Arthritis
The content of the article:
- Arthritis Causes and Risk Factors
- Forms
- Stages
- Arthritis symptoms
- Features of the course of arthritis in children
- Diagnosing arthritis
- Arthritis treatment
- Complications and possible consequences
- Forecast
- Prevention
Arthritis (from Latin arthritis - joint aches) is a general designation for all types of inflammatory processes in the joints, acting as independent nosological forms or manifestations of systemic pathology. With a progressive disease, inflammation spreads to adjacent tissues: synovium, bursa, ligaments, tendons, muscles and bones.
Joint damage in arthritis
Arthritis Causes and Risk Factors
The reasons for the development of inflammatory processes in the joints can be very diverse. Acute inflammation can be caused by trauma, infection, an allergic reaction, or the ingress of toxic substances into the joint cavity when bitten by snakes, spiders and poisonous insects. The chronic form often develops against the background of various disorders in the work of internal organs and systems:
- endocrine disorders;
- diseases of the nervous system;
- autoimmune, allergic and atopic conditions;
- congenital anomalies in the structure of the musculoskeletal system and birth injuries - for example, dysplasia of the head of the hip joint;
- the presence of persistent infectious foci in the body.
The onset of reactive arthritis is most often associated with enterobacteria, chlamydia, and mycoplasma. In the case of rheumatoid arthritis, genetic predisposition is of paramount importance.
Among the statistically significant risk factors for the development of arthritis, the WHO names age over 65 years, overweight, arterial hypertension, kidney disease and being female: due to sharp changes in hormonal levels during menopause, women get sick more often than men. In Russia, joint inflammation is observed in about 60% of people of retirement age against the background of a trend towards an increase in the incidence and a decrease in the age at first manifestation of the disease. Diagnosing neuro-arthritic diathesis in childhood increases the likelihood of arthritis in adulthood.
A predisposing factor for arthritis is old age and the presence of chronic diseases.
Often, the cause of arthritis is the constant microtrauma of the articular structures during professional sports and hard physical labor, when there is an intense load on the same muscle groups. On the other hand, a sedentary lifestyle also contributes to the development of inflammatory processes in the joints, especially when alcohol abuse, unbalanced nutrition and a lack of vitamins in the diet are mixed with hypodynamia.
Forms
Due to the variety of manifestations of arthritis in clinical practice, it is customary to distinguish different forms of the disease, which differ in the specifics of the clinical picture and therapeutic measures. Depending on the nature of the course, acute and chronic arthritis are distinguished, and three forms of the disease are differentiated by the number of affected joints:
- monoarthritis - inflammation of one joint;
- oligoarthritis - inflammation affects from two to four joints;
- polyarthritis - inflammation of five or more joints.
Based on the prevailing etiological factor, a distinction is made between primary arthritis with an independent pathogenesis and secondary arthritis as a consequence of an underlying disease. The primary forms include infectious, traumatic and rheumatoid arthritis, juvenile idiopathic arthritis, Still's disease, and joint inflammation in osteoarthritis and spondylitis.
With polyarthritis, five or more joints are affected
Secondary arthritis occurs against the background of a number of diseases, of which the best known are dysentery, tuberculosis, gout, diabetes mellitus, systemic lupus erythematosus, gonorrhea, borreliosis, psoriasis, purpura, hepatitis, granulomatosis, hemochromatosis, Reiter's syndrome and others. Joint inflammation that develops after the transfer of nasopharyngeal, intestinal and genitourinary infections is called reactive arthritis.
Stages
In the dynamics of the pathological process in arthritis, four stages are distinguished:
- Clinically, the disease does not manifest itself, however, the first signs of inflammation are present on X-rays of the joints. Sometimes there is a slight stiffness of movements and periodic pain during physical exertion.
- The progressive inflammatory process leads to tissue thinning of the articular structures and erosion of the bone heads. Swelling appears in the area of the affected joints; often there is a local increase in temperature and redness of the skin, movements are accompanied by a crunch.
