EARLY VS. ADVANCED OSTEOARTHRITIS FROM A RADIOLOGICAL ASPECT

Osteoartritis (OA) je najčešći oblik artritisa koji znatno utječe na život pojedinca i općenito na zdravlje populacije. Napredak slikovne obrade i napredak u tehnici snimanja omogućio je prikaz zglobne hrskavice i mekih tkiva oko zgloba i u zglobu. Upotrebom tih tehnika moguć je prikaz morfologije hrskavice te procjena njezinoga biokemijskog sastava. Magnetska rezonancija (MR) je najvažniji u slikovnom prikazu hrskavice u OA iako se grublje promjene hrskavice mogu vidjeti i UZ-om koji se smatra komplementarnom metodom. Očekuje se porast prevalencije OA s rastućom epidemijom debljine i povećanja prosječne životne dobi, odnosno sve veće starosti populacije. Rizični čimbenici za nastanak OA uključuju: dob, debljinu, prethodnu povredu zgloba ili ekstremiteta, genetsku podlogu sa znatnom familijarnom anamnezom, smanjenu razinu spolnih hormona, mišićnu slabost ili ponavljanu upotrebu zgloba. Također čimbenici koji pospješuju razvitak OA su infekcija, odlaganje kristala, akromegalija, prethodna upalna bolest ili metabolička bolest poput alkaptonurije, hemokromatoze i Wilsonove bolesti, te hemoglobinopatija, kao što je anemija srpastih stanica, talasemija, neuroartropatija koje vode Charcotovoj artropatiji ili siringomijeliji, tabesu i dijabetesu. Unatoč svim terapijskim dostignućima nema efikasnog lijeka za OA, što se odražava u nedostatku potpunog shvaćanja patofiziologije i prirodnog procesa. Upalne promjene u OA vjerojatno su sekundarne; prvo nastanu promjene u hrskavici i subhondralnoj kosti, zato se i smatra da to nije pasivna degenerativna bolest, nego aktivan proces koji pokreće mehanički čimbenik. Primarni i sekundarni OA imaju istu patohistološku osnovu. Bilateralna i simetrična afekcija nađe se uvijek u primarnom OA, posebice kada su zahvaćene šake. U OA prve promjene se nađu na artikulacijskoj hrskavici sinovijalnih zglobova, a promjene nastanu i na sinovijskoj tekućini, kao i na subhondralnoj kosti, na kapsuli zgloba i ostalom zglobnom staničju.Osteoarthritis (OA) is the most common form of arthritis. It has a significant impact on the life of an individual as well as on the general health of the population. The progress achieved in image processing and acquisition techniques has made it possible to visualize the articular cartilage as well as the soft tissues around and inside the joint. By using these techniques, it is possible to depict the morphology of cartilage and assess its biochemical composition. MRI is the most important imaging method for visualization of the cartilage in OA, although certain larger cartilage lesions can also be seen by US, which is considered a complementary imaging method. With the growing epidemic of obesity and longer life expectancy in the general population, the prevalence of OA is expected to rise in the future. Risk factors for OA include: older age, obesity, previous injury, genetic predisposition with a significant family history for certain diseases, reduced levels of sex hormones, muscle weakness, and repeated overuse of a joint. Factors that can also contribute to the development of OA include: infection, crystal deposition disease, acromegaly, inflammatory bowel disease, metabolic diseases such as alkaptonuria, hemochromatosis, and Wilson’s disease, or hemoglobinopathies such as sickle cell anemia and thalassemia, as well as neuroarthropathies that lead to Charcot arthropathy or syringomyelia, tabes, and diabetes. Despite all recent advances in therapy, there is still no effective treatment for OA, which results from the still incomplete understanding of the pathophysiology and natural processes of OA. The inflammatory changes that occur in OA are probably secondary, with changes in cartilage and subchondral bone occurring first. This is the reason why OA is not considered to be a passive degenerative disease but an active process caused by mechanical factors. Primary and secondary OA have the same pathohistological basis. Bilateral and symmetrically affected joints are typically encountered in primary OA, especially when wrists are involved. Initial changes in OA are usually found on the articular cartilage of synovial joints, but they also occur in the synovial fluid, subchondral bone, joint capsule, and other articular tissue