Causes, symptoms, diagnosis and treatment of arthritis

The urgency of the problem the study and treatment of articular syndrome is caused by high dependency of the population at a young age, because there is a high risk of joint damage in systemic and infectious diseases. Moreover, this disease is often associated with pathology of bone and muscular systems, and often have a common mechanism of development. In the elderly 25% disability due to joint damage.

Arthralgia with the presence of signs of local inflammation may disturb more than 200 different diseases. This can be a leading symptom or one of many disguised manifestations of pathologies.

With the defeat of one joint talking about monoarthritis, when a few affected oligoarthritis, polyarthritis affects more than three large or small joints.

For the diagnosis it is important to determine the localization of the process, the symmetry of the lesion, number of involved joints, presence of deformities, and extra-articular manifestations.

risk Factors, classification and causes

Arthritis (from the Latin аrtr – joint, itis – inflammation) is a joint damage inflammatory nature, differing in origin, localization, manifestations, but have common features of local inflammation and destruction of the inner lining of the joint.

Types and causes of arthritis:

• infectious (inflammatory);
• degenerative (non-infection)
• traumatic
• arthritis in other diseases.

risk Factors lesions:

• developmental defects of the joints;
• genetic predisposition
• trauma
• professional activities
• overweight
• allergic predisposition.

Signs of arthritis:

• increased pain at rest;
• limited mobility
• local and (or) total temperature rise;
• change skin
• swelling and shape change of joint;
• deformation of brush by the type "fin walrus" and "the Swan neck" lesion in rheumatoid.

Adrift distinguish:

• sharp – up to 6 months;
• prolonged up to 12 months;
• chronic – more than 12 months;
• recurrent.

Rheumatoid arthritis is a chronic progressive systemic disease with the most frequent lesion of small hand joints (interphalangeal, metacarpophalangeal, wrist). Young women suffer three times more often than men. Characterized by arthritis of the joints of the hands is morning stiffness and the formation of typical deformations, it is also the distinctive features of the rheumatoid lesion. Of extra-articular manifestations of rheumatoid process often affects the eyes, lungs, skin (formation of rheumatoid nodules), patients suffer from insomnia. IN ICD-0 – M 05.

still's Syndrome in adults is a seronegative variant of rheumatoid arthritis, but occurs with a significant rise in body temperature, skin rashes, enlarged lymph nodes and spleen. IN ICD-10 – 06.1 M.

Rheumatism (rheumatic fever) – toxic-immune disease of connective tissue affecting the heart and joints (migratory rheumatoid arthritis knee, elbow, ankle or wrist joints). The main manifestations are also of annular erythema on the skin, subcutaneous rheumatic nodules, and chorea. IN ICD-10 – I 00.

Ankylosing spondylitis (ankylosing spondylitis) – a systemic disease, mainly affecting joints and ligaments of the spine, sacroiliac joints and peripheral joints, with frequent involvement of internal organs. ICD 10 – M45.

Reactive arthritis is an inflammatory disease of the joints caused by the development of immunologically mediated inflammation after vaccination, the flu, tuberculosis, intestinal or other infections. Arthritis of the joints in this form proceeds more favorably, not causing permanent deformation. Rarely becomes chronic arthritis. In ICD-10 – M 00-M 03

Reiter's syndrome – a form of reactive arthritis – acute non-purulent inflammation developed within 1 month after urogenital infection (chlamydia, Ureaplasma). May be due to immune mechanisms and direct ingress of microorganisms into the joint cavity. Develop acute asymmetrical polyarthritis with lesions of the joints of the lower extremities, the development of tendinitis and bursitis. IN ICD-10 – M 02.3.

Psoriatic arthritis and its symptoms appear in 40% of patients with psoriasis. Is characterized by asymmetric joint involvement of the lower extremities and spine, inflammatory changes of the eyes, intestines, and urogenital tract. Accompanies or precedes the skin lesions. Pathognomonic is the "radiophobia" configuration of the affected interphalangeal joints. IN ICD-10 – M 07.

