With joint diseases, the patient always experiences sensations that are far from pleasant. With the development of the disease in its later stages, the appearance of unbearable pain is quite likely. Common diseases of the leg joints are arthritis and arthrosis.

Arthritis is a disease that is always accompanied by inflammatory processes in the joints. Arthrosis is a disease in which the tissues in the joints degrade and the joint capsule is destroyed. Joint diseases are almost always accompanied by pain symptoms. These pains are different. In some diseases, they appear weakly at first, and only in certain situations, for example, when getting up from a chair, or with the start of physical activity, and later stop. Over time, such pain becomes more frequent and intensifies. Therefore, it is better to consult a doctor at the first occurrence of discomfort - since in this case the disease can be quickly cured.

In this case, the symptoms of disease of the joints of the legs can completely deprive a person of the ability to walk independently for some time. If you hope that the pain will go away on its own, do not seek qualified medical help, and self-medicate, the matter can be brought to surgical intervention, during which there may even be a need to replace the joint.

Arthritis of the leg joints

When you have arthritis, inflammation occurs in the joints. Arthritis usually begins with inflammation of the synovial membrane. After this, over time, swelling appears around the joint and the joint loses mobility.

The reasons for such processes can be very different.

If the cause of arthritis is a general infection in the body, such arthritis is called infectious. It occurs as a concomitant and spreads to many joints. Localized arthritis, inflammation of one joint, can occur after infection through broken skin. Infection can occur after spread by blood flow.

Rheumatoid arthritis is characterized by the fact that the joints in the patient’s body are affected symmetrically, on both sides of the body. Rheumatoid arthritis can affect and cause dysfunction of the lungs, nervous system, and heart. Cause pathological changes in the skin and eyes. Both young people and older people are affected by the disease.

Gout is a form of arthritis. The cause of gout is improper metabolism, as a result of which uric acid salts are deposited in the joints. Gout can develop in the body, both on the elbow or knee joints, and on the big toes or ankle joints. Men are more often affected by gout.

Arthrosis of the leg joints

Arthrosis is a disease of the joint in which its cartilage tissue is destroyed. The causes of the disease include, first of all, excessive loads on the joint, or constant monotonous repetitions of the same action. Constant microtraumas, injuries to joints and ligaments, and previous surgeries can also cause the development of arthrosis. After some time, even after successful surgery on a joint, the body may begin to produce substances that cause degenerative degeneration of cartilage tissue. Metabolic disorders, hypothermia, excess weight, flat feet, excessive stress on the legs, predisposition to hereditary diseases, hereditary diseases, uncomfortable shoes can also cause the development of arthrosis.

Symptoms

Since each disease of the leg joints has its own symptoms, this makes diagnosis easier.

Pain, redness, swelling, increased skin temperature around the affected joint are signs of arthritis. If a patient feels stiffness in his joints in the morning, if his legs also hurt when wearing regular shoes, if there is pain when walking, or fatigue quickly, this can also cause a diagnosis of “arthritis.”

Rheumatoid arthritis also leads to joint stiffness, especially after a night's sleep or prolonged inactivity of the limbs, which can last more than an hour; the patient feels pain, swelling appears, the skin near the affected joint turns red, and its temperature rises. In some cases, the course of the disease is similar in symptoms to the flu, accompanied by joint pain. As a result of arthritis in the legs, you may experience rapid fatigue when walking and pain that makes it difficult to walk.

Psoriatic arthritis is characterized by the most severe swelling, with the skin taking on a blue-purple tint, being very swollen and looking like a sausage.

Gout is accompanied by very painful inflammation of the joints.

Symptoms of arthrosis are pain in the joints during exercise, cracking in the joints. The slight crunch of a healthy joint should not be confused with the crunch of a joint affected by arthrosis. In the second case, pain is always present.

The diagnosis should only be made by a doctor

Do not be surprised if, in order to establish a diagnosis, the doctor asks the patient not only to talk about symptoms and complaints, but also to walk around the office. After all, you can also see from your gait where the problem lies. Patients with joint diseases are usually referred for blood tests and x-rays. MRI, ultrasound, etc. are prescribed only if the diagnosis is difficult to establish or the treatment does not have a good effect.

Self-medication is harmful

Serious diseases such as joint diseases are not something to joke about. Treatment must be carried out under the supervision of an experienced doctor, who also makes a diagnosis and prescribes a course of treatment.

When treating arthritis, patients are necessarily prescribed painkillers, drugs that relieve inflammation, non-steroidal origin, chondroprotectors - drugs that accompany the restoration of cartilage tissue in the early stages of the disease and prevent its rapid destruction. If the cause of arthritis is infection, antibiotics are used.

As accompanying measures, physical exercises, gymnastics, massage, physiotherapy, diets rich in vitamins E, C, etc. are recommended. B, mud therapy. You may need special orthopedic shoes and crutches. Folk remedies are also used, such as mustard plaster, warming compresses and baths. But such funds can only be used as an addition to the main course of treatment. It must be remembered that any warming compresses or baths are unacceptable in the presence of inflammation, especially purulent inflammation.

In the most extreme cases, if it is impossible to achieve results using other methods, an operation is prescribed in which the joint can be replaced with an artificial one.

Nutrition

In the treatment and prevention of joint diseases, a proper diet is important. Smoked meats, salted fish, legumes, lard, alcohol, and meat products are excluded from consumption. It is useful for a quick recovery to eat porridge, whole grains, vegetables, fruits, herbs (except sorrel and rhubarb).

Preventive measures

To prevent joint diseases, it is enough to lead a healthy lifestyle, exercise hardening, get used to proper, healthy eating, do gymnastics, move more, and lose excess weight.

Video - leg joint disease symptoms

Complex cartilage disease

Arthrosis is a joint disease that affects the cartilage tissue. Cartilage is needed to ensure that the bone in the joint moves softly and smoothly. It serves for good sliding of the surfaces of the joint bones relative to each other. But over time, joints age, cartilage tissue recovers less well from microtraumas, and with more significant harmful effects it begins to deform and collapse faster. All human joints can be affected by the disease. And the risk group includes, first of all, dancers and people in professions where the load on the joints is very large - builders, loaders, miners.

What is the danger?

Arthrosis of any joint, if you do not consult a doctor in time and do not treat the disease, can lead to complete immobility of this joint and even to surgical intervention. With dystrophic changes in cartilage, the body begins to compensate for its deficiency, and the growth and ossification of connective tissue begins at the site of articulation of the joint bones. The joint loses mobility, the person begins to experience increasing pain, and over time, mobility may disappear completely. In the case of the hip joint, the disease can lead to a femoral neck fracture, which is common among older people. The risk of fracture increases with incorrect position of the hip joint bones and their poor mobility. Women in adulthood may develop calcium deficiency in bone tissue, which leads to additional bone fragility.

Osteoarthritis of the hip joint lies in wait for older people, because cartilage wears out over time. And the more mercilessly a person treats them in his youth, the more likely it is to get this disease over the years.

Women suffer from arthrosis of the hip joint somewhat more often than men, and their disease is more severe, but no one should ignore the unpleasant and dangerous symptoms. Because with timely diagnosis of the disease, it will be possible to treat it more effectively, prevent exacerbations and choose a therapy that will help avoid pain or discomfort with the least inconvenience for the patient.

Symptoms of the disease

The symptoms of the disease will help determine arthrosis of the hip joint. One of the main symptoms, of course, is pain in the groin area, which is sometimes transmitted to the thigh or buttock. Usually the painful sensations do not reach below the middle of the thigh, less often to the middle of the lower leg. They usually spread along the front or side of the thigh and lower leg.

Pain in the hip joint is the main symptom of the disease

It is difficult to detect the disease at an early stage, since the pain is not severe and appears only when moving. Usually the patient hopes that it is harmless, not serious, and that the disease will go away on its own over time. Over time, the pain becomes more severe. At first, the joint hurts only when moving, and then, when a person walks for a while, the pain weakens and even stops. Pain can also occur with heavy loads on the joint.

As the disease progresses, cartilage tissue degenerates more and more, the surfaces of the articular joints of the bones begin to come into contact without shock-absorbing cartilage tissue, and the pain becomes constant. It does not stop even when the movement stops, bothers the patient day and night, and interferes with night sleep.

When moving, you can hear a dry cracking sound in the joint, which should not be confused with the crunching sound of a healthy joint, which is not accompanied by pain.

Over time, the patient begins to avoid unnecessary movements that cause pain. He cannot get up from a sitting or lying position on his own, or “saddle” a chair with his legs spread wide apart. Difficulty is caused by trying to move the leg to the side or press it to the chest. Even moving the affected leg while lying down causes pain.

After the cartilage tissue has degraded sufficiently, it is replaced by the body with connective tissue, which becomes ossified over time, and the bones in the articular joint take on an incorrect position relative to each other. This can cause the affected leg to shorten. In rare cases, the affected leg lengthens. The difference in leg length can be seen most strongly when the patient lies on his back with his legs extended.

Subsequently, the gait also changes. The patient begins to fall on the sore leg, his posture becomes distorted, and the muscles are in constant unhealthy tension. And because of the painful sensations, the patient’s mental state changes, he becomes irritable, and nervous exhaustion appears. Due to constant incorrect posture and curvature of the spine, increased load on the group of muscles that support the spine, pain in the lumbar region may occur over time.

With the further development of the disease, the blood vessels and nerve endings going to the muscles of the affected leg become increasingly compressed. Her muscle mass decreases, her muscles begin to atrophy, and over time this muscle degradation becomes clearly visible. Pain also appears at the site of attachment of the tendons of these muscles in the knee. Sometimes it is mistakenly interpreted as a symptom of a disease of the knee joint, since this pain can be more severe than the pain in the groin, buttock and thigh characteristic of hip arthrosis.

Osteoarthritis can affect one or both joints. And in the second joint, after the first, pain also appears.

How to diagnose the disease?

Only a qualified doctor can make a correct diagnosis. To establish such a diagnosis, an examination using an x-ray or ultrasound is often prescribed.

The likelihood of developing the disease arises for many reasons. There may be a hereditary predisposition to it; the cause may be severe stress on the joint, including excess weight, poor nutrition, hypothermia, stress, and impaired metabolism. To establish the cause of the disease, and therefore prescribe the correct treatment, sometimes a simple survey about the patient’s work and his lifestyle and dietary preferences is enough. Less often they resort to analysis of metabolism, hereditary characteristics, and even a special blood test for a genetic predisposition to arthrosis.

If the cause of the disease is correctly established, in order to avoid recurrence of exacerbations and prevent progression of the disease, this cause must be eliminated. In the case of excessive loads, it is enough to change the mode of work or rest, stop activities that lead to overwork of the joint and muscles. If the cause of the disease is poor nutrition or excess weight, a special diet is developed, which the patient will have to follow to improve his condition.

Prevention and timely consultation with a doctor is the key to health

With timely consultation with a doctor and qualified diagnosis, many problems can be avoided, but if you neglect the disease and hope for a spontaneous cure, you can end up with a lot of troubles - from complete loss of mobility to mandatory surgery to replace the diseased joint with an artificial one. If the disease is not treated, it can provoke the development of other diseases - nervous exhaustion, degradation of the femoral muscle, diseases of the lumbar spine.

Video - Osteoarthritis of the hip joint symptoms

Symptoms of joint disease |

There are a large number of different diseases of the musculoskeletal system. The most widespread among them are arthritis and arthrosis, and we’ll talk about them.

Arthritis– this is a joint disease that is inflammatory in nature and occurs due to an infectious disease, various types of injuries, and metabolic disorders. It can affect both a single joint and several. The disease can progress extremely rapidly and is characterized by pain in the knee joint and elevated temperature. This condition is called acute arthritis. In contrast, the disease may progress slowly, or in other words, chronic arthritis.

Arthrosis– a joint disease in which the main changes occur in the articular cartilage.

Common symptoms of joint disease

The list of them is quite extensive. Among the most obvious are changes in the articular area and surrounding tissue.

1. Unbearable pain.

2. Feeling of “crunching” while moving.

3. Swelling and redness around the affected joint.

4. The range of movements becomes sharply limited.

The above symptoms appear in almost all of their lesions. However, there are characteristic differences for each of them. Let's take a closer look at them.

1. Arthritis caused by an infectious disease. Most often, reactive arthritis occurs after serious diseases of the gastrointestinal tract and genitourinary system. This disease mainly causes inflammation of the joints of the lower extremities. The duration of such arthritis varies from one to two days to a couple of weeks. Most often, this disease goes away on its own, but cases may also develop into a chronic form. Another type that is much less common is purulent arthritis, which occurs due to joint injury or blood poisoning. This type is only a consequence of the underlying disease.

2. Arthritis arising from rheumatism

This type of disease is mild in nature. Its duration is short, but the most important thing is that it is able to affect one joint after another. It doesn't happen often.

3. Rheumatism of the joints

During this disease, the inflammation process affects several joints at once. First the small ones (hands and feet), and then the larger knee ones. Clear signs of this are a feeling of stiffness in the affected joints and an increase in skin temperature. The course of the disease is measured, but constantly increasing, while initially healthy joints are gradually affected by the disease, change and their functioning is impaired.

Now a few words need to be said about articular cartilage disease, that is, osteoarthritis. With this disease, the body experiences a significant lack of calcium and phosphorus. The area of ​​inflammation around the diseased joint is not clearly expressed and is not constant. The joints that bear the maximum load, such as the knees and hips, are affected. During movement, severe pain occurs in the knee and the joint swells, becomes thicker, changes and is less mobile.

4. When uric acid salts accumulate, this type of arthritis is called gouty. It mainly affects middle-aged males. The lower extremities are most often affected: the joints of the knee and shin. The causes of this type of arthritis can be considered poor diet and alcohol. The rate of increase in pain is very high, within an hour the joint becomes impossible to move, it turns red, and the person’s temperature rises greatly.

Treatment of joint arthritis

Treatment of the symptoms of this disease is carried out by the doctor prescribing anti-inflammatory and painkillers. For osteoarthritis, treatment with chondoprotectors and drugs that significantly improve bone metabolism is allowed. If the disease is severely advanced, then surgical intervention becomes necessary.

It is recommended to minimize the presence of sodium in your daily diet, that is, significantly limit your salt intake. Courses of therapeutic fasting lasting a week are allowed (with complete abolition of medications). The intensity of the pain decreases and the feeling of stiffness in them disappears. However, it should be noted that all this is short-term in nature and therefore the effect of such fasting is short-term.

Nutrition for arthrosis

There are currently no general recommendations on nutrition for osteoarthritis. However, for patients who, along with this disease, also suffer from a number of other diseases, such as obesity, and are treated with non-steroidal anti-inflammatory drugs, some adjustments are made to the diet.

Since these medications may have undesirable side effects: vomiting, heartburn, nausea, they try to limit to a minimum the consumption of a variety of fish broths, sauces, pickled and salted vegetables, mushrooms, white cabbage, alcoholic beverages and soda. The stomach and intestines can react extremely negatively to long-term use of these drugs, and the formation of ulcerative lesions and iron deficiency in the body is quite possible.

With very long-term use of painkillers and anti-inflammatory drugs, difficulties may arise in the normal functioning of the circulatory system and digestion. That is why when choosing medicines it is recommended to give preference to a variety of ointments and gels. They act locally, the effect is quite noticeable, and the risk of side effects is minimal.

Traditional treatment of joint disease

Ordinary sand is an extremely useful and effective preventive and therapeutic agent for joint diseases. A positive result can be achieved provided that the sand is warmed up. You need to use only clean, preferably sea sand. The sand should be sifted through a fine sieve, washed and dried. Then the sand is heated in the oven to 50 degrees, poured into an appropriate fabric container and this bag is applied to the affected joint for a short period of time. In summer, sand baths on the beach are allowed. There are a number of limitations with this type of treatment: heart disease, skin disease, tumors, exhaustion, tuberculosis.

The next natural aid in the treatment of joint diseases is clay. It reduces inflammation around the affected joint and significantly reduces pain. There are no negative side effects when treating with clay. When used, clay wraps or compresses are used. Clay is able to accumulate heat, thereby significantly improving blood flow in the problem area.

1. Take 25 grams of honey and 25 ml of lemon juice and dissolve them in water, then pour it into the clay and mix. The resulting mass is placed in a thick layer on gauze, wrapped around the affected joint and covered with woolen cloth for several hours. Then rinse everything off with water. Duration – ten procedures.

2. Clay compress using honey and aloe.

We dilute the clay with water to a liquid porridge and add a small amount of aloe juice and honey inside and mix. We wet the bandage in this mixture and apply it to the joint, wrap it in polyethylene, woolen cloth and fix it for half an hour. Duration – fifteen procedures.

3. Dilute the clay with water to a liquid state, add a couple of drops of lemon juice, soak a bandage in this mixture and apply to the sore joint for half an hour. Wash off the remains with water. Duration – five procedures.

4. Dilute the clay with water, add a small amount of crushed garlic, mix. Dip a cotton swab into this mixture and wipe the affected joint with it. Duration – ten procedures.

Types of compresses for the knee joint

1 . Take a radish and finely grate it. This mass is spread on gauze, wrapped around the joint and covered with a cloth. All this is done before bed. Duration: week.

2. Boil the turnips and mash them with a spoon. The mass is spread on a towel and wrapped around the joint, and covered with a woolen cloth on top. Make this compress for a couple of hours, then wash off with water. The duration of treatment is two weeks.

3. Take fresh birch leaves, add water, bring to a boil, then turn down the heat, keep for another twenty minutes and then drain the water. A thin, even layer of leaves is placed on a bandage and wrapped around the affected joint, covered with flannel cloth. This compress is left for seven hours. The duration of treatment is half a month.

4. Mix 20 grams of honey, 10 grams of dry mustard, 20 grams of vegetable oil. All this is heated up. Next, take gauze, fold it in half and apply the resulting mass on it, then wrap it around the affected area, and place plastic film and cloth on top. The compress is applied for two hours. Duration - a week.

