Arthrosis deformans

Osteoarthrosis (osteoarthritis) is known as the most frequent cause of the articular pain. It’s also called a degenerate joints disease. This disease depending on the frequency of the loss of the capacity for work caused by itself yields only to ischemic heart disease among men senior then 50 years.

Heterogeneity of osteoarthrosis complicates its classification. Traditionally it is subdivided on primary (idiopathic) and secondary form. The reason of the first one is unknown. The secondary one arises as consequence of metabolic, anatomic, traumatic or inflammatory injury. Osteoarthritis can be also classified on number of the injured joints. There exist monoarticulary, oligoarticular or polyarticular (generalized) forms of disease.

Pathophysiological theories of osteoarthritis describe disorder of a normal structure of a joint, change of a capsule and cartilage damage as a result of a disorder of tissues remodelling of a normal joint. Osteoarthritis results from interaction of mechanical and biological factors. This process begins as a change in a cartilage or in a subchondral bone, or as a result of the disease inside these tissues (for example, gene defects of 11th type of collagen – ochronosis), or as a result of an abnormal external mechanical stress (for example, at instability of the joint, an increased loading, traumas). In process of progressing the specified changes become more expressed during the osteoarthritis. There are testimonies in favour of the femoral osteoarthritis professional risk arising on account of increased physical activity connected with work.

Recently a special attention has been given to the biochemical shifts promoting osteoarthritis. Obviously, this disease is developing, when the enzymes causing degradation of a cartilage (for example, proteases, cytokines, aggrecanases, substance Р, nitric oxide), outweigh by their action functions of the fibers responsible for preservation of the integrity of a cartilage (such, as tissular inhibitor of metaloproteinase, kininogens, inhibitor-1 of the plasminogen activator transforming the factor of growth, insulin-like growth factor -1, gamma interferon). Matrix proteinase metaloproteinase, including collagenases, stromelysins, gelatinises, membraneous proteases and metalloelastase are found out in a cartilage during the osteoarthritis. Their concentration, as a rule, correlate with a histologic injury rate. Various cytokines, including, interleukine -1 and tumor necrosis factor can cause also damage of joints and cartilage loss in consequence of the activation of the metaloproteinase enzymes of a degeneration and by dint of other mechanisms.

Osteoarthritis usually injures the following joints: distal interphalangeal joint, proximal interphalangeal joint, the first carpometacarpal articulation, the first metatarsophalangeal hip joint, knee-joint, joints of cervical and inferior lumbar sections of the backbone.

This disease is characterised by a pain, constraint and movement restriction in a joint. The pain originally appearing after movements in joints and relieving in rests is a cardinal symptom. More often patients say that it is "aching", and indistinctly localised. In process of osteoarthritis progressing, the pain starts to arise as a result of the minimum activity. In the gone too far cases it can even awake a patient at night. Also constraint is observed especially in the mornings and after the period of a small activity. However, unlike the inflammatory diseases of joints, constraint of joints during the osteoarthritises is short-term. Usually it does not last longer than 15 minutes. Movement restriction in a joint finally develops. It happens because of discrepancy of articulate surfaces, capsule contraction, muscular spasm and mechanical block created by osteophytes and articulate muscles.

During an examination a local morbidity and a pain during passive movements can be defined. Especially it becomes apparent in case of the maximum flexion/extension. Articular crunch is possible to hear or define by touch. It reflects the roughnesses of an articulate surface and the loss of the cartilaginous tissue. An area of a joint often increases in sizes. It is caused by changes of the soft tissues, accumulation of a liquid or osteophytes. Illness development leads to the rough deformation, subluxation and to the small range of motions.

Though osteoarthrosis does not lead to fatal outcomes, it is the most widespread disease of joints. Osteoarthrosis is one of the principal causes of an invalidity of an elder age people. The prevailing age of the beginning of osteoarthritis is 40-60 years.

The reduction of the joint loading is a basis of preventive maintenance of osteoarthritis. It is promoted by maintenance of a normal weight of a body. Optimum muscular loading has a great value. Clinical researches have shown that the training of the quadriceps muscle of thigh reduces risk of development of an osteoarthritis of knee joints. It is connected with the fact that a weakness of the quadriceps muscle of thigh decreases an ability to distribute loading in joints and maintain its stability. It is necessary to notice that damage of knee joints early in life increases risk of appearance of osteoarthritis in elder age. Prophylaxis of traumas including sport ones (in particular, working out of a regimen of sportsmen trainings with application of the graduated loading, use of the special devices protecting joints during the loading) has a great value.

Osteoarthrosis is characterized by the following signs:

• The gradual beginning of a pain;
• Pain strengthening during the loading and in a standing position;
• A crunch (crepitaiton) in a joint during the active movement;
• Restriction of the range of motions in a joint;
• An atrophy of surrounding muscles.

For the purpose of osteoarthritis treatment the preparations reducing a pain and a local inflammation of a joint are prescribed (analgesics and nonsteroidal resolvents) as well as the preparations improving a condition of a cartilaginous tissue (they are taken protractedly (6-12 months) under the doctor's prescription. In difficult cases prosthesic arthroplasty (replacement of joints with a mechanical artificial limb) is applied. Endoprosthesis replacement is medically necessary in case of the high degree of defeat of the joint, expressed painful syndrome, intractable reception of medicamentous means.

Efficiency of the osteoarthritis treatment by means of the stem cells transplantation is defined by a stage of a pathological process. Stem cells are not able to eliminate the deformation of joints developing at late stages of illness. Besides, stem cells replacement can strengthen this process to the point of anchylosis in case of prevalence of the fibrosis genesis in a joint. At early stages of disease in regenerative medicine patient’s own mesenchymal marrowy stem cells are used for osteoarthrosis treatment. The cells are injected in a joint after their preformation to the ondrocytes and ostoblasts .

At Institute of cellular therapy the technique of system transplantation of haemopoetic and mesenchymal stem cells is applied. After transplantation the 10-day course of injections of placentae cryopreserved extract is prescribed. Such approach applied at early stages of destruction of a cartilage allows to displace a remodelling balance to the direction of the chondrogenesis and osteogenesis that blocks the further disease progressing.

Clinical example. At present time within the framework of the researches conducted by the Coordination centre of transplantation of bodies, tissues and cell of the Ministry of Health of Ukraine on the basis of Institute of cellular therapy, 7 patients are receiving medical treatment for osteoarthrosis. All patients have got the initial stage of disease. It’s been diagnosed clinically using radiographic examination in accordance with criterias of American rheumatologic association. Within 6 months after transplantation of the haemopoetic and mesenchymal stem cell and a 10-day course of injections of the placentae cryopreserved extract all patients notice considerable improvement. It is proved by X-ray examination.