- The gradual destruction of articular structures leads to significant joint deformation, limited mobility, persistent pain and partial loss of joint function, which are partially compensated by muscle tension.
- Pathological changes in the articular tissues become irreversible; the diseased joint is completely immobilized. When the knee joints are damaged, contractures are formed, ankylosis develops in the hip joints - the fusion of the heads of the articular bones due to the filling of the joint capsule with replacement bone or fibrous tissue.
Stages of rheumatoid arthritis
Arthritis symptoms
Symptoms of arthritis depend on the stage and form of the disease. General signs of joint inflammation are nonspecific: in the early stages of the pathological process, moderate pain and stiffness in the joints is often attributed to fatigue, hypothermia, and age-related changes. When some joints become inflamed, warning signs may appear:
- swelling of the feet and increased fatigue when walking with damage to the ankle joints;
- "Glove symptom" for inflammation of the joints of the hand;
- lameness and pain radiating to the knee, with arthritis of the hip joint;
- Difficulty lifting and abducting a limb with shoulder damage.
In the early stages, arthritis presents with mild pain and stiffness in the joints.
Most patients see a doctor at stage II of the disease. Constant discomfort in the joint area, the appearance of sensitive swelling caused by excessive production of synovial fluid, a characteristic crunch, erythema and swelling of problem areas are clear signs of inflammation. Forced position of the body and limbs can indicate severe muscle spasms against the background of loss of joint mobility.
Specific symptoms are inherent in only some forms of the disease. Reactive arthritis is characterized by asymmetric inflammation of the joints of the extremities against a background of fever, headache and conjunctivitis. In some cases, signs of a urinary tract infection are added. Hallux valgus deformities of the thumbs and toes give reason to suspect gouty arthritis, and in the case of psoriatic arthritis, the joints of the hand become severely deformed and thicken.
In rheumatoid arthritis, the joints are affected symmetrically, and dense nodules form in the folds. During the period of remission, the discomfort is felt mainly in the morning and practically disappears by the afternoon. Exacerbations are accompanied by a febrile condition, numbness of the extremities, pain on inhalation, inflammation of the lymph nodes and salivary glands, photophobia and eye pain.
Rheumatoid foot
Features of the course of arthritis in children
There are two forms of arthritis that are diagnosed exclusively in childhood - juvenile idiopathic arthritis and juvenile rheumatoid arthritis, or Still's disease. Both diseases are characterized by a persistent course and a weak response to therapy; with Still's disease, in addition to the joints, internal organs are often affected.
Also, children are characterized by a more acute course of infectious arthritis compared with adult patients. Soreness and severe deformities of the joints are accompanied by high fever and severe intoxication of the body - severe headache and muscle pain, confusion, nausea and vomiting.
Diagnosing arthritis
Although signs of joint inflammation are clearly visible even to a non-specialist, it is not possible to accurately determine the form and stage of arthritis, as well as to develop the correct therapy strategy, based solely on the data of the history and physical examination, is not possible.
When making a preliminary diagnosis, the doctor pays attention to the size, shape and sensitivity and mobility of joints, the color and temperature of the skin, muscle tone; conducts functional tests. The next stage of the diagnostic search should be instrumental techniques that visualize the characteristic signs of arthritis:
- thickening and hardening of adjacent soft tissues;
- calcifications;
- tendinitis and tendosynovitis;
- periarticular osteoporosis;
- cystic enlightenment of bone tissue;
- roughness of articular surfaces;
- bone erosion;
- narrowing of the joint space;
- osteophytes, etc.
The passage of MRI guarantees maximum accuracy in the diagnosis of articular pathologies due to high-quality imaging of hard and soft tissues. X-ray and CT of the joint in frontal, lateral and oblique projections can reveal changes in the bone apparatus. To assess the condition of cartilage, tendons, ligaments, muscles and nerves, ultrasound of large joints is additionally prescribed. If the knee is injured, arthroscopy with synovial fluid collection and biopsy may be required. In order to monitor the dynamics of the process in the absence of exacerbations, contrast arthrography may be appropriate.
