Osteoarthritis (arthrosis): treatment of joints without myths in Tashkent

What actually happens to the joint

For a long time, osteoarthritis was described simply as wear and tear of cartilage, similar to wear and tear on a piece of machinery. Today it is clear that this is not only mechanics. The entire joint is involved in the process: the cartilage becomes thinner and loses its elasticity, the bone underneath is rebuilt, the marginal bony protrusions - osteophytes - grow, the synovial membrane becomes inflamed, the ligaments and surrounding muscles suffer. There is also an inflammatory component, although it is less pronounced than with real arthritis.

• Cartilage loses its ability to absorb stress and retain water
• The underlying bone becomes denser, cysts and areas of restructuring form in it
• Osteophytes form along the edges of the joint - bone growths, not “salts”
• The synovial membrane periodically becomes inflamed, effusion and swelling appear
• The muscles around the joint weaken from sparing and the joint loses its natural support
• Biomechanics changes: gait becomes more gentle, the load is redistributed to other joints and the spine

This leads to an important fact that explains a lot: the cartilage itself does not have nerve endings and cannot hurt. Pain in arthrosis comes from the bone under the cartilage, from the inflamed synovium, from the ligaments, capsule and overstrained muscles. That is why the degree of cartilage destruction in the image and the severity of pain do not always coincide: there is pronounced radiographic arthrosis with almost no complaints and moderate changes with severe pain. And this is why treatment aimed at muscles and reducing stress works, although it does not restore cartilage.

The myth about salt deposition: where did it come from?

The expression “salt deposits” has become so firmly established in everyday life that it is even used in relation to the spine and heel spur. Let's look at it in parts, because the choice of treatment directly depends on this.

• In osteoarthritis, no salts are deposited in the joint. What is visible on x-rays at the edges of the joint are osteophytes, that is, bone tissue that has grown in response to stress and instability.
• The only disease that actually deposits salt crystals in the joint is gout: uric acid crystals. But this is a completely different disease with sudden attacks of severe pain, usually in the first toe, and it is treated differently
• There is also the deposition of calcium crystals in the cartilage, also a separate condition; it is identified by characteristic changes in the image
• The myth leads to useless tactics: limiting salt in food, “cleansing” with rice and herbs, rubbing. They do not affect the course of osteoarthritis in any way.
• The crunch that people say “salts creak” has nothing to do with salts

The practical harm of myth is that it shifts focus. A person has been doing no-salt diets and rubbing for years, instead of doing two things with proven effectiveness - strengthening muscles and losing weight. The second most popular harmful conclusion from the same myth: since something is “deposited and in the way” in a joint, you need to move it less. In fact, the opposite is true: movement improves the nutrition of cartilage, which does not have blood vessels and receives nutrients from the joint fluid precisely during loading and unloading.

Symptoms and how to distinguish from inflammatory arthritis

Osteoarthritis develops slowly, over years, and begins unnoticed. At first, the pain appears only with significant exertion - when climbing stairs, long walking, after gardening, and goes away with rest. Then comes the initial pain: the first steps after a long period of sitting are difficult, but after a few minutes of walking it becomes easier. In later stages, pain also occurs at rest, and movement in the joint is limited.

• Pain with activity and at the end of the day, relieved by rest - unlike inflammatory arthritis
• Initial pain and stiffness after rest, usually disappearing within 15–30 minutes; with arthritis, morning stiffness lasts more than an hour
• Crunching and friction sensation when moving
• Gradual limitation of mobility: difficulty in fully bending or straightening the joint
• Periodic swelling of the joint after exercise
• Change in the shape of the joint in the later stages, nodules on the fingers
• No general symptoms: no fever, weight loss, night sweats

Localization also helps. Osteoarthritis typically affects the knees, hips, distal and middle joints of the fingers, the base of the big toe, the first metatarsophalangeal joint of the foot, and the spine. Rheumatoid arthritis, on the contrary, is characterized by symmetrical damage to the small joints of the hands closer to the palm with prolonged morning stiffness. If joint pain is accompanied by morning stiffness for more than an hour, swelling of several joints, fever, rash or weight loss, this is a reason to look not for arthrosis, but for an inflammatory disease, and contact a rheumatologist.

Examination: when a picture is needed and when not

The diagnosis of osteoarthritis in many cases is made clinically: by age, nature of pain, examination data. Instrumental studies are needed to confirm, assess the stage and exclude other causes, but not to “see what’s there.”

