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What is the difference between arthritis and arthrosis of the joints
According to statistics, joint pain bother almost every third person in the age range 35 to 49, every second over fifty and under seventy to 90% of people suffer from this disease in the category over 75 years of age.
According to official sources, Russia has seen about 4 million people, who are concerned about disease, manifested by pain in the articular cavities. The deterioration in the quality of life this pathology is at the fourth position in women and eighth in men.
Types of pathology of the joints
Pain in the joints occur various diseases of the musculoskeletal system (ODE), the most common of which are:
- Arthritis. Arthritis is disease is mainly caused by inflammatory lesions of the articular surface.
- the Difference between arthrosis and arthritis is destruction of cartilage and bone in the area below the level of the cartilage.
- Arthropathy is a violation of the joints in systemic diseases (pathology of the musculoskeletal system is only one of the symptoms, affected, and other vital systems).
To the pathology of periarticular tissues include changes of all anatomical structures surrounding sostavnoi connection:
- tendinitis is an inflammation in the tendons;
- intezet (enthesopathy) – changes in the point of attachment of the soft structures to the bony protrusions;
- bursitis – diseases of the articular capsule;
- capsulitis – inflammation and damage of the joint capsule.
Differences in manifestations
Difference between osteoarthritis arthritis is the different manifestation of pain.
Arthritis is accompanied by constant nagging intense pain that does not subside even at rest, with full immobilization. In addition, the overall picture is of further markers of inflammation.
The skin over the articulation surface may become reddish, the temperature locally increases, the impaired mobility: reduced scale as independent movements, and perpetrated with someone. Sometimes the occurrence of arthritis is preceded by an infectious disease.
Pain in degenerative arthrosis increases with exertion, maximized with increased function of the joint. However, at rest (e.g. At night), the pain may completely go and not be disturbed.
The Person feels stiffness, mechanical obstruction of joint movement, can happen even full immobilization in a severe stage of the disease. Another difference osteoarthritis arthritis – absence of obvious inflammatory signs, no redness, no swelling, no local thermal reactions.
To diagnose artropaticheskom change, it is important to remember that they are part of a syndromic pathology, because the nature of the disease system. So, changes are and other organs, often a digestive tract, organs of sight, the urinary system and dermatological manifestations.
Disease periarticular tissues often expressed local (point) pain. The patient indicates the specific place where most can feel pain, struggling to perform a particular movement, which give him discomfort (for example, abduction of the foot, or adduction of the arm).
The Proliferation of different types of joint pathology in the General population are shown in the table below.
| Disease | Frequency of occurrence |
| Osteoarthritis | 60-70% of all diseases of the joints (registered 20% of the population), women suffer more often than men. The most common localization: • the hip joint (coxarthrosis) – 25%; • changes of the knee (gonarthrosis) – 38%; • distal (closer to the nail plate) of the interphalangeal joints (heberden's polyarthritis) – 20%; • proximal (closest to wrist) joints of the fingers (Bouchard nodules) – 10%. |
| Rheumatoid arthritis | 0,7-1,4% |
| Psoriatic | Occurs in 5-7% of psoriasis sufferers |
| Gouty | 7-8% among all diseases of the musculoskeletal system, 0.1% of the total population |
| Reactive | 1-3% in the General population |
| Arthropathy in SLE | 0.5% of all residents |
| scleroderma | 0,012% of the population |
| the defeat of the periarticular structures | Worried about 2-3% of the population |
Differential diagnosis
Characteristics of the main pathologies the ODE is given in the table below. Giventhe main complaints, clinical features and the results of some additional tests.
