Artropatiya – secondary damage of joints against the background of other diseases and pathological states. Can develop at an allergy, some infectious diseases, endocrine violations, chronic diseases of internals, metabolic violations and violations of nervous regulation. The clinic of artropatiya can significantly differ. The common distinctive features are pains, asymmetry of defeat, dependence of an articulate syndrome on the course of the main disease and poorly expressed changes by results of tool researches (a X-ray analysis, KT, MPT). The diagnosis an artropatiya is exposed in case articulate the syndrome and extra articulate symptomatology do not correspond to diagnostic criteria of gouty or rheumatoid arthritis. Treatment is carried out taking into account the main disease.
Artropatiya – the damage of joints caused by not rheumatic diseases. Can arise at diseases of various etiology. Proceeds in the form of artralgiya (pains without violation of a form and function of a joint) or in the form of jet arthritises. The main distinctive characteristic of artropatiya is dependence of an articulate syndrome on the course of the main disease. Rough pathological changes in joints usually do not develop, in most cases the articulate symptomatology completely disappears or significantly decreases at adequate treatment of the main disease.
Joint pains arise against the background of allergic reaction. Artropatiya can develop both practically right after contact with allergen, and several days later. The diagnosis is exposed on the basis of characteristic allergic symptomatology: existence of fever, skin rash, limfoadenopatiya, bronkhoobstruktivny syndrome etc. On blood tests the gipergammaglobulinemiya, an eozinofiliya, plasmatic cages and antibodies of the class IgG comes to light. The phenomena of an artropatiya disappear after performing the desensibilizing therapy.
Artropatiya at a syndrome of Reuters
The syndrome of Reuters represents the triad including damage of organs of vision, joints and urinogenital system. Most often clamidiosis becomes the reason of development, less often the syndrome is caused by salmonellas, shigellas, iyersiniya or arises after an enterokolit. The persons having hereditary predisposition suffer. Usually symptoms appear in the following sequence: at first – the sharp urinogenital infection (cystitis, uretrit) or enterokolit, soon after that – damage of eyes (conjunctivitis, uveit, iridotsiklit, retinit, keratit, Irit) and only 1-1,5 months later – an artropatiya. At the same time symptoms from eyes can be shown within 1-2 days, to be poorly expressed and to remain unnoticed.
Artropatiya is the leading sign of a syndrome of Reuters and becomes frequent the first reason of the request for medical care. Asymmetric arthritis with damage of joints of the lower extremities is usually observed: ankle, knee and small joints of foot. At the same time joints are, as a rule, involved in inflammatory process consistently, from below up, with an interval in several days. The patient with an artropatiya complains of the pains amplifying at night and in the morning. Joints are edematous, local hyperaemia is noted, at some patients the exudate comes to light. Sometimes there are backbone pains, develops sakroileit, calcaneal is possible bursit with bystry formation of a calcaneal spur and an Achilles tendon inflammation.
The diagnosis is exposed on the basis of the clinical record, symptomatology, these laboratory and tool researches. At identification in the anamnesis of enteritis or uric infection of patients with an artropatiya direct to consultations to the corresponding experts: to the gastroenterologist, urologist and venereologist. At damage of eyes consultation of the ophthalmologist is necessary.
In blood tests inflammation signs, in analyses of urine – insignificant or moderate quantity of leukocytes come to light. For detection of hlamidiya scrape is carried out from the tservikalny channel, an urethra and a conjunctiva. When carrying out a X-ray analysis of a knee and ankle joint some narrowing of articulate cracks and the centers of circumarticular osteoporosis is found. The X-ray analysis of a calcaneal bone usually confirms existence of a calcaneal spur. The X-ray analysis of foot demonstrates existence of periostit, erosion and spurs of plusnevy bones and bones of phalanxes of fingers.
Treatment is directed to fight against the main infection and elimination of symptoms of a disease. To patients with an artropatiya appoint antichlamydial medicines, if necessary – analgetics and NPVP. In 50% of cases of an artropatiya completely disappear, at 30% of patients an arthritis recurrence is observed, in 20% of cases the chronic current of an artropatiya with further aggravation of symptomatology and dysfunction of joints is noted.
Artropatiya at other diseases
Artropatiya can arise at a row parasitic and a set of infectious diseases. Flying artralgiya, sometimes in combination with mialgiya are characteristic of trichinosis, a brucellosis and Lyme's disease. At a rubella there is unstable symmetric polyarthritis. Remind Artropatiya at epidemic parotitis a picture of rheumatoid arthritis: the inflammation in joints is changeable, has the migrating character and sometimes is followed by a pericardium inflammation. Infectious and chicken pox are followed by an artropatiya in the form of the unstable arthritis which is quickly passing when fading symptoms of the main disease.
