Causes, symptoms, diagnosis and treatment of arthritis knee joint
Arthritis is a disease of the joints of an inflammatory nature. According to statistics, every hundredth of people in our country sick with arthritis.
The Reasons for the development of such serious complications of the pathological process there may be various factors, among which scientists believe is the main catalyst of genetic predisposition (it is primarily for women).
The Second factor – injuries associated with excessive stress on the joints. In third place was hypothermia. In addition, arthritis can develop as a complication of angina or viral infection. Very often this phenomenon occurs in childhood.
Arthritis can affect all joints but the most vulnerable are the hip area and knees, small joints of the hands, at least – elbows, ankles. In the absence of treatment inevitably develops joint deformity and immobility.
The Disease is not limited to age range, but women of middle age this diagnosis is more often than representatives of a strong half. The exception is infectious reactive arthritis, which is diagnosed mostly in men aged 20-40 years (more than 85% of patients with reactive arthritis are carriers of HLA-B27 antigen).
we Should concentrate more on rheumatoid arthritis (RA) is an autoimmune disease with unclear etiology. The disease belongs to the common disease – affects about 1% of the population. Very rare cases of self-healing, 75% of patients have sustained remission; 2% of patients the disease leads to disability.
When this disease breaks down the inner surface of the joints (cartilage, ligaments, bones) and replaced by scar tissue. The rate of development of rheumatoid arthritis vary from several months to several years. Features of the clinical picture or another type of inflammation of joints allow to suspect the disease and prescribe the necessary tests to confirm the diagnosis. In accordance with ICD-10 classified seropositive RA (M05 code), seronegative (code M06), youth (code МО8)
Arthritis in children
Some types of arthritis affect only children and adolescents, so they should be in a separate row.
Juvenile rheumatoid arthritis (ICD-10 code М08) affects children after suffering bacterial and viral infections. Inflamed, usually one knee or another large joint. The child experiences pain during movement, in the joint swelling. Children limp, barely get up in the morning. If untreated, gradually developing deformity of the joints that can't already be corrected.
Children's Reactive arthritis (ICD-10 code МО2) manifests itself in two weeks after suffering an intestinal infection. If the process develops in the knee joint, the external signs are well visible: the skin becomes red, under the patella visible swelling without marked boundaries. The child often raises the temperature, which decreases from antipyretic drugs, but there is still soreness in the knee region.
In Addition to infectious, reactive, rheumatoid arthritis in children is often diagnosed disease of allergic nature. Disease begins suddenly the child – immediately after the hit of allergens in blood. Quickly swollen joints, shortness of breath, urticaria. May develop angioedema, bronchial spasm. In eliminating allergic reactions are the signs of arthritis.
knee osteoarthritis may develop as an independent disease, or be a complication of injury and disease.
Knee joint, arthritis that swells when it moves there is pain. The skin in the joint region changes color (turns red or becomes the "parchment"), but this is not a reliable sign of an inflammatory process.
The Main cause of puffiness and visible increase of the kneecap is the accumulation of fluid within the joint. Excess pressure on walls of joint tissue causes severe pain. Fluid volume over time is steadily increasing, so it becomes more intense pain.
In addition, in the joint, the deposited uric acid crystals that have the appearance of thin needle-like thorns. They injure the small vessels, which is the basis for the development of attached infections.
Arthritis knee runs hard, not only because of the intense pain, but also in connection with violation of activity of functional systems. Primarily affect the cardiovascular and endocrine systems. Observed dyspnea, tachycardia, low-grade fever, sweating, poor circulation in the extremities, insomnia, and other nonspecific signs.
the Degree of violationfunction
Symptoms vary depending on the degree of dysfunction, stages and etiology of the disease:
The First degree is characterized by moderate pain, slight limitation of motion during rotations of the knee, when climbing or during squats.
The Second degree – the pain intensifies, the reduced physical activity that leads to reduced work capacity and limitation of self.
In the third degree – the impossibility of self-service, significant loss of mobility in the joint (joints).
Types of arthritis
On the nature of in medicine, there are several forms of arthritis:
- jet – a complication arising from untreated (undertreated) infections;
- rheumatoid – is a consequence of the rheumatic diseases
- acute – develops after injuries, fractures, severe physical exertion;
- infectious – caused by a virus or fungal infection that enters the joint through the bloodstream, or through non-sterile surgical instrument, often leads to the development of purulent inflammation of the knee joint;
- Reiter's syndrome – a form of reactive arthritis;
- arthritis with ankylosing spondylitis, gout (rare phenomenon);
- psoriatic arthritis (occurs in 10-40% of patients, psoriasis patients)
Reiter's Syndrome (ICD-10 code 02.3) can develop in two forms – sporadic (the causative agent is C. Trachomatis) and epidemic (Shigella, Yersinia, Salmonella).
