Artralgiya – a symptom of the articulate pains characteristic of one or at the same time several joints (poliartralgiya). Emergence of an artralgiya is promoted by irritation of neuroreceptors of sinovialny covers of articulate capsules inflammation mediators, products of immune reactions, salt crystals, toxins, osteofita etc. of Artralgiya can be observed at rheumatic, endocrine, infectious, tumoral, neurologic, autoimmune diseases, injuries, excess weight. Clarification of the reasons of artralgiya has the important differential and diagnostic importance. Treatment of artralgiya comes down to therapy of the disease which caused them; symptomatic measures – analgetics, local heat and ointments are applied.
Absence of objective simptomokompleks of defeat of the articulate device – deformation, puffiness, a local hyperthermia and hyperaemia, palpatorny morbidity, considerable restriction of mobility is characteristic of the articulate syndrome taking the artralgiya form, is frequent – radiological signs. Nevertheless, the artralgiya can be a harbinger of serious organic damages of joints or a symptom of terrible extra articulate pathology.
Types of artralgiya
Manifestations of an artralgiya differ on localization and depth of pains, the number of the involved joints, character and intensity of a pain syndrome, its daily rhythm, existence duration, communication with a certain type of movements etc. In the presence of a single joint pains speak about a monoartralgiya, at a simultaneous or consecutive pain syndrome in several joints – about an oligoartralgiya, when involving 5 or more joints – about a poliartralgiya syndrome.
On character of an artralgichesky syndrome distinguish acute and dull ache; on intensity – from weak and moderate expressiveness to intensive; as a current – passing and constant. More often the artralgiya arises in large joints – coxofemoral, knee, humeral and elbow, is more rare in average and small – luchezapyastny, talocrural, interphalanx.
In rheumatology it is accepted to allocate the following types of articulate pains:
- the artralgiya caused by a toxic syndrome at sharp infections;
- primary episode or the alternating (intermittiruyushchy) artralgiya at sharp or recurrent arthritis;
- it is long the current monoartralgiya of large joints;
- oligo-or the poliartralgichesky syndrome accompanying involvement of sinovialny covers or the progressing degenerate and dystrophic changes of a cartilage;
- residual post-inflammatory or post-traumatic artralgiya;
Factors of development of an artralgiya
The Artralgichesky syndrome quite often accompanies the course of sharp infections. Artralgiya can be marked out both in the prodromalny period of a disease, and in the early clinical stage proceeding with fever and intoxication. "Ache" in joints of the lower and top extremities, the polyarticulary nature of pains, their associativity to a mialgiya is characteristic of an infectious form of an artralgiya. Mobility in a joint at the same time is completely kept. Usually the artralgiya of infectious character disappears within several days in process of weakening of the toxic syndrome caused by the main disease.
Options of development of a post-infectious jet artralgiya after the postponed sharp intestinal or urogenital infections are possible; the parainfectious artralgichesky syndrome caused by tuberculosis, an infectious endocarditis, secondary syphilis. Quite often as the reason of artralgiya serve the centers of the available chronic infection - pyelonephritis, a holangit, an adneksit, paratonzillyarny abscess or a parasitic invasion.
Poly-or ologiartralgiya are the main symptom of inflammatory rheumatic diseases. The constant, intensive, migrating pain syndrome, involvement of large joints of mainly lower extremities, limitation of the movement in joints is characteristic of rheumatic artralgiya. The debut of rheumatoid arthritis, and also system rheumatic diseases are shown by the polyarticulary syndrome taking small symmetric joints of feet and brushes, motive constraint in the mornings. At microcrystalline gouty arthritis the artralgiya is shown in the form of the recurrent pristupoobrazny isolated joint pains which, having suddenly arisen, quickly reach peak intensity and several days do not weaken.
The artralgiya which is gradually accruing for a long time can testify to the deforming osteoarthrosis and other degenerate and dystrophic damages of joints. In this case involvement of knee or coxofemoral joints is typical; the stupid, aching, connected with loading type of pains and their disappearance at rest. Artralgiya can have meteodependent character, be followed by "pokhrustyvaniye" of joints during the movement, weaken when using of the local distracting therapy.
Resistant oligo-and the poliartralgiya of a long current which are followed by formation of "Hippocrates's fingers" (deformations of nails and disteel phalanxes as "hour fragments of glass" and "drum sticks"), demonstrate paraneoplastic defeat of sinovialny covers. At such patients it is necessary to suspect oncological pathology of internals, first of all lung cancer.
Endocrine frustration – primary , ovariogenny dysfunctions, , etc. are the frequent reasons of artralgiya. Articulate the syndrome of endocrine genesis proceeds in the form of the oligoartralgiya interfaced to an ossalgiya, a mialgiya, pelvic bone and backbone pains. It is necessary to distinguish intoxication from the other possible causes of artralgiya with heavy metals (thallium, beryllium), frequent overloads or microinjuries of joints, long medicinal therapy, post-allergic reactions, etc.
Residual artralgiya after the postponed inflammations of joints have chronic or passing character. Within weeks or months pains and rigidity in joints can remain; further the health and functions of extremities are completely restored. At a chronic form of an artralgiya of its aggravation are connected with an overstrain, a meteorolability, overcooling. The pain syndrome feigned by primary ossalgiya, neuralgia, mialgiy, vascular pathology, flat-footedness, H-shaped or About-shaped deformation of extremities, psychosomatic frustration belongs to psevdoartralgiya.
Diagnostics of an artralgiya
As the artralgiya is not independent nosological unit, and only a subjective symptom, into the forefront at clarification of the reasons of its emergence kliniko-anamnestichesky characteristics and fizikalny inspection act. Consultation of the rheumatologist is desirable. For the purpose of differentiation of an etiology of an artralgiya a number of objective researches is conducted. In laboratory diagnostics the clinical blood test including calculation of platelets, biochemical and bacteriological tests, serological reactions is indicative.
Among tool techniques of diagnostics the X-ray analysis and ultrasonography of joints, a tomography, a termografiya, an electrox-ray analysis, a podografiya, and also invasive interventions - a contrast artrografiya, an arthroscopy, a diagnostic puncture of a joint with a microbiological and cytologic research of a punktat is used.
Treatment and forecast of an artralgiya
In therapy of artralgiya the main role is assigned to treatment of the leading pathology. Drug treatment is directed to knocking over of inflammatory intra articulate processes and a pain syndrome. System therapy includes use of NPVP - an ibuprofen, diclofenac, a naproksen, etc. At a moderate artralgiya or existence of contraindications to oral administration of medicines local external therapy is carried out by the warming, anti-inflammatory and analgeziruyushchy ointments containing diclofenac, ketoprofen, turpentine ointment. Applications with a dimethyl sulfoxide on area of a joint are imposed.
The neglect competent inspection and treatment at an artralgiya is fraught with development of irreversible functional violations of joints – rigidnost, ankiloz, a contracture. As the artralgiya can serve as a marker of the most various diseases, the address to the doctor is necessary at emergence and preservation of an articulate syndrome over 2 days.