Arthritises unite group of inflammatory damages of joints of various genesis in which sinovialny covers, the capsule, a cartilage, etc. joint elements are involved. Arthritises can have infectious and allergic, traumatic, metabolic, dystrophic, jet and other origin. The clinic of arthritises consists of an artralgiya, a swelling, an exudate, hyperaemia and local temperature increase, malfunction, deformation of joints. Character of artirit is specified by laboratory researches of sinovialny liquid, blood, rentgeno-, ultrasonography diagnostics, termografiya, a radio nuclide research etc. Treatment of arthritises includes etiotropny, pathogenetic, system and local therapy.
Incidence of arthritis makes 9,5 cases on 1 000 population; prevalence is high among persons of different age, including children and teenagers, but more often arthritis develops at women of 40-50 years. Arthritis is a serious medico-social problem as its long and recidivous current can cause an invalidization and disability.
Classification of arthritises
On the nature of defeat arthritises are subdivided into 2 groups – inflammatory and degenerate. The following types – rheumatoid, infectious, jet arthritis, gout concern to group of inflammatory arthritises. Their development is connected with an inflammation of a sinovialny membrane, the serving internal vystilky surface of a joint. The traumatic arthritis and osteoarthrosis caused by damage of an articulate surface of a cartilage enter into group of degenerate arthritises.
The clinic of arthritis distinguishes sharp, subsharp and chronic development.
The inflammation at sharp arthritis can carry serous, serous or purulent character. Formation of a serous exudate is characteristic of a sinovit. At loss of a fibrinozny deposit the course of arthritis takes more severe form. The most serious fears are caused by the course of purulent arthritis which is characterized by distribution of an inflammation on all articulate bag and adjacent fabrics with development of capsular phlegmon.
The subsharp and chronic form of arthritis leads to a hypertrophy of fibers of sinovialny covers, pathological proliferation (growth) of a blanket of sinovialny cages, plazmotsitarny and lymphoid infiltration of fabrics from the outcome in fibrosis. At long arthritis development of granulations on the articulate surfaces of a cartilage, their gradual distribution on cartilaginous tissue, destruction and an erozirovaniye of a bone and cartilaginous rag is noted. In process of replacement of granulyatsionny fabric fibrous there is a process of an ossifikation, i.e. formation of fibrous or bone ankiloz. At interest of the articulate capsule, sinews and circumarticular muscles deformations of joints, incomplete dislocations, contractures develop.
On localization of an inflammation distinguish the isolated damage of a single joint (monoarthritis), processes with distribution on 2-3 joints are (oligoartrit) also by more than 3 joints (polyarthritis). Taking into account etiologichesky and pathogenetic mechanisms allocate primary arthritises developing owing to a trauma, an infection, immune and metabolic violations and also secondary arthritises as result of pathological changes of bone elements of a joint and circumarticular fabrics.
Specific infectious arthritises tubercular, gonorrheal, dysenteric, virus, etc. etiologies belong to independent (primary) forms of a disease; arthritis is rheumatoid, polyarthritis rheumatic, spondiloartrit ankiloziruyushchiya, polyarthritis of psoriaticheskiya, etc. Secondary arthritises can be a consequence of osteomyelitis, diseases of lungs, a GIT, blood, a sarkoidoza, malignant tumors and so forth.
Depending on a nosological form at arthritis various groups of joints are surprised. Symmetric interest of joints of feet and brushes - pyastno-phalanx, interphalanx, luchezapyastny, plusnefalangovy, predplusnevy, talocrural is characteristic of rheumatoid arthritis. Psoriatichesky arthritis is characterized by damage of disteel joints of manual phalanxes of feet and brushes; ankiloziruyushchiya spondiloartrit (Bekhterev's disease) – joints sacral a joint and a backbone.
The clinic of arthritis develops gradually from a general malaise which is first regarded as fatigue and overfatigue. However these feelings gradually increase and soon affect daily activity and functioning. The leading symptom of arthritis is the artralgiya which has steady wavy character, amplifying in the second half of night and at daybreak. Expressiveness of an artralgiya varies from insignificant pain to strong and enduring, sharply limiting mobility of the patient.
The typical clinic of arthritis is supplemented with a local hyperthermia and hyperaemia, a swelling, feelings of constraint and restriction of mobility. Palpatorno is determined morbidity over all surface of a joint and by the course of an articulate crack. Gradually deformations and violations of functioning of joints, modification of integuments over them, ekzostoza join these symptoms. Restriction of functionality of joints at arthritis can be shown both in easy degree, and in heavy – up to a full obezdvizhennost of an extremity. At infectious arthritises fever and oznoba is noted.