| Group of diseases | Complaints | Clinical picture | Advanced research methods | ||||
| ultrasound | X-ray | Arthroscopy | blood Analysis | ||||
| Osteoarthritis | Osteoarthritis | pain occur during exercise. As a rule, the first changes occur in the hip, knee, and hand can be damaged elbow, interphalangeal sustavchikov with the peculiarities of professional activity (at rest, the pain may not bother); reduced range of motion. | Defeat manifests in one joint but gradually with the progression may involve other articular surface. Externally visible deformation, change of the anatomical shape, slight swelling during an examination of the drastically reduced scope of movements. More worried about older people. | Uneven surface of the articular liners, visualized joint space narrowing, uneven thickness of the synovial membranes, synovial fluid is turbid in nature, with cereals, inclusions | the Presence of spines directed into the joint cavity (osteophytes) that alter the articular surface and anatomy break; Narrow interarticular lumen; bone formation is sealed. Not mandatory indications: dislocations, subluxations, "intra-articular mouse" – nekrotizirovanne ottorgšimsâ fabric. | Visualized bony outgrowths (osteophytes), cartilage defects, narrowing the distance between the two articular surfaces | little or No inflammatory markers in the blood – the difference between osteoarthritis arthritis. Maybe a slight acceleration of ESR, proteins of inflammation, as a rule, normal; blood test (KLA) no shift of leukocyte – neutrophils do not exceed 50%. |
| Arthritis | Rheumatoid | pain in the small joints, intense in the morning, subsides in the evening; loss of range of movement in the affected joint | Reddening, the temperature rise above the projection of the joint, rheumatoid nodules in the joint. Appears in people of middle age | Roughness of the synovial lining of the joint capsule, minimal serous effusion, damage to the head bone | Reduce the clearance of the joint cavity, reducing bone density (bone looks lighter transparent than normal). | Sagging into the joint cavity of synovial villi, destruction of joint tissue, fibrous plaque on the synovial sheath. | Anemia (in 5% of patients), increased C-reactive protein, increased neutrophils in the blood (up to 90-92%), decreased platelet count, erythrocyte sedimentation rate acceleration – most importantly, the rheumatoid factor, increased levels of alpha and betaglobin, the appearance of immune complexes. |
| m | Jet | Lesion, usually, of one major joint in the lower limb (e.g. knee, ankle, hip). | Characterized by a triad of symptoms arthritis, conjunctivitis, urethritis. More often the lesion of the joint is preceded by the transfer of infection (chlamydia, Salmonella heat, Yersinia). | to determine the difference between arthritis and arthrosis, it is necessary to determine the inflammatory exudate in the joint cavity (very characteristic of inflammation). | the Restructuring of the epiphyses of the bones, rarefaction of bones (osteoporosis minor). | Single erosion at the synovial surfaces | Defines specific antigen HLА-B27, it is possible to determine chlamydia infection in the smear from the urethra, inflammatory indicators in the blood (shift to the left leukocyte, increased neutrophils, a dramatic acceleration of erythrocyte sedimentation rate |
| Gouty | the Pain is most often localized in the big toe, burning character, sometimes unbearable | most Often affects men 40-50 years old | bone Defects, deposition of urate crystals. | Pronounced rarefaction of bone density. | Defines "tophi" (deposits of urate crystals) appear as tumor-like growths inside the joint). | blood high uric acid content | |
| Psoriatic | Affects the small joints of the hand (more often closer to the nail phalanx). | Occurs in patients with psoriasis, the skin above the surface of the joints becomes a bluish-purple hue (a symptom of the "radish"). | Damage to articular joints, change the correct form of the joint. | Bone dystrophy with thinning of the epiphysis and diaphysis ("ground off the tops of the bones"). | Erosion at the edges of the synovial membranes. | decreased hemoglobin, increased white blood cells, increased erythrocyte sedimentation rate, is determined by a protein of inflammation (CRP). | |
| Arthropathy | Systemic lupus | Pain in the small joints of the hands and feet | Weakness in the muscles, redness on the face, taking the form of "butterfly" on the cheeks and nosethe septum, lesions of the digestive tract, ulcers in the mouth, impaired renal function. | the Inhomogeneity of the ULTRASOUND signal from the soft tissue thickening. | Seal periarticular structures bone osteoporosis. | Single erosion on the surface of the involved joints. | the Presence in the blood is pathognomonic for lupus erythematosus LE cells, antinuclear antibodies. |
| systemic scleroderma | the Pain, constrained movement in the joints until full immobilization (stiffness), mostly in the carpometacarpal joint of 1 finger of a brush. | "mask-like" face, devoid of facial expression, vascular spiders in the skin, impaired peripheral circulation (cold fingers, toes). | of Inflammatory changes in periarticular tissues, calcifications. | the Deposition of calcification in bones, destruction of bone. | Erosive changes in the articular joints | Elevated erythrocyte sedimentation rate, greater than normal level of blood proteins at the expense of globulins, specific | |
| Pathology of periarticular tissues | the defeat of the anatomical structures of the shoulder joint: Inflammation of the tendons (tendonitis) supraclavicular muscle | Pain in abduction of the hand | Pain is reduced during periods of rest (up to disappearance in the night) | Swelling of the periarticular tissues. | the Pathology is not detected. | Normal picture. | variations in the blood that are important for inflammation. |
| Tendinitis infraspinatus muscle. | Pain on external rotation of the arm (e.g., combing hair). | ||||||
| Inflammation of the muscles beneath the scapula. | internal torsion of the upper limb. | ||||||
| damage to the bursae. | Pain on all movements | ||||||
| trauma hip connections: inflammation of the tendon of the adductor muscles. | Discomfort in the groin area, aggravated by abduction of the leg. | ||||||
| If the damage of the knee joint: trauma bag knee | Sharp pain when you try to rest on the knees (often the hockey players, the parquet floor, miners). | ||||||
Despite the difference between osteoarthritis arthritis, according to the above classification, in some cases, a combination of two pathological processes. The breakdown of cartilage may be complicated by the accession of the inflammatory response.
In this case, competent diagnosis of "artrose-arthritis", which indicates a multifactorial lesions of the articulation tissue. Clinical manifestations of this disease is very diverse, since they include both signs of inflammation, and the processes of destruction of tissue.