The Clinical picture differs from other kinds of arthritis as concomitant signs of the disease are lesions of the mucous membranes of the oral cavity, prostatitis (in men), vaginitis and cervicitis (in women). A common symptom is eye inflammation (conjunctivitis, iridocyclitis), which is manifested in redness of the sclera, purulent discharge, swelling of the eyelids.
Arthritis of the knee should be differentiated from other pathological processes, the most common of which are osteoarthritis and bursitis. Bursitis presenting an inflammation in the synovial bag, an experienced specialist can easily distinguish from arthritis at the first appointment.
first, when bursitis the knee's mobility is slightly limited, and secondly, the area of the articular inflammation has clear contours. On palpation the doctor quickly determines the borders of the inflammatory focus. As for the arthritis, differentiation to spend more difficult, because these diseases have a completely different etiology, have many similar characteristics.
Osteoarthritis – degenerative process in bone and cartilage, resulting in the violation of metabolism, not associated with an inflammatory component. The main group of patients – elderly people (60 years old most people diagnosed degenerative changes in the joints).
Arthritis is always inflammation, which over time, with the progression of the disease (autoimmune in nature), distributed throughout the body. That is why there is a lot of related symptoms in autoimmune arthritis – and fever, and low-grade fever, and headache, and General malaise. In rheumatoid arthritis seriously affected the cardiovascular system.
To be diagnosed as "arthritis of the knee joint" (heartit), it is necessary to conduct multi-directional diagnostic tests. In some cases, doctors put the diagnosis "artrose-arthritis of the knee" when conducting a differential diagnosis between osteoarthritis and arthritis, usually in the initial stages of pathologies.
The table of differential diagnosis of arthritis of the knee
|Etiology||Inflammation||Degenerative changes in the joint|
|Age group||No restrictions (any age)||As a rule, older than 50-60 years of age|
|process||Acute or chronic||Always chronic|
|Beginning||Sharp, sudden||Gradual (develops months, years)|
|Symptoms||usually pronounced||Manifest themselves with changes in cartilage and bone|
|pain Intensity||Strongly expressed from the onset of the disease||expressed moderately at First, gradually increases|
|Swelling||Pronounced swelling with the onset of the disease||Swelling appears upon accession of inflammation|
|redness of the joint||Yes, but may not be||Yes, but in the later stages the redness may not be present|
|Symptoms of intoxication||Observed in the case of the autoimmune nature of the disease||No|
|Symptoms "of a sticking joint"||No||Yes|
|Laboratory methods||Detect modifications||Not identify specific deviations||Instrumental methods of research||Radiography, additional methods (MRI)||x-ray, MRI|
|Treatment||Comprehensive (hospital + outpatient+ sanatorium)||Comprehensive (hospital + outpatient+ sanatorium|
|Drug treatment||Antibiotics (meningitis, reactive arthritis), NSAIDs, corticosteroids, cytotoxic agents, vitamin preparations, blockade with corticosteroids||Symptomatic therapy, chondroprotectors, blockade with corticosteroids|
|physical therapy, sanatorium, physiotherapy, massage||Shown during remission||Shown|
Diagnosis of arthritis of the knee
Arthritis of the knee can be diagnosed at home, if you carefully study the symptoms of the disease. Regardless of etiology, there are symptoms such as swelling, redness in the joint, General malaise, external signs of deformity of joint tissue.
However, you should not ask the idea, how to treat arthritis of the knee joint independently, using the more questionable recipes of folk medicine. This can lead to irreversible consequences. The decision about how to treat arthritis of the knee, are accepted only after a comprehensive survey.
Doctors must determine the nature of the disease to prescribe adequate treatment. The direction of laboratory and instrumental studies provide traumatologists-orthopedists, surgeons, rheumatologists. The therapy develops the subject matter specialist (this may be a TB doctor, dermatologist-venerologist, cardiologist and other doctors).
First step to identifying diseases (ICD 10) – visual examination, collection of history.
The Second phase, blood tests (for inflammation there is an increase in ESR, leucocytosis, a marker of inflammation CRP, other specific reactions).
The Third stage – radiography. If you have arthritis is detected the curvature of the articular surface, bony ankylosis.