Diagnosis of arthritis
Diagnosis of arthritis is based on set of clinical symptomatology, the fizikalny signs radiological yielded of results of the cytologic and microbiological analysis of sinovialny liquid. Patients with the revealed arthritis go for consultation of the rheumatologist for an exception of the rheumatic nature of a disease. As the main diagnostic testing at arthritis serves the X-ray analysis of joints in standard (direct and side) projections. If necessary tool diagnostics is supplemented with a tomography, an artrografiy, elekrorentgenografiy, magnifying X-ray analysis (for small joints).
Radiological symptoms of arthritis are diverse; the most characteristic and early is development of circumarticular osteoporosis, narrowing of an articulate crack, regional bone defects, the destructive cystous centers of a circumarticular bone tissue. For infectious, including tubercular arthritises, formation of sequesters is typical. At syphilitic arthritis, and also the secondary arthritis which developed against the background of osteomyelitis presence of periostalny imposings at a projection of a metafizarny zone of tubular bones radiological is noted. In a sacral pozdvzdoshnykh joints at arthritis on roentgenograms the osteosclerosis is defined. Radiological symptoms of chronic arthritis incomplete dislocations and dislocations of joints, bone growths at the edges of epifiz belong.
By means of a diagnostic termografiya local changes of heat exchange, characteristic of arthritis, are confirmed. Help to determine by ultrasonography of joints existence of an exudate in his cavity, and also paraarticulary changes. Data of a radio nuclide stsintigrafiya allow to judge reaction of a bone tissue and activity of an inflammation. According to indications the diagnostic arthroscopy is carried out. For definition of extent of functional violations in joints at arthritis techniques of measurement of amplitude of passive and active movements, a podografiya (registration of duration of separate phases of a step) are used.
Character of an inflammation at arthritis is specified by means of a laboratory research of articulate liquid on its viscosity, cellular structure, content of enzymes and protein, existence of microorganisms. If necessary morphological assessment of a bioptat of sinovialny covers is carried out.
Treatment of arthritis
Etiologichesky treatment of arthritis is carried out only at some of its forms – infectious, gouty, allergic. Arthritises with a subsharp and chronic current are subject to the general pharmacotherapy by means of anti-inflammatory nonsteroid (an ibuprofen, diclofenac, ) and steroid (Prednisolonum, methylprednisolonum) medicines. Synthetic steroids are also used for introduction to a joint cavity (medical punctures of joints).
In process of subsiding of an acute inflammation the physical therapy (Ural federal district in eritemny doses, an electrophoresis with analgetics, with a hydrocortisone, an amplipulsterapiya) rendering antipainful and anti-inflammatory effect, preventing fibrous changes and dysfunctions of joints is added to medicamentous therapy. Training of physiotherapy exercises and massage at arthritis is directed to the prevention of development of a contracture and functional violations in joints. It is recommended to include mud cure, a balneoterapiya, sanatorium and resort treatment in a complex of recovery therapy.
Use of techniques of efferent therapy (a plasma exchange, a krioaferez, a cascade filtration of plasma of blood) is directed to extracorporal absorption of antibodies and the CEC at autoimmune arthritises, urat – at a gouty form of arthritis. The extracorporal pharmacotherapy allows to use own blood cells of the patient (leukocytes, erythrocytes, platelets) for effective delivery of medicinal substances to the inflammation center.
For treatment of severe forms of arthritis introduction of stem cells is used. Stem cellular therapy promotes restoration of a metabolism and improvement of food of the tissues of joint, subsiding of an inflammation, increase in immunity to infections which are the frequent reason of arthritis. The special value of use of stem cells consists in stimulation of regeneration of a cartilage and restoration of its structure.
In certain cases at rheumatoid and other forms of arthritis performing surgery – a sinovektomiya is required, to an arthrotomy, a resection of a joint, an artrodez, a heylektomiya, arthroscopic operations, etc. At the destructive changes in a joint caused by arthritis endoprosthesis replacement, reconstructive and recovery artroplastichesky operations is shown.
Forecast and prevention of arthritis
The next and remote forecast at arthritis is caused by the reasons and character of the inflammatory phenomena. So, course of rheumatic arthritis usually good-quality, but quite often recidivous. Well therapies jet arthritises give in (postenterokolitichesky, urogenny), however subsiding of residual manifestations can drag on for a year and more. Predictively the course of the rheumatoid and psoriatichesky arthritises leading to heavy motive dysfunctions is the most adverse.
Basis of prevention of arthritis is change of character of food. The various, balanced food, control of weight, reduction of consumption of animal fats and meat, restriction of amount of sugar and salt, an exception of smoked products, carbonated drinks, marinades, fancy bread, canned food, increase in a share of fruit, vegetables, grain crops in a diet is recommended. The obligatory requirement of prevention of arthritis is the exception of alcohol and smoking. The joints affected with arthritis need to be kept constantly in the warm. The regular dosed activity, remedial gymnastics, massage are useful.