Treatment of joint pain with folk remedies

1. Take twenty bay leaves, pour 0.5 liter of boiling water, keep on fire for five minutes, then leave for three hours, filter and consume in small portions throughout the day. Duration: three days.

2. Take 350 grams of horseradish and squeeze the juice out of it. We consume small portions throughout the day. Duration - half a month.

3. Take 50 grams of rice, fill it with a quarter liter of cold water and leave for a day. Then we cook this mass and eat it in the morning without salt. Everyday food can then be consumed after a couple of hours. Duration of treatment is two weeks.

4. Take ten grams of dried nettle and pour boiling water (250 ml), leave for half an hour, filter, consume 100 ml twice a day. Duration - half a month.

5. Take one hundred grams of finely chopped white cabbage, thirty ml of vegetable oil and mix them. You need to consume 50 g three times a day. Duration of treatment is three weeks.

In conclusion, I would like to say that all symptoms of diseases of the musculoskeletal system are very dangerous and therefore it is recommended to pay special attention to their prevention.

I wish you good health.

Arthritis of the joints: causes, symptoms and methods of treating the disease

Arthritis is inflammation of a joint. Arthritis of the joints has the following symptoms: the patient begins to experience pain during activities and lifting heavy objects; the joint loses its former mobility; the site of the lesion swells, its shape changes accordingly; the skin turns red. If the disease occurs on one joint, then it is diagnosed as arthritis, and if it occurs on several joints, it is diagnosed as polyarthritis. The disease has a sharp form (acute) and develops gradually (chronic).

As a rule, the pain is spontaneous, and strong intensity can be felt at night and closer to the morning. Inflammation occurs in the synovial membrane (also called internal). Exudate begins to accumulate in the joint cavity (this is liquid that leaks from the smallest capillaries and vessels during inflammatory processes). After this, the process spreads to the remaining parts of the joint - capsule, cartilage, bone tissue, tendons, etc.

Arthritis of the joints has a variety of causes, from infection to excessive stress during physical activity. Therefore, based on the reasons, experts have identified several subtypes of the disease:

1. Infectious. Accordingly, the causative agent of the disease is an infection in the body.
2. Traumatic. Caused by joint damage. This can be either a one-time exposure or multiple injuries.
3. Dystrophic. Develops due to metabolic disorders, lack of vitamins, physical overexertion, severe hypothermia.

The most common causes of joint arthritis are viral or fungal infections.

Ways to eliminate the disease

You can often hear the question of how to cure arthritis of the joints. Effective treatment of a disease must always be comprehensive, systematic and vary in course duration. It is important to direct it to combat the causes of the disease, to alleviate pain, as well as inflammation processes. And the doctor must establish a prognosis for cure, which takes into account the form and degree of the disease, and sometimes it is not the most comforting. But first things first. The traditional scheme for treating joint arthritis looks something like this. The first step is to prescribe non-steroidal drugs that are designed to pacify inflammation. They are used as muscle and intra-articular injections. The next prescription is glucocorticosteroids in the form of injections, which are also aimed at reducing the severity of inflammation. Muscle spasms that occur against the background of joint ailments are relieved by muscle relaxants. In chronic forms of the disease, injections with anesthetics are often prescribed.

The most important step in treatment is the use of chondroprotective drugs. These products improve and increase the regeneration of cartilage that makes up the joint. In addition, you should consume complexes enriched with vitamins, microelements and amino acids.

Arthritis of the joints also often develops during physical activity. Therefore, to effectively combat it, you will need a complete revision of your daily routine, reducing pressure on the joints with the help of a bandage, orthoses and a pair of special insoles. Your own diet will also need to be reviewed, especially if doctors have diagnosed gout. You can't do this without a special diet. Physical therapy combined with manual therapy can also have a huge impact. These effects will help restore the natural mechanics of the joints, prevent the consequences of stagnant processes in them and dystrophy of neighboring muscle groups. Medicine has learned to eliminate arthritis of the joints using various physical therapy techniques. Namely laser, shock wave, magnetic, pulse and other therapy.

First of all, when diagnosing this disease, you should not despair. It is important to add some actions on your own to all medical techniques. To begin with, it is important to reduce the load on the joints as much as possible. For this, many devices are used: tourniquets, bandages, splints, bandages, heel pads.

It is necessary to perform some exercises (with moderate load) that will help alleviate pain, increase joint flexibility, and also improve the overall condition of the body. However, these actions should depend on the type of disease and the affected joint. It is important not to harm yourself. You can get comprehensive knowledge on this matter from your doctor.

The disease arthritis of the joints does not tolerate stress and tension in the body. If you are overweight, it is vital to reduce it. After all, extra pounds place inadequate pressure on the knees and pelvic elements in the body. It is necessary to reduce the dose of alcoholic beverages, as well as the number of dishes in which animal fats predominate.

Folk remedies in the fight against arthritis

Traditional medicine is not always recognized by professional doctors, but this does not mean that it is not effective. Apple cider vinegar works quite effectively. It requires a large spoon, which is diluted in a glass of water. The resulting product is consumed several times before meals. But it should be remembered that if you have stomach diseases, it is better to avoid this remedy. The course of taking such a drink sometimes lasts up to a month.

Arthritis of the knees is treated in the form of compresses. The most popular remedy is potato compress. You will need green tubers, which, after washing, are immediately finely chopped (without the cleaning process). This mass is poured into hot water and slightly warmed up, and then laid out in a thin layer on the joint. It is very important to additionally insulate the compress with a scarf or winter scarf. The manipulation is carried out before bedtime and quickly eliminates pain.

The disease arthritis responds well to tinctures made from chestnut or lilac inflorescences. The container with these materials is topped up with vodka and infused for several weeks. Used for rubbing sore joints.

systawy.ru

Main reasons

The cause of joint diseases can be various conditions, their nature largely determines the course of the pathology. The most significant reasons:

Hereditary predisposition, gender of the patient, hypothermia, low physical activity, poor nutrition and obesity are only risk factors. The immediate causes of joint disease can be the conditions listed above.

Characteristic symptoms and signs

General symptoms of joint diseases:

Each specific disease has specific symptoms that make it possible to distinguish them from each other.

The development of joint diseases in children is usually caused by congenital pathologies, among which the first place is occupied by dysplasia (underdevelopment) of the hip joints. It manifests itself as a congenital unilateral or bilateral dislocation. Signs of this condition are increased tone of the back muscles, different lengths of the limbs, asymmetry of the gluteal folds and incomplete spread of the legs. When the baby begins to walk, club feet, the desire to lean on his toes and a characteristic crunching sound attract attention. Rarely, children can also develop other diseases that occur in adults.

Treatment methods

Treatment options for joint diseases can vary greatly depending on the specific pathology. Traditionally, they are divided into therapeutic (conservative) agents, surgical intervention and alternative methods of treatment (traditional, alternative medicine). The doctor decides which method to treat a particular pathology after a full examination of the patient, taking into account all his individual characteristics.

Conservative methods

Almost all lesions of the musculoskeletal system can be treated with therapeutic agents. Depending on the direction of action, the drugs used are divided into two groups:

• Etiotropic – that is, affecting the cause of the disease. For example, for the infectious nature of arthritis, antibiotics are prescribed, and for autoimmune reactions, steroid hormones are prescribed.
• Symptomatic – eliminating signs of the disease. Among them, the most important are anti-inflammatory drugs, which reduce pain and slow down inflammation.

To effectively treat diseases of the musculoskeletal system, several forms of active substances can be used:

In addition to medications, conservative remedies include physiotherapeutic procedures, massage, physical therapy and some other methods.

Surgery

If therapeutic agents are ineffective or in advanced cases, surgical methods for treating joint disease can help. Operations can also be performed to eliminate painful symptoms in order to make the patient’s life easier and improve his quality of life. The most important are arthroplasty (restoration of motor function) and arthrodesis (fixation in a given position). During an exacerbation, immobilization is often performed using a splint or tight bandage. In severe situations, operations are performed to replace the joint with an artificial prosthesis.

Traditional methods

In cases where traditional medicine is powerless, folk remedies come first. In recent years, more and more of its adherents have appeared: this is due to the fact that herbal and natural remedies act much more gently and cause fewer side effects. Traditional medicine methods have anti-inflammatory, analgesic, antiseptic, antibacterial effects, and also have a general strengthening effect.

As a rule, for the treatment of diseases of the musculoskeletal system, not individual herbs are used, but herbs, which can contain several dozen components.

Here are the most effective herbal mixtures:

To prepare the infusion, take 2–3 tablespoons of the mixture and pour 300–400 ml of boiling water. It is advisable to take it before meals 2-3 times a day.

Of course, there are a huge number of traditional medicine methods. Here are some recipes:

• hot wax, spread in layers, quickly eliminates pain;
• burdock root ointment should be used in a bath at least twice a week;
• a product prepared from 50 g of camphor, 50 g of mustard, 100 g of egg white, 500 ml of vodka, must be rubbed into painful areas every night.

Nutritional Features

For effective treatment of diseases of the musculoskeletal system, it is important to follow a special diet. Nutrition for joint diseases has a significant impact on the structure and metabolism of connective tissue, changes the inflammatory and immune response of the body.

Depending on the specific disease, nutritional recommendations may vary significantly:

If the patient is overweight, then the diet for joint diseases, among other things, should be low-calorie: in order to reduce excess body weight and reduce the load on the musculoskeletal system.

Prevention measures

To prevent arthrosis, it is very useful to move more. It is advisable that these are not strength exercises, but aerobic exercises. One of the most effective methods is swimming, since in water a person’s weight is significantly reduced (and, consequently, the load on articular cartilage and ligaments), while at the same time the muscles actively work.

If you have excess body weight, then you need to say goodbye to it, since with every extra kilogram the likelihood of developing pathologies increases.

To prevent osteoporosis, it is necessary to monitor calcium levels, and if there is a deficiency, take multivitamin and mineral complexes. You should definitely stop drinking alcohol and smoking, as these bad habits negatively affect the metabolism of bone and cartilage tissue.

Prevention of the development of infectious and inflammatory changes is carried out by eliminating the primary focus. For example, for chronic tonsillitis, treatment by an ENT specialist is indicated; if necessary, tonsil removal can be performed.

Unfortunately, in advanced cases, both traditional methods and traditional medicine are ineffective, so it is very important from a young age to make every effort to prevent diseases of the musculoskeletal system.

sustavzdorov.ru

Arthrosis

Arthrosis is the general name for a group of diseases associated with the gradual destruction of the main structures of the joint. Primary arthrosis develops in joints that were previously completely healthy. It may be caused by excessive physical stress on the bones and their joints, or mechanical microdamage. Secondary arthrosis occurs against the background of pre-existing and already identified pathologies of the joint. The manifestation of certain signs of joint damage depends on their location. The main symptom of arthrosis is a dull or aching pain that limits movement, intensifying after stress on the body. Many people who reach old age often complain about how their joints react to cold, damp weather and begin to “achieve”. This condition is not considered normal and indicates the presence of arthrosis. As the disease progresses, pain in the joints may intensify, leading to complete disruption of their motor and flexion function. A variety of arthrosis are: hemarthrosis associated with hemorrhage into the joint cavity, gonarthrosis or arthrosis of the knee joint, coxarthrosis or arthrosis of the hip joint, epicondylosis or arthrosis of the elbow joint, articular mouse (exit of any element of the joint into its cavity). The basis for the treatment of such dystrophic diseases are anti-inflammatory drugs, used both in the form of tablets and injections, and topically in the form of creams and ointments. If motor activity is completely lost, the diseased joint can be replaced with an artificial one.

Arthritis

Arthritis is inflammation of a joint, primarily affecting its capsule, cartilage and synovium. Depending on the cause of occurrence, the following types of arthritis are distinguished: infectious, traumatic, allergic, rheumatoid, reactive, gouty. Simultaneous inflammation of several joints at once is called polyarthritis. This disease occurs in acute or chronic form. The most severe form of arthritis is inflammation of the joint, accompanied by the accumulation of pus in its cavity. In this case, its purulent contents can spread far beyond the focus of inflammation and involve the capsule, synovial membrane, and neighboring soft tissues in this process.

Arthritis can be recognized by some of its characteristic signs: significant swelling in the area of ​​inflammation, sharp pain upon palpation, during physical exertion on the affected area, increased temperature, hyperemia. Diagnosis of the disease is based on the results of x-rays, thermography and MRI of the joint. As the main treatment, the patient is prescribed anti-inflammatory drugs to reduce the main symptoms of arthritis, and chondroprotectors - drugs that slow down the process of joint destruction. Some patients are also recommended: warming, mud therapy, massage, ultrasound. Treatment methods are selected depending on the patient’s age, the presence of chronic diseases, and the degree of joint damage.

Hygroma

Hygroma is a cyst filled with serous fluid. Most often, this benign tumor affects the wrist joint. The cause of hygroma can be wearing tight shoes that injure the bones of the feet and their joints, constant stress on the hands, etc. A small cyst usually does not appear in any way, but as it grows it becomes noticeable to the naked eye and is accompanied by a dull aching pain in the joint area. These pains usually intensify when pressure is applied to the tumor. If left untreated, hygroma can reach impressive sizes, limiting the patient’s physical activity and thereby significantly reducing his quality of life. The most dangerous is the spontaneous rupture of a cyst, in which its contents leak under the skin. The basis for diagnosing and treating the disease is a puncture, which makes it possible to pump out the fluid accumulated in the tumor and conduct a thorough examination of it. Sometimes a puncture helps to completely eliminate this pathology. In other cases, surgical excision is performed. The operation is performed under local or general anesthesia, increasingly using an endoscope or laser, and takes no more than half an hour. Traces from such intervention are usually minimal.

Bursitis

Bursitis is an inflammation of the periarticular bursa. There may be several reasons for this pathology: excessive physical stress on the joint, prolonged tension, the presence of gout or arthritis. Large joints of the human body are most often susceptible to inflammation of the bursa. For example, shoulder or hip. The disease has the following symptoms: swelling and redness of the joint, its pain and limited mobility. The main complication of bursitis is the addition of an infection, which can penetrate to the site of inflammation through microscopic damage to the surface of the skin. At the first suspicion of a disease, you should limit the mobility of the diseased joint. To do this, it is recommended to apply a clean, tight bandage to it. You can get rid of the unpleasant manifestations of bursitis by applying cold and warm compresses to the inflamed area. It would be a good idea to take some kind of anti-inflammatory drug. After the pain and redness of the joint subsides, you should begin to make minor movements with it. If self-treatment does not have the desired effect, you should consult a doctor, who will definitely take a picture of the joint and, if necessary, conduct an analysis of the joint fluid. The basis of treatment in this case is painkillers and anti-inflammatory drugs, physiotherapeutic procedures. In case of relapses of the disease, bursectomy is indicated - removal of the inflamed periarticular bursa.

Gout

Gout is a joint disease known since ancient times, associated with the deposition of salt crystals in them. The main reason for the development of this pathology is the excessive formation of uric acid in the human body, as well as impaired renal function, which consists in the inability to fully excrete these substances along with urine. Gout most often occurs in older men, although currently there is a noticeable “rejuvenation” of the disease. Gout usually affects only one joint (for example, the knee), and can be chronic and not manifest itself in any way for several years. Exacerbations of the disease lead to gradual destruction of the affected joint and complete loss of its functions.

An attack of gout begins with severe pain in the joint, which differs from healthy ones by a significant increase in size. The skin around such a joint is usually hot to the touch and has a red, inflamed color. The first attack of gout passes quite quickly, and no doctor can say exactly when the next exacerbation of the disease will occur. The lack of treatment for gout leads to the fact that its attacks begin to recur more often, and their duration increases significantly. A gout attack usually begins suddenly, often at night, and the patient experiences severe pain that cannot be relieved with a regular painkiller. Such pain can continue for days.

Gout is an incurable disease, but modern medicine has learned to control its course. During the next attack, the patient is prescribed anti-inflammatory and painkillers, drugs that reduce the content of uric acid salts in the body. Patients are also recommended to maintain a healthy lifestyle, diet, and weight control. All persons with this disease must undergo a thorough examination of the urinary system.

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Folk remedies for treating arthritis

Note that when treating arthritis with folk recipes, painful sensations that are associated with the fact that an inflammatory process occurs in the joints are relieved.

Add 1 cup of magnesia to a bath of water. Get into the bath for thirty minutes. A salt bath gives the body relaxation and relieves pain.
Take medicinal baths as many times as you like.

If it is not possible to use a bath with salt, use a hot shower.
Sometimes heat makes the pain worse, in which case use cold therapy.
It is carried out like this: apply ice cubes to the joint or lower the sore joint into water.

Pain sensations may go away due to the fact that the tissues become less sensitive. This usually dulls the pain.

Apply ice packs maximum once a day for 25 minutes.

Balanced diet and exercise

Eating healthy when you have arthritis is very important. Excess weight puts unnecessary pressure on your joints. Sometimes uncontrolled weight is the cause of arthritis.
Keeping yourself in shape will help ease your arthritis. You don't need extra pounds.

Small loads on the body will help maintain joint flexibility and muscle strength, which will speed up the healing process.
The set of exercises must be selected carefully. If you experience discomfort while playing sports, rest.

Ointment

In order to get rid of lameness caused by pain in the joints, prepare a liquid ointment. You will need the yolk of one egg, 1 tsp. turpentine, 1 tbsp. l. natural apple cider vinegar. Whisk all ingredients thoroughly and rub into the sore spot.

Decoctions

Lingonberry decoction

2 tsp. Boil lingonberry leaves in a glass of water for about 15 minutes, then cool, strain and consume in small portions throughout the day.
Lingonberry decoction can be taken both for arthritis and for joint rheumatism, gout, swelling and salt deposits.