The Fourth stage – MRI, ultrasound (assigned for differentiation of osteoarthritis from arthritis, ankylosing spondylitis, and bursitis). If you erased the signs that come with slow chronic process, can be assigned the additional hardware examination of the joint examination of joint tissue, CT, pneumotachography.
At this stage shows a puncture of the joint and taking a synovial fluid for laboratory examination (if indicated biopsy).
When determining the type and extent of reactive arthritis (code ICD-10) is investigated biological material (General blood and urine tests), performed urogenital and ophthalmological examination, is test for the presence НLA-B27, ECG, thymol turbidity test, sialic sample, determination of ALT, AST, seeding of biological fluids.
Treatment of reactive arthritis, in accordance with ICD-10, is held in two directions – it is a therapy with antibiotics and removal of articular syndrome (pain, stiffness).
Despite the leading role of radiography in the diagnosis of arthritis, it is necessary to remember that in the early stages of the disease are not always visible pathological changes in images. Artrografia is of informative value to the doctors in the study of large joints, polyarthritis and when this diagnostic method is not effective. To identify the causative agent of infectious arthritis nature used serological tests.
Arthritis Treatment is a lengthy process, requiring not only the implementation of the recommendations of the doctor regarding drug therapy and a rehabilitation course.
Diet for knee arthritis should be strictly observed. Excluded food rich in carbohydrates, meats, fatty meats and legumes. When translated into food diet and the use of individual therapy, there is a positive effect. In General, the treatment of knee arthritis includes the following areas:
- medications (pills, injections, ointments, gels);
- exercise therapy
- methods of operative surgery (injections into the joint cavity).
From the medical prescribed NSAIDs, cytotoxic drugs, hormonal agents, antibiotics, etc. A Set of drugs depends on the type and etiology of arthritis. Table 2 shows the scheme of treatment of rheumatoid arthritis.
|Drug||Principle||Principle||destination Schema||Possible side effects|
|Drugs quinoline series (delagil tablets of 0.25 g)||Stabilization of lysosomal membranes, inhibition of phagocytosis and chemotaxis of neutrophils, inhibition of the synthesis of cytokines.||the Initial stage of RA.||2 table. Per day the first 2-4 weeks, then 1 tab. A day for a long time.||Dyspepsia, pruritus, dizziness, leukopenia, retinal lesions.|
|Sulfa drugs (sulfasalazine, salazopiridazin) – tablets 500 mg||Inhibition of synthesis of prostaglandins and leukotrienes, inhibition of synthesis of antibodies and RF.||500 mg per day with gradual increase in dose to 2-3 grams per day.||Stabilization of lysosomal membranes, inhibition of phagocytosis and chemotaxis of neutrophils, inhibition of the synthesis of cytokines.|
|gold Preparations (tauredon)||Inhibition of the functional activity of macrophages and neutrophils, inhibition of the production of immunoglobulins and RF.||Predominantly articular form of RA regardless of disease activity.||Tauredon – 10, 20 mg/day,|
auranofin – 6 mg/day, supporting dose – 3 mg/day.
|Skin rash, stomatitis, peripheral edema, proteinuria, myelosuppression.|
|D-penicillamine (capsules of 150 and 300 mg); kuprenil (tablets 250 mg)||Inhibition of collagen synthesis, inhibition activity of T-helper cells type I and b-lymphocytes, the destruction of CEC||High clinical and laboratory activity of RA||Starting dose of 250 mg/day with gradual increase up to 500— 1000 mg/day; maintenance dose of 150-250 mg/day||Skin rash, dyspepsia, cholestatic hepatitis, myelosuppression|
|Methotrexate (tablets of 2.5 mg, ampoules 5 mg)||folic acid Antagonist; inhibits the proliferation of T - and b-lymphocytes, production of antibodies and pathogenic immune complexes.||RA with systemic manifestations, the high activity of RA, the low efficiency of other underlying funds.||7.5 to 25 mg per week oral.||Myelosuppression, liver damage (fibrosis), the lungs (infiltrates, fibrosis), activation foci of chronic infection.|
|Azathioprine, imuran (tablets 50 mg)||Inhibition of proliferative activity of T - and b-lymphocytes.||RA with systemic manifestations.||150 mg/day, maintenance dose – 50 mg/day.||Myelosuppression, activation foci of chronic infection.|
|Cyclophosphamide (capsules of 200 mg),Endoxan tablets 50 mg||Alkylating cytostatic; produces alkyl radicals with DNA, RNA and proteins, impairing their function; has anti-proliferative effect.||RA with systemic manifestations (vasculitis, nephropathy).||200 mg I/m 2-3 times per week until a total dose of 6-8 g per course; combined pulse therapy; Endoxan in a dose of 100-150 mg/day, maintenance dose – 50 mg/day.||Hemorrhagic cystitis, myelosuppression, activation foci of infection.|
|Chlorambucil (leukeran) – 2 tablets and 5 mg||Alkylating cytostatic; produces alkyl radicals with DNA, RNA and proteins, impairing their function; has antiproliferative effect||High activity RA with systemic manifestations, generalized lymphadenopathy, splenomegaly.||6-8 mg/day, maintenance dose – 2-4 mg/day.||Myelosuppression.|
In connection with what is specified in the schema table for the treatment of RA is not always effective, in practice are used several combinations of the underlying funds, among which the most widespread are the combination of methotrexate with sulfasalazine, methotrexate and delagila. Currently, the most promising is the scheme of treatment in which methotrexate is combined with anticytokine.
