Chronic arthritis – the inflammatory disease of joints which is characterized by the long, progressing current with a periodic sharpening of activity of pathological process. Irrespective of localization, chronic arthritis is characterized by local morbidity, constraint at the movements, puffiness of fabrics and over time leads to deformation of joints, contractures, incomplete dislocations. Diagnostics of various forms of chronic arthritis includes comprehensive radiological, ultrasonic, tomographic examination, carrying out laboratory analyses. The temporary immobilization of a joint, purpose of nonsteroid and steroid anti-inflammatory medicines, basic means is the cornerstone of therapy of an exacerbation of chronic arthritis. During the periods of remission recovery treatment (FTL, LFK, massage) is shown.
Chronic arthritis – an arthritis form at which signs of inflammatory damage of joints remain more than 3 months. As chronic arthritis inflammatory diseases of joints of various etiology can proceed: rheumatoid arthritis, gouty arthritis, infectious arthritises (gonorrheal, tubercular, fungal), psoriatichesky arthritis, etc. Due to the features of a clinical current in independent nosological forms are allocated juvenile chronic arthritis and chronic VNChS arthritis. The variety of options of chronic arthritis causes interest in a disease from rheumatology, pediatrics, stomatology and other disciplines. Chronic arthritis can arise in the outcome of an acute articulate inflammation or as primary and chronic process. Incidences of various forms of chronic arthritis are subject both adults, and children.
Reasons of chronic arthritis
The group of the diseases united by the concept "chronic arthritis" is non-uniform therefore their etiology is also difficult and diverse. The course of infectious arthritises can be supported by a persistiruyushchy infection in an organism: nonspecific (tonsillitis, sinusitis, pyelonephritis, viral hepatitis C, etc.) or specific (tuberculosis, gonorrhea, syphilis). Arthritis at gout is caused by infiltration of articulate fabrics of an uratama with the subsequent inflammatory reaction.
The etiology of such serious inflammatory illness of joints as rheumatoid arthritis is less studied, ankiloziruyushchy spondiloartrit and so forth. Participation of infectious agents in an origin of these types of arthritis remains unproven, but the conventional pathogenetic factors are change of the general and fabric reactivity, development of an allergy and immunocomplex reactions. Chronic arthritises can accompany the course of various diseases, for example, - psoriasis, a system red volchanka, a syndrome of Reuters, a sarkoidoz, Bekhchet's disease, recidivous polychondrite and some others.
As the factors promoting development of primary and chronic arthritis serve the inactive way of life, overcoolings, hyper insolation, long load of the same joint, endocrine changes (a puberty, pregnancy, a menopause, etc.), diseases (diseases of a thyroid gland, diabetes), vaccination, etc.
Clinical forms of chronic arthritis
Juvenile chronic arthritis
This term designates various forms of arthritis lasting over 12 weeks arising at children. Juvenile chronic arthritis meets frequency of 0,3-0,4 cases at 1 thousand children. The peaks of incidence fall on age of 2-6 years and the pubertatny period; girls are ill about 3 times more often. At a part of children communication of juvenile chronic arthritis with the previous SARS, a trauma, inoculations (AKDS, etc.), is traced by introduction of medicines (gamma globulin). Close relatives of young patients quite often have rheumatoid arthritis, collagenases.
Clinical symptoms of juvenile chronic arthritis consist of artralgiya, change of a configuration and dysfunction of the affected joints. At monoarticulary or oligoartikulyarny juvenile chronic arthritis is surprised from 1 to 4 joints (usually talocrural, knee, separate fingers on hands). Oligomonoartrit often proceeds with the phenomena of the chronic uveit leading to a blindness.
At polyarticulary option of chronic arthritis more than 4 joints – usually small joints of brushes, joints of legs, sometimes - cervical department of a backbone, a temporal and mandibular joint are involved in inflammatory process. Interest of joints of the lower extremities results in difficulties of movement; the top extremities – to problems with performance of household actions and the letter; VNChS – to an underdevelopment of the lower jaw ("a bird's jaw"). The disease tends to the progressing course with formation of permanent deformations and contractures, atrophies of periartikulyarny muscles; the delay of physical development, shortening of extremities is possible.
Fever, existence of the spotty, itching rash, limfadenopatiya, gepatosplenomegaliya is characteristic of system juvenile rheumatoid arthritis. Articulate the syndrome is followed by artralgiya, sinovita. This form often is complicated by pleurisy, myocarditis, perikardity, pulmonity.