Infusion of spruce branches

We collect spruce branches. Now pour boiling water over them. We insist for thirty minutes.
Wait until the infusion has cooled to 37 degrees, then immerse the painful part of the body in it for half an hour. We wrap the area that hurts with warmth and rest for 1 hour.
To feel the effect of this type of treatment, it is necessary to carry out at least several procedures.

Dandelion infusion

Need 1 tsp. mixture of dandelion roots and flowers. Pour boiling water over it (1 cup). Leave for 1 hour. Strain the infusion. Drink one fourth of a glass four times a day before meals.
The product is effective for polyarthritis and rheumatism.

Currant leaves

Take a couple of grams of dried blackcurrant leaves. Pour boiling water (250 g). You need to insist for 20 minutes. Drink half a glass of infusion several times a day instead of tea.

Propolis lotions

Radiculitis and arthritis are treated with a cloth soaked in propolis.

To soak it, you need to put the cloth in the bee hive for the whole winter. Then remove it and apply it to the sore spot.

Grinding with radish and honey

This folk remedy is easy to prepare: cut a hole in a large radish. Pour honey into it. Four hours pass. Juice comes out of the radish, rub the areas that hurt with this juice, you will feel much better.

Traditional methods of treating arthrosis

When cartilage tissue wears out, a disease such as arthrosis appears.
Cartilage tissue becomes less elastic.

Inflammation of the tissues around the joints occurs.
Why are these changes happening?

Metabolic processes in the human body are disrupted. Before starting the process of treating arthrosis, it is necessary to cleanse the body, regulate the correct functioning of your liver and gastrointestinal tract.

Alternative treatment will alleviate the course of the disease, but it should be an integral part of the main treatment; observation and treatment by a doctor are required.

When treating arthrosis, it is necessary to use herbal medicine.
It reduces pain and has a positive effect on regeneration processes in cartilage tissue. Swelling will also decrease.

Use cinquefoil infusions, thyme, horsetail infusions, strawberry leaves, birch leaves, and dandelion rub.

There is such a wonderful remedy as birch leaves. You can do therapeutic baths, massages, and steaming procedures.
If you boil birch leaves, excess uric acid will be removed from the body.

Series

The series is an ancient folk medicine. It heals wounds, fights inflammation, has a calming effect on the nervous system, and normalizes metabolism.

To prepare the infusion, you need 2 tablespoons of string, boiling water (1 glass. Leave for twenty minutes, strain, drink two tablespoons three times a day. The course of treatment should last about one month.

Make a decoction of the string and pour it into the bath. These baths are quite effective.
The series contains a large amount of manganese and tannins. These substances help improve blood circulation and stop inflammatory processes in the sore joint.

Medicinal ointment

To prepare this ointment, you need to take nettle leaves, juniper berries, and butter. The proportions should be the same.

The berries and leaves need to be crushed, and cow’s butter should be put there in a ratio of 1:3.
We rub what we get into the sore spot a couple of times a day for 1 month.

The ointment must be placed in a glass jar and placed in the refrigerator.

Burdock compresses

We wash the burdock leaves and crush them with a rolling pin. Now apply it to the sore spot. The compress improves the composition of blood and urine. It also helps strengthen tissues and removes salt from joints.

There are also indications for using this compress, such as rheumatism and gout.

Treatment of gout with traditional methods

The oldest and most effective method of treating gout in the field of folk remedies is lemon tincture.

Take three lemons and 150 g of garlic. Now grind the lemons and garlic in a meat grinder. Infuse with boiled water (1 glass) for 24 hours. Now strain the infusion, drink 50 g of infusion in the morning.

People suffering from gout need to constantly remove excess uric acid. A mixture of chamomile and linden blossom, 1 tablespoon of each plant, can help with this. Pour boiling water (2 cups) over them and let them sit for about an hour. Drink the infusion for 1 day.

Compresses

We make compresses from garlic. A few teeth are needed. Boil the garlic in water for twenty minutes. Sprinkle the decoction with 1 tsp. lemon juice.
When the broth has cooled, strain it, soak a gauze cloth in it, and place it on the sore spot.

You can also use a recipe made from cabbage leaves. The compress is easy to prepare. Take cabbage leaves and beat them with a hammer. Apply to the area that hurts. We put film and fabric on top.

You can brush cabbage leaves with honey. We carry out the procedure before going to bed.

Traditional treatment of osteoporosis

Osteoporosis is considered a disease that reduces the degree of bone density. Bones break and become more fragile.

To avoid this, rub egg oil into problem areas.
Boil the egg yolks hard. Fry them in a frying pan until a black liquid appears - egg oil.

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Causes of joint pain

In medical language, this disease is called arthralgia and can be a symptom of many diseases. The joint is first affected and then arthritis develops, with some exceptions.

Arthralgia occurs due to irritation of neuroreceptors that are present in each joint, which occurs under the influence of a variety of factors. The main and primitive cause of pain in the joints is a banal bruise followed by the formation of a hematoma, which is invisible to the eye.

Here is a list and a short description of diseases that can cause joint pain.

Osteoarthritis

One of the most common chronic diseases, which most often affects the hip, maxhalangeal and knee joints. It is based on disorders of a degenerative-dystrophic nature, that is, a simple violation of the metabolic process of bone tissue, joint cartilage and connective tissue. The impetus for the sore can be anything, including impaired metabolic processes, occupational factors, deficiency of vitamins D and C in the body, age-related changes, various injuries, as well as excess weight.

Symptoms of osteoarthritis include stiffness due to joint pain. This increases when a person is exposed to physical activity, and also decreases when the patient is at relative rest. There are regular dull pains at night, and in the morning, when there is little activity, the joints calm down. At the very beginning of movements, sharp starting pains can form, and then just as quickly go away. There are also blockade pains, in which the affected cartilage located between the surfaces of the joints becomes jammed and pinched. A local increase in temperature in the sore spot was also noticed.

Ankylosing spondylitis

Inflammatory process of the axial articular skeleton (costovertebral, intervertebral, etc.). The basis lies in immuno-inflammatory processes in the body, as a result of which scar fibrinous tissue is formed in the joints, on which various salts and trace elements cling, which blocks the full mobility of the joint. The first symptoms appear at a young age of the patient and are characterized by constant pain in the buttocks and lower back. At night the pain intensifies. Pain is also noted where the ribs attach to the spine and is made worse by coughing or deep breathing. There is a feeling of stiffness in the movement of the back. Posture is impaired, increased sweating is observed during the day, and parallel diseases associated with the heart, kidneys, aorta and eyes are noted.

Reactive arthritis

Acute inflammatory process in a joint (often in the lower extremities). The main impetus for the occurrence of reactive arthritis is a previous infection. These are, as a rule, acute respiratory infections and acute respiratory viral infections. Symptoms are as follows: persistent severe pain in the joints, which intensifies with movement, swelling and redness. There are also extra-articular manifestations: fever, heart disease, damage to the central nervous system, skin and mucous membranes, problems with nails, etc.

Reiter's disease

A separate type of arthritis that develops against the background of a genetic predisposition. It often appears after intestinal or chlamydial infections. The manifestation of symptoms is mainly noted in the lower extremities as rheumatoid arthritis. There are extra-articular signs: diseases such as prostatitis, conjunctivitis, lesions on the skin and mucous membranes, heart problems and the appearance of fever. And, of course, there is no escape from the primitive pain that is also observed with other types of arthralgia.

Chronic type of arthritis. This is a progressive inflammatory process, an autoimmune inflammation that occurs in the joints. As a rule, small joints located in the feet and hands are affected, while knee and elbow joints are less likely to be affected.

Characteristic symptoms of rheumatoid arthritis are constant pain in the affected area, swelling of the affected joint, stiffness in movements, which is observed in the morning, increased fatigue, weight loss, skin lesions (pallor, cyanosis, small focal necrosis appear), asymmetry, enlarged lymph nodes, lesions nail plates, problems in the gastrointestinal tract, heart damage and heart disease, damage to the eyes, kidneys, etc. With this type of arthritis, many organs are affected and a large number of body functions are blocked; it is difficult to list them all here.

Psoriatic arthritis

In the vast majority of cases, this type of arthritis develops in people who are genetically predisposed to psoriasis. Exacerbation of psoriatic arthritis coincides with the inflammatory processes of psoriasis itself. Symptoms are manifested by pain in the joints, usually interphalangeal, the skin acquires a purplish-bluish color, swelling occurs, pronounced asymmetry is observed, pain appears in the lumbosacral spine, nails are affected, and psoriatic plaques appear on the skin.

Gout

This is microcrystalline arthritis and is an inherited disease. The cause of the development of the disease is impaired purine metabolism, which leads to the formation of deposits of urate crystals (uric acid salt) in articular and periarticular tissues. Symptoms, and most often they are localized in the first metatarsophalangeal joint of the foot, manifest themselves as follows: swelling appears, the temperature in the problem area rises, the skin peels on the elbows, near the ears, on the arms, feet, hands, and other skin manifestations are noted in the mentioned areas.

In addition, damage to internal organs, the heart and kidneys in particular, is detected. Therefore, parallel diseases such as endocarditis, arrhythmia, amyloidosis, etc. begin to appear.

Pseudogout

This is microcrystalline arthritis, the basis of which lies in impaired metabolic processes associated with calcium (local failure of the metabolic process of calcium pyrophosphate in the joint). This all leads to the accumulation of calcium salts in the articular and periarticular tissues. The knee joints are most often affected. There is severe redness near the affected joint, swelling, and joint deformity. In this case, no other organs are affected.

Drug-induced arthralgia

This is a temporary condition in which aching pain is observed, usually in small joints, characterized by taking certain medications at increased daily dosages. Such a case is not considered a disease and is not included in the medical classification. Such side effects are most often caused by barbiturates, antibiotics, sleeping pills, contraceptives, etc. Deterioration of the “patient’s” condition is not observed and, as a rule, the symptoms disappear on their own after discontinuation of the problematic drug.

Similar symptoms are observed with meteopathic arthralgia. These are situations when a person has a sensitive body to changes in weather conditions. This is not a disease and goes away on its own when the climate improves.

By analyzing the nature of the appearance of joint diseases, as well as the symptoms of each, it can be revealed that most of all this is very similar in the main number of symptoms. Self-diagnosis will definitely not work here, so if you have problems, always contact a specialist who, after conducting all the tests, will prescribe high-quality and most appropriate treatment.

Hand joints hurt

As a rule, pain in the joints of the arms and hands appears after high physical activity, prolonged work at the computer, and also after various injuries. You shouldn’t panic right away; it’s quite possible that the pain will go away on its own. If the pain does not go away, but only increases and lasts for a long time, be sure to consult a neurologist and orthopedist.

Any type of arthritis, and almost any can appear in the hands, develops very quickly, and the further the sore goes, the more severe the consequences and the more difficult the treatment. Lack of treatment is fraught with destruction of cartilage and joint tissues, difficulty in the movements of hands and fingers, and bone deformation is observed. In the most severe cases, the hand may deviate towards the elbow.

Most often, osteoarthritis, gout, rheumatoid arthritis and simple arthritis are diagnosed in the hands. However, only a specialist can make an accurate diagnosis.

Remember, perhaps you hit your hand or there was a case when the hand could have become dislocated and sprained. There are often cases when patients complained about their joints, but the cause of the pain was precisely the reasons mentioned.

Treatment of hand joints often involves taking medications, as well as prescribing physical therapy, which works on the diseased joints. One of the main disadvantages of tablet treatment is the presence of side effects, which often result in problems with the gastrointestinal tract. Ointments help well in complex treatment.

Hip pain

The main provocateurs that cause pain in the hip joint are:

• tuberculosis;
• inflammatory processes in the periarticular bursa;
• fractures and dislocations;
• coxarthrosis;
• arthritis or infectious diseases;
• autoimmune processes in the body.

If the cause of pain in the hip joint is a minor injury, and the pain itself is mild, you can take the following measures: give the sore joint a rest and stop serious physical activity, take a non-steroidal anti-inflammatory drug, and during sleep, try to lie only on the healthy side.

However, if you notice redness at the joint, obvious deformation, heating, any changes in the skin, or disturbances in sensitivity, be sure to consult a doctor immediately.

Elbow pain

The elbow joint has a synovial membrane and is formed from three bones. Near the joint there are nerve trunks, blood vessels, muscle tissue, tendons and much more. The cause of pain can be anything, and even the weakest, at first glance, bruise can lead to it. The fact is that this joint is very sensitive to any physical impact.

Pain in the elbow joints can be a symptom of a variety of diseases, as a rule it is:

• Bursitis. Characterized by inflammation of the joint capsule. This disease is preceded by various injuries: falls, dislocations, bruises.
• Internal and external epicondylitis. In this case, a person experiences severe pain even with slight physical exertion on the elbow joint. Even simple flexion and extension of the elbow is problematic.
• Various inflammatory processes and tumors.
• Diffuse fasciitis. In addition to simple pain, the motor function of the elbow joint is impaired, and changes in the skin at the site of the problem joint are also noted.
• Infringement of nerve endings. Often observed against the background of an intervertebral hernia. The elbow may stop bending completely.
• Dislocations that easily occur after suffering fractures, bruises and blows. It is almost impossible to distinguish between a fracture, dislocation and joint pain on your own - that’s why x-rays come to the rescue.

For treatment, specialists also use both medication and physiotherapeutic methods.

Knee joint hurts

The knee joint is considered one of the most complex connecting systems in its structure, and it bears a colossal amount of load every day. Therefore, in order to understand exactly why it may hurt, you need to know its structure. It is problematic to go into all the details, so we will immediately consider the provocateurs that cause pain in the knee joint. This:

• pathology of articular bones (tumors, osteolysis, osteoporosis, etc.);
• pathology of the joint capsule (incarceration, inflammation and ruptures);
• pathologies of blood vessels and nerves;
• various muscle pathologies;
• injuries and pathologies of the ligamentous apparatus;
• problems with cartilage tissue.

There are many factors that can contribute to the development of the disease, the main ones being:

• elderly age;
• overweight;
• poorly developed muscles;
• early knee injuries;
• various diseases that can lead to various pathologies: these are hormonal imbalances, metabolic disorders, and congenital structural defects;
• predisposition at the genetic level;
• gender: according to statistics, women most often suffer from diseases of the knee joints.

Finger joints hurt

Since fingers are constantly involved in human life, it is logical that they are regularly exposed to physical activity, which seriously increases the risk of joint disease. There are also several reasons why fingers may hurt, but most often it is:

• Arthritis - pain and swelling of the finger joints, redness of the skin. If the inflammatory process is bacterial in nature, fever may occur. If the disease is not cured, then with a high probability the hands may begin to deform.
• Arthrosis - inevitable deformation of the joints occurs. More than half of the population over the age of 50 has this disease. The development of the disease occurs gradually. Joint pain is accompanied by stiffness, which is especially pronounced during the daytime, and numbness of the entire hand may also occur. Over time, the hands take on an irregular shape, and the muscles and skin begin to become rough.
• Gout can also affect the entire hand at once. This disease is characterized by itching, burning, redness and pain in the joints.

There are actually significantly more reasons, but these are the top three, which are most often diagnosed by doctors to their patients. As in other cases, treatment mostly involves taking medications and using ointments.

Severe joint pain

Severe joint pain does not come immediately. Yes, the disease can develop quickly, but there are always some prerequisites for the disease that you should always pay attention to. Severe joint pain may indicate:

• Osteomelitis. This is an inflammatory disease affecting the bone marrow located inside some bones. The main symptoms are swelling, spreading throughout the entire limb for several days in a row, severe pain, which may increase and not go away for several hours or even days, which creates difficulties in moving the limb, general poor health of the patient, increased fatigue and drowsiness, and also high temperature, up to 40°C.
• Infectious arthritis. Purulent inflammation of the joint. The disease can be identified by the following symptoms: swelling and increased temperature in the area of ​​the problem joint, increased sensitivity, severe pain that increases over several days, high body temperature; if we are talking about small children, then they may experience nausea and vomiting. In this case, you need to urgently call a doctor, since if the progression is not stopped in time, this can even result in the death of the patient.
• Reactive arthritis. The sore often develops after illnesses of an infectious nature. Often this type of arthritis is accompanied by conjunctivitis. Other symptoms include severe and developing pain, high body temperature, eye problems, and may affect difficulty urinating.

Severe and prolonged pain in the joints may indicate the presence of a tumor in the bones. You need to be especially wary of this if the pain does not subside even with complete rest of the limbs, after taking painkillers, and when you palpate the diseased joint, you feel a tightness.

Treatment of joint pain

Treatment of pain can be done using various methods: taking medications, using ointments and gels, as well as traditional medicine recipes. It is better to discuss the first two with doctors, since such self-medication can result in negative consequences, but with the last one you can experiment a little. First, let's look at what drugs and ointments are most often prescribed for joint diseases, and then we will give several effective recipes from the book of traditional healers.

Painkillers for joint pain

Ideally, medications should be prescribed by the attending physician. However, not always and not everyone has the opportunity to get an appointment with a specialist in a timely manner and receive a prescription. Below are some drugs that are prescribed as painkillers.

• Metamizole. The duration of the analgesic effect is from 3 to 6 hours, depending on the severity of the pain.
• Lornoxicam. One of the most powerful and effective non-narcotic painkillers. However, its cost is relatively high, and Lornoxicam is prescribed exclusively for severe pain. The effect lasts for 8 hours.
• Non-steroidal anti-inflammatory medications: Ibuprofen, Paracetomol, Diclofenac, Celecoxib, Nimesulide. These tablets have many contraindications and also have a large number of side effects, so they must be taken with extreme caution. In addition, the reception cannot be carried out for a long time.

Before taking any medication, always carefully read the contraindications. Never increase the dosage specified by the manufacturer; the effect will not be stronger, but side effects are more likely to appear.

Ointment for joint pain

All anesthetic ointments are divided into several groups, depending on the principle of action and effectiveness.

