joint. A plastic wrap and a woolen scarf are tied on top. After 6 - 8 hours, the compress is removed. It's best to do it before bed. The procedure must be repeated daily until complete recovery.
If there is no swelling, you can massage the joint by rubbing liquid honey into it. Movements should be soft and leisurely. The duration of the procedure is 15 minutes.
To eliminate arthrosis of the elbow joint, treatment may include the use of blue clay. It is diluted with warm water to a thick sour cream, spread on a piece of clean cotton cloth, applied to the sore spot and wrapped in a woolen scarf. Procedures can be repeated daily 3 times a day. Their duration is 30 minutes. Each time you need to use a new portion of clay.
It is useful to make baths with an infusion of spruce or pine needles and young cones. The raw material is poured with water until it covers it. Then boil it for 10 minutes. When the infusion has cooled to a temperature that is pleasant for the body, the elbow is immersed in it. The procedure lasts until the water cools down.
To treat any pain syndrome or inflammatory disease, drugs belonging to the group of non-steroidal drugs with anti-inflammatory effects (NSAIDs) are often prescribed. This group of drugs is quite diverse. The most commonly prescribed substances among them are ibuprofen, meloxicam, ketoprofen, nimesulide, diclofenac, etc. Among these drugs, meloxicam is worth highlighting.
Artrosan is a Russian medicinal product that is produced:
Tablets consist of 7.5 or 15 mg of meloxicam and excipients. Packaged in 20 pcs. Auxiliary components are: trisodium citrate, lactose monohydrate, silicon dioxide, potato starch.
Artrosan solution looks like a transparent greenish product. It is administered intramuscularly. Each ampoule contains 2.5 milliliters of the substance, packaged in two types of packaging - 3 each; 10 ampoules. Artrosan solution consists of meloxicam, meglumine, poloxamer substance, glycofurol ether, and water for injection.
Artrosan ointment is available in tubes of 30 g and 50 g. Suppositories for rectal use are white capsules, available in 25, 50, 100 mg. The main components of suppositories are glycerin and gelatin. One package contains 10 suppositories. They can be used once a day.
The cost of Artrosan ranges from:
Instructions for use recommend using the tablet form once a day with food. The maximum amount of medication taken per day is 15 mg. It should be dosed in accordance with the general diagnosis:
Artrosan injections are prescribed when oral administration is not possible. The medicine is administered intramuscularly, slowly, deep into the tissue. It is recommended at the beginning of the disease, then it is advisable to switch to tablets. The daily volume of injections is 7.5; 15 milligrams. Therapy should be started with a lower dosage, gradually increasing it in order to achieve the desired effect. To avoid the risk of side effects, recommended doses should not be exceeded.
The ointment is used externally, 2-4 grams are applied to the site of inflammation by rubbing into the skin, it is allowed to use for 7-17 days.
This drug is taken if the patient's condition is accompanied by inflammation and pain. The main indications are:
Indications for the use of arthrozan in ampoules are for the same symptoms as the tablet form of the drug, with the difference that intramuscular injections of meloxicam are indicated for very severe, severe pain, and they need to be urgently alleviated or completely stopped.
Indications for use of Artrosan ointment and gel are the same as tablets, injections, and for traumatic inflammation of tendons, ligaments, muscles, joints that are the result of sprains, high loads, bruises.
There are contraindications; Artrosan is not recommended for treatment in the following cases:
Meloxicam should be taken with caution in parallel with cyclosporine, diuretics, antihypertensive drugs, lithium drugs, non-steroidal anti-inflammatory drugs - the risk of bleeding in the gastrointestinal tract increases.
If liver or kidney function is impaired, you should consult a doctor who will select the most appropriate form of the drug, dose and regimen of daily medication. If the medicine is used for more than 14 days, it is necessary to monitor the activity of the liver and kidneys. Erosive conditions of the gastrointestinal tract require caution when taking this drug.
Persons over 55-60 years of age, especially those with high cholesterol or diabetes, should use this medicine very carefully. Limitation of use is also recommended for patients who have recently used NSAIDs for a long period of time, during treatment with heparin (anticoagulants), aspirin (antiplatelet agents), and glucocorticoids.
This drug is not recommended for women who are planning a pregnancy, as it may affect fertility. Persons taking diuretics concomitantly with meloxicam should drink enough fluids.
If the dosage is exceeded and if meloxicam is used incorrectly, side effects may occur, manifested in the form of:
Side effects when using Artrosan ointment are described in the annotation as:
Artrosan has low systemic absorption, so when using the gel the likelihood of overdose is not high. If drugs used externally are taken orally accidentally, a side effect may occur. In this case, you need to act as follows:
During simultaneous use of Artrosan with medications used to lower blood pressure, its effectiveness decreases. Poor compatibility with diuretic drugs manifests itself as renal failure. Drugs that affect blood clotting: fibrinolytics, vitamin K antagonists, serotonin reuptake inhibitors, when interacting with arthrozan, can lead to bleeding.
When using contraceptives, such as the IUD, use this medication with caution, after consulting with your doctor.
Intramuscular injections of Artrosan are strictly contraindicated when drinking alcohol. The drug is completely incompatible with this substance. Once treatment begins, it is necessary to completely eliminate alcoholic beverages from the diet. Any drinks that contain alcohol are strictly prohibited when taking Artrosan.
Along with this drug there may be substances that contain meloxicam as the main active ingredient - these are its analogues. Artrosan has a similar nature of action to them. It has many similar drugs, the most famous of which are: Meloxam (price from 39 to 220 rubles depending on the dosage form, dosage and packaging), Amelotex (107-523 rubles), Movasin (68-630 rubles), Movalis (460 – 842 rubles), Mirlox (197-239 rubles).
The drugs that have the most suitable content of the main active ingredient and are cheaper than Artrosan include tablets in minimal packaging: Meloxicam - 14 rubles, Meloxicam-DS (164 rubles). These drugs are recommended for use as analogues. Less effective cheap drugs include Movis with a price of 93 rubles and Oxycamox, which costs 110 rubles.
Artrosan (meloxicam) is a prescription drug. During storage, contact with the aquatic environment should be avoided and contact with direct sunlight should be avoided. This product must be stored at a temperature of more than 25 0C in a place inaccessible to children.
Diclofenac or Artrosan - which is better?
Diclofenac is an analogue of Artrosan in terms of the active substance. Their actions, side effects and contraindications are almost the same. But Diclofenac is cheaper in many pharmacies, which cannot be said about large dosages of Artrosan (meloxicam).
Reviews about this medicine are mostly positive; it can be selected in various forms and at the most reasonable cost. Its effectiveness is confirmed by many patients; it helps cope with painful conditions, relieves inflammation and provides excellent pain relief.
People consider side effects as negative characteristics, such as headaches, pain in housing and communal services, dizziness, but these phenomena are not observed often.
The drug Artrosan is an effective remedy that has an effective anti-inflammatory and analgesic effect. It has a gentle effect on the gastric mucosa, but only if used correctly.