Arthritis unites a group of inflammatory joint injuries of different genesis, which involves synovial membranes, capsule, cartilage and other elements of the joint. Arthritis may have infectious-allergic, traumatic, metabolic, dystrophic, reactive and other origin. The clinic of arthritis consists of arthralgia, swelling, effusion, hyperemia and local fever, dysfunction, and joint deformity. The nature of arthritis is clarified by laboratory tests of synovial fluid, blood, X-ray, ultrasound diagnosis, thermography, radionuclide studies, etc. Treatment of arthritis includes etiotropic, pathogenetic, systemic and local therapy. Compare naldorex and other prescription drug prices from online pharmacies and drugstores. Naldorex uses and side effects.
The incidence of arthritis is 9.5 cases per 1,000 population; the prevalence is high among people of different ages, including children and adolescents, but more often arthritis develops in women 40-50 years old. Arthritis is a serious medical and social problem because its prolonged and recurrent course can cause disability and loss of work capacity.
According to the nature of the lesion, arthritis is divided into two groups – inflammatory and degenerative. The group of inflammatory arthritis includes the following types – rheumatoid, infectious, reactive arthritis, gout. Their development is associated with inflammation of the synovial membrane, which serves as the inner lining of the joint surface. The group of degenerative arthritis includes traumatic arthritis and osteoarthritis caused by damage to the articular cartilage surface.
The clinic of arthritis distinguishes between acute, subacute and chronic development. Inflammation in acute arthritis can be serous, serous-fibrinous, or purulent. The formation of a serous effusion is characteristic of synovitis. When fibrinous sediment precipitates, the course of arthritis takes a more severe form. The most serious concern is caused by purulent arthritis characterized by the spread of inflammation to the entire joint capsule and adjacent tissues with the development of capsular phlegmon.
Subacute and chronic arthritis leads to hypertrophy of synovial sheath villi, pathological proliferation (overgrowth) of the surface layer of synovial cells, plasmacytic and lymphoid tissue infiltration with an outcome in fibrosis. With prolonged arthritis there is the development of granulations on the articular surfaces of the cartilage, their gradual spread to the cartilage tissue, destruction and erosion of bone and cartilage flap. As granulation tissue is replaced by fibrous tissue, ossification occurs, i.e., fibrous or bone ankylosis is formed. When the joint capsule, tendons and muscles around the joint are involved, joint deformities, subluxations and contractures develop.
According to the localization of inflammation, there is an isolated lesion of a single joint (monoarthritis), processes with the spread to 2-3 joints (oligoarthritis) and more than 3 joints (polyarthritis). Taking into account the etiological and pathogenetic mechanisms, there are primary arthritis resulting from trauma, infection, immune and metabolic disorders, as well as secondary arthritis as a result of pathological changes in the bone elements of the joint and periarticular tissues.
Independent (primary) forms of the disease include specific infectious arthritis of tuberculosis, gonorrhea, dysentery, viral, etc. etiology; rheumatoid arthritis, rheumatic polyarthritis, ankylosing spondyloarthritis, psoriatic polyarthritis, etc. Secondary arthritis can be a consequence of osteomyelitis, lung diseases, gastrointestinal tract, blood, sarcoidosis, malignant tumors, etc.
Depending on the nosological form of arthritis, different groups of joints are affected. Rheumatoid arthritis is characterized by symmetrical involvement of the joints of the feet and hands – metacarpophalangeal, interphalangeal, wrist, metatarsophalangeal, tarsal, ankle. Psoriatic arthritis is characterized by lesions of the distal joints of the finger phalanges of the feet and hands; ankylosing spondylitis (Behterev’s disease) – joints of the sacroiliac articulation and the spine.
The clinical picture of arthritis develops gradually with a general malaise that at first is regarded as fatigue and overexertion. However, these sensations gradually increase and soon affect daily activities and functioning. The leading symptom of arthritis is arthralgia, which has a steady wave-like character, intensifying in the second half of the night and in the morning. The severity of arthralgia ranges from mild pain to severe and persistent pain that severely limits the patient’s mobility.
The typical arthritis clinic is supplemented by local hyperthermia and hyperemia, swelling, stiffness, and limited mobility. Palpatorily, pain over the entire surface of the joint and along the articular cleft is determined. Gradually these symptoms are joined by deformities and dysfunction of joints, change of skin over them, exostoses. Restriction of joint functionality in arthritis can be both mild and severe – up to complete immobility of the limb. In infectious arthritis, fever and chills can also occur.