• Local non-steroidal drugs. The most popular ointments, which are distinguished by high and rapid effectiveness. Such ointments are used for absolutely all problems associated with joints.
• Chondroprotectors are used for problems with the musculoskeletal system.
• Warming ointments often contain extracts of red pepper, snake and bee venoms, as well as various extracts of essential oils. You need to be very careful when using them.
• Ointments based on salicylic acid.

The most popular ointments used for pain relief:

• Voltaren;
• Diklak;
• Ketonal gel;
• Bystrumgel;
• Fastum gel;
• Diclofenac;
• Viprosal;
• Apizartron.

Traditional methods of treating joints

• An ordinary bay leaf is excellent for removing accumulated salts in the body. Take 20-30 leaves and brew them with a couple of glasses of boiling water. Boil for about five minutes, and then let it brew in a thermos for about three to four hours. Take the resulting decoction in small sips for twelve hours. This therapy must be repeated three days in a row. It is very important to cleanse the intestines before treatment, otherwise an allergic outbreak may occur under the influence of laurel.
• Introduce jellied meat into your diet - this is one of the best ways to maintain and restore the health of your joints and more.
• Chicken cartilage is also useful. The fact is that they contain a unique protein, which is the main building element of connective tissue, the destruction of which leads to the development of arthrosis and other diseases. You can eat a small spoonful of chopped chicken cartilage in the morning and wash it down with orange juice. You can cook the knees of this bird for several hours. Lightly salt and pepper the finished broth and add the bay leaves. Take pre-diluted several times during the day. It is acceptable to eat jellied meat made from chicken cartilage.
• Take 100 g of sunflower root and blend it in a blender until it becomes more like a powder. Fill it with a liter of clean water and boil for ten minutes. Cool the finished mixture and strain. Drink this decoction every time you want to quench your thirst. Duration of treatment is about three months.
• Mix the squeezed golden mustache juice with any baby cream (preferably unscented) in a 1:1 ratio. Add some fat and Vaseline. Mix thoroughly and apply to the sore spot as a compress for half an hour. You can bandage and keep the composition longer, which will be very useful for severe pain.

DISEASES OF THE JOINTS

Joint lesions of various etiologies are recorded quite often in the internal medicine clinic. Joint diseases can be an independent nosological form (RA, OA, gout), a sign of pathological changes in other systems (arthritis in SLE, SSc) or a reaction to another pathological process (reactive arthritis in any acute infectious disease).

The whole variety of joint diseases can be reduced to two forms - arthritis (inflammatory lesions of the joints, independent of the immediate cause of their occurrence - infectious lesions, autoimmune processes or loss of salt microcrystals in the synovial fluid) and arthrosis (dystrophic-degenerative lesions).

This chapter will discuss the most common joint diseases - RA, OA, gout and idiopathic ankylosing spondylitis (AS).

RHEUMATOID ARTHRITIS

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of connective tissue with predominant damage to joints in the form of erosive-destructive progressive polyarthritis. The essence of the disease is damage to articular tissues (synovial membrane, articular cartilage, joint capsule) by an inflammatory process that develops on an immune basis and leads to erosion of the articular surfaces of bones, followed by the formation of severe deformations and ankylosis. The often observed extra-articular lesions are based on immunocomplex vasculitis, which causes damage to internal organs and systems.

RA is one of the most common chronic inflammatory joint diseases. The frequency of its occurrence in the population is 1%. The disease can occur in people of any age. Women get sick 2.5 times more often than men. In old age, this difference is less obvious.

Etiology

The reasons for the development of RA are unknown. They attach importance to viral agents (Epstein-Barr virus), as well as other infectious pathogens (group B streptococci, mycoplasma). The molecular components of microbial cells and the products of their destruction have a tropism for joint tissues, are capable of persisting in them for a long time and causing a characteristic immune response. Viruses, integrating into the DNA of host cells, can induce the synthesis and secretion of non-infectious proteins that have antigenic activity, which serves as a stimulus for the development of immune reactions. It is assumed that the Epstein-Barr virus can exist for a long time in the body of individuals with a genetic predisposition to such persistence, which leads to disruption of the suppressor function of T cells and disruption of the production of immunoglobulins by B lymphocytes.

Currently, genetic factors are considered important in the origin of this disease. Thus, the risk of developing RA is 16 times higher among blood relatives. RA is more often found in carriers of certain class II major histocompatibility complex antigens (especially HLA-DR1 and HLA-DR4). Thus, carriage of HLA DRW4 is registered in 52% of patients with RA and only in 13% of individuals in the population.

Hormonal factors matter: in men under the age of 50, RA is diagnosed 2-3 times more often than in older people. Taking contraceptives and pregnancy reduce the risk of developing the disease in women. On the contrary, during lactation (hyperprolactinemia), the risk of developing RA increases significantly.

In general, the contribution of genetic factors to the development of RA is 15%, and environmental factors - 85%.

Pathogenesis

At the early stage of RA, joint damage is associated with a nonspecific inflammatory reaction caused by various stimuli, which, in turn (in genetically predisposed individuals), leads to pathological changes in the cells of the synovial membrane. Subsequently, as a result of the involvement of immune cells (T-, B-lymphocytes, etc.) in the joint cavity, an ectopic lymphoid organ is formed, the cells of which begin to produce autoantibodies to the components of the synovial membrane. Autoantibodies (primarily RF - antibody to aggregated IgG, as well as antibodies to the enzyme G-6-PD, etc.) and immune complexes, activating the complement system, further enhance the inflammatory reaction, causing progressive damage to joint tissues. The leading morphological sign of rheumatoid inflammation is formed - a focus of connective tissue hyperplasia, the so-called pannus. Activated

T lymphocytes stimulate the synthesis of proinflammatory mediators (cytokines) by macrophages, among which TNF-α, as well as IL-1, occupy a central place. Metalloproteinases (collagenase, gelatinase) formed in the pannus zone play an important role in the development of destruction of cartilage and subchondral bone in RA.

At later stages, the pathogenesis of RA is dominated by processes caused by somatic mutation of synovial fibroblasts and defects in apoptosis. This explains the difficulty of anti-inflammatory treatments that are effective for a short period of time, after which the target cells begin to lose the ability to respond to regulatory anti-inflammatory stimuli and become resistant to pharmacological influences.

The main feature of RA is that pannus gradually destroys cartilage and epiphyses of bones with the formation of usurs (erosions). The disappearance of cartilage leads to the development of fibrous and then bony ankylosis of the joint. Deformation of joints is also caused by changes in periarticular tissues (joint capsule, tendons and muscles). In addition to joint damage, changes in connective tissue and various organs and systems are almost always noted in RA. The morphological basis of their lesions is vasculitis and lymphoid infiltration.

Classification

Currently, our country has adopted a working classification of RA (Plenum of the All-Union Society of Rheumatologists, 1980), which takes into account the clinical-anatomical and clinical-immunological characteristics of the process, the nature of the course, the degree of activity, the radiological stage of arthritis and the functional activity of the patient.

Clinical and anatomical characteristics:

RA - polyarthritis, oligoarthritis;

RA with systemic manifestations (visceritis, damage to the reticuloendothelial system, serous membranes, lungs, heart, blood vessels, eyes and kidneys, organ amyloidosis, pseudoseptic syndrome);

Special syndromes (Felty's syndrome, Still's disease in adults);

In combination with OA, rheumatism and other chronic diseases. Clinical and immunological characteristics:

Seropositive;

Seronegative. Course of the disease:

Slowly progressive (classical);

Rapidly progressive;

Without noticeable progression (benign, non-progressive).

Activity level:

Minimum;

Average;

High;

Remission.

X-ray stage:

.periarticular osteoporosis;

.osteoporosis + narrowing of the joint space (there may be isolated lesions);

.osteoporosis, narrowing of the joint space, multiple disorders;

.the same + bone ankylosis. Functional activity:

.completely preserved;

.professional ability to work is limited;

.professional ability to work is lost;

.the ability to self-care has been lost.

Clinical picture

The main complaints of the patient, usually associated with damage to the joints, as well as the characteristics of the onset of the disease are determined. There are several starting options.

.At gradual beginning disease (over several months), in approximately half of the cases a slow increase in pain and stiffness in small peripheral joints (wrist, proximal interphalangeal, metacarpophalangeal, ankle and metatarsophalangeal) is noted. Movements in the joints are slightly limited, body temperature remains normal. Morning stiffness of the joints of the hand is characteristic - the inability to clench the fingers into a fist (the duration of stiffness is from one to several hours).

. Monoarthritis of the knee or shoulder joints followed by rapid involvement of small joints of the hands and feet in the pathological process.

. Acute monoarthritis of large joints, resembling septic arthritis, which occurs with high body temperature and is combined with tenosynovitis, bursitis and subcutaneous (rheumatoid) nodules.

. Palindromic rheumatism- multiple recurrent attacks of acute symmetrical polyarthritis of the joints of the hands, less often - of the knee and elbow joints. The attacks continue for several days and end with recovery.

. Recurrent bursitis and tenosynovitis, especially often in the area of ​​the wrist joints.

. Acute polyarthritis with multiple lesions of small and large joints, severe pain, diffuse swelling and limited mobility in the elderly. This variant is described as remitting seronegative symmetrical synovitis with cushion-like edema.

. Generalized polyarthralgia or a symptom complex reminiscent of polymyalgia rheumatica (usually in older people).

As RA progresses, patients note the development of deformation of the affected joints and limitation of their mobility, which in severe cases leads to complete loss of joint function.

At the first stage, you can obtain information about possible damage to internal organs (the occurrence of complaints according to the involvement of various organs in the pathological process), as well as information about previous treatment. The use of gold preparations, penicillamine and cytostatics indicates a detailed clinical picture of the disease, while the effectiveness of the administration of NSAIDs and aminoquinoline derivatives indicates a short duration of the disease and low activity of the pathological process.

A study of the affected joints provides essential information: at the onset of the disease or during the period of exacerbation, clinical signs of arthritis are noted in the form of smoothness of the contours of the joint due to inflammatory intra-articular edema and edema of the periarticular tissues.

Characterized by symmetrical damage to the small joints of the hand. As the pathological process develops, joint deformities develop due to proliferative changes in the synovial membrane and joint capsule, as well as destruction of articular cartilage and adjacent bone tissue. Subluxations occur, aggravated by the development of contractures due to damage to the tendons at the places of their attachment to the bones.

Some of the deformities that are most typical for RA are of independent significance: deviation of the entire hand to the ulnar side (“walrus fin”), flexion contracture of the proximal interphalangeal joint with simultaneous hyperextension in the distal interphalangeal joint (“button loop” finger deformity), shortening of the phalanges , accompanied by wrinkling of the skin over them, in combination with ulnar deviation of the hand (deformation of the “hand with a lorgnette” type of hand). Damage to other joints does not differ from arthritis of other etiologies. Changes in the joints of the hand in RA serve as a “calling card” of the disease.

As RA progresses, atrophy of the skin develops, which looks shiny and somewhat transparent. Skin changes are most pronounced in the area of ​​the fingers and shins. In some cases, ulceration of the skin of the legs occurs, which may be associated with vasculitis, causing the formation of local necrosis. Sometimes, with long-term RA, erythema is noted in the palm area.

In 20-30% of patients, so-called rheumatoid nodules are found - painless, fairly dense round formations with a diameter of 2-3 mm to 2-3 cm, usually localized in places subject to mechanical pressure (extensor surface of the ulna near the elbow joint, Achilles tendon, ischial tuberosities). Sometimes nodules form in the area of ​​small joints of the hand or feet and in the walls of the synovial bursa located in the area of ​​the coronoid process of the ulna. Usually the nodes are located subcutaneously, but can form intradermally and in the tendons. The size of the nodes changes over time, and during the period of remission they can completely disappear. They are found only in patients with seropositive RA.

Joint damage is accompanied by the development of muscle atrophy. One of the early symptoms of RA when the joints of the hand are affected is atrophy of the interosseous

ny muscles. When other joints are affected, atrophy of the muscles that are “motor” for them develops. Over time, atrophy spreads not only to the muscles located near the affected joints, but also to the entire muscle mass, which leads to general exhaustion. A crunching sound in the joints is also noted during active and passive movements.

In patients with RA, damage to the tendons and synovial bursae can be detected. In the synovium of the tendon sheaths and bursae, inflammation may also develop, accompanied by the formation of effusion. The most common lesion is the sheath of the flexor and extensor tendons of the fingers, characterized by pain and swelling in the hand area. Crepitation is detected by palpation during movements. Flexion of the fingers may be difficult due to tenosynovitis of the flexor tendons. In rare cases, rheumatoid nodules form in the tendons, which can cause them to rupture.

The autoimmune nature of the disease with predominant damage to the joints and other connective tissue elements causes the spread of the pathological process to the internal organs. As follows from the working classification, RA can damage almost all internal organs, but the frequency and degree of its severity are different. As a rule, it occurs subclinically, without pronounced symptoms.

Heart damage can manifest as myocarditis (usually focal and therefore difficult to diagnose), as well as endocarditis. In rare cases, RA develops valve defects exclusively in the form of aortic or mitral valve insufficiency. The degree of damage to the valve is usually small, and the defect manifests itself with valvular (direct) symptoms, while indirect signs indicating the severity of hemodynamic disorders and compensatory hypertrophy of various parts of the heart are absent or extremely mild.

Pericarditis, as a rule, is adhesive, and is detected only with the development of congestion in the systemic circulation, as well as during X-ray examination (at the third stage of the diagnostic search). Effusive pericarditis, which is recorded extremely rarely, is usually combined with pleurisy.

Rheumatoid lung disease is represented by diffuse fibrosing alveolitis, nodular lesions of lung tissue, or pulmonary vasculitis. In this regard, physical examination data are very scarce: signs of pulmonary insufficiency syndrome, emphysema, and, less often, pneumosclerosis with listening to moist, ringing, fine-bubble rales in the affected areas are noted.

In RA, pleurisy may develop, usually dry and asymptomatic. Traces of previous pleurisy are detected only during x-ray examination (at the third stage of the diagnostic search). Exudative pleurisy with the formation of a small amount of rapidly resolving effusion is extremely rare.

Rheumatoid kidney disease is diagnosed only at the third stage. Only with the development of renal amyloidosis and the development of nephrotic syndrome

Massive swelling may occur. In the proteinuric stage of renal amyloidosis, typical signs can only be detected by examining urine.

Damage to the nervous system - polyneuropathy - manifests itself as sensory disturbances in the area of ​​the affected nerves. Movement disorders occur less frequently. Damage to the distal nerve trunks is typical, most often the peroneal nerve.

In 10-15% of patients, involvement of the salivary and lacrimal glands in the pathological process is recorded, which is diagnosed by dryness of the oral mucosa and conjunctiva. The combination of RA with damage to the exocrine glands is called Sjögren's syndrome. In some cases, an enlarged liver and spleen is found, sometimes in combination with moderate enlargement of lymph nodes and leukopenia. This combination is called Felty's syndrome.

Vascular damage is characteristic of RA. During examination of the nails and distal phalanges, small brownish lesions can be detected - a consequence of local microinfarctions. Vasculitis of larger vessels occurs less frequently. In RA, Raynaud's syndrome may develop as a result of arteritis.

Eye damage is reported infrequently. It is usually represented by bilateral scleritis.

They determine the degree of activity of the inflammatory process and the severity of immunological changes, and also clarify the degree of damage to joints and internal organs.

In a laboratory study, the activity of the inflammatory process is assessed by the existence and severity of acute-phase indicators (increased ESR, increased concentrations of fibrinogen, CRP and α2-globulins). Severe PA and damage to internal organs are characterized by hypochromic anemia. Its severity correlates with the degree of activity of the pathological process.

The number of leukocytes and neutrophils in peripheral blood in RA is usually normal. Leukocytosis is detected with high fever or treatment with glucocorticoids, leukopenia - with Felty's syndrome - a variant of RA.

Immune changes in RA are represented by the detection of RF (antibodies to aggregated IgG) in the blood of patients (in 70-90% of cases). As noted earlier, RF is synthesized in the plasma cells of the synovial membrane, therefore, at the onset of the disease (within several months, less often years), especially with a benign course, RF is determined only in the synovial fluid. It is detected in the blood using the Waaler-Rose reaction or the latex test. The magnitude of the RF titer is directly proportional to the activity of the pathological process, the rate of progression and the development of extra-articular symptoms of the disease.

An RF titer in the Waaler-Rose reaction of about 1:160 is considered high. In a low titer (1:10-1:20) it can be found in the blood of healthy young people, as well as in a number of diseases with an immune mechanism of development, SLE, chronic active hepatitis and cirrhosis of the liver. RF appears at different times from the onset of the disease (usually within 1-2 years), and sometimes from its very

started. There was a positive correlation between the RF titer and its detection at an early stage of the disease with the severity of arthritis and the development of systemic manifestations. In approximately 10-20% of cases, RF is not detected in any of the periods of RA (seronegative forms of the disease).

Other signs of immune changes - LE cells, antinuclear antibodies and smooth muscle antibodies - are found in significantly lower titers than in SLE.

X-ray examination visualizes changes in the joints. Depending on their severity, four stages are distinguished:

Stage I - osteoporosis without destructive radiological changes;

Stage II - slight destruction of cartilage, slight narrowing of the joint space, single bone abnormalities;

Stage III - significant destruction of cartilage and bone, pronounced narrowing of the joint space, subluxations and bone deviations;

Stage IV - stage III symptoms + ankylosis.

This staging reflects the temporary course of the disease: in the early stage, changes in the joints may be absent or correspond to stage I, and with a long course of the disease, changes corresponding to stages III-IV are determined.

To clarify the diagnosis of arthritis, a diagnostic puncture of the joint is performed, followed by examination of the synovial effusion. In RA, the number of cells and protein content in the synovial fluid are increased due to neutrophils; neutrophils phagocytizing RF, immune complexes containing RF, as well as RF itself are found.