In medical practice often there are cases of lack of effect of treatment (for example, in reactive arthritis, inflammation is not removed even when using antibiotics in combination with NSAIDs), when patients remain disease activity and rapid progression of joint deformities.
Conclusion about the need to change treatment programs doctors do in the case if patient was treated for six months using at least three basic drugs.
A Testament to the ineffectiveness of therapy is a negative dynamics of laboratory studies, the persistence of inflammation. In this case, you need alternative solution on how to treat arthritis of the knee joint. Medical statistics show a positive trend in the application of the pulse therapy by use of hormonal drugs (methylprednisolone intravenously, isotonic solution for three days – three repeats of the course is one month). Be wary appoint methylprednisolone in combination with cyclophosphamide because of the high toxicity of drugs.
A New direction in the treatment of rheumatoid arthritis is therapy, involving the use of so-called biological agents (biologic agents). The drugs are based on inhibition of synthesis of cytokines (TNF-α and IL-1β).
Reliably established the fact that 60% of patients with active rheumatoid articular syndrome even when the third degree of the disease there is a decrease (or lack of) progression of articular changes on the background of maintenance therapy with Remicade. However, the use of this form of treatment is justified in that case, if the basic therapy did not produce the expected effect.
The Value of drugs several NSAIDs, earlier actively applied in the treatment of arthritis of the knee joint, decreased, as were other treatment programs, high efficiency.
Nonsteroidal anti-inflammatory drugs ("Movalis", "Diclofenac" – in tablets and by injection) continue to be administered when the diagnosis of "arthritis",because these drugs have a pronounced anti-inflammatory effect and improve the General condition of the patient.
However, reliably established that NSAIDs do not have a significant impact on the course of the disease of autoimmune nature – this is evidenced by the data of x-rays, and laboratory tests. However, nonspecific process responds well to treatment with drugs of the NSAIDs group.
Massage, exercise therapy, the mud – all of these methods are applicable only in the case if the doctor is a rheumatologist found that the inflammatory process localized drug therapy, and I was reaching the stage of remission. Special exercises and therapeutic massage aims to restore mobility of the knee joint.
When performing rotational movements can be a pain, but it is quite a normal phenomenon, because the fabric at the time of disease progression, lost elasticity. All exercise and massage sessions must be supervised by a physician – it will help to avoid accidental injury arising from the excess of physical effort or exertion.
Balneological therapy – highly effective treatments in a comprehensive program of treatment of arthritis of the knee joint. However, this area of rehabilitation is indicated for patients who have no serious diseases of cardiovascular system, malignant neoplasms of nature, and previously had heart attacks or strokes. All treatments using therapeutic biological components are assigned with great care.
Because there are many types of arthritis and joint pathologies, it is necessary to consult a doctor at the first signs of the disease. The earlier they are identified the reasons that caused the inflammatory process, the more likely it is to cure the disease completely.
In Any case, do not attempt to draw up a regimen yourself, especially meds. Not only is this inefficient, but also dangerous. Medical techniques applied in recent years in the treatment of arthritis of different etiology, have a high efficiency, which is a strong argument for the use of the methods of treatment offered by conventional medicine.
- Rheumatology: national manual edited by E. L. Nasonov, V. A. Nasonova.
- Rheumatoid arthritis E. N. Dormidontov, N. I. Korshunov, B. N. Friesen.
- Arthritis and physical activity. Gordon N. F.