1. Рентгенография сустава в стандартных проекциях, для коленных суставов — обязательно в положении стоя, с нагрузкой: только так видна истинная ширина суставной щели.
2. Анализы крови — не для диагностики артроза, а для исключения воспалительных и обменных болезней: общий анализ, СОЭ и С-реактивный белок, при подозрении на подагру — мочевая кислота.
3. Ультразвуковое исследование сустава — оценивает выпот, состояние синовиальной оболочки, кисты.
4. Пункция сустава с исследованием жидкости — при выраженном выпоте и подозрении на инфекцию или кристаллы.
5. Магнитно-резонансная томография — не рутинный метод. Её назначают при неясной картине, подозрении на серьёзное повреждение или перед планированием операции.

MRI has its own pitfall. In middle-aged and older people, the image will almost always show degenerative changes in the menisci, cartilage breakdown, cysts - many people have these findings without any complaints. Mistaking them for the cause of pain, it is easy to end up with unnecessary surgery. Therefore, MRI is prescribed when the decision depends on its result, and not “just in case” for ordinary knee pain.

What really helps

The mainstay of treatment for osteoarthritis is not drugs. Three things have the greatest proven effect: patient education, therapeutic exercise and weight loss. They act slower than the injection, but their effect accumulates and persists, and there are no side effects.

1. Упражнения. Для колена ключевое значение имеет сила четырёхглавой мышцы бедра: сильные мышцы разгружают сустав и стабилизируют его. Программа включает силовые упражнения, растяжку и аэробную нагрузку. Заниматься нужно регулярно и длительно — эффект появляется через недели, а исчезает при прекращении занятий.
2. Снижение веса при избыточной массе тела — самое результативное вмешательство при артрозе колена и тазобедренного сустава. Клинически заметное улучшение наступает уже при снижении веса примерно на десятую часть, а сочетание диеты с упражнениями работает лучше, чем каждое по отдельности.
3. Правильный выбор нагрузки: ходьба, плавание, водная гимнастика, велосипед с невысоким сопротивлением. Ограничивают прыжки, бег по твёрдому покрытию при выраженном артрозе, глубокие приседания, подъём тяжестей, длительное стояние на коленях.
4. Трость в руке, противоположной больному суставу, — простой приём, который заметно снижает нагрузку. Именно противоположной: это не интуитивно, но механически верно.
5. Обувь с амортизирующей подошвой, отказ от высокого каблука и от плоской жёсткой подошвы.
6. Тепло и холод: тепло помогает при скованности, холод — при припухлости после нагрузки. Дешёвые, безопасные и вполне рабочие меры.

Separately, about the fear of “erasing the joint completely.” Moderate regular exercise does not accelerate the destruction of the joint - it improves the nutrition of the cartilage, strengthens the muscles and reduces pain. Two extremes are harmful: complete immobility and sudden excessive load after a long break. The correct tactic is gradual build-up. The guideline is simple: if pain after exercise returns to its normal level within 24 hours, the load is adequate; if it lasts longer, it needs to be reduced, but not completely eliminated.

Medicines, injections and surgery

Medications for osteoarthritis solve the problem of pain relief and reduction of inflammation, allowing a person to move and exercise. There is currently no drug that restores cartilage, and this should be taken as a starting point so as not to spend years searching for a miracle remedy.

• Local forms of non-steroidal anti-inflammatory drugs - gels and ointments on the joint area. For arthrosis of the knee and hands, they are effective and noticeably safer than tablets, so it is wise to start with them
• Non-steroidal anti-inflammatory drugs orally - in short courses and in the minimum effective dose, taking into account the condition of the stomach, kidneys and heart. Constant uncontrolled use is a common cause of complications.
• Intra-articular administration of glucocorticosteroids - provides pronounced but temporary relief from inflammation and effusion; the number of injections into one joint is limited, since frequent injections can worsen the condition of the cartilage
• Intra-articular hyaluronic acid preparations - the effect according to research is contradictory and on average small; the decision is made individually
• Chondroprotectors in tablets and injections - the evidence base is weak and contradictory: no significant effect on the progression of the disease was obtained in high-quality studies. They are relatively safe, but they should not be considered as the basis of treatment
• Painkillers of other groups - as prescribed by a doctor, taking into account concomitant diseases

Joint endoprosthetics is an operation to replace a joint with an artificial one. This is not an admission of defeat, but an effective decision at its stage. The indications are determined not by the image on the X-ray, but by the quality of life: constant pain, including night pain, which cannot be controlled; severe limitation of walking and self-care; lack of effect from fully implemented conservative treatment. It is unprofitable to wait until the last minute: the worse the condition of the muscles and general physical fitness at the time of the operation, the more difficult the rehabilitation. It is worth preparing for the intervention in advance - strengthen muscles, lose weight, quit smoking.