Chronic arthritis is an inflammatory disease of the joints characterized by a long, progressive course with periodic exacerbations of the activity of the pathological process. Regardless of the localization, chronic arthritis is characterized by local soreness, stiffness during movements, swelling of tissues and eventually leads to joint deformation, contractures, subluxations. Diagnostics of various forms includes a comprehensive X-ray, ultrasound, tomographic examination, laboratory tests. The therapy of exacerbation is based on temporary immobilization of the joint, the appointment of nonsteroidal and steroid anti-inflammatory drugs, basic drugs. During periods of remission, restorative treatment (FTL, exercise therapy, massage) is indicated.
M06.8 Other specified rheumatoid arthritis
Chronic arthritis is a form of arthritis in which signs of inflammatory joint damage persist for more than 3 months. According to the type of chronic arthritis, inflammatory diseases of the joints of various etiologies can occur: rheumatoid arthritis, gouty arthritis, infectious arthritis (gonorrhea, tuberculosis, fungal), psoriatic arthritis, etc. Due to the peculiarities of the clinical course, juvenile chronic arthritis and chronic TMJ arthritis are distinguished into independent nosological forms.
The variety of variants causes interest in the disease from clinical rheumatology, pediatrics and other disciplines. Disease can occur in the outcome of acute joint inflammation or as a primary chronic process. Both adults and children are susceptible to the incidence of various forms of chronic arthritis.
The group of diseases united by the concept of “chronic arthritis” is heterogeneous, therefore their etiology is also complex and diverse. The following groups of reasons are distinguished:
- Infectious. The course of infectious arthritis can be supported by a persistent infection in the body: nonspecific (tonsillitis, sinusitis, pyelonephritis, viral hepatitis C, etc.) or specific (tuberculosis, gonorrhea, syphilis).
- Metabolic. Arthritis in gout is caused by infiltration of articular tissues with urates, followed by an inflammatory reaction.
- Autoimmune. The etiology of such severe inflammatory diseases of the joints as rheumatoid arthritis, ankylosing spondylitis, etc. is less studied. The involvement of infectious agents in the origin of these types of arthritis remains unproven, but generally recognized pathogenetic factors are changes in general and tissue reactivity, the development of allergies and immunocomplex reactions. Chronic arthritis can accompany the course of various diseases, for example, psoriasis, systemic lupus erythematosus, Reiter’s syndrome, sarcoidosis, Behcet’s disease, recurrent polychondritis and a number of others.
Factors contributing to the development of primary chronic arthritis are:
- sedentary lifestyle;
- prolonged load on the same joint;
- endocrine changes (puberty, pregnancy, menopause, etc.);
- diseases (thyroid diseases, diabetes mellitus);
- vaccination, etc.
Juvenile chronic arthritis
This term refers to various forms of arthritis lasting more than 12 weeks that occur in children. Juvenile chronic arthritis occurs with a frequency of 0.3-0.4 cases per 1 thousand children. The incidence peaks at the age of 2-6 years and puberty; girls get sick about 3 times more often. In some children, there is a link between juvenile chronic arthritis and previous acute respiratory viral infections, trauma, vaccinations (DPT, etc.), the introduction of medications (gammaglobulin). Close relatives of young patients often suffer from rheumatoid arthritis, collagenoses.
Clinical signs of juvenile chronic arthritis consist of arthralgias, changes in the configuration and dysfunction of the affected joints. With monoarticular or oligoarticular juvenile chronic arthritis, from 1 to 4 joints are affected (usually ankle, knee, individual fingers on the hands). Oligomonoarthritis often occurs with the phenomena of chronic uveitis, leading to blindness.
With the polyarticular variant of chronic arthritis, more than 4 joints are involved in the inflammatory process – usually small joints of the hands, joints of the legs, sometimes the cervical spine, the temporomandibular joint. The interest of the joints of the lower extremities leads to difficulties of movement; of the upper extremities – to problems with performing household actions and writing; TMJ – to underdevelopment of the lower jaw (“bird jaw”). The disease tends to progress with the formation of persistent deformities and contractures, atrophy of the periarticular muscles; there may be a delay in physical development, shortening of the limbs.
Systemic juvenile rheumatoid arthritis is characterized by fever, the presence of spotty, itchy rash, lymphadenopathy, hepatosplenomegaly. Articular syndrome is accompanied by arthralgias, synovitis. This form is often complicated by pleurisy, myocarditis, pericarditis, pulmonitis.
