DISEASES OF THE ORGANS OF MOTION (JOINTS AND MUSCLES) : ARTHRITIS (OSTEOARTHRITIS) DEFORMING (OSTEOARTHRITIS DEFORMANS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
It is necessary to distinguish Hesse, or actually deforming, an arthritis from deforming arthritis secondary origin as the outcome of other arthritis etiology and pathogenesis (generaly, syphilis, tuberculosis, infectious nespetsificheskie, endocrinopathies, hemarthrosis, and others).
The etiology and pathogenesis are poorly understood. And pathogenesis of essential metabolic substances encompassed by the notion of arthritis, mechanical overload and tear of the joints due to intense and prolonged physical stress or static deformations, malnutrition joint tissue (primarily cartilage) in connection with degenerative changes in the blood vessels supplying the joint. Some attach great importance to changes in the quantity and physical and chemical properties of joint fluid under the influence of adverse external, including meteorological factors. Undoubtedly importance in the development of the disease neuro-trophic component. Whereas long, for many years, throughout the process, cannot be excluded in some cases, deforming arthritis and the effect of chronic intoxications and infections as pathogenetic aspects. Deforming arthritis often become ill during the second half of life, when clearly it can be observed the influence of unfavorable factors of life (overvoltage organs of movement, the influence of the cold raw air and others).
Deforming arthritis is one of the representatives of a large group of degenerative polyarthritis, which are based on violations of the trophic joints of different etiology and pathogenesis. Anatomical changes initially are often found in cartilage: they lose their luster, become thinner, as if worn out, sometimes completely disappear, exposing the bone. Cartilage changes its structure from hyaline becomes fibrous. These degenerative changes are invariably combined with the regenerative processes in the cartilage and articular sections of bone, very different in scope and form, but usually localized in the peripheral areas of the joint. Different combinations of destructive and regenerative processes in the cartilage and joint departments bones cause a very diverse picture of deforming arthritis. Patients usually do not lose the ability to use joints and in most cases continue to fulfill its often quite difficult to joints. Therefore, deformation of joints evolves and grows: the primary deformation joints aggravated by secondary deformation, tensile joint capsules, subluxations, etc.
Arthritis deformans occurs in the form of monarthritis (often) and polyarthritis (rarely). When monetite affects large joints - knee, hip, shoulder. The disease begins gradually, imperceptibly, with little pain, embarrassment and some stiffness in the joint, which felt clearer in the morning and weaken after some period movements. Gradually the intensity and duration of these symptoms persist, the freedom of movement in the joints and the health of progressive decline. Pain aggravated by changes in the weather. In the first period of the disease, there is no objective signs of illness, except for the crunch in joints, which gradually increases and becomes rougher. In the second period with the development of regenerative processes and the formation of osteophytes and strain of joint sections of bone appear first external signs of defiguration joint, and then its deformation: the joint loses its normal shape, the protrusions and protrusion of various shapes and sizes disfigure the joint and in some degree disturb its function. Education joint mice causes when driving characteristic symptom is a loud click, and the infringement of the mouse affects the attack of sharp pain, endangered when it is reset. Changing the shape of the articular surfaces, formation of osteophytes, secondary changes in the ligaments and articular capsule, in turn, determine the static deformation and the corresponding symptoms of subluxations, the forced position of the extremities, contraction, restriction of functions. However, even with severe deforming arthritis ankylosis does not happen: In advanced stages the skin over the affected joint becomes atrophic, shiny, thin, dry; the function of sweat and sebaceous glands is reduced; pain and temperature sensitivity of the skin can also be reduced. Body temperature is usually normal. The effects of moderate anemia. From white blood no characteristic changes; ROHE normal or slightly faster. The earliest and objective signs of deforming arthritis detected on the radiograph initially in the form of narrowing of the joint space (due to destruction of the articular cartilage), in the future, in the form of various size and shape (blunt, sharp spikes, golovine razresheniya) bone growths on the free side surfaces of the epiphyses, as a rule, outside of the joint space. Focal osteoporosis or focal compaction of the bone substance in the surface layers of the spongy substance of the epiphyses although observed in soft form in some cases, deforming arthritis, but is not characteristic for them.
Recognition is made on the basis of anamnestic indications progressive sustavnoi disease, growing out of touch with any clear etiological moment, on the basis of the deformation of the joint without ankylosauria, characteristic x-ray pattern, absence of fever, changes in blood and ROE.
The prediction is determined by the characteristic property of this arthritis is a constant progression without ankylosauria. By itself, the arthritis is not life threatening, but when polyarticular form of deforming arthritis and adverse occupational and living conditions prediction may be adversely affected.
1. Possible sparing of the affected joints, various, depending on the severity and stage of the process, professional and living conditions of the patient: reducing the load on aching joints through the rationalization of labor, for backward - weight reduction, correction of static deformations (fight with flat feet, etc.), elimination of cooling.
2. Improve the trophic tissue of diseased joints: physical methods of treatment, mainly pelotherapy, hydrotartrate; mud application (42 - 46 ° 15 - 20 - 30 minutes, 3 to 4 applications per week, 15 to 20 per course); paraffin application 60º daily, 15 to 20 per course; local warm (38 - 39º) fresh or brine baths daily, 15 - 18 for the course. When polyarticular form - General freshwater or brine, hydrogen sulfide baths, 12 - 15 per course; the temperature of the fresh bath 37 - 38º, brine 37º, mos 36º, through the day, lasting 10 - 12 - 15 minutes; individual, nenarushaja gymnastics, massage of the muscles associated with diseased joints; full vitaminize food. In endocrine disorders - related drugs.
3. The removal of the most painful symptoms: pain, stiffness and limitation of function of joints using these tools physiotherapy; in severe pain - multiple UV exposures in erythema doses (exposed area 400 - 600 cm2), 2 - 4 x-ray exposure (one week interval) . When a particularly persistent and acute pain - circular novocaine blockade on Vishnevskaya on the area above the affected joint.