DISEASES OF THE ORGANS OF MOTION (JOINTS AND MUSCLES) : ARTHRITIS (POLYARTHRITIS) BRUCELLOSIS (ARTHRITIS BRUCELLOSA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Brucellar arthritis is one of the most frequent manifestations of brucellosis (see Infectious diseases). In most cases of brucellar arthritis has toxico-allergic origin that brings the clinic of the disease with clinical rheumatoid arthritis. In more rare cases, we are talking about bacterial-metastatic origin of brucellosis lesions of the locomotor apparatusrata (brucellosis spondylitis, osteomyelitis, septic arthritis).
The most frequent form of brucellosis joint injury is arthralgia (without visible changes in the joints), followed by acute Brucella arthritis synovitis with serous effusion, swelling of the joints, swelling of the periarticular tissues and sharp pain. Arthritis often combined with periarthritis, buritama, tendovaginitis, and neuralgia (e.g., intercostal), neuritis (usually the sciatic nerve, lumbar and lumbosacral radiculitis, plexitis, etc. In the connective tissue aponeurosis, joint capsules, muscles often so-called cellulite and fibrosity in the form of connective tissue nodules and infiltrates of various sizes and shapes. Much less defined brucellosis osteoarthritis and osteoperiostitis, purulent arthritis, spondyloarthropathies and osteomyelitis, localization of the lesion in the first place are the shoulder, wrist, hip, knee and ankle joints. For brucellosis was also characterized by a localization of inflammation in the sacroiliac joint (sacro-ileitis brucellosa): forced posture, increased pain with pressure on the sacroiliac joint and in trying to bring apart and fixed in this position with bent knees; a symptom of a ripe watermelon (A. Oparin) - crunch compression of the pelvis in the region of the iliac bones on both sides to the center; the widening of the joint space between the sacrum and Ilium, sometimes shadenet osteoarticular circuit on the radiograph. The lesions are often multiple, polyarticular. However, there are mono -, which are usually persistence of flow. Arthralgia and serous synovitis brucellosis origin are characterized by instability, volatility, purity flow, good outcomes that it brings together their clinical picture to that in rheumatoid arthritis. In some relatively rare cases, there is great persistence of brucellosis lesions (periarthritis of shoulder, elbow and knee bursitis, sacroileitis) and a strong tendency to relapse. Osteoarthritis and septic arthritis find great perseverance and often lead to secondary contractures and ankylosis. Special persistence differ brucellosis spondyloarthropathies (in Bendikov). The latter may be accompanied by cold abscesses and, thus, give rise to mixing them with tuberculosis spondyloarthropathies. Cellulites and fibrosity cause persistent focal pain, sometimes in combination with seals and infiltrates, giving also rise to incorrect diagnosis (for example, when they are localized in the retroperitoneal tissue).
The clinical picture of acute and subacute brucellosis arthritis (polyarthritis) has many features in common with rheumatoid arthritis, from which it can be differencirovany through the use of salicylates (ex juvantibus), the combination of arthritis with the defeat of the periarticular tissues, soft tissues of the skeleton and peripheral nervous system, as well as the absence of endocardial lesions and relatively rare lesion of the myocardium (brucellosis of cardiomyopathy, myocarditis). Crucial to the diagnosis are the main signs of brucellosis, as well as the positive reaction Wright, the data of the accelerated method agglutination of Heddleson, test for specific allergies Byrne, opsona-phagocytic index, the results are punctate and negative results of the search for tubercle bacilli and other pathogenic flora.
Prediction in most cases favorable. It is mainly determined by the status of other internal organs. Serous arthritis over, usually without clinically detectable residual phenomena. Osteoarthritis, spondyloarthropathies, especially metastatic purulent arthritis usually end ankylosaurian and contractures.
In the acute period is at rest, the physiological position of the limbs, warm immobilsarda dressing, nursing care and medical treatment.
In subacute persistent and chronic stages - diathermy, paraffin, ozokerite applications in dosages that are normal for subacute and chronic infectious arthritis. When the subsidence of the acute effects - therapeutic exercises, massage associated with the affected joints muscles. For chronic forms of brucellar arthritis recommended treatment in the balneological resorts (Saki, Evpatoria, Odessa, Pyatigorsk, Karachi, Bitter lake, Matsesta, Sergius mineral water, Belokurikha, Tskaltubo), depending on the shape and course of arthritis and in combination with lesions of other organs. Water treatments (baths), artificial hydrogen sulfide and radon baths can be used in inpatient and outpatient settings and outside of the resort. For overall stimulation - autohemotherapy (2 - 5 - 8 ml), blood transfusion (100 - 200 - 300 ml). For most acute and chronic brucellosis arthritis requires a comprehensive therapy (vaccine therapy, local heat therapy, physical treatments the overall impact is simply water, hydrogen sulfide, radon baths, autologous hemotherapy, medical gymnastics) individually in various combinations.