Intermittent hydrarthrosis is a chronic, constantly recurring disease, manifested by acute attacks of hyperproduction of synovial fluid with an increase in joint volume, discomfort and stiffness in it. It is characterized by the defeat of large joints, most often the knee. Diagnosis includes examination of blood and synovial fluid, ultrasound and radiography of the joint, histological examination of synovial biopsy. Treatment is carried out with nonsteroidal anti-inflammatory drugs, in severe cases, X-ray therapy or surgical treatment is possible.
ICD 10
M12.4 Intermittent hydrarthrosis
Information
Cases are noted among both adults and children. But most often the disease is diagnosed in people aged 20 to 40 years. It is noted that women get intermittent hydrarthrosis more often than men. Cases of this disease have not been observed in children under 7 years of age.
Causes
Modern rheumatology does not know the causes of intermittent hydrarthrosis. It is assumed that the disease is associated with traumatic factors and endocrine abnormalities. In women, the appearance of intermittent hydrarthrosis is often associated with the menstrual cycle. In some cases, there was a hereditary predisposition to the occurrence of the disease.
Many patients with intermittent hydrarthrosis have a history of having previously suffered allergic diseases: urticaria, allergic dermatitis, Quincke’s edema, etc. However, the allergic or autoimmune nature of intermittent hydrarthrosis is not confirmed, since attempts to treat it with antihistamines or glucocorticosteroids in most cases do not give effect.
Symptoms
Intermittent hydrarthrosis always has an acute onset with rapidly progressive changes in the joint. As a rule, only one large joint is affected. In some cases, lesions of two or more joints were noted. A very rare phenomenon for intermittent hydrarthrosis is the involvement of two symmetrically located joints in the process. The most common lesion of the knee joint, but the appearance of hydrarthrosis in the ankle, hip, wrist or elbow joint is possible.
Disease is manifested by a rapidly increasing increase in the volume of the joint associated with the accumulation of an increasing amount of synovial fluid in its cavity. This process is accompanied by discomfort in the joint and progressive stiffness in it. At the same time, there are no inflammatory signs (redness and an increase in local temperature in the joint area). There are also no general symptoms: weakness, headache, fever, etc.
An acute attack is independently resolved within 3-5 days from the moment of its appearance. Excess synovial fluid is resorbed from the joint, leaving no changes behind. However, in the period from 1 week to a month, the attack of intermittent hydrarthrosis repeats. In some patients, the interval between attacks is several months, in rare cases, attacks occur only a few times a year. Periodically worsening, the disease can occur for a long period, sometimes for the entire life of the patient. Moreover, each patient is characterized by his own, always the same, time period between attacks.
Diagnostics
The rather characteristic clinical picture of the disease allows us to assume intermittent hydrarthrosis. Patients with similar symptoms should be referred to a rheumatologist. To clarify the diagnosis, clinical and biochemical blood tests, synovial fluid analysis, radiography and ultrasound of the joint, the study of synovial biopsy are carried out.
In a clinical blood test in patients with this disease, a slight acceleration of ESR can be determined. A biochemical blood test, as a rule, does not reveal any pathological changes. To take synovial fluid for analysis, a diagnostic puncture of the joint is performed. During its study, cytosis is observed, the content of polynuclears in the amount of 50% or more, an increase in the number of lymphocytes, an increase in viscosity. Synovial membrane biopsy with intermittent hydrarthrosis reveals lymphocytic infiltration and thickening of the synovial membrane in 50% of patients.
Ultrasound of the joint during the attack reveals an expansion of the joint cavity and a large accumulation of effusion in it, signs of chronic synovitis in the form of thickening of the synovial membrane. When radiography of the joint during the attack, there is an expansion of the articular gap, an increase and “blurring” of the shadows of the periarticular tissues. There are no X-ray and ultrasound changes during the inter-approach period of intermittent hydrarthrosis. A few years after the onset of the disease, persistent radiologically detectable disorders appear in the form of subchondral osteosclerosis, narrowing of the joint gap and the appearance of marginal osteophytes.
Differential diagnosis of intermittent hydrarthrosis is carried out with rheumatoid arthritis, Bekhterev’s disease, reactive arthritis, hydroxyapatite arthropathy, pigmented villonodular synovitis, palindromic rheumatism.
Treatment
Therapy of intermittent hydrarthrosis is carried out mainly with nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac, etc.). Numerous authors have noted the ineffectiveness of glucocorticosteroid therapy in the treatment of intermittent hydrarthrosis. However, there is evidence in the literature of cases of improvement against the background of weekly intra-articular administration of hydrocortisone. With severe and frequent exacerbations of the disease, with the ineffectiveness of other methods of treatment, radiation therapy may be used.
In some cases, they resort to surgical treatment — synovectomy. However, this method of treatment usually gives an unstable result and after a while relapses of intermittent hydrarthrosis resume.
