Polyarthritis is multiple inflammation of the joints. Both simultaneous and consecutive damage of several joints is possible. The cause of development is immune disorders, metabolic disorders, as well as some specific and non-specific infections. Polyarthritis is manifested by pain, swelling, hyperemia and hyperthermia in the affected area. The diagnosis is made on the basis of laboratory data, the results of radiography, CT, MRI, scintigraphy, microbiological and cytological examination of articular fluid. The treatment is conservative.
Meaning
Polyarthritis is a sequential or simultaneous inflammation of several joints. It can be an independent disease or develop as a result of other diseases, injuries, immune disorders and metabolic disorders. It is manifested by pain, dysfunction, swelling of the joints, local hyperemia and hyperthermia. Pain syndrome, as a rule, has a wave-like character, the pain increases at night and in the morning. The phenomena of acute polyarthritis are completely reversible; with chronic polyarthritis, irreversible pathological changes develop in the joints.
Dysfunction can be caused by both pain and changes in tissues. With mild forms of the disease, the ability to work is preserved, with severe forms, it is limited or lost. Polyethologicity of polyarthritis determines the importance of accurate clinical diagnosis and selection of adequate treatment methods, taking into account the cause, form and variant of the course of the disease. Depending on the cause of the development of polyarthritis, the treatment of this pathology can be carried out by traumatologists, orthopedists, rheumatologists, therapists, infectious disease specialists, venereologists and doctors of other specialties.
Rheumatoid polyarthritis
Rheumatoid polyarthritis is an independent disease accompanied by a systemic lesion of connective tissue. Significantly reduces the quality of life, in 70% of cases it causes early disability. Women suffer about three times more often than men, the average age of patients is 30-35 years. The disease has an autoimmune character, that is, it occurs due to a kind of “malfunction” in which the immune system begins to attack the cells of its own body. The causes of rheumatoid polyarthritis have not been fully elucidated. Predisposing factors include: hereditary predisposition, certain infections, hypothermia, stress, intoxication and hyperinsolation.
There are several forms of rheumatoid polyarthritis. The classical form progresses rather slowly, accompanied by a mirror lesion of large and small joints. Mono- and oligoarthritis affects one or more joints; knee joints are more often affected. In Felty syndrome, inflammation of the joints is combined with an increase in the spleen. In the pseudoseptic form, severe fever, chills, torrential sweats and vasculitis are observed; symptoms from the joints are weak or absent. Juvenile rheumatoid arthritis is characterized by an early onset (in adolescence). In the articular-visceral form, joint damage is combined with severe pathological changes in internal organs: the heart, kidneys, lungs, as well as the nervous system and blood vessels.
The leading clinical symptoms of rheumatoid polyarthritis are joint pains and deformities. Most often, small joints of the hand and fingers are affected. In most cases, symmetry (mirroring) of the lesion is observed. The disease begins gradually, in the early stages, patients feel only moderate or slight morning stiffness. Subsequently, wave-like joint pain (arthralgia), a feeling of numbness, muscle atrophy, sweating, an increase in body temperature, cold and burning in the arms and legs, as well as a change in the shape and increase in the size of the joints are added.
Along with joints, pathological changes occur in other organs, primarily in the lungs, kidneys and heart. In 50% of patients, disorders of the cardiovascular system (pericarditis, vasculitis, atherosclerosis) are detected, some patients develop heart defects. Focal nephritis is possible, with severe progressive course of polyarthritis, amyloidosis develops. Pleurisy and interstitial tissue lesions may be observed from the respiratory system. Damage to the nervous system can manifest itself in the form of cervical myelitis, multiple mononeuritis, sensory-motor neuropathy and compression neuropathy. In a number of patients, pathology of the visual organs is revealed: peripheral ulcerative keratopathy, scleritis, episcleritis and dry keratoconjunctivitis.
Reactive polyarthritis
Reactive polyarthritis develops after bacterial, viral, fungal and chlamydial infections. Inflammation in the joints can occur after infectious intestinal lesions (salmonellosis, shigellosis and yersiniosis), genitourinary infections (urethritis, cystitis, endometritis, prostatitis), infections of the respiratory tract and ENT organs (pneumonia, sinusitis, bronchitis, sore throat, pharyngitis). Young men get sick more often. Predisposing factors are chronic foci of infection, increased stress, hypothermia and limb injuries.
Symptoms of reactive polyarthritis appear a few weeks after the onset of an infectious disease. The onset is acute, accompanied by general malaise, chills and fever. Inflammation occurs more often in the joints of the lower extremities. Simultaneous damage to the mucous membranes is possible, which manifests itself in the form of urethritis, conjunctivitis and aphthous stomatitis. In some cases, myocarditis develops. Symptoms persist from a week to 2-3 months. A transition to a chronic form is possible.
Exchangeable (crystalline) polyarthritis
It develops in metabolic diseases accompanied by the deposition of salts in the joints. So, with gout, due to a violation of uric acid metabolism, its accumulation occurs in organs and tissues. In the joints, uric acid crystals are deposited in the form of needle formations that irritate the tissues and cause inflammation. Gouty polyarthritis is characterized by a recurrent course with alternating exacerbations and remissions. Due to repeated inflammatory processes, joint deformation occurs over time. Some patients suffer only one gouty attack during their lifetime, in such cases there is usually no deformation.