In some cases, arthroscopy can be performed in combination with a biopsy of the synovial membrane of the joint and morphological examination. A typical sign is the proliferation of synovial membrane cells with their palisade-like arrangement in relation to fibrin deposits. Other changes in the form of villous hyperplasia, lymphoid infiltration, fibrin deposits and foci of necrosis are recorded in arthritis of other etiologies. Arthroscopy at an early stage of the disease makes it possible to differentiate RA from other inflammatory joint diseases.

ECG and chest x-ray are used to detect damage to the heart and lungs in visceral forms of RA.

Based on a comprehensive assessment of clinical and laboratory signs, three degrees of activity of the rheumatoid process are distinguished:

I degree - minimal;

II degree - average;

III degree - high (Table 8-1).

Based on the severity of articular syndrome and extra-articular lesions, the following clinical forms of RA are distinguished:

Mainly articular;

Articular-visceral;

Combination of RA with other diffuse connective tissue diseases or joint damage;

Juvenile RA.

Table 8-1. Clinical and laboratory criteria for the activity of rheumatoid arthritis

The predominantly articular form is recorded in 80% of patients. In 66% of patients it occurs in the form of chronic progressive polyarthritis, in 14% - in the form of oligo- and monoarthritis with a subacute course, damage to one or two large joints (usually the knees) and their slight deformation.

The articular-visceral form is diagnosed in 12-13% of cases. It occurs with damage to internal organs and pronounced general reactions in the form of fever, weight loss, anemia and high activity of laboratory parameters (acute phase and immunological).

RA can be combined with other connective tissue diseases, including rheumatism, and also develop against the background of already existing deforming OA.

Juvenile RA (JRA) is a form of RA registered in children under the age of 16 years. In JRA, an acute onset of the disease is noted with high fever, extra-articular disorders (vasculitis with damage to internal organs), and significant immune changes. Damage to mainly large joints (mono-, oligoarthritis) is noted, with frequent involvement of the spine in the pathological process. Eye damage (uveitis) is often found. RF is rarely determined. The prognosis and course are more favorable than with RA in adults. Transformation of the disease into adult RA or ankylosing spondylitis (BD) is often noted.

Based on the rate of development of the pathological process, slowly progressing, rapidly progressing and low-progressing (benign) RA should be distinguished.

Based on a dynamic study of RA activity, the following variants of the disease are conventionally distinguished.

Lungs:

Arthralgia;

Swelling (pain) of 3-5 joints;

There are no extra-articular symptoms;

RF is absent or detected in low titer;

ESR and (or) CRP are within normal limits or moderately elevated;

Absence of pathological changes during X-ray examination.

Moderately heavy:

Arthritis of 6-20 joints;

Absence of extra-articular symptoms (in most cases);

RF in high titer;

ESR and (or) CRP are persistently changed;

X-ray examination revealed osteopenia, moderate narrowing of the interarticular spaces, and small isolated erosions.

Heavy:

Arthritis of more than 20 joints;

Rapid development of joint dysfunctions;

Persistent significant increase in ESR and CRP;

Anemia associated with chronic inflammation;

Hypoalbuminemia;

RF in high titer;

X-ray examination reveals the rapid formation of new erosions;

There are no extra-articular symptoms.

Complications

Damage to internal organs (lungs, heart), tendon ruptures, as well as Sjogren's and Felty's syndromes are considered part of RA itself. Kidney amyloidosis and the addition of septic arthritis are considered as complications.

Amyloidosis is histologically detected in 20-25% of RA cases. Clinically, it manifests itself much less frequently and is more likely related to the duration of the disease than to age and gender. The most characteristic symptom is proteinuria, which can be determined by chance. Sometimes the existence of amyloidosis is indicated by a high ESR and anemia in clinically inactive RA. Splenomegaly and malabsorption syndrome may also be detected. The diagnosis is made after a morphological examination (biopsy of the mucous membrane of the gums or rectum). Kidney biopsy has high diagnostic value.

Glomerulonephritis is detected quite often (35-60%), but it manifests itself with slight proteinuria and microhematuria (isolated urinary syndrome) without increased blood pressure and edema syndrome.

Septic arthritis is most often reported in individuals treated with glucocorticoids. High body temperature, an increase in joint volume and signs of an inflammatory process (swelling, hyperemia, severe pain) indicate the need for immediate aspiration of exudate for diagnostic purposes. Microscopic examination of the exudate reveals a large number of neutrophils. With the development of septic arthritis, all acute phase parameters change significantly.

Diagnostics

Morning stiffness lasting at least 1 hour.

Swelling of three or more joints.

Arthritis of the hand joints is swelling of the wrist, metacarpophalangeal or proximal interphalangeal joints.

Symmetry of arthritis.

Rheumatoid nodules.

Detection of RF in blood.

X-ray changes typical of RA.

In accordance with these criteria, the diagnosis of RA is reliable when at least four criteria are detected, and the first four of the listed signs must persist for at least 6 weeks (especially important in the initial period of the disease).

Differential diagnosis

RA should be differentiated from a number of diseases accompanied by joint damage. Differential diagnosis is especially difficult at the early stage of the disease, when there is no RF, as well as in the articular-visceral form of the disease.

RA should be differentiated from rheumatoid arthritis, deforming OA, articular syndrome in SLE, scleroderma, BD, psoriatic arthritis and Reiter's disease.

In ARF (rheumatism), arthritis is characterized by volatility and damage to large joints. The administration of antirheumatic drugs (acetylsalicylic acid, phenylbutazone, indomethacin) quickly relieves joint changes. Heart damage comes first: during the initial attack, the defect has not yet formed, but the signs of rheumatic carditis are clearly expressed. At the onset of RA, the articular syndrome is not prone to rapid regression when treated with NSAIDs; the heart is not affected. With relapses of rheumatic polyarthritis, the heart defect is usually already clearly formed, and if there is stenosis of the aortic orifice or mitral valve, then RA is completely excluded. The existence of mitral or aortic insufficiency does not exclude RA, but hemodynamic changes in a defect that develops in RA are very insignificant, unlike heart disease of rheumatic origin. Finally, joint changes in rheumatism are completely reversible, which is not the case with RA.

With OA, the distal interphalangeal joints are predominantly affected with the formation of bone growths around them (Heberden's nodes), as well as ankle and knee joints. In the future, damage to the hip joints and joints of the spine is possible. The disease develops in middle-aged and elderly people, often in combination with a disorder of fat metabolism. The pain occurs during exercise and subsides with rest; there is no morning stiffness. There are no acute phase indicators. X-ray examination reveals changes that are not characteristic of RA (overgrowth of bone tissue - osteophytes, subchondral osteosclerosis, narrowing of the joint space and racemose lucencies in the epiphyses).

Articular syndrome in SLE and SSc is not considered the main symptom. Unlike RA, in these diseases the first place is taken by skin changes, most characteristic of SSc, as well as damage to internal organs (especially in SLE). In SLE and SSc, myositis is usually pronounced, Raynaud's syndrome often occurs (especially in SSD) and musculoskeletal syndrome (impaired swallowing in SSD), which usually does not happen in RA. X-ray changes in joints in SLE and SSc are minor, but differ from those in RA.

Finally, immunological changes are significantly pronounced in SLE, which are not expressed to the same extent in RA. Dynamic observation of patients allows us to detect predominant joint damage in RA, visceritis and skin lesions in SLE and SSc.

Ankylosing spondylitis is characterized by damage to the small joints of the spine, spreading from bottom to top in a certain sequence: sacroiliac joints, lumbar, thoracic and cervical spine. The disease manifests itself with persistent back pain and limited mobility of the spine. Difficulties in differential diagnosis arise in the so-called peripheral form of the disease, when a predominant lesion of the lower extremities (knee, ankle and hip joints) is noted. Acute inflammatory signs are usually mild. The disease begins gradually, gradually. In differential diagnosis, attention should be paid to damage to the spine, especially the iliosacral region. BD predominantly affects young men. The disease is genetically determined: the histocompatibility antigen HLA B-27 is determined in 90-97% of patients, while in the population it is found in 5-10% of individuals.

Psoriatic arthritis occurs in approximately 5% of psoriasis patients. The distal joints of the hands and feet are typically affected, but other joints (including the spine) may also be affected. Exacerbation of the skin process is usually accompanied by an increase in the severity of polyarthritis. The difficulty of diagnosis is due to the fact that skin lesions may be limited to the formation of single plaques, the detection of which requires a thorough examination of the scalp. Sometimes arthritis develops before the skin lesions. RF is mostly absent in the blood. Acute-phase indicators are usually slightly expressed.

Reiter's syndrome (disease) is an acute disease characterized by a combination of polyarthritis, urethritis and conjunctivitis. In rare cases, intestinal disorders and dermatitis of the plantar surface of the foot are noted. The disease develops as a reaction to infection with chlamydia of the genitourinary system, in more rare cases - as a response to salmonella infection. Hereditary predisposition to such reactions matters. The difficulty of diagnosis is due to the fact that in many patients the episode of acute urethritis, conjunctivitis and intestinal disorders is short-lived or absent altogether, and the course of the articular syndrome with the persistence of changes, the existence of fairly pronounced local, general and laboratory signs of inflammation, as well as morning stiffness, resembles that of RA. When carrying out differential diagnosis, it should be remembered that

Reiter's disease causes asymmetrical damage to the joints of the lower extremities (knees and ankles), spreading from bottom to top. Arthritis is often associated with sacroiliitis, Achilles tendon disease, and plantar fasciitis. There are practically no changes in the small joints of the hand. RF is not detected in the blood.

The formulation of a detailed clinical diagnosis must correspond to the main headings, the working classification of RA and reflect:

Clinical and anatomical characteristics (polyarthritis, oligo-, monoarthritis, combination of joint damage with visceritis or other diseases);

Clinical and immunological characteristics (existence or absence of RF);

The severity of the disease and the nature of the course (slowly or rapidly progressing, slightly progressive);

Degree of activity;

X-ray characteristics (by stages);

The patient’s functional ability (preserved, lost, degree of loss).

Treatment

Treatment of patients with RA should begin in a specialized hospital, which avoids wasting time until effective treatment is prescribed. The sooner a patient with RA gets into it, the sooner he will receive full treatment.

For RA, complex treatment is prescribed aimed at eliminating the inflammatory process in the joints, correcting immune disorders, restoring the functions of the affected joints and increasing the life expectancy of patients.

Basic treatment begins immediately after the diagnosis of RA is established;

It begins with prescribing the most effective drug;

Basic therapy is continued indefinitely;

If there is no effect from sufficiently long-term use of the basic drug, it should be replaced;

If there is no effect from monotherapy, combined basic treatment should be carried out;

Basic therapy should be started as early as possible, especially in patients with a high titer of RF, a marked increase in ESR, damage to more than 20 joints and extra-articular disorders (rheumatic nodules, damage to internal organs).

Methotrexate is currently considered as the drug of choice. It is considered the gold standard for the treatment of seropositive active

RA.

Methotrexate is initially prescribed at a dose of 7.5 mg (trial dose), and then it is gradually increased to 15-25 mg/week. During treatment, the consumption of alcohol (even small doses) and food products is strictly prohibited.

containing caffeine. Methotrexate should be taken in the evening once a week. Split doses cause toxic reactions in the form of stomatitis, gastrointestinal lesions, and rarely myelosuppression. To reduce the severity of side effects, the use of NSAIDs (if the patient receives them) is discontinued on the day of taking the drug. 24 hours after taking methotrexate, folic acid is prescribed at a dose of at least 1 mg/day (until the next dose). The effectiveness of treatment is assessed after 4-8 weeks. When increasing the dose of methotrexate, toxicity assessment is carried out after six days. Parenteral administration is used if there is no effect from oral administration or if toxic reactions develop.

The new basic drug leflunomide is prescribed at a dose of 100 mg/day for three days, and then 20 mg/day. The effect occurs after 1-2 months. Possible complications in the form of diarrhea, alopecia, skin rash and itching, as well as increased blood pressure.

The basic drug - gold salts - is prescribed in the form of intramuscular injections: a test dose is 10 mg, and then the drug is administered in a dose of 25-50 mg. The expected effect develops after 3-6 months. The maintenance dose is 50 mg once every 2-4 weeks. Treatment with gold salts is recommended for all patients with active RA (both with early erosive arthritis and in the advanced stage of the disease) in the absence of obvious contraindications (damage to internal organs). In fact, therapy with gold salts (crisotherapy) is prescribed to patients who have contraindications to the use of methotrexate.

Another basic drug, sulfasalazine, is prescribed at a dose of 0.5 g/day in two doses (after meals). The dose is gradually increased to 2-3 g/day. The expected result of treatment is usually obtained in 1-2 months. Sulfasalazine is mainly used for low RA activity. It can also be prescribed to patients who are contraindicated for treatment with methotrexate.

Cytostatic drugs such as azathioprine, cyclophosphamide, penicillamine and cyclosporine are now rarely used, primarily due to the development of side effects and the lack of reliable data on their effect on the progression of joint damage. They are prescribed mainly to patients with RA refractory to methotrexate.

Aminoquinoline drugs are not prescribed in isolation. Their prescription complements the use of sulfasalazine for low RA activity: hydroxychloroquine is prescribed orally at 400 mg/day in two doses (after meals). The expected effect occurs after 2-6 months.

Currently, a genetically engineered drug containing monoclonal antibodies to TNF-α is used - infliximab. This is the drug of choice in patients resistant to treatment with basic drugs. Infliximab causes rapid positive dynamics in clinical symptoms and laboratory parameters (ESR, CRP), and also slows down the progression of joint destruction (regardless of gender and age). A single dose is 3 mg/kg. The drug is reused at the same dose 2 and 6 weeks after the first administration, and then every 8 weeks. Treatment with infliximab should be carried out simultaneously with the use of methotrexate. Another drug, rituximab, contains chimeric human monoclonal antibodies to the CD20 + B-lymphocyte antigen.

NSAIDs, which have analgesic and anti-inflammatory effects, are prescribed to almost all patients with RA. This is especially important, since the therapeutic effect of basic therapy does not occur immediately after its administration. The effect of these drugs usually develops during the first 24 hours, but disappears almost as quickly after they are discontinued. The most commonly used are naproxen (0.75-1 g/day), diclofenac (100-150 mg/day), ibuprofen (1.2-1.6 g), meloxicam (7.5 mg 2 times per day), ketoprofen (at a dose of 100-300 mg/day in two doses), nimesulide (200-400 mg/day in two doses) and celecoxib (200-400 mg/day in two doses). There is individual sensitivity to NSAIDs, so the therapeutic effect of individual drugs may vary. NSAIDs do not affect the progression of destruction and prognosis of the disease.

Ingestion of glucocorticoids in low doses for RA is prescribed extremely rarely: with severe inflammation in the joints, high fever and visceral lesions. Treatment is stopped when the effect of using long-acting drugs - methotrexate and gold preparations - occurs.

From the above it follows that glucocorticoids are not used in isolation, but only in combination with basic drugs. If the inflammatory process in any joint persists, then intra-articular administration of glucocorticoids (depomedrol, methylprednisolone, betamethasone) is effective.

Physiotherapeutic methods (phonophoresis of hydrocortisone, electrophoresis of hyaluronidase, thermal procedures) help reduce the local inflammatory process in the joints. Applications of dimethyl sulfoxide in combination with NSAID solutions on the most affected joints also have a positive effect on pain and signs of inflammation.

In addition to medication and physiotherapeutic methods, so-called non-standard treatment methods are used, which include:

Plasmapheresis - removal of blood plasma in order to reduce the content of CEC;

Leukocytopheresis - removal of lymphocytes;

External or intra-articular irradiation of the affected joints with a low-power laser beam to affect the synovial membrane;

Cryotherapy (exposure to ultra-low temperatures on joints) to reduce the severity of the inflammatory process in the joint;

Surgical methods of treatment (early synovectomy, reconstructive surgery, replacement of the affected joint with a prosthesis).

Forecast

The life expectancy of patients with RA is three years below average for women, and seven years for men. However, since the causes of death in patients with RA do not differ from those in the general population, this diagnosis does not appear among the causes of death in most cases. The mortality rate of patients with RA is higher than in the general population. Its main causes are infectious and respiratory diseases, kidney damage and gastrointestinal tract. The prognosis for restoration of joint function is made unfavorable by the following factors:

ry: onset of the disease at a young age, persistence of the process activity for more than one year, high RF titer and the formation of rheumatoid nodules.

Prevention

Prevention consists of preventing exacerbations of diseases and further progression of joint damage. In relation to the patient's relatives, primary prevention is possible, consisting of the prevention of hypothermia and careful treatment of intercurrent infectious diseases.

OSTEOARTHROSIS

Osteoarthritis (OA) is a heterogeneous group of diseases of various etiologies with similar biological, morphological and clinical signs and outcome, which are based on damage to all components of the joint, primarily cartilage, subchondral bone, synovial membrane, ligaments, capsule and periarticular muscles.

Degeneration of articular cartilage is a normal physiological process that occurs in 100% of individuals over the age of 60 years. Stages of age-related degeneration of cartilage tissue:

Reducing the content of chondroitin sulfate, leading to a change in the hydrodynamic properties of cartilage and the rate of diffusion of nutrients;

Replacement of the main substance of cartilage with connective tissue due to the death of chondrocytes;

Loss of elasticity and firmness of cartilage;

Disintegration of cartilage tissue, formation of ulcerations with exposure of the underlying bone in the area of ​​greatest load (usually in the middle of the articular surface of the bone).

With OA, cartilage degeneration occurs similar to that described, but earlier and faster, accompanied by changes in surrounding tissues.