Artropatiya at a meningococcal infection develops approximately in a week after the beginning of a disease; monoarthritis of a knee joint is usually observed, is more rare – polyarthritis of several large joints. At viral hepatitises artropatiya in the form of artralgiya or flying arthritises with symmetric damage of mainly knee joints and small joints of a brush are possible; artropatiya usually arise in the onset of the illness, even before emergence of jaundice. A big variety of articulate symptomatology is characteristic of HIV infection: are possible both arthritises, and artralgiya, in some cases the AIDS-associated arthritis of ankle and knee joints which is followed by the expressed dysfunction of an extremity and an intensive pain syndrome develops.
In all listed cases the articulate symptomatology quickly enough disappears at treatment of the main disease.
Artropatiya at vaskulita
At a nodular periarteriit, Takayasu's syndrome and Cherdzha-Strauss's granulematoza of an artropatiya usually proceed in the form of artralgiya. At a disease of Kawasaki both artralgiya, and arthritises are possible. At Shenleyn-Genokh's disease and Wegener's granulematoza symmetric damage of large joints, a changeable pain syndrome against the background of a swelling of circumarticular fabrics is observed.
Artropatiya at endocrine violations
The most widespread damage of joints at violation of hormonal balance are climacteric or ovariogenny artropatiya. Articulate the syndrome develops against the background of a climax or decrease in function of ovaries, caused by other reasons (surgical removal, radiation concerning a malignant new growth). To the Artropatiy thicket women with an excessive weight suffer. Usually small joints of feet are surprised, is more rare – knee joints. There are pains, constraint, a crunch and a swelling. The configuration of joints – in the beginning at the expense of hypostasis, then due to dystrophic processes is broken. At initial stages the radiological picture normal, on MRT of joints or during an arthroscopy of a knee joint comes to light some thickening of a sinovialny cover. In the subsequent also arthroses of joints of foot are found . After selection of effective replacement therapy of an artropatiya decrease or disappear.
Diabetic artropatiya develop mainly at the young women having diabetes of the I type within 6 and more years, especially – at irregular and inadequate treatment. Defeat is usually unilateral, foot joints suffer. Are involved in process a knee and ankle joint less often, is even more rare – a backbone and joints of the top extremities. The clinic of quickly progressing arthrosis is characteristic of diabetic artropatiya. On roentgenograms the centers of an osteoliz, osteoporosis and an osteosclerosis, flattening of articulate surfaces and an osteofita come to light. Treatment of diabetes leads to reduction of an artropatiya, however at the expressed arthroses the therapy directed to elimination of a pain syndrome and restoration of a cartilage is necessary.
Giperparatireoz becomes the reason of a rassasyvaniye and the subsequent restoration of a bone tissue, at the same time in an articulate cartilage there are limy deposits, develops articulate . Artropatiya are shown in the form of flying joint pains, sharp mono - and polyarthritises. After correction of hyperfunction or removal of adenoma of a parathyroid gland articulate symptoms usually disappear.
Gipertireoz, especially his severe forms, can be also followed by artropatiya. Are possible both arthritises, and artralgiya, sometimes in combination with muscle pain. A radiological picture poor, only the phenomena of widespread osteoporosis come to light. The diagnosis is exposed on the basis of clinical manifestations. Therapy of the main disease leads to reduction or disappearance of an artropatiya.
Damage of large joints is characteristic of a hypothyroidism, is more often than knee. Also coxofemoral joint pains are possible. Artropatiya are combined with mialgiya, constraint and weakness of muscles. A radiological picture without changes. At development of a hypothyroidism at children's age rotation and shift of a head of a hip with development of a sgibatelny contracture of a coxofemoral joint is possible.
At dysfunction of a hypophysis damage of a backbone and disteel joints of extremities is sometimes observed. In hard cases develops sheynogrudny department in combination with decalcification of a breast and edges. Deformations of extremities and looseness of joints are possible. Artropatiya are shown by pains in a back and joints of extremities. Contractures are uncharacteristic.
Artropatiya at somatic pathology
Artropatiya in the form of the sharp migrating arthritises are characteristic of a disease Krone and nonspecific ulcer colitis. Usually ankle and knee joints are surprised. At nonspecific ulcer colitis arthritises of coxofemoral joints and backbone pain are possible. All manifestations of an artropatiya independently disappear within 1-2 months.
The most known artropatiya at diseases of internals is Mari-Bambergera's syndrome – deformation of fingers in the form of drum sticks and nails in the form of hour glasses. Is the reason of deformation ossifitsiruyushchiya disteel departments of tubular bones, arising owing to reaction of a bone tissue to violations of acid-base balance and a lack of oxygen. The syndrome most often arises at pulmonary diseases (lung cancer, kavernozny tuberculosis, nagnoitelny diseases). Can also meet at cirrhosis, a long septic endocarditis and some congenital heart diseases. Artropatiya are shown in the form of the expressed joint pains. Insignificant hypostasis is possible.