An attack of gouty polyarthritis is characterized by an acute sudden onset with a pronounced pain syndrome. Usually the metatarsophalangeal, metacarpal, elbow, ankle or knee joints suffer. The pain is accompanied by edema, local hyperemia and hyperthermia. The attack lasts 3-4 days, then the symptoms of polyarthritis completely disappear. With an unfavorable course, over time, the attacks become longer, and the intervals between them are shorter. In the area of the joints and auricles, tofuses are formed – whitish nodules filled with uric acid crystals in the form of a mushy mass.
Psoriatic polyarthritis
It is detected in 5-7% of patients suffering from psoriasis. As a rule, skin changes appear before joint pain, however, in 15% of cases, polyarthritis occurs first, and only then the skin lesion joins. The exact cause of joint damage in psoriasis is unknown, but it is believed that stress and infectious diseases can become provoking factors. Distinctive features of this form of polyarthritis are the asymmetry of the lesion, swelling and soreness of the joints, a purplish-cyanotic skin tone over inflamed joints, heel pain and frequent simultaneous inflammation of several joints on one finger (“finger in the form of a sausage”).
The course is chronic and recurrent. In some cases, skin and joint damage is combined with pathological changes in the myocardium, eyes and urinary tract. There are several main forms of psoriatic polyarthritis: polyarthritis of the interphalangeal joints, sacroiliitis and spondylitis, symmetrical polyarthritis, oligoarticular asymmetric polyarthritis (less than 5 joints are affected, usually one large and several small) and mutating (disfiguring) polyarthritis, accompanied by pronounced deformities.
Infectious specific polyarthritis
It is detected in specific infections: syphilis, tuberculosis, gonorrhea, dysentery and brucellosis. Usually, inflammation in the joints occurs “at the peak” of the underlying disease. Several joints are involved in the process (oligoarthritis), multiple lesions are uncharacteristic. Symptoms of syphilitic polyarthritis appear in the tertiary period of syphilis. Large joints are affected: ankle, elbow, knee, shoulder. The onset is acute or subacute, there are pains that increase at night. The general condition is satisfactory, palpation is painless, joint deformity forms quickly with gum.
Gonorrheal polyarthritis usually develops within a month after infection. It is characterized by a sudden onset with an increase in temperature and sharp pains. Large joints are more often affected, with a purulent course, ankylosis may develop. Signs of dysentery polyarthritis, as a rule, appear in the recovery phase. It is characterized by the defeat of one or more joints, accompanied by pain and fever. The course is benign. Brucellosis polyarthritis usually proceeds chronically, manifested by pain, swelling and limited mobility of large joints. It is accompanied by wave-like fever, enlarged lymph nodes and hepatosplenomegaly.
Diagnostics
The tactics of treatment depends on the cause of the disease, therefore, in the process of diagnosis, the doctor pays special attention to the collection of anamnesis, complaints and features of the clinical picture of the disease. Thus, the gradual onset and symmetrical lesion of small joints should cause suspicion of rheumatoid polyarthritis, the presence of psoriasis – psoriatic polyarthritis, etc. This takes into account the possibility of a combination of several diseases or an atypical course of polyarthritis (for example, the defeat of several large joints in the rheumatoid form of the disease).
The diagnosis is clarified on the basis of radiography, ultrasound of joints, scintigraphy, MRI, CT, synovial fluid examination, biochemical blood analysis, erythrocyte sedimentation rate test, creatinine level determination, AST level determination, urine analysis and rheumatoid factor test. It should be borne in mind that a negative test result for rheumatoid factor (RF) is not a reason to exclude rheumatoid polyarthritis, since in 30% of patients with this disease, RF is not determined (in such cases, they talk about seronegative rheumatoid polyarthritis).
If there are indications, patients are referred for additional studies of internal organs: abdominal ultrasound, ECG, etc. To exclude crystalline polyarthritis, a biopsy of the synovial membrane of the joint is performed. If a specific polyarthritis is suspected (syphilitic, gonorrhea, tuberculosis, dysentery), consultations of appropriate specialists are prescribed: a venereologist, a phthisiologist and an infectious disease specialist, as well as special tests, including PCR, Wasserman reaction, precipitation microrepaction, bacterioscopy, enzyme immunoassay test, etc.
Treatment
Treatment of rheumatoid polyarthritis is complex, aimed at combating pain syndrome, restoring joint function and slowing the progression of the disease. NSAIDs are prescribed to reduce inflammation and pain. In the presence of infection, antibacterial agents are used. Plasmapheresis is used. In severe cases, corticosteroids are injected into the cavity of inflamed joints. If the listed methods of treatment are ineffective, basic drugs are used.
With rheumatoid polyarthritis, osteoporosis often develops, so patients are prescribed a special diet with a high content of calcium, as well as vitamin D and calcium preparations for preventive purposes. To preserve the function of the joints, massage, physical therapy and physiotherapy are used: phonophoresis, electrophoresis and dimexide applications. With pronounced deformities and ineffectiveness of conservative therapy, surgical interventions are performed.
In the treatment of reactive polyarthritis, symptomatic agents are used to help eliminate pain and reduce inflammation. Therapy of metabolic and infectious polyarthritis involves mandatory treatment of the underlying disease in combination with the use of symptomatic drugs. NSAIDs, analgesics and corticosteroids are used, if necessary, antihistamines, antibiotics and immunosuppressants are prescribed.
Physiotherapy procedures that reduce pain, swelling and inflammation in the joints are of great importance in the treatment of polyarthritis of various etiologies. Massage, phonophoresis, ultrasound, UHF, ozokerite, paraffin, magnetotherapy and barotherapy are used. Patients are referred to physical therapy. Treatment of chronic polyarthritis is carried out in courses, usually in spring and autumn – during seasonal exacerbations. In the absence of contraindications, spa treatment is prescribed.