OA is the most common joint disease. The incidence is 8.2 cases per 100 thousand population, the prevalence is 20%. OA is not fatal. The disease usually begins after the age of 40 years. Its radiological signs are found in 50% of people aged 55 years and in 80% of people over 75 years of age. Damage to the knee joint (gonarthrosis) is more often recorded in women, and to the hip joint (coxarthrosis) - in men.

Etiology

There are primary and secondary OA. Primary OA is premature aging of the cartilage of joints that were not previously affected by the pathological process. Secondary OA is damage to the cartilage of joints that were previously exposed to pathological influences.

In primary OA, the following factors are important:

Genetic (in families with OA patients, the disease is registered 2 times more often than in the control group), associated with defects in the type II collagen gene;

Endocrine (during menopause, OA develops at a faster rate);

Permanent microtrauma of the joints as a result of inadequate physical activity (in particular, sports).

In secondary OA, a decrease in the resistance of cartilage to physiological stress is noted due to:

Cartilage injuries;

Congenital static disorders;

Weakness of muscles and ligaments;

Previously suffered arthritis;

Disturbances of congruence of articular surfaces.

Pathogenesis

In OA, all stages of age-related cartilage degeneration occur faster and at a younger age. Three factors play a role in the pathogenesis of OA:

Changes in the articular surfaces of the bone (cartilage and underlying parts of the bone);

Inflammation of the synovium (reactive synovitis);

Fibrous-sclerotic changes in the synovial membrane.

The pathogenesis of OA is based on a disruption of the normal metabolism of cartilage tissue with a predominance of catabolic processes over anabolic ones. Impaired production of mediators and enzymes during pathological changes in chondrocytes includes the synthesis of pro-inflammatory cytokines, especially IL-1, under the influence of which chondrocytes synthesize proteinases that cause degradation of collagen and cartilage proteoglycan. In addition, prostaglandins are synthesized, which take part in the development of nonspecific inflammation, and excessive formation of nitric oxide occurs, which also has a toxic effect on cartilage.

The main substance of cartilage (acidic and neutral mucopolysaccharides) covering the articular surface degenerates and disappears in places, being replaced by dense connective tissue. Chondrocytes die, the cartilage becomes dull, dry, loses elasticity, and may crack and ulcerate, exposing the underlying bone.

This process is not identical to erosive arthritis in RA, in which the destruction of cartilage is carried out by loose connective tissue - pannus. With OA, osteosclerosis develops subchondrally, and bone growths - osteophytes - appear on the periphery of the articular surfaces. Fibrous-sclerotic changes involve the joint capsule and synovial membrane. In addition, fibrous changes in the ligamentous apparatus occur, accompanied by calcification, which leads to subluxation of the joint.

Reactive synovitis (inflammation of the synovial membrane) occurs due to irritation by intra-articular detritus - pieces of necrotic

leg cartilage. Sometimes hypertrophy of synovial villi with cartilaginous or bone metaplasia is noted. The detachment of such altered villi leads to the formation of articular “mice.”

Clinical picture

OA is registered mainly in women aged 40-60 years. The main symptom is considered to be articular syndrome. The following main forms of joint damage in OA are distinguished:

Damage to the hip joint - coxarthrosis - is the most severe form of the disease, found in 40% of all cases of OA;

Damage to the knee joint - gonarthrosis - is registered in 33% of cases (the primary form occurs mainly in menopausal women, the secondary form - as a result of joint injury and static disturbances);

Damage to the distal interphalangeal joints with the formation of Heberden's nodes (bone growths in the joint area) is found in 1/3 of all patients with OA (registered mainly in menopausal women);

Damage to the joints of the spine, intervertebral discs (spondylosis or spinal osteochondrosis) and synovial intervertebral joints (spondyloarthrosis).

On first stage of diagnostic search The patient's main complaint is discovered - pain in the affected joint and some limitation of its mobility. The pain is associated with the load on the affected joint, which is why they are called mechanical. They usually begin unnoticed, and at first patients complain only of vague, low-intensity pain in the affected joints (one joint). As a rule, they appear towards the end of the day and disappear with rest. As pathological changes in the joint develop, the pain becomes more intense and lasts longer, and a small amount of physical activity is enough for it to occur. So-called starting pains are noted at the beginning of walking. Gradually, the patient “gets used to it” and they subside, but as the load continues, they appear again and disappear (diminish) only when it stops. Pain in the affected joints (hip, spine) can occur during prolonged stay in a fixed position - when working while sitting, staying in an upright position for a long time, etc. To reduce pain, the patient must definitely change his position. The causes of pain are not associated with damage to the cartilage itself, since it is devoid of nerve endings. They are determined by damage to bones, joints (stretching of the altered joint capsule and ligamentous apparatus, compression of nerve endings by fibrous tissue of the joint capsule) and periarticular tissues. A special place is occupied by reactive synovitis (tenosynovitis), caused by irritation of the synovial membrane with detritus, as well as the influence of nonspecific factors - hypothermia or excessive physical activity. With the development of reactive synovitis, patients note swelling of the affected joint, an increase in its volume and a sharp increase in pain when moving. Sometimes an increase in body temperature to subfebrile levels is noted.

Movement in the joint at the beginning of the development of the pathological process is slightly limited due to pain. In the future, as changes in the joint capsule and ligamentous apparatus develop, the amplitude of movements may be significantly limited (especially with coxarthrosis). In some cases, a so-called joint blockade develops, characterized by sudden sharp pain and the almost complete impossibility of movement in the joint, which is caused by pinching of the articular “mouse” between the articular surfaces. A characteristic symptom of OA is crepitus (crunching, crackling or squeaking) in the joints during movement, resulting from a violation of the congruence of the articular surfaces.

Patients with spinal lesions have unique complaints. They note not only pain in the affected area when staying in a long fixed position, but also pain in other places (for example, in the chest, which sometimes simulates angina, as well as in the lower extremities, which is combined with weakness of the thigh muscles).

On the second stage of the diagnostic search changes can be detected in the affected joints. Thus, the distal interphalangeal joints of the hands become less mobile, ankylosis develops in them and nodular formations appear - Heberden's nodes, represented by bone growths. The same bone formations can be located in the proximal interphalangeal joints (Bouchard's nodes). The nail phalanges of the fingers gradually become curved and sharpened.

Subluxations can occur in small joints of the hand, foot, and ankle as a result of excessive physical exertion and repeated injuries.

In case of damage to the intervertebral discs and joints of the spine, pain may occur when tapping the spinous processes of the vertebrae, as well as symptoms of secondary radicular syndrome due to compression of the nerve roots by osteophytes.

If the hip joint is affected, then due to the shortening of the limb due to flattening of the femoral head, gait is impaired. Fibrosclerotic changes in the joint capsule impair abduction of the limb. Atrophy of the thigh muscles gradually develops.

Deformation of the knee joint may be detected, caused by thickening and shrinking of the knee joint capsule and associated with the formation of osteophytes.

On palpation, tenderness is determined in the medial part of the joint space and the places where the tendons attach to the bones. With the development of secondary synovitis, swelling of the affected joint occurs, palpation becomes painful, and the range of motion decreases. The sensitivity of the fingertips decreases, paresthesia and a feeling of numbness occur.

A physical examination can confirm the correct diagnosis.

On third stage of diagnostic search it is necessary to reject a number of diseases that occur with a similar articular syndrome, and also to clarify the nature and severity of joint damage.

Examination of peripheral blood does not reveal any pathological changes. Only with reactive synovitis is a slight

but pronounced acute-phase indicators (increased ESR to 20-25 mm/h and increased CRP content).

Biochemical and immunological blood tests showed no changes: RF, ANF, LE cells, as well as no antibodies to smooth muscle tissue or DNA.

X-ray examination of the joints reveals progressive changes that increase in parallel with the duration of the disease and the severity of clinical symptoms. There are four stages of radiological changes:

Stage I - normal joint space, osteophytes are slightly expressed;

Stage II - pronounced osteophytes, slight narrowing of the joint space;

Stage III - multiple osteophytes, obvious narrowing of the joint space, moderate deformation of the articular surfaces of the bone, subchondral osteosclerosis;

Stage IV - pronounced numerous osteophytes and narrowing of the joint space, deep osteosclerosis, significant deformation of the articular surfaces.

When the spine is damaged, the following types of damage are noted:

Spondylosis - spines form along the edges of the vertebral bodies - so-called osteophytes;

Spondyloarthrosis - damage to the joints of the spine (as is known, each thoracic vertebra has four intervertebral and two spinal-costal joints);

Osteochondrosis is a lesion of the intervertebral discs, often with the formation of Schmorl's hernias and prolapse of the pulp nucleus of the intervertebral disc in one direction or another.

Diagnostics

OA is diagnosed based on the detection of characteristic clinical signs (pain, rate of disease progression, nature of damage to certain joints) and X-ray data. When establishing a diagnosis, it is necessary to take into account the patient's age, gender and factors that can cause OA.

The Institute of Rheumatology of the Russian Federation (1993) proposed criteria for OA.

Clinical criteria:

Joint pain that occurs at the end of the day and (or) in the first half of the night;

Joint pain that occurs during physical activity and decreases with rest;

Joint deformation due to bone growths (including Heberden's and Bouchard's nodes).

Radiological criteria:

Narrowing of the joint space;

Osteosclerosis;

Osteophytosis.

The first two criteria in each group are considered basic, and the third - additional. To establish a diagnosis of OA, it is necessary to detect the first two clinical and radiological criteria.

At the same time, it is necessary to exclude a number of diseases in which joint damage resembles the clinical picture of OA. First of all, it is necessary to exclude RA in elderly people. The differential diagnosis is based on the following signs. Damage to large joints in RA occurs after a long period of illness. RA itself debuts with damage to the small joints of the hand and foot (proximal interphalangeal, but not distal, which is typical for OA). Heberden's nodes are sometimes mistaken for rheumatoid nodules, but the latter are characterized by a different localization (under the skin of the elbow joints). During the study of synovial fluid in OA, signs of inflammation characteristic of RA are not detected, and a biopsy of the synovial membrane reveals fibrosis and minor cellular infiltration.

The formulation of a detailed clinical diagnosis should take into account:

Localization of the lesion;

Phase of the disease (exacerbation, remission);

The existence of secondary changes in muscles, nerve roots, etc. Treatment

Treatment of OA continues to be a complex and insufficiently solved problem.

Complex treatment is prescribed with the following goals:

Slowing down the progression of the pathological process;

Reducing the severity of pain - the main reason for a patient to see a doctor;

Normalization of metabolic processes in articular cartilage;

Improving the functions of affected joints.

Since increased body weight and decreased muscle tone are risk factors for the development and progression of OA, normalizing weight and strengthening muscles are important areas of treatment for the disease.

Elimination of pain is ensured by the administration of non-narcotic centrally acting analgesics (paracetamol), NSAIDs and so-called chondroprotectors.

For moderate pain without signs of inflammation (synovitis), a non-narcotic centrally acting analgesic (paracetamol in a dose of up to 4 g/day) should be periodically prescribed. Its advantage over NSAIDs is that it is less likely to develop side effects from the gastrointestinal tract.

In patients with severe persistent pain, often associated not only with mechanical factors, but also with inflammation (synovitis), NSAIDs are considered the drugs of choice. The most preferable use is ibuprofen (1200-1400 mg/day), ketoprofen (100 mg/day) and diclofenac (100 mg/day). NSAIDs are effective when used in smaller doses,

than in the treatment of RA. It is considered rational to start treatment with a full dose. When the analgesic effect is achieved, it is reduced to the required maintenance level. If the condition improves, NSAIDs are discontinued, but if the condition worsens, they are re-prescribed. The use of piroxicam and indomethacin is not recommended due to the fact that they reduce the effect of other drugs that the elderly patient may be taking (for example, antihypertensive drugs). In addition, indomethacin has a chondrodestructive effect, and its use may contribute to the progression of cartilage degeneration. In elderly patients taking NSAIDs, the possibility of developing erosive gastritis should be taken into account, therefore it is recommended to prescribe drugs that cause selective blockade of cyclooxygenase-2 (COX-2) - meloxicam (7.5 mg / day) or celecoxib (at a dose of 100-200 mg/day).

Tramadol (an opioid analgesic) is used for a short time to relieve severe pain when paracetamol or NSAIDs are ineffective, or when optimal doses of these medications cannot be prescribed. Tramadol is prescribed at a dose of 50 mg/day with a gradual increase to 200-300 mg/day.

Applications of dimethyl sulfoxide to the affected joint (especially with the addition of an NSAID solution) have an analgesic effect.

In addition, intra-articular administration of various drugs is performed:

Intra-articular administration of glucocorticoids is recommended for OA accompanied by symptoms of inflammation. The effect of treatment (reduction of pain and symptoms of inflammation) lasts from 1 week to 1 month. Methylprednisolone (at a dose of 20-40 mg) and triamcinolone (at a dose of 20-40 mg) are used. The frequency of administration should not exceed 2-3 times a year.

Derivatives of hyaluronate for intra-articular administration (osteonyl) reduce pain in the knee joints. The effect lasts from 3 to 12 months.

Natural components of articular cartilage (chondroprotectors) - chondroitin sulfate and glucosamine - are considered very effective drugs.

Chondroitin sulfate is used for a long time (repeated courses are possible) at a dose of 1000-1500 mg/day in 2-3 doses, which allows you to reduce the dose of NSAIDs. Glucosamine, which is prescribed at a dose of 1500 mg/day once for at least 6 months (repeated courses), has similar efficacy and tolerability.

The chondroprotector Afletop is injected into the knee joint 2 times a week (five injections in total). Its use is combined with oral administration of 2-3 tablets of chondroitin sulfate + glucosamine (at a dose of 500 mg + 500 mg per day). Chondroitin sulfate + glucosamine is taken for six months. This combined course is carried out up to 2 times a year.

The hyaluronic acid drug Suplazin is injected into the joint once a week (a course of three injections). Suplazin is also combined with oral administration of chondroitin sulfate + glucosamine (at least six months).

Improvement in the functions of the affected joints is achieved using physiotherapeutic treatment methods: exercise therapy, thermal (paraffin baths, ozokerite) and electrical procedures (UHF currents or ultrasound on the area of ​​the affected joints). Electrophoresis of hyaluronidase and ca-

liium iodide*, which promotes the resorption of fibrous tissue of the joint capsule and tendons attached to the joint.

After the exacerbation subsides and the pain decreases, sanatorium treatment (therapeutic mud, radioactive or sulfide baths) has a good effect.

Surgical treatment (arthroscopic operations to remove cartilaginous detritus) is considered quite effective. Endoprosthetics of the hip or knee joint is performed only in cases of severe disabling damage to these joints.

Forecast

OA (especially primary) rarely leads to disability, but when the process is localized in the hip joint, due to rapidly progressing limitation of movements, the patient becomes disabled.

Prevention

Primary prevention comes down to the fight against external factors that can contribute to the development of degenerative changes in articular cartilage (prevention of permanent microtrauma of the joints and long-term functional overload, normalization of body weight, etc.).

GOUT

Gout is a disease caused by a disorder of purine metabolism, characterized by hyperuricemia, recurrent acute, and later chronic arthritis and kidney damage.

The essence of the disease is a violation of uric acid metabolism, as a result of which monosodium urate crystals are deposited in the joints and periarticular tissue, which leads to the development of arthritis. In addition, excessive formation of urate stones in the renal pelvis and urinary tract, as well as the development of interstitial nephritis, are noted.

The increase in uric acid levels in the body is due to three mechanisms:

Metabolic - increased synthesis of uric acid;

Renal - decreased excretion of uric acid by the kidneys;

Mixed - a moderate increase in the synthesis of uric acid in combination with a decrease in its excretion by the kidneys.

All these mechanisms of uric acid metabolism disorders are involved in the development of gout.

Hyperuricemia is found in 4-12% of the population, but gout affects 0.1-1% of the population. The incidence of gouty arthritis in different populations varies and ranges from 5 to 50 cases per 1000 men and 1-9 cases per 1000 women. The risk of gout increases as uric acid levels increase. The peak incidence occurs at the age of about 40-50 years in men and over 60 years in women (before menopause, women practically do not suffer from gout). Male to female ratio

among patients is 2-7:1. An acute attack of gout in adolescents and young adults is rare. It is usually caused by a primary or secondary defect in uric acid synthesis.

Etiology

There are primary and secondary gout.

Primary (idiopathic) gout is a hereditary disease determined by the simultaneous action of several pathological genes. In addition to hereditary predisposition, a nutritional factor plays a role in its development - increased consumption of foods with an excess content of purines, fats, carbohydrates and alcohol.

Secondary gout is the result of hyperuricemia that occurs in certain diseases: hematological malignancies, neoplasms, kidney diseases, heart failure, some metabolic and endocrine diseases, as well as when taking medications that increase the concentration of uric acid in the blood (diuretics, salicylates, cytostatic drugs, glucocorticoids ).

Pathogenesis

With gout, there is a violation of the ratio of synthesis and excretion of uric acid from the body.

Due to a genetically determined dysfunction of enzymes involved in purine metabolism (decreased activity or absence of glucose-6-phosphatase, hypoxanthine phosphoribosyltransferase, etc.), the synthesis of uric acid increases and constant hyperuricemia occurs. On the other hand, urate excretion by the kidneys decreases. As a result of these processes, the accumulation and deposition of urate occurs in the body, mainly in the connective tissue of the joints, kidneys and other tissues.

Under the influence of urate crystals, stimulation of pro-inflammatory mediators (IL-1, TNF-α, IL-8, IL-6, phospholipase A 2, anaphylotoxins, etc.) occurs by phagocytes, synovial cells and other components of the joint. As a result, neutrophils penetrate into the joint cavity, where phagocytosis of the crystals occurs. Urate crystals damage the neutrophil lysosome, promoting further release of lysosomal enzymes and the development of inflammation. The main links in the pathogenesis of gout are presented in Fig. 8-1.

Clinical picture

The clinical picture of the disease is represented by various syndromes.