X-rays, MRIs, or CTs are done to diagnose arthritis
Laboratory diagnostics of arthritis includes a general, biochemical and immunological blood test. A high erythrocyte sedimentation rate and an increased concentration of fibrinogen confirm the presence of an inflammatory process; increased white blood cell count - bacterial infection. With eosinophilia, the likelihood of an allergic reaction is high. The detection of rheumatoid factor in the blood serum, along with an excess of the permissible level of antibodies and circulating immune complexes, clearly indicates rheumatoid arthritis. With gouty arthritis, sialic and uric acid levels increase.
Arthritis treatment
The choice of a therapeutic strategy depends on the form, etiology and stage of the disease, the localization of inflammation, as well as the age, health status and constitutional characteristics of the patient. To relieve the inflammatory process and pain syndrome, a complex of non-steroidal anti-inflammatory drugs, muscle relaxants and painkillers in combination with physiotherapeutic procedures is selected. A good effect is given by electrophoresis and phonophoresis, hilt therapy, amplipulse therapy, magnetotherapy and CMT therapy (treatment with sinusoidal modulated currents).
Physiotherapy is effective in treating arthritis
Corticosteroids in rheumatological practice are used with great caution, limited to injections into the affected joint in the absence of a response to sparing treatment methods. For the treatment of severe pain syndromes, drugs are needed that have a powerful and rapid anti-inflammatory and analgesic effect with a minimum risk of adverse events. Such drugs, undoubtedly, include the drug Amelotex. A wide range of various forms of release allows for stepwise therapy - quickly relieve pain with injections, while continuing treatment in a convenient tablet form. Amelotex has a high anti-inflammatory and analgesic efficacy, a low incidence of gastrointestinal and cardiovascular adverse events. Unlike 1st generation drugs, it is well tolerated for gastrointestinal diseases,as well as cardiovascular diseases. In the case of infectious arthritis, courses of antibiotics or antiviral drugs are prescribed, and in rheumatoid arthritis - immunosuppressants and immunomodulators. In case of purulent complications, arthrocentesis is performed daily.
A therapeutic diet for arthritis involves avoiding high-calorie foods, red meat and organ meats, legumes, salt, spices and alcohol. For rheumatoid arthritis, you should also avoid tomatoes, potatoes, eggplants and other vegetables of the Solanaceae family that contain solanine. The patient's diet should contain foods rich in fiber and vitamins, as well as sources of easily digestible protein - poultry and dairy products.
To consolidate the therapeutic effect, massage, exercises in the exercise therapy group and a course of balneotherapy in a specialized sanatorium are recommended. It is permissible to turn to folk remedies and non-traditional methods only after consulting with your doctor.
Complications and possible consequences
Early complications in the form of panarthritis, phlegmon and other purulent processes develop mainly in infectious arthritis. Late complications include contractures, pathological dislocations, osteomyelitis, osteolysis, bone necrosis, and generalized sepsis. In the absence of adequate treatment, progressive chronic arthritis can lead to disability: the patient loses the ability to self-care and move freely.
Forecast
In the early stages, acute infectious arthritis responds well to treatment until the joint functions are fully restored. If the development of the inflammatory process is associated with endogenous factors, it is more difficult to achieve recovery, but it is possible to slow down the rate of progression of the disease, prevent the development of complications and avoid disability.
Prevention
Prevention of arthritis is not particularly difficult. It is enough to lead a moderately active lifestyle, give up bad habits, adhere to a balanced diet and control weight. For infectious diseases and injuries of the joints, you should see a doctor, not relying on home remedies. To prevent exacerbations of chronic arthritis, it is important to follow a diet, avoid hypothermia, not lift heavy loads and undergo a spa treatment according to the profile at least once every two years.
YouTube video related to the article:
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
