Arthritis is a heterogeneous group of inflammatory lesions of joints of various genesis, which involve synovial membranes, capsule, cartilage, and other elements of the joint. Arthritis can have an infectious-allergic, traumatic, metabolic, dystrophic, reactive and other origin. Disease clinic consists of arthralgia, swelling, effusion, hyperemia and local fever, dysfunction, joint deformities. The nature is clarified by laboratory studies of synovial fluid, blood, X-ray, ultrasound diagnostics, thermography, radionuclide studies, etc. Treatment includes etiotropic, pathogenetic, systemic and local therapy.
ICD 10
M13.8 Other refined arthritics
Meaning
The incidence of arthritis is 9.5 cases per 1,000 population; the prevalence is high among people of all ages, including children and adolescents, but more often arthritis develops in women 40-50 years old. Arthritis is a serious medical and social problem, since its prolonged and recurrent course can cause disability and disability.
Classification
By the nature of the lesion, arthritis is divided into 2 groups – inflammatory and degenerative. The group of inflammatory arthritis, the development of which is associated with inflammation of the synovial membrane, which serves as the inner lining of the joint surface, includes the following types:
- rheumatoid;
- infectious;
- reactive arthritis;
- gouty.
The group of degenerative form includes traumatic arthritis and osteoarthritis caused by damage to the articular surface of cartilage.
The arthritis clinic distinguishes between acute, subacute and chronic development. Inflammation in acute arthritis can be serous, serous-fibrinous or purulent in nature. The formation of serous effusion is characteristic of synovitis. With the loss of fibrinous sediment, the course takes a more severe form. The most serious concerns are caused by the course of purulent arthritis, characterized by the spread of inflammation to the entire joint bag and adjacent tissues with the development of capsular phlegmon.
According to the localization of inflammation, there is an isolated lesion of a single joint (monoarthritis), processes with a spread to 2-3 joints (oligoarthritis) and more than 3 joints (polyarthritis). Taking into account the etiological and pathogenetic mechanisms , there are:
- Primary arthritis. They develop as a result of trauma, infection, immune and metabolic disorders. The independent (primary) forms of the disease include specific infectious arthritis of tuberculosis, gonorrhea, dysentery, viral, etc. etiology; rheumatoid arthritis, rheumatic polyarthritis, ankylosing spondylitis, psoriatic polyarthritis, etc.
- Secondary arthritis. They arise as a result of pathological changes in the bone elements of the joint and periarticular tissues. They may be the result of osteomyelitis, lung diseases, gastrointestinal tract, blood, sarcoidosis, malignant tumors, etc.
Pathogenesis
The subacute and chronic form leads to hypertrophy of the villi of the synovial membranes, pathological proliferation (proliferation) of the surface layer of synovial cells, plasmocytic and lymphoid infiltration of tissues with the outcome of fibrosis. With prolonged arthritis, there is the development of granulations on the articular surfaces of cartilage, their gradual spread to the cartilage tissue, destruction and erosion of the bone-cartilage flap. As the granulation tissue is replaced by fibrous tissue, the process of ossification occurs, i.e. the formation of fibrous or bone ankylosis. When the joint capsule, tendons and periarticular muscles are interested, joint deformities, subluxations, contractures develop.
Depending on the nosological form, various groups of joints are affected. Rheumatoid arthritis is characterized by a symmetrical interest in the joints of the feet and hands – metacarpal, interphalangeal, wrist, metatarsophalangeal, tarsal, ankle. Psoriatic arthritis is characterized by damage to the distal joints of the finger phalanges of the feet and hands; ankylosing spondylitis (Bekhterev’s disease) – joints of the sacroiliac joint and spine.
Arthritis symptoms
The arthritis clinic develops gradually with a general malaise, which at first is regarded as fatigue and overwork. However, these feelings gradually increase and soon affect daily activity and functioning. The leading symptom is arthralgia, which has a steady undulating character, intensifying in the second half of the night and in the morning. The severity of arthralgia varies from minor pain sensations to strong and persistent, sharply limiting the mobility of the patient.
A typical arthritis clinic is complemented by local hyperthermia and hyperemia, swelling, feelings of stiffness and limited mobility. Palpation is determined by soreness over the entire surface of the joint and along the course of the articular gap. Gradually, these symptoms are joined by deformities and disorders of the functioning of the joints, modification of the skin above them, exostoses. Limitation of joint functionality in arthritis can manifest itself both to a mild degree and to a severe degree – up to complete immobility of the limb. With infectious arthritis, fever and chills are noted.
