DISEASES OF THE ORGANS OF MOTION (JOINTS AND MUSCLES) : ARTHRITIS (OSTEOARTHRITIS) DEFORMING ENDEMIC KASHIN-BECK (OSTEOARTHRITIS DEFORMANS ENDEMICA). - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Endemic deforming osteoarthritis is one of the variants of degenerative osteoarthritis without a clearly defined etiology. Occurring almost exclusively in Transbaikalia (between the rivers Shilka and Argun and several rivers in this area) this form of osteoarthritis was first described in 1865 N. I. Kashin and originally named urowsky disease (named river Level); subsequently it has been extensively studied E. C. Beck and received the name of a disease Kashin-Beck.
The pathogenesis of arthritis is still not accurately fitted; however, its nutritional origin (the value of the power supply is defective local cereals) is the most likely. As a rule, the disease develops at the age of 8 - to 15 - 20 years. The basis of anatomical changes are violations of the trophic articular cartilage and articular sections of bone which result in parallel develop atrophic (mainly in the articular cartilage and hypertrophic processes (mainly in the bone joint parts). The pathological process is generalized in nature, symmetrically exciting few joints, most often interphalangeal joint and the elbow, knee, wrist, ankle, less hip, shoulder and vertebrae.
Symptoms emerge gradually, slowly strengthening and growing quantitatively. Initially, patients complain only of fatigue and aching pain in the joints and muscles after work (arthralgia stage of the disease). Clinically the disease is only issued in the period already pronounced deformation of the joints, which are manifested in their thickening, deformation, increasing the epiphyses and scallops; further revealed shortening of the long bones and stunted growth; when the movements in the small joints pain, mixed intra - and perivascularly crunch (surface roughness of cartilage and bone, rice bodies), some limitation of mobility due to pain or contractures. Expressed ankylosis, and effusion into the joint cavity, as a rule, is not observed. Physical labor accelerates the development described anatomical changes and can lead to the formation of subluxations, dislocations, genu valgum, pes valgus, plow vara and others (see Surgical diseases). On the radiograph marked osteoporosis of the epiphyses, the flattening at the point of maximum load with protrusion of bone substance in hand, growth, elongation of the epiphyses, scallops bones in the direction of action of attached muscles.
For. The disease is chronic, belehradska, without common manifestations, no characteristic changes of internal organs and blood. The progression of the disease, lasting many years, may be suspended when a radical change of lifestyle and nutrition, with a change of residence.
The recognition follows from the above.
The prediction is good, especially when radical lifestyle change.
The treatment is carried out on the General principles of treatment of degenerative arthritis (see Arthritis deformans). It consists of the mode of sparing of affected joints (decrease physical activity, elimination of cooling, trauma), improve circulation and trophic affected joints using a variety of local thermal procedures (paraffin, wax, mud, peat, sollux, and others), to improve the overall nutritional and circulatory (good nutrition, vitamins, when depletion of blood transfusions in small quantities - 100 - 150 - 200 ml; total thermal water baths, radon, hydrogen sulfide; when indicated - hormonal drugs). In some cases it may be useful to orthopedic shoes.