Gout is a progressive disease that is caused by disorders of purine metabolism.Is pathognomonic of acute arthritis of the metatarsophalangeal joint of the first finger. Rarely involved knee, ankle and metatarsal. There is a genetic predisposition, triggered by the acute malnutrition, with a predominance of purine-rich foods (meat poultry, fish, eggs, chocolate, beer, red wine, mushrooms, legumes). ICD-10 refers to the subclass of microcrystalline arthritis: M10.

breakdown of the most common inflammatory diseases of joints (table 1)

Arthritis process usually begins acutely, there is a link to previous infection or intoxication, hypothermia. It differs from arthritis of osteoarthritis or degenerative disc disease, aggravated after prolonged trauma or physical stress.

Symptoms of arthritis depend on:

The type of the affected joint:

• fixed connection – sinatras;
• umpierrez – slow-moving;
• free-moving – diestros.

Type of svobodnodispersnye joint:

• flat (carpal)
• spherical (shoulder, hip)
• ellipsoidal (metacarpophalangeal, radiocarpal);
• hinge (elbow)
• condylar (knee);
• rotate (I cervical vertebra)
• saddle (metacarpal-carpal).

The Degree of activity process.

The Epiphyses of the bones of all joints are covered with cartilage and enclosed in a fibrous capsule, which is held in place by ligaments. In inflammatory-degenerative processes, all these structures may be involved in the pathological process.

Characteristics of lesions in some diseases

The nature of damage, symptoms in some types of arthritis are shown in table 2 below.

Diagnosis

For a variety of diseases characterized by loss of different joints, the severity of inflammation and symmetry.

The Main problem with which the patient comes to the doctor is pain during movement in the affected joint (or several). Pain occurs in all articular pathologies, but each disease it is possible to note its peculiarities. It is constant, increases at rest (in rheumatoid arthritis, gout) or when driving (Bechterew's disease), or in a certain position of the body or limbs. May also occur in nearby muscles, tendons, ligaments. According to the severity of the pain varies from low-intensity to sharp, limiting motor activity and forcing to take painkillers.

A detailed examination can reveal swelling and atrophy of the surrounding muscles. Swelling can be from a slight flattening of the articular contour to significant, as in gout. Swelling is also indicative of the presence of inflammatory effusion within the joint and thickening of its synovial sheath.

When viewed on the affected side can also determine abnormal position and shortening of the limb, instability of the ligamentous apparatus. Defigure is one of the symptoms of arthritis, change the shape of the joint due to edema, in contrast to the deformation – persistent changes due to the bone deformities, ankylosis and subluxation.

Palpation (probing) to determine local tenderness of the joint and its adjacent tissues, crepitus or crunching, the presence of intra-articular exudate, muscle tone, increased local temperature, often combined with General fever. Local temperature can be defined by the back surface of the finger, comparing with the healthy side or surrounding tissues when bilateral lesions.

Change skin (hyperemia) occurs quite rarely, but if you have to think about purulent or gouty arthritis, rheumatic process. In true arthritis the swelling and redness does not extend to the nearby tissues and the change in color and temperature indicate the presence of active inflammation. Fluctuation indicates the presence of intra-articular effusion.

To assess motor function is determined by the amount of available active and passive movements. They are proportional to the severity of lesions and the severity of pain. Compares the range of motion of the affected and the intact side (asymmetric lesion). The patient tries to maintain the joint in a bent position, which is achieved by reducing intra-articular pressure and, consequently, pain. Limitation of motion due to effusion in the joint cavity, pain in extension, deformity or contracture.

Consistently should explore all available major and minor joints to detect early signs of defeat of other groups.

Instrumental and laboratory methods of diagnosis of arthritis

• radiography
• spiral computed or magnetic resonance tomography
• osteoscintigraphy;
• NMR spectroscopy
• SPL of joint;
• Arthroscopy.

Laboratory:

• clinical findings
• biochemical research;
• immunologic
• immunoelectrophoresis
• the study of synovial fluid.

Characteristics of methods of diagnostics (table 3)

One of the diagnostic tools is an arthrocentesis and synovial fluid examination (table 4).