Recurrent attacks of acute gouty arthritis (most often monoarthritis). The basis of acute arthritis is the acute precipitation of crystalline urates in the synovial fluid with their subsequent phagocytosis by neutrophils. Phagocytic leukocytes are subsequently destroyed, and many lysosomal enzymes penetrate into the joint cavity, causing an inflammatory reaction of the synovial membrane.

Rice. 8-1. Pathogenesis of gout

lobules and periarticular tissues - arthritis. In the development of joint damage, the following are distinguished:

Interictal (interval) gout;

Chronic tophi gout.

Kidney damage in the form of urolithiasis and gouty kidney (interstitial nephritis, rarely diffuse glomerulonephritis). The basis of the gouty kidney is the deposition of urate or uric acid in the medulla, less often in the renal cortex. The deposits are focal in nature and are located in the interstitial tissue. An inflammatory reaction develops around them. Glomerular involvement is rarely detected. It is characterized by thickening of capillary walls, cellular proliferation, hyaline deposits and glomerular sclerosis.

Damage to peripheral tissues (deposition of urates, forming gouty nodes specific to gout). Gout is often combined with other metabolic diseases: diabetes mellitus, lipid metabolism disorders, as well as atherosclerosis and hypertension.

Ha first stage of diagnostic search you can obtain information about the onset of the disease, the characteristic signs of acute gouty arthritis and the further involvement of the joints in the pathological process, as well as the existence and severity of renal syndrome.

Gout most often manifests itself as attacks of acute gouty arthritis, often occurring against the background of complete health in men over 30 years of age. Factors provoking an attack: hypothermia, minor trauma, long walking, alcohol abuse or rich fatty meat foods, intercurrent infectious diseases. The attack begins suddenly (usually at night) and manifests itself with sharp pain in the metatarsophalangeal joint of the big toe (less often in other joints) of the foot, ankle,

knee, elbow and extremely rarely - in the wrist joint. Severe pain occurs at rest and intensifies when lowering the limb. At the height of pain, it is possible to increase body temperature to 38-39 °C. The joint swells, the skin over it becomes bluish-purple. The attack lasts from 3 to 10 days, after which the pain completely disappears, the function of the joint is restored, and outwardly it takes on a normal shape. Over time, a shortening of interictal periods is noted with an increase in the duration of joint pain. Other joints are also involved in the pathological process. Over the years, patients note deformation and limited mobility of the joints (mainly the lower extremities). When the kidneys are involved in the pathological process (development of urolithiasis), attacks of renal colic occur, accompanied by all the characteristic signs; stones pass periodically.

On the second stage of the diagnostic search During an attack, characteristic signs of acute gouty arthritis are detected: swelling of the joint, severe pain on palpation and discoloration of the skin over the joint. In the interictal period, all articular changes disappear.

Over time, persistent changes in the joints of the extremities (usually the lower ones) increase and signs of chronic polyarthritis appear: deformation occurs, limited joint mobility, deformation due to nodular deposits and bone growths, subluxations of the fingers, contractures and rough crunching in the knee and ankle joints. Patients lose their ability to work and have difficulty moving.

When the disease lasts more than 3-5 years, tophi are formed - nodules specific to gout, represented by the deposition of urates and surrounded by connective tissue. They are localized mainly on the ears and elbows, less often on the fingers and toes. Tophi sometimes soften and spontaneously open with the formation of fistulas, through which a whitish mass (crystals of sodium urate) is released. Infection of fistulas is rare. With the development of a gouty kidney, hypertension occurs. Gout contributes to the development of lipid metabolism disorders and atherosclerosis, contributes to the progression of hypertension and other diseases of the cardiovascular system (for example, coronary artery disease).

On third stage of diagnostic search Can:

Confirm characteristic joint damage;

Detect kidney damage;

Detail the degree of purine metabolism disorders.

X-ray examination of the affected joints reveals changes that develop in severe cases, long duration of the disease and the onset of arthritis at a young age. The most significant changes:

Round (“stamped”) defects of the epiphyses of bones, surrounded by a sclerotic border;

Cyst-shaped defects that destroy the cortical bone;

Thickening and expansion of the shadow of soft tissues due to the deposition of urates in them.

Kidney damage - gouty kidney - manifests itself with proteinuria and cylindruria (usually minor). In case of development of urolithiasis

diseases with moderate proteinuria note hematuria and a large number of uric acid crystals in the sediment. After an attack of renal colic, hematuria intensifies.

Renal failure rarely develops due to kidney damage. Its signs are an increase in the concentration of creatinine in the blood, a sharp decrease in filtration and a relative density of urine below 1015.

Violation of purine metabolism is represented by hyperuricemia (0.24-0.50 mmol/l or 4-8.5 mg in 100 ml of urine).

During an attack of gouty arthritis, the presence of acute-phase indicators in the blood (neutrophilic leukocytosis, increased ESR, increased levels of fibrinogen, α 2 -globulin and CRP) is noted, disappearing after the attack is stopped.

Diagnostics

Diagnosis of the disease is based on the detection of characteristic attacks of joint pain, gouty tophi, hyperuricemia, crystals of uric acid salts in the synovial fluid and characteristic radiological changes.

Currently, the so-called classification criteria are used to establish a diagnosis:

Detection of characteristic crystals in the joint fluid;

Detection of tophi containing uric acid, which is confirmed by a chemical method or using polarization microscopy;

Detecting six of the following 12 symptoms:

History of more than one attack of acute arthritis;

Joint inflammation reaches its maximum on the first day of illness;

Monoarthritis;

Hyperemia of the skin over the affected joint;

Swelling and pain in the first metatarsophalangeal joint;

Unilateral damage to the first metatarsophalangeal joint;

Unilateral damage to the joints of the foot;

Suspicion of tophi;

Hyperuricemia;

Asymmetric joint swelling;

Subcortical cysts without erosion (on X-ray);

Negative results of synovial fluid culture.

Six or more clinical criteria are found in 88% of patients with gout, less than 3% of patients with septic arthritis, and 11% of patients with pyrophosphate arthropathy.

Differential diagnosis

Gout must be differentiated from a number of diseases that manifest as both acute and chronic damage to the joints. The differential diagnosis is based on the following features of gout and diseases with a similar clinical picture.

Heberden's nodes, typical for OA, are sometimes regarded as gouty tophi, but in OA the nodules are found in the area of ​​the distal interphalangeal

the upper joints of the fingers, where tophi are not localized. Unlike tophi, Heberden's nodes have a dense consistency. In addition, with OA, large joints (hip and knee) are primarily affected, while with gout, the metatarsophalangeal (97%) and ankle (50%) are affected. Changes in the knee joints are recorded less frequently (in 36% of cases). There is no history of typical attacks of acute arthritis in OA.

Rheumatoid nodules must also be differentiated from tophi, especially if RA occurs with damage to the metatarsophalangeal joints of the big toes. The need for differential diagnosis with RA also arises when gout lasts for a long time, many joints are involved in the pathological process and their deformation develops. The difference is quite obvious: with gout, the disease usually debuts with attacks of acute arthritis of a typical localization (first metatarsophalangeal or small joints of the foot), there is no RF and there are typical radiological changes. At the same time, RA begins with damage to the joints of the hand, the disease often debuts at a young age, with a long course, muscle atrophy develops, there is no hyperuricemia, and radiological signs have other features. Rheumatoid nodes are never opened, while tophi are often opened with the release of a whitish crumbly mass.

An acute attack of gouty arthritis often resembles acute rheumatic arthritis, but distinguishing gout from rheumatism is relatively easy. Rheumatism is recorded mainly in children and adolescents (less often in adults), and gout debuts in people aged about 40 years. Rheumatism is characterized by heart damage and a high titer of antistreptococcal antibodies.

In some cases, there is a need for differential diagnosis of gouty arthritis and arthrosis of the first metatarsophalangeal joint. Deforming OA of this location often develops, combined with flat feet, impaired fat metabolism and varicose veins of the lower extremities. It manifests itself with pain when walking, the formation of osteophytes in the epiphysis of the metatarsal bone and gradual curvature of the big toe. With repeated damage to the joint (long walking, wearing tight shoes), reactive synovitis of the first metatarsophalangeal joint and inflammation of the periarticular tissues may develop. Unlike gouty arthritis, signs of inflammation appear gradually, are moderate and are represented by mild swelling and slight hyperemia. The pain is mild, there is no disturbance in the general condition, there are no acute phase signs of inflammation, and the body temperature does not rise. The radiograph shows signs of OA.

Treatment

Complex treatment is prescribed, including:

Normalization of purine metabolism;

Relief of an acute attack of gouty arthritis;

Restoring the function of affected joints (treatment of chronic polyarthritis).

Normalization of purine metabolism is carried out using a system of measures, which include:

Normalization of nutrition;

Elimination of factors contributing to hyperuricemia;

Long-term use of medications that help reduce the synthesis of uric acid in the body and its increased excretion by the kidneys.

Obese patients need to lose weight, since obesity is naturally combined with an increase in urate production and a simultaneous decrease in its excretion by the kidneys.

Patients are strictly prohibited from drinking alcohol, which, when taken frequently, causes hyperuricemia. It is believed that lactic acid, the end product of ethyl alcohol metabolism, slows down the excretion of urate by the kidneys.

It is necessary to limit the consumption of foods rich in purines (meat, fish, liver, kidneys, legumes) and take a sufficient amount of fluid (more than 1500 ml/day), since the excretion of less than 1 ml/min (1400 ml/day) of urine leads to a decrease excretion of urates.

Almost 40% of patients with gout have hypertension, so it should be remembered that the use of thiazide diuretics to normalize blood pressure in patients with gout increases the level of uric acid in the blood. They should not be prescribed acetylsalicylic acid, as this increases the level of uric acid in the blood, which can provoke an attack of gouty arthritis.

In some cases, these measures are sufficient to prevent attacks of arthritis and reduce the severity of uricemia, but some patients have to be prescribed medications that normalize purine metabolism. Otherwise, there is a risk of developing hypertension and impaired renal function, as well as the risk of developing urolithiasis. In addition, untreated gout contributes to the development of atherosclerosis.

When deciding on the choice of drug for long-term anti-gout treatment, it is necessary to take into account the mechanisms that cause an increase in the concentration of uric acid in the blood. In case of hyperproduction of purines, antagonists of purine synthesis should be prescribed, and in case of a decrease in their secretion, uricosuric drugs should be prescribed. For patients with normal purine excretion, agents of both mechanisms of action are recommended.

One of the uricosuric drugs is sulfinpyrazone 8. An increase in the excretion of uric acid is achieved by suppressing its reabsorption in the renal tubules. The initial dose is 50 mg 3 times a day. The dose is gradually increased (usually to 200-400 mg/day) until the concentration of urate in the blood normalizes. When treating with sulfinpyrazone 8, to reduce the risk of kidney stones, the patient should take a relatively large amount of fluid (2-3 l/day). Side effects: nausea, vomiting, allergic skin reactions, leukopenia. The use of the drug is contraindicated for peptic ulcers of the stomach and duodenum. Sulfinpyrazone 8 should not be prescribed for hyperproduction of urates, decreased glomerular filtration rate, gouty nephropathy and urolithiasis.

Among the agents that reduce purine synthesis, allopurinol is considered the best. It is prescribed at a starting dose of 100 mg/day with a gradual increase in dose to 300 mg/day. If glomerular filtration is reduced to 30-60 ml/min, then the dose of allopurinol should not exceed 100 mg/day, and with glomerular filtration 60-90 ml/min it should not be more than 200 mg/day.

Treatment with allopurinol is recommended for severe overproduction of urates (especially in patients with uricemia more than 0.6 mmol/l), gouty nodules, gout accompanied by renal failure, secondary gout with excessive formation of uric acid (in patients with leukemia, multiple myeloma, erythremia), acute nephropathy caused by the deposition of uric acid as a result of treatment of neoplasms with cytostatic agents, as well as in patients suffering from the formation of urate stones.

With long-term treatment with allopurinol, reverse development of urate deposits in tissues and improvement of kidney function are possible. Patients tolerate the drug well, but some of them may experience skin changes and symptoms of gastrointestinal irritation.

These drugs are prescribed only after complete relief of acute gouty arthritis, since their use against the background of subsiding inflammation of the joints can cause a serious exacerbation of arthritis.

In case of primary gout, allopurinol should be taken for life; in case of secondary gout, it should be taken depending on the elimination of the specific provoking situation. Interruptions in treatment lead to relapse of the disease.

The effectiveness of antihyperuremic treatment is determined by the normalization of uric acid in the blood (less than 360 µmol/ml), a decrease in the frequency of gout attacks, resorption of tophi and the absence of progression of urolithiasis.

An acute attack of gouty arthritis is stopped by prescribing colchicine, which is taken orally at a dose of 0.5-0.6 mg every hour until the signs of arthritis subside or until side effects occur (vomiting, diarrhea), but not more than 6 mg/day, or on the first day in a dose of 3 mg (1 mg 3 times a day after meals), in the second - in a dose of 2 mg (1 mg in the morning and evening), and then - 1 mg / day.

In the absence of contraindications, the drugs of choice are NSAIDs in full therapeutic doses: nimesulide (100 mg 2 times a day), naproxen (500 mg 2 times a day) and diclofenac (25-50 mg 4 times a day).

An attack of gouty arthritis can begin suddenly, without any warning signs, so the patient should always have a sufficient amount of pain-relieving medication. The earlier treatment is started, the higher the effectiveness of treatment.

Glucocorticoids are usually not used to relieve an attack; only in case of particularly unbearable pain, intra-articular administration of depomedrol, methylprednisolone, betamethasone and triamcinolone is possible (10-40 mg in large joints, 5-20 mg in small joints).

The antihypertensive drug losartan (angiotensin II receptor blocker) has a moderate uricosuric effect, which allows its use in patients with gout with hypertension.

Restoration of the functions of the affected joints in the chronic course of gouty arthritis is achieved with the help of exercise therapy and sanatorium-resort treatment. At the resort, patients take radioactive or sulfide baths, as well as mud therapy (applications to the affected joints). During balneotherapy, an exacerbation of arthritis is possible, and therefore, during the first 8-10 days, it is recommended to take NSAIDs that previously stopped an acute attack of arthritis (indomethacin, phenylbutazone, diclofenac).

Forecast

Joint damage usually does not lead to disability, but the vast majority of patients with gout die from cardiovascular diseases associated with atherosclerosis (stroke, MI). Less than a quarter of patients die from chronic renal failure.

Prevention

Primary prevention of gout consists, first of all, in normalizing nutrition and avoiding alcohol. This is especially necessary if there is a hereditary burden.

IDIOPATHIC ANKYLOSING SPONDYLOARTHRITIS (BECHTEROW'S DISEASE)

Ankylosing spondylitis (BD) is a chronic systemic inflammatory disease of the axial skeleton, characterized by predominant damage to the sacroiliac joints and spine. In addition to the latter, peripheral joints and internal organs (heart, kidneys, eyes) are often involved in the pathological process.

BD belongs to the group of spondyloarthritis, which also includes reactive arthritis, psoriatic arthropathy, spondylopathies in intestinal diseases (UC and CD), as well as undifferentiated spondyloarthropathy. These diseases are characterized by common features: asymmetrical oligoarthritis, sacroiliitis and damage to other parts of the spine, aortitis, anterior uveitis, hereditary predisposition, frequent existence of HLA-27 and the absence of RF in the blood.

The prevalence of BD among adults ranges from 0.2 to 1.1%. The disease develops mainly in young men. The incidence ratio among men and women ranges from 5:1 to 9:1. Usually people aged 15-30 years are affected. After reaching the age of 45, BD develops extremely rarely.

The inflammatory process begins with the sacroiliac joints. Following this, multiple lesions of the intervertebral and costovertebral joints occur, and, less commonly, peripheral joints. Syndesmophytes (intervertebral braces) apparently form as a result of the transfer of calcium from the bones of the spine into the ligaments and annulus fibrosus. As a result of ossification of the fibrous ring of intervertebral discs and ligamentous apparatus,

that spine takes on a shape reminiscent of a bamboo cane; there is practically no movement in it.

Etiology and pathogenesis

The etiology and pathogenesis of the disease have not been fully elucidated. Of great importance is the hereditary predisposition associated with carriage of HLA-B27 (in more than 90% of patients, while in the population this antigen is found in only 7% of individuals). The frequency of BD among parents of patients is 3%, and among people in the control group - 0.5%. The tendency to a more severe course of the disease in HLA-B27 carriers indicates that this antigen not only serves as an immunogenetic marker, but also has a direct pathogenetic significance.

Clinical picture

The clinical picture of the disease is very diverse, so it is customary to distinguish several of its forms.

The central form affects only the spine.

Rhizomelic form - damage to the spine and “root” joints (hip and shoulder).

Peripheral form - damage to the spine and peripheral joints (knees, feet).

Scandinavian form - damage to the spine and small joints of the hands. This form is very similar to RA.

On first stage of diagnostic search(the disease usually begins gradually, imperceptibly) is determined by patient complaints of pain in the lumbosacral region, which occurs during prolonged stay in one position, more often at night, especially closer to the morning. The pain decreases after a few movements or light exercises. For manual workers, pain may occur or intensify at the end of the working day. When the thoracic spine is affected, girdling pain occurs, similar to intercostal neuralgia, which intensifies with coughing and deep inhalation.

In the advanced stage of the disease, patients complain of constant pain in the spine, worsening at night, with physical activity and changes in weather. Shooting pains are noted in various parts of the spine, back muscles, hips and legs.

In the late stage of the disease, the pain takes on the character of radiculoalgia and sharply intensifies with physical activity and movement. The ability to work of patients is significantly reduced.

If peripheral joints are involved in the process, then patients note pain and limited mobility in the “root” joints (especially when the hip joint is affected). With arthritis of the knee, ankle and foot joints, pain during movements and limitation of the amplitude of the latter are noted.

