Polyosteoarthrosis is a multiple joint lesion that has a degenerative-dystrophic nature. The disease develops in people older than 40-50 years. Pathologies are susceptible to the metatarsophalangeal joints of the big toes and interphalangeal joints of the hands.
Deforming osteoarthrosis can occur in the form of mono-, oligo- or polyarthrosis. In the first case, only one joint is affected (usually the hip or knee). With oligoarthrosis, 2-3 large and / or medium joints suffer.
Due to the similar clinical picture, arthrosis of the interphalangeal joints of the upper extremities is confused with rheumatoid arthritis. Many people make a diagnosis on their own and begin to be actively treated, which leads to unreasonable intake of dangerous drugs (Methotrexate, Remicade, Arava, etc.).
Medicines have a cytostatic and immunosuppressive effect, inhibit the development of rheumatoid arthritis. However, they are useless in the treatment of deforming osteoarthrosis. Uncontrolled administration of cytostatics and immunosuppressants can cause serious damage to human health (for example, lead to inhibition of the immune system and the development of infectious diseases).
If you have pain and stiffness in your fingers, do not rush to take any medications. See a doctor and get tested. This will help to find out what you are sick with. Osteoarthrosis and rheumatoid arthritis are treated with different drugs. Only a doctor can choose the right treatment regimen for you.
Where does osteoarthrosis come from?
The main cause of polyosteoarthrosis is chronic joint overload. Provoking factors – hypothermia, genetic predisposition, wearing uncomfortable shoes, overweight, lack of calcium during menopause, etc.
Polyosteoarthrosis of small joints of the hands usually develops in pianists, typists, programmers, secretaries. Representatives of these professions regularly perform active movements in the interphalangeal joints, which leads to their trauma.
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The mechanisms of the development of the disease:
- Disruption of blood circulation in the periosteum, located under the cartilage. Lack of oxygen, nutrients leads to loss of elasticity, thinning of articular cartilage. Over time, they become covered with cracks, are destroyed.
- Decrease in hydrophilicity of cartilage due to metabolic disorders of their basic substance and proteoglycan insufficiency. Joint tissue loses its ability to absorb nutrients from synovial fluid, which accelerates its destruction.
- Decreased elasticity, viscosity of the synovial fluid, due to which it becomes unable to perform its basic functions (depreciation, lubricating, metabolic).
Osteoarthrosis of the I-II stage is characterized by damage only to articular cartilage. At stages III-IV, the disease leads to exposure of bone surfaces, the gradual destruction of bones. Small articular joints of the fingers are deformed, which makes it difficult for a person to do the usual work. The patient is concerned about pain, a feeling of stiffness, difficulty in performing flexion / extensor movements.
How to distinguish arthrosis from rheumatoid arthritis
Since polyosteoarthrosis of the joints of the hands can be confused with rheumatoid arthritis, consider the symptoms of both diseases. The information below is for informational purposes only. Only a doctor can make a diagnosis based on anamnestic data, the clinical picture of the disease, and the results of laboratory tests.
Table 1. The main differences between arthrosis and rheumatoid arthritis:
|Evidence||Deforming osteoarthrosis||Rheumatoid arthritis|
|Pain||Strengthen during exercise, but disappear at night. For arthrosis, the “starting” pains that occur at the beginning of the movement are also typical.||Painful sensations appear at night or early in the morning, pass after a few hours. Unlike arthrosis, with arthritis, pain after exercise decreases|
|Stiffness||The patient notes minor difficulties with flexion / extension of the fingers. In the morning, stiffness lasts no more than 15-20 minutes||A pronounced stiffness in the fingers according to the type of “tight gloves”. Usually appears in the morning, persists for several hours.|
|The presence of nodules||Nodules of Bushar and Heberden, representing bone growths on the interphalangeal joints. They are always motionless.||Rheumatoid nodules are located subcutaneously in the joints. They are mobile. Nodules can also appear on the back of the palms, ears, knees, elbows|
|Crunch||Occurs with active finger movements||The appearance of a crunch for arthritis is not typical|
|Temperature increase||No||Body temperature can rise to 37-37,5 degrees|
|Analysis Changes||Doctors sometimes reveal nonspecific signs of inflammation in a general blood test.||Characteristic is an increase in the level of RF, C-reactive protein, antibodies to MCV and ADC. In patients with rheumatoid arthritis, the HLAB27 antigen is also detected.|
|X-ray signs||In the initial stages, joint changes are almost imperceptible. Later in the pictures you can see a narrowing of the joint spaces, signs of bone damage. In many patients, osteoporosis is detected, which is manifested by a decrease in bone density||Joint lesions are characteristic, the severity of which depends on the severity of the disease. Radiographs show periarticular osteoporosis|
Polyosteoarthrosis of the joints of the foot and hand is treated with the same means as arthrosis of any other localization. To combat the disease, chondroprotectors, anti-inflammatory drugs of the steroid and non-steroid groups, physical therapy, physiotherapy are used.
Methods of surgical treatment of polyosteoarthrosis
Deforming osteoarthritis causes a slow but steady destruction of cartilage and bones. Sooner or later, the disease leads to constant severe pain in the joints, a pronounced violation of the joint functions. In the later stages, unpleasant symptoms can no longer be stopped by conservative treatment methods – a person needs surgery.
Osteoarthritis of the interphalangeal and metatarsophalangeal joints is treated by endoprosthetics – replacing the affected joints with artificial implants. But modern endoprostheses are quite voluminous, and their implantation is highly traumatic. Therefore, scientists continue to improve the design of prostheses.
Today, doctors are working on introducing into clinical practice the so-called endoprostheses with a shape memory of titanium nickelide. They easily bend when cooled, which allows them to be implanted with minimal soft tissue trauma. Having warmed up to body temperature, such prostheses acquire their original form. Such implants are already widely used in dentistry.
Modern scientists are learning to create joint prostheses using a 3D printer. They recently managed to print articular cartilage using programmed stem cells. But such implants are still imperfect and are not suitable for endoprosthetics.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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