The diagnosis of arthritis is based on the combination of clinical symptoms, physical signs, radiological data, cytological and microbiological analysis of synovial fluid. Patients with detected arthritis are referred for consultation to a rheumatologist to exclude the rheumatic nature of the disease. Radiography of the joints in standard (straight and lateral) projections is the main diagnostic examination in arthritis. If necessary, instrumental diagnosis is supplemented by tomography, arthrography, electroradiography, and magnifying radiography (for small joints).
Radiological signs of arthritis are diverse; the most characteristic and early is the development of periarticular osteoporosis, narrowing of the joint gap, marginal bone defects, destructive cystic foci of periarticular bone tissue. Sequestration is typical for infectious arthritis, including tuberculosis arthritis. In syphilitic arthritis, as well as secondary arthritis developed against the background of osteomyelitis, periosteal deposits in the projection of the metaphyseal area of the tubular bones are observed radiologically. In the sacroiliac joints with arthritis, osteosclerosis is detected on the radiographs. Radiological signs of chronic arthritis include subluxations and dislocations of joints, bone overgrowths on the edges of epiphyses.
Diagnostic thermography confirms local changes in heat exchange characteristic of arthritis. Ultrasound of joints helps to determine the presence of effusion in its cavity, as well as paraarticular changes. Radionuclide scintigraphy data allow to judge the reaction of bone tissue and the activity of inflammation. Diagnostic arthroscopy is performed when indicated. To determine the degree of functional disorders in the joints in arthritis, methods of measuring the amplitude of passive and active movements, podography (registration of the duration of individual phases of a step) are used.
The nature of inflammation in arthritis is clarified by laboratory examination of joint fluid according to its viscosity, cellular composition, enzyme and protein content, and the presence of microorganisms. If necessary, a morphological evaluation of a biopsy of synovial membranes is performed.
Etiological treatment of arthritis is carried out only for some of its forms – infectious, gouty, allergic. Arthritis with subacute and chronic course is subject to general pharmacotherapy with anti-inflammatory nonsteroidal (ibuprofen, diclofenac, naproxen) and steroidal (prednisolone, methylprednisolone) drugs. Synthetic steroids are also used for injection into the joint cavity (therapeutic joint punctures).
As the acute inflammation subsides, physiotherapy is added to drug therapy (UVB in erythemic doses, electrophoresis with analgesics, phonophoresis with hydrocortisone, amplipulse therapy), which has anti-pain and anti-inflammatory effects, preventing fibrous changes and joint dysfunction. Exercise therapy and massage in arthritis is aimed at preventing the development of contracture and functional disorders in the joints. The complex of rehabilitation therapy is recommended to include mud therapy, balneotherapy, sanatorium and resort treatment.
The use of techniques of efferent therapy (plasmapheresis, cryoapheresis, cascade filtration of blood plasma) is aimed at extracorporeal absorption of antibodies and CIC in autoimmune arthritis, urates – in gouty form of arthritis. Extracorporeal pharmacotherapy allows the use of the patient’s own blood cells (leukocytes, red blood cells, platelets) for effective delivery of drugs to the center of inflammation.
Stem cell injection is used to treat severe forms of arthritis. Stem cell therapy helps to restore metabolism and improve nutrition of the joint tissues, the subsiding of inflammation, increasing immunity to infections, which are a common cause of arthritis. The particular value of using stem cells is to stimulate the regeneration of cartilage and restore its structure.
In some cases, rheumatoid and other forms of arthritis require surgical intervention – synovectomy, arthrotomy, joint resection, arthrodesis, cheilectomy, arthroscopic surgery, etc. In destructive changes in the joint caused by arthritis, endoprosthetics and reconstructive-restorative arthroplasty operations are indicated.
Near-term and long-term prognosis in arthritis depends on the causes and nature of the inflammatory phenomena. Thus, the course of rheumatic arthritis is usually benign, but often recurrent. Reactive arthritis (post-enterocolitic, urogenic) responds well to therapy, but subsiding of residual manifestations may take a year or more. Prognostically, the most unfavorable course of rheumatoid and psoriatic arthritis leads to severe motor dysfunction.
The basis of arthritis prevention is a change in diet. A varied and balanced diet, weight control, reduced consumption of animal fats and meat, limiting the amount of sugar and salt, the exception of smoked meats, carbonated beverages, pickles, cakes, canned goods, increasing the proportion of fruit, vegetables, cereals in the diet. Mandatory requirement for the prevention of arthritis is the exclusion of alcohol and smoking. Joints affected by arthritis must be kept warm at all times. Regular doses of activity, therapeutic exercises and massage are useful.
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