Medication
- In the presence of a pathogen infection prescribe antibiotics (active against reactive, septic arthritis):
- tetracyclines – "Doxycycline", "Tetracycline";
- macrolides – "Erythromycin", "Clarithromycin";
- fluoroquinolones – "Ofloxacin", "Lomefloxacin".
- To eliminate the symptoms of inflammation apply a non-steroidal agent that has anti-inflammatory activity: "Diclofenac, Ketoprofen, Naproxen, Aceclofenac, Meloxicam, Ketorolac," etc.
- Severe immunosuppression (suppression of the immune system) properties have glukokorticosteroida: "Prednisone, Methylprednisolone, Hydrocortisone, Deflazacort".
- Inhibit the growth of microorganisms and reduce the severity of inflammatory reactions of gold drugs ("Auranofin", "Krizanol").
- active Immunosuppressive drugs D-penicillamine ("Toproping", "Pyritinol", "Bucillamine").
- Immune, analgesic, antiplatelet drugs exhibit capacity quinoline series ("Delagil", "Plaquenil").
- Drugs (treatment of diseases, poorly responsive to therapy other drugs) – "Methotrexate", "Azathioprine", "Cyclophosphamide".
- Have the antimicrobial activity of sulfonamides ("Sulfasalazine").
- anti-cytokine funds ("Remicade") – these drugs eliminate endogenous agents of inflammation in the body (stotinov), decreases the response of the immune system, improves the prognosis of the disease.
- enzyme therapy ("Longdata", "Wobenzym", "flogènzim"). The drug "Longidasa" has, in addition to proteolytic abilities, immune, antioxidant effect.
- Immune active vitamin E ("Tocopherol").
- Allopurinol and uricosuric some (leading Urata) drugs ("Sulfinpirazon") is highly effective in the treatment of arthritis gouty arthritis.
Other therapies
- intra-Articular administration of drugs (effectively administering corticosteroids).
- application of the drug onthe projection of the joint (different ointments).
- physical therapy promotes correction of disorders of movement, prevention of contractures, reduction in pain sensation and stiffness of joint.
- Spa treatment.
- Magnetic therapy.
- laser Therapy.
- the Adoption of paraffin baths.
- Ozone.
- hydrocortisone Phonophoresis.
- massage therapy.
- Maintaining diet (it is extremely important diet for gouty arthritis). It is necessary to follow a low protein, diet with the consumption of fatty acids, which reduce the concentration of urate in the body.
- Methods of plasmapheresis (plasmodesmata) is the cleansing of the blood using special filters. In rheumatology often used selective apheresis, which adsorb large molecules (immune complexes, antibodies, various proteins) that contribute to the development of inflammation.
- Photochemotherapy is a treatment in which lymphocytes of a man taking an important part in the mechanism of the immune response, shall be exposed to radiation.
- Drainage lymphatic duct – this method is the removal of a large number of lymphocytes.
Surgery
- Manipulation in the treatment and arthroscopy (removal of intra-articular pathological tissue: osteophytes, “joint mouse”).
- the Fusion is the creation of artificial immobilization of the articular joints in a physiologically correct position to reduce inflammatory changes. At the moment, almost never used.
- Arthroplasty is an operation to create new joint surfaces using biological gaskets in place of the destroyed joint with a possible restoration of its normal functioning.
- Arthroplasty is the creation of new joint with the use of artificially created mechanism of inert materials. Often perform hip (the largest) and knee joints.
Diseases of the supporting structures is very diverse in the nature of the damage. In some cases there are similar symptoms, but the pathological mechanisms occurring in the joints differ, and therefore require different methods of treatment.
At the moment available a wide range of drugs for the treatment of joint pathology. Medicines have different mechanisms of action and point of application. Some are active against certain types of lesions of the musculoskeletal system, while others will be totally ineffective in such nosology.
It is Important to understand that it is not necessary to determine, what is the difference between arthritis and arthrosis, and to appoint a drugs. Therefore it is necessary to come to the doctor for the proper conduct differential diagnostics with the use of additional examination methods. When data is received, the doctor will prescribe the necessary treatment that is appropriate for the patient.
Sources:
- Rheumatology. National manual edited by E. L. Nasonov, E. A. Nasonova, 2008.
- diseases of the joints. Ryabov S. I., 2008.
- anti-Inflammatory therapy of rheumatic diseases. E. L. Nasonov.
- the Problem of pain in osteoarthritis. N. In. Chichasova, MMA. Sechenov, Moscow. The magazine "doctor", №2, 2007.
- Chronic diseases of the joints. N. In. Chichasov, G. R. Imametdinova, E. V. Igolkina, E. L. Nasonov, sbei HPE First MSMU n. A. I. M. Sechenov of rmph, Moscow. The magazine "doctor", No. 5, 2013.
- the Treatment of pain in patients with osteoarthritis of different localization N. In. Chichasova, sbei HPE First MSMU n. A. I. M. Sechenov of rmph, Moscow. The magazine "doctor", No. 7, 2014.