Rheumatoid arthritis proceeds as the chronic polyarthritis leading to development of deformations and ankiloz of joints. Involvement in pathological process of the 3rd and smaller joints of brushes and feet, symmetry of defeat, the morning constraint of movements in the affected joints which is gradually passing during the day is typical signs of rheumatoid arthritis. Changeable fever, weight loss, perspiration, fatigue are noted. Extra articulate displays of rheumatoid arthritis include hypodermic small knots, ekssudativny pleurisy, vaskulit, peripheral neuropathy. The long, chronic course of rheumatoid arthritis leads to the characteristic deformations (to ulnarny deviation of brushes, S-shaped deformation of fingers) expressed to functional violations - rigidity or a full immovability of joints.
Chronic gouty arthritis
The current of a chronic form of arthritis is characterized by emergence of frequent, more long, but less bad gouty attacks. There can periodically be a so-called gouty status – long attacks mono - or polyarthritis duration up to several weeks. The I plusnefalangovy joint, brush joints, knee, talocrural, luchezapyastny, etc. are surprised.
3-5 years later after the demonstration of gout the expressed deformations of joints, contractures, permanent restrictions of the movement develop. As typical display of chronic gouty arthritis serves formation of tofus – fabric congestions of urat in the form of whitish-yellow small knots. Tofusa can be localized on the internal surface of auricles, in joints, more rare – on a skler and a cornea. At the long course of gout damages of internals, mainly kidneys (an urolithic disease, an uratny nephropathy, a renal failure) develop. Chronic gouty arthritis leads to development of secondary osteoarthrosis, a fibrous or bone anchylosis and can cause disability and physical activity of patients.
Chronic psoriatichesky arthritis
Articulate the syndrome associated with psoriasis develops approximately at a third of patients, mainly, at a severe form of a disease. Skin displays of psoriasis include rashes (psoriatichesky plaques) which are localized on a hairy part of the head and in the field of the razgibatelny surfaces of large joints, a peeling, an itch, feeling of tightness of skin. In most cases damage of skin precedes arthritis, sometimes they arise at the same time or articulate the syndrome arises before skin manifestations.
Asymmetry is typical for damage of joints, daktilit with involvement of disteel interphalanx joints. At a chronic daktilit, pain and hyperaemia, as a rule, are absent, however the thickening of fingers, formation of sgibatelny contractures and restriction of mobility of brushes and feet is noted. Quite often at patients with chronic psoriatichesky arthritis develops spondilit, sakroileit, entezopatiya.
Diagnosis of chronic arthritis
Therapists, pediatricians, dermatologists, rheumatologists, etc. can participate in recognition of various forms of chronic arthritis. The fact of existence of arthritis is confirmed by data of the anamnesis, objective survey and results of tool researches (ultrasonography of a joint, a X-ray analysis, an artrografiya, KT of a joint, MRT). The puncture of the affected joint, a diagnostic arthroscopy, a biopsy of a sinovialny cover are informative.
Osteoporosis, narrowing of interarticular cracks, erosion of articulate surfaces, circumarticular cysts belong to the most typical radiological symptoms of chronic arthritis circumarticular, periostit. For definition of clinical option of chronic arthritis a paramount role is played by laboratory tests: OAK, immunological and biochemical blood tests, IFA, research of sinovialny liquid. So, as the main marker of rheumatoid arthritis serves detection of the Russian Federation in serum of patients; a juvenile oligomonoartrit – identification of an anti-nuclear factor etc.
Treatment and forecast of chronic arthritis
Performing etiotropny therapy is possible only at some forms of chronic arthritis (infectious, gouty). In other cases at an aggravation of inflammatory process are appointed nonsteroid (NPVP) and steroid anti-inflammatory medicines which can be applied systemically and locally. Perhaps intra articulate introduction of glucocorticosteroids. At rheumatoid and psoriatichesky arthritis basic anti-inflammatory therapy is carried out. At height of an aggravation the short-term immobilization of a joint, further – use of the orthopedic devices facilitating movement is shown (walkers, canes and so forth).
For the purpose of increase in the general mobility of joints regular trainings of LFK, massage are necessary. For reduction of residual inflammatory reactions, the prevention of development of fibrosis, maintenance and extension of remission of chronic arthritis carrying out courses of physical therapy, a balneoterapiya, sanatorium treatment is recommended. Surgical treatment of chronic arthritis can be required in case of destructive damages of joints and the expressed functional violations. At the same time endoprosthesis replacement of joints, an artroplastika, an arthroscopic sinovektomiya, etc. can be carried out.
Chronic arthritis cannot be cured completely, however correctly picked up therapy and regular observation of the rheumatologist allow to reach long remission and satisfactory quality of life, both in household, and in the professional plan. A frequent recurrence of chronic arthritis, and also system displays of a disease burden the forecast: in these cases early there comes the invalidization limiting physical activity, self-service and self-realization.