The sequence of involvement of joints in the pathological process has its own characteristics: most often complaints arise when the sacral-

iliac joint and spinal joints. If the disease begins in adolescence, then at the onset most often there is damage to the peripheral (large and small) joints, usually accompanied by an increase in body temperature, palpitations and unpleasant sensations in the heart area, which makes the clinical picture very similar to an attack of rheumatism. Complaints associated with sacroiliitis arise later.

Patients also complain of impaired posture and gait, limited physical activity, and periodic exacerbations of the disease.

On the second stage of the diagnostic search you can obtain a lot of information valuable for making a diagnosis (especially in the advanced stage of the disease). In the initial stage of BB there is less data, but nevertheless it turns out to be extremely useful.

In the early stage of BD, the patient’s posture and gait are not disturbed, but palpation reveals pain in the sacroiliac joints. Hypotrophy and tension of the rectus dorsi muscles are also noted.

In the advanced stage of the disease, the findings are more significant: there is already a violation of posture and gait, thoracic kyphosis, cervical lordosis and smoothing of lumbar lordosis are more pronounced. Sharp changes in the rectus dorsi muscles develop, and then their atrophy. When tapping on the spinous processes of the spine, pain occurs, and when the chest is compressed laterally, sharp pain occurs.

In the late stage of the disease, pronounced kyphosis of the thoracic spine is noted. The patient's gait changes sharply: he moves, spreading his legs wide and making rocking movements with his head. Upon palpation, atrophy of the muscles of the back, neck and trapezius muscles is detected. The spine is completely motionless and in order to look to the side, the patient needs to turn the whole body.

If, along with damage to the spine, changes in other joints (large or small) are noted, then during the period of disease activity all the signs of arthritis are determined: joint defiguration of varying degrees of severity, limitation of mobility and pain during movements.

With the development of extra-articular lesions (cardiovascular system, kidneys, eyes), changes in the heart muscle (myocarditis) and the valvular apparatus of the heart (minor mitral or aortic valve insufficiency) can be detected. It is extremely rare that pericarditis may develop, accompanied by corresponding symptoms.

Eye damage in BD occurs in the form of iritis, uveitis, iridocyclitis and episcleritis (according to various authors, it is registered in 10-30% of patients).

Kidney damage is represented by amyloidosis, which develops with high activity of the inflammatory process and a severe progressive course of the disease.

Rarely recorded lung damage is expressed in the development of fibrosis, accompanied by corresponding symptoms.

On third stage of diagnostic search confirm the diagnostic assumption about BD, the degree of activity of the process, damage to internal organs and their functional state.

During the period of activity of the process, acute-phase indicators are detected (increased ESR, concentration of α2-globulins and CRP). It is possible to develop moderate hypochromic anemia, increased IgA and CEC levels. RF and ANF are not detected.

HLA-27 is detected in 90-95% of patients. Due to the relatively high frequency of expression of this gene in healthy individuals (in Russia - about 10%), the determination of this marker does not have independent diagnostic value. Its detection may be important for the early diagnosis of BD in young men who have certain clinical reasons to suspect this disease (family history, spinal pain), but there are no obvious radiological signs of sacroiliitis. In case of undoubted BD, its detection has prognostic significance.

X-ray data are very significant. At an early stage, an x-ray of the pelvic bones can reveal signs of sacroiliitis: blurred articular contours, uneven articular surfaces and foci of subchondral osteosclerosis. In the advanced stage, pronounced signs of sacroiliitis or ankylosis of the sacroiliac joints and damage to the intervertebral joints are noted, in the late stage - changes typical for BD: ankylosis of the intervertebral joints, ossification of the fibrous ring of the intervertebral discs, anterior and lateral ligaments.

With the development of renal amyloidosis, proteinuria of varying severity is detected. Renal failure is diagnosed by the magnitude of the decrease in renal filtration and the concentration of creatinine in the blood.

Restricted mobility of the chest leads to a decrease in pulmonary ventilation, which is determined by studying the function of external respiration.

Diagnostics

Currently, the modified New York criteria are recognized as optimal.

Clinical criteria:

History of inflammatory pain in the back or lumbar region (pain with a gradual onset in patients under 40 years of age, lasting at least 3 months, accompanied by morning stiffness, aggravated by rest and relieved by exercise);

Limitation of movements in the lumbar spine in the sagittal and frontal plane;

Limitation of chest mobility (the difference in chest circumference during inhalation and exhalation is less than 2.5 cm at the level of the fourth intercostal space), adjusted for gender and age.

Radiological criteria:

Bilateral sacroiliitis stage II-IV;

Unilateral sacroiliitis stage II-IV.

The diagnosis is considered reliable when one radiological sign is detected in combination with any clinical symptom. The sensitivity of the criteria is 83%, specificity is 98%. The HLA-B27 detection test is only useful as a supplement.

BD in young men can be suspected at a very early stage based on the presence of the following changes:

Inflammatory pain in the joints or lower back;

Symmetrical mono or oligoarthritis of the leg joints;

Pain on palpation of the lumbosacral spine;

Feelings of stiffness in the lower back;

Early signs of bilateral sacroiliitis on a radiograph (subchondral osteoporosis, unclear contours of joints with false widening of the joint space, focal periarticular osteosclerosis of the sacrum and ilium).

In the early period of the disease, detection of pain when loading the sacroiliac joint is important. Rare symptoms such as arthralgia or arthritis in the area of ​​the sternoclavicular and sternocostal joints, heel pain, muscle tension in the lumbar region, smoothness of the lumbar lordosis, as well as difficulty in flexing the lower back are also important for early diagnosis.

In the advanced stage, the disease is easier to diagnose: radicular pain, poor posture (“supplicant pose” or straight plank-shaped back), tension of the back muscles (“string” symptom) or their atrophy, limited mobility of the chest, characteristic radiographic changes, arthritis of the hip and ( or) knee joints.

It should be noted that these signs have diagnostic value after excluding other diseases that occur with similar inflammatory damage to the spine and joints (secondary spondyloarthritis). If severe peripheral arthritis is detected, differential diagnosis of BD with RA is carried out.

Treatment

The main goals of treatment are to relieve the severity of pain in the spine and peripheral joints, as well as maintain mobility in them; relief of uveitis. Treatment must be systematic and carried out throughout the patient’s life.

The main medications are NSAIDs (indomethacin, diclofenac). Diclofenac is prescribed at an initial dose of 100-150 mg/day; indomethacin is used in the same dose. When a positive effect is achieved, the dose is reduced to 50-75 mg/day. The medication is continued indefinitely. During an exacerbation, the dose of NSAIDs can be increased again. In case of poor tolerability or the existence of risk factors for gastrointestinal damage, it is advisable to prescribe selective NSAIDs (celecoxib, meloxicam).

Long-term treatment with sulfasalazine (2-3 g/day for at least 3-4 months) can be effective, especially in cases of damage to peripheral joints.

Glucocorticoids are usually not used for routine treatment. Prednisolone is prescribed only in certain situations - when NSAIDs are ineffective, high fever and uveitis. They are prescribed in the form of pulse therapy: methylprednisolone is administered intravenously at a dose of 750-1000 mg daily for three days in a row.

For arthritis of peripheral joints, a rapid effect occurs with intra-articular administration of methylprednisolone, depomedrol, betamethasone and triamcinolone. Special indications for their use include such extra-articular disorders as inflammatory eye lesions (iritis, iridocyclitis) and rarely recorded severe febrile forms of the disease, accompanied by systemic vasculitis. In the latter case, the dose of prednisolone is 30-40 mg/day.

The effectiveness of the use of TNF-α inhibitors has been proven in patients with severe disease and high activity of the pathological process, despite the use of NSAIDs, glucocorticoids and sulfasalazine. Infliximab is prescribed at a dose of 5 mg/kg, less often - 3 mg/kg. The vast majority of patients develop a rapid effect (often the very next day after the injection), which persists for 7 years during maintenance treatment.

Some patients with severe muscle pain due to increased tone of the spinal muscles are recommended to use the muscle relaxant scutamil-S (a combination of isoprotan at a dose of 0.15 g and paracetamol at a dose of 0.1 g) one tablet 3 times a day.

Exercise therapy is very important for patients, preventing the development of stiffness of the spine and peripheral joints. The complex should not be too heavy and should be performed up to 3 times a day. Exercise therapy classes conducted in a swimming pool are very useful.

An important place in the treatment of patients is occupied by the annual use of radon, hydrogen sulfide baths and mud applications at resorts or in specialized hospitals.

Forecast

Unfavorable prognostic factors:

Damage to the hip joint and early cervical kyphosis;

. “sausage-shaped” lesions of the fingers;

Low effectiveness of NSAIDs;

ESR more than 30 mm/h;

Early limitation of spinal mobility;

Persistent oligoarthritis;

Onset of the disease before the age of 16 years.

In the absence of these factors, a favorable outcome is likely (sensitivity - 92.5%, specificity - 78%). If the pelvis is affected,

drained joint or the existence of three factors, an unfavorable outcome is more likely (sensitivity - 50%, specificity - 97.5%).

Mortality in BD is 1.5 times higher than in the population. The main causes of death for patients are cardiovascular diseases and amyloidosis.

In most patients, the functional mobility of the musculoskeletal system gradually decreases (especially ten years after the onset of the disease). With clinical observation and long-term systematic treatment, in 70% of cases it is possible to delay the progression of the disease.

Article publication date: 04/23/2013

Article updated date: 12/02/2018

The human musculoskeletal system consists of muscles, bones, joints and ligaments. About a third of the population suffers from various dysfunctions. Joint diseases occupy a leading place among its pathologies and often lead to the development of disability. They can be divided into two large groups: arthritis (inflammatory nature of the lesion) and arthrosis (arising from degenerative-dystrophic processes).

A special group includes conditions when changes are associated with the proliferation of tumor tissue, and are also caused by diseases of other organs of the musculoskeletal system. For example, osteoporosis (a disease in which the density and strength of bone tissue decreases) leads to damage to the joints by redistributing the load on them - this is due to disruption of the structure of bone tissue and changes in the mechanics of movement.

Among arthritis, the most common are infectious and rheumatoid. This group also includes gout, which develops due to the deposition of uric acid salts. Psoriatic arthritis is quite rare (develops in 5% of patients with arthritis).

Arthrosis includes osteochondrosis, deforming osteoarthritis, and ankylosing spondylitis.

Since the treatment of the above diseases, unfortunately, is not always effective, special attention must be paid to prevention.

Main reasons

The cause of joint diseases can be various conditions, their nature largely determines the course of the pathology. The most significant reasons:

Infectious agents (tuberculosis, streptococcus) can directly affect joint tissue, leading to the development of inflammatory changes - arthritis. In this case, the pathogenic microorganism is often found in the joint fluid, but in some cases it acts through toxins released into the blood.

A special type of joint disease is a cross-immune reaction to foci of chronic streptococcal infection (usually in the tonsils). In this case, rheumatism or nonspecific polyarthritis develops.

The mechanical factor, along with the infectious factor, occupies a leading place among all causes of pathology of the musculoskeletal system. Chronic traumatic exposure leads to the development of occupational arthrosis and arthritis, and excessive load on the joints often aggravates the course of other diseases.

Allergies are quite often accompanied by the appearance of changes and pain in all joints of the body: this is due to the increased sensitivity of immune cells to special proteins (allergens). Most often, articular syndrome due to allergies occurs against the background of an infectious process in the body.

Endocrine pathologies lead to disruption of mineral metabolism. As a result, bone tissue and cartilage are destroyed, and ligaments become softer and more pliable (metabolic-dystrophic arthrosis, and osteoporosis). Endocrine arthritis also includes diabetic and acromegalic arthropathy, which are caused by changes in the levels of hormones of the hypothalamus and pituitary gland.

Impaired blood supply to joint tissues leads to (arthrosis). Also, with increased permeability of the vascular walls, the risk of infection increases.

Hereditary predisposition, gender of the patient, hypothermia, low physical activity, poor nutrition and obesity are only risk factors. The immediate causes of joint disease can be the conditions listed above.

The development of joint pathologies is largely facilitated by widespread physical inactivity.

Characteristic symptoms and signs

General symptoms of joint diseases:

• Pain at rest, during or after exercise.
• Stiffness, limited mobility.
• Local changes (that is, in the affected area): redness of the skin, loss of sensitivity, increased temperature, deformation of bone and cartilage tissue, swelling.
• Crunching and jamming during movements.

Each specific disease has specific symptoms that make it possible to distinguish them from each other.

The development of joint diseases in children is usually caused by congenital pathologies, among which the first place is occupied by dysplasia (underdevelopment) of the hip joints. It manifests itself as a congenital unilateral or bilateral dislocation. Signs of this condition are increased tone of the back muscles, different lengths of the limbs, asymmetry of the gluteal folds and incomplete spread of the legs. When the baby begins to walk, club feet, the desire to lean on his toes and a characteristic crunching sound attract attention. Rarely, children can also develop other diseases that occur in adults.

Treatment methods

Treatment options for joint diseases can vary greatly depending on the specific pathology. Traditionally, they are divided into therapeutic (conservative) agents, surgical intervention and alternative methods of treatment (traditional, alternative medicine). The doctor decides which method to treat a particular pathology after a full examination of the patient, taking into account all his individual characteristics.

Conservative methods

Almost all lesions of the musculoskeletal system can be treated with therapeutic agents. Depending on the direction of action, the drugs used are divided into two groups:

• Etiotropic – that is, affecting the cause of the disease. For example, for the infectious nature of arthritis, antibiotics are prescribed, and for autoimmune reactions, steroid hormones are prescribed.
• Symptomatic – eliminating signs of the disease. Among them, the most important are anti-inflammatory drugs, which reduce pain and slow down inflammation.

To effectively treat diseases of the musculoskeletal system, several forms of active substances can be used:

• tablets for oral administration;
• solutions for injections;
• special concentrations of drugs in ampoules, when the drug is administered directly into the joint cavity.

In addition to medications, conservative remedies include physiotherapeutic procedures, massage, physical therapy and some other methods.

Surgery

If therapeutic agents are ineffective or in advanced cases, surgical methods for treating joint disease can help. Operations can also be performed to eliminate painful symptoms in order to make the patient’s life easier and improve his quality of life. The most important are arthroplasty (restoration of motor function) and arthrodesis (fixation in a given position). During an exacerbation, immobilization is often performed using a splint or tight bandage. In severe situations, operations are performed to replace the joint with an artificial prosthesis.

Traditional methods

In cases where traditional medicine is powerless, folk remedies come first. In recent years, more and more of its adherents have appeared: this is due to the fact that herbal and natural remedies act much more gently and cause fewer side effects. Traditional medicine methods have anti-inflammatory, analgesic, antiseptic, antibacterial effects, and also have a general strengthening effect.

As a rule, for the treatment of diseases of the musculoskeletal system, not individual herbs are used, but herbs, which can contain several dozen components.

Here are the most effective herbal mixtures:

Calamus root (one part);
lemon balm, pine buds and eucalyptus leaf (two parts each);
oregano, black nightshade and thyme (three parts each);
violet (four parts);
St. John's wort and hawthorn (five parts each).

Flax seeds (one part);
juniper berries, horsetail and yarrow (two parts each);
sweet clover, elecampane root, St. John's wort and lily of the valley (three parts each);
wild rosemary (four parts);
series (five parts).

Linden, mint, dill seeds (one part each);
nettle, horse sorrel, pine buds (two parts each);
chamomile, hops, St. John's wort, thyme (three parts each);
wild rosemary and violet (four parts each).

To prepare the infusion, take 2–3 tablespoons of the mixture and pour 300–400 ml of boiling water. It is advisable to take it before meals 2-3 times a day.

Of course, there are a huge number of traditional medicine methods. Here are some recipes:

• hot wax, spread in layers, quickly eliminates pain;
• burdock root ointment should be used in a bath at least twice a week;
• a product prepared from 50 g of camphor, 50 g of mustard, 100 g of egg white, 500 ml of vodka, must be rubbed into painful areas every night.

Nutritional Features

For effective treatment of diseases of the musculoskeletal system, it is important to follow a special diet. Nutrition for joint diseases has a significant impact on the structure and metabolism of connective tissue, changes the inflammatory and immune response of the body.

Depending on the specific disease, nutritional recommendations may vary significantly:

• For gout, it is necessary to limit the intake of meat and fish, increase the amount of milk, cereals and liquids.
• For osteoporosis, consumption of foods rich in calcium (dairy products, fish, seafood, some fruits) is recommended.
• For rheumatism and rheumatoid arthritis, it is necessary to pay special attention to the amino acid composition of protein foods and limit the intake of salt and carbohydrates.

If the patient is overweight, then the diet for joint diseases, among other things, should be low-calorie: in order to reduce excess body weight and reduce the load on the musculoskeletal system.

Proper balanced nutrition is an important element of both treatment and prevention of, perhaps, any disease.

Prevention measures

To prevent arthrosis, it is very useful to move more. It is advisable that these are not strength exercises, but aerobic exercises. One of the most effective methods is swimming, since in water a person’s weight is significantly reduced (and, consequently, the load on articular cartilage and ligaments), while at the same time the muscles actively work.

If you have excess body weight, then you need to say goodbye to it, since with every extra kilogram the likelihood of developing pathologies increases.

To do this, it is necessary to monitor calcium levels, and if there is a deficiency, take multivitamin and mineral complexes. You should definitely stop drinking alcohol and smoking, as these bad habits negatively affect the metabolism of bone and cartilage tissue.

Prevention of the development of infectious and inflammatory changes is carried out by eliminating the primary focus. For example, for chronic tonsillitis, treatment by an ENT specialist is indicated; if necessary, tonsil removal can be performed.

Unfortunately, in advanced cases, both traditional methods and traditional medicine are ineffective, so it is very important from a young age to make every effort to prevent diseases of the musculoskeletal system.