Rheumatoid arthritis proceeds according to the type of chronic polyarthritis, leading to the development of deformities and ankylosis of the joints. Typical signs of rheumatoid arthritis are the involvement of 3 or more small joints of the hands and feet in the pathological process, the symmetry of the lesion, morning stiffness of movements in the affected joints, gradually passing during the day. Fickle fever, weight loss, sweating, fatigue are noted. Extra-articular manifestations of rheumatoid arthritis include subcutaneous nodules, exudative pleurisy, vasculitis, peripheral neuropathy. Prolonged, chronic course of rheumatoid arthritis leads to characteristic deformities (ulnar deviation of the hands, S-shaped deformation of the fingers), pronounced functional disorders – stiffness or complete immobility of the joints.
Chronic gouty arthritis
The course of the chronic form of arthritis is characterized by the occurrence of frequent, longer, but less acute gouty attacks. Periodically, the so–called gouty status may occur – prolonged attacks of mono- or polyarthritis lasting up to several weeks. The I metatarsophalangeal joint, the joints of the hand, knee, ankle, wrist, etc. are affected.
3-5 years after the manifestation of gout, pronounced joint deformities, contractures, persistent movement restrictions develop. A typical manifestation of chronic gouty arthritis is the formation of tofuses – tissue accumulations of urates in the form of whitish-yellow nodules. Tofuses can be localized on the inner surface of the auricles, in the joints, less often on the sclera and cornea. With a prolonged course of gout, lesions of internal organs develop, mainly kidneys (urolithiasis, urate nephropathy, renal failure). Chronic gouty arthritis leads to the development of secondary osteoarthritis, fibrotic or bone ankylosis and can cause disability and motor activity of patients.
Chronic psoriatic arthritis
The articular syndrome associated with psoriasis develops in about a third of patients, mainly with a severe form of the disease. Skin manifestations of psoriasis include rashes (psoriatic plaques) localized on the scalp and in the area of the extensor surfaces of large joints, peeling, itching, a feeling of tightness of the skin. In most cases, skin lesions precede arthritis, sometimes they occur simultaneously or joint syndrome occurs before skin manifestations.
Asymmetry, dactyl with involvement of distal interphalangeal joints is typical for joint damage. In chronic dactyl, pain and hyperemia are usually absent, but there is a thickening of the fingers, the formation of flexion contractures and limited mobility of the hands and feet. Quite often, patients with chronic psoriatic arthritis develop spondylitis, sacroiliitis, and enthesopathy.
Internists, pediatricians, dermatologists, rheumatologists, etc. can participate in the recognition of various forms of chronic arthritis. The fact of the presence of arthritis is confirmed by the data of anamnesis, objective examination and the results of instrumental studies:
- Methods of instrumental visualization. If arthritis is suspected, ultrasound of the joint, radiography, arthrography, CT of the joint, MRI are performed. The most typical radiological signs of chronic arthritis include periarticular osteoporosis, narrowing of the articular gaps, erosion of articular surfaces, periarticular cysts, periostitis.
- Laboratory markers. To determine the clinical variant of chronic arthritis, laboratory tests play a primary role: blood test, immunological and biochemical blood tests, ELISA, synovial fluid examination. Thus, the main marker of rheumatoid arthritis is the detection of RF in the serum of patients; juvenile oligomonoarthritis is the detection of antinuclear factor, etc.
- Invasive research. Puncture of the affected joint, diagnostic arthroscopy, synovial membrane biopsy are informative.
Etiotropic therapy is possible only in some forms of chronic arthritis (infectious, gouty). In other cases, with an exacerbation of the inflammatory process, nonsteroidal (NSAIDs) and steroid anti-inflammatory drugs are prescribed, which can be used systemically and locally. Intra-articular administration of glucocorticosteroids is possible. In rheumatoid and psoriatic arthritis, basic anti-inflammatory therapy is carried out. At the height of the exacerbation, short–term immobilization of the joint is indicated, in the future – the use of orthopedic devices that facilitate movement (walkers, canes, etc.).
In order to increase the overall mobility of the joints, regular exercise therapy and massage are necessary. To reduce residual inflammatory reactions, prevent the development of fibrosis, maintain and prolong remission of chronic arthritis, it is recommended to conduct courses of physiotherapy, balneotherapy, spa treatment.
Surgical treatment of chronic arthritis may be required in case of destructive joint lesions and pronounced functional disorders. In this case, joint replacement, arthroplasty, arthroscopic synovectomy, etc. can be performed.
Chronic arthritis cannot be cured completely, but properly selected therapy and regular observation of a rheumatologist can achieve long-term remission and a satisfactory quality of life, both in everyday and professional terms. Frequent relapses of chronic arthritis, as well as systemic manifestations of the disease, aggravate the prognosis: in these cases, disability occurs early, limiting physical activity, self-care and self-realization.