Diagnostics
Diagnosis of arthritis is based on a combination of clinical symptoms, physical signs, radiological data, results of cytological and microbiological analysis of synovial fluid. Patients with identified arthritis are referred to a rheumatologist’s consultation to exclude the rheumatic nature of the disease.
The main diagnostic study for arthritis is joint radiography in standard (direct and lateral) projections. Radiological signs are diverse; the most characteristic and early is the development of periarticular osteoporosis, narrowing of the articular gap, marginal bone defects, destructive cystic foci of periarticular bone tissue. For infectious, including tuberculous arthritis, the formation of sequesters is typical. With syphilitic arthritis, as well as secondary arthritis that has developed against the background of osteomyelitis, the presence of periosteal overlays in the projection of the metaphysical zone of tubular bones is radiologically noted. In the sacroiliac joints with arthritis, osteosclerosis is determined on radiographs. Radiological signs of chronic arthritis include subluxations and dislocations of the joints, bone growths along the edges of the epiphyses.
If necessary, instrumental diagnostics is supplemented by tomography, arthrography, electorentgenography, magnifying radiography (for small joints). With the help of diagnostic thermography, local changes in heat exchange characteristic are confirmed. Ultrasound of the joints helps to determine the presence of effusion in its cavity, as well as paraarticular changes.
Radionuclide scintigraphy data allow us to judge the reaction of bone tissue and the activity of inflammation. According to the indications, diagnostic arthroscopy is performed. To determine the degree of functional disorders in the joints in arthritis, methods of measuring the amplitude of passive and active movements, podography (recording the duration of individual phases of a step) are used.
The nature of inflammation in arthritis is clarified by laboratory examination of articular fluid by its viscosity, cellular composition, enzyme and protein content, and the presence of microorganisms. If necessary, a morphological assessment of the synovial membrane biopsy is carried out.
Arthritis treatment
Conservative therapy
Etiological treatment is carried out only in some of its forms – infectious, gouty, allergic. Arthritis with subacute and chronic course is subject to general pharmacotherapy with the help of anti-inflammatory nonsteroidal and steroid drugs. Synthetic steroids are also used for injection into the joint cavity (therapeutic joint punctures).
As acute inflammation subsides, physiotherapy is added to drug therapy (UFO in erythemic doses, electrophoresis with analgesics, phonophoresis with hydrocortisone, amplipulsterapy), which has an analgesic and anti-inflammatory effect, preventing fibrous changes and joint dysfunction.
Conducting physical therapy and massage classes for arthritis is aimed at preventing the development of contracture and functional disorders in the joints. It is recommended to include mud therapy, balneotherapy, sanatorium and spa treatment in the complex of rehabilitation therapy.
The use of efferent therapy techniques (plasmapheresis, cryopheresis, cascade filtration of blood plasma) is aimed at extracorporeal absorption of antibodies and CEC in autoimmune arthritis, urates – in the gouty form. Extracorporeal pharmacotherapy allows the use of the patient’s own blood cells (leukocytes, erythrocytes, platelets) for the effective delivery of drugs to the focus of inflammation.
Surgical treatment
In some cases, rheumatoid and other forms require surgical intervention:
- synovectomy;
- arthrotomy;
- joint resection;
- arthrodesis;
- arthroscopic operations, etc.
In case of destructive changes in the joint caused by arthritis, endoprosthetics, reconstructive and reconstructive arthroplastic operations are indicated.
Experimental therapy
For the treatment of severe forms, the introduction of stem cells is used. Stem cell therapy helps to restore metabolism and improve the nutrition of joint tissues, reduce inflammation, increase immunity to infections, which are a common cause. The special value of using stem cells is to stimulate the regeneration of cartilage and restore its structure.
Prognosis and prevention
The immediate and long-term prognosis is due to the causes and nature of inflammatory phenomena. Thus, the course of rheumatic arthritis is usually benign, but often recurrent. Reactive form (postenterocolitic, urogenic) lends itself well to therapy, but the subsiding of residual manifestations may take a year or more. Prognostically, the most unfavorable course of rheumatoid and psoriatic arthritis, leading to severe motor dysfunction.
The basis for the prevention is a change in the nature of nutrition. It is recommended to have a varied, balanced diet, weight control, reduce the consumption of animal fats and meat, limit the amount of sugar and salt, exclude smoked meats, carbonated drinks, marinades, muffins, canned food, increase the proportion of fruits, vegetables, cereals in the diet. A mandatory requirement for the prevention is the exclusion of alcohol and smoking. Arthritic joints must be kept warm at all times. Regular dosed activity, therapeutic gymnastics, massage are useful.
