DISEASES OF THE ORGANS OF MOTION (JOINTS AND MUSCLES) : ARTHRITIS (POLYARTHRITIS) INFECTIOUS NONSPECIFIC INFEKTARTRIT (ARTHRITIS, POLYARTHRITIS INFECTIOSA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Infectious disease, probably streptococcal origin. Develops in most cases due to alopecia, often chronic focal infection (tonsillitis, sinusitis, otitis, carious teeth, periapical abscesses, Pelit, cholecystitis, bronchiectasia, adnexitis, prostatitis and other). The infection causes a change in the reactivity of the organism and its high sensitivity to a variety of influences, most of which is perceived healthy body without pathological reactions. Cooling, physical stress, fatigue, intestinal toxemia, light infection (seasonal katarr and so on) can cause disease and mistakenly be taken for the cause of the disease. These same factors in already developed the disease are very often the cause of such frequent in these arthritis exacerbations. Most recently appeared in the literature point to the value of disorders of the endocrine formula for the development of the disease (pituitary, adrenal cortex). In the most persistent and severe cases, the whole picture of the disease becomes septico-allergic in nature with very frequent and severe recurrences, remittent fever, weight loss, animeseries. Changes from joints in the acute exudative phase of the disease have bright allergic in nature and are localized mainly in the synovial membrane, capsule and periarticular tissues (synovitis serous, sero-fibrinous, arthritis, periarthritis). Articular cartilage and bone is primary in the process do not participate; they can be involved in it again due to progression of the process and organization of sero-fibrinous exudate and education of ankylosis (fibrous and bone). Are affected most often, and then symmetrically, knee, wrist, metacarpophalangeal, ankle, elbow joints. More rarely affected hip and shoulder joint and the joints of the spine.
Depending on the clinical form of infectoria or stage of the disease, its clinical picture may be different. The rapidity and intensity of the disease can distinguish between two basic forms: the form with acute onset, usually occurring in the form of acute exudative polyarthritis, a form with a slow beginning, acquiring right of chronic sluggish pace and gradually leading to ankylosauria and deformation.
The most important characteristic of this infectoria is its strong tendency to recurrence, progression and formation of ankylosis.
Along the evolution process can be divided in three main forms (or stage) of infectoria.
1. Acute exudative non-infectious polyarthritis (literary synonyms: septic, focal-septic, youth, adhesive, revocations and others) in his early and major symptoms are very similar to acute rheumatic fever. As with rheumatism, it is based on the allergic serous synovitis. Usually develops at a young age (20 - 30 years). Women get 1 ½ to 2 times more often than men. The disease begins painting acute arthritis of one or more joints, acute pain, swelling of joints due to serous or sero-fibrinous effusion into the joint cavity and zerosaqueous impregnation periarticular tissues; increase in body temperature to 38 - 39º and the skin over the affected joints. The rapid development of ametropia in the area of the affected joints. Moderate leukocytosis, nuclear shift to the left, always sharp acceleration ROHE. Common symptoms: weakness, decrease of appetite, headaches, insomnia associated with intoxication, fever and sharp pain in the joints. Severe sweating no. Salicylates do not give such a clear effect, as in rheumatoid arthritis.
On the x-ray phenomena moderate osteoporosis, widening of the joint space.
2. Pastry exudative-proliferative infectious nonspecific polyarthritis. Upon reaching the well-known maximum all of the described phenomena begin to subside and in some cases may completely disappear. However, in most cases after the first articular attacks in affected joints remains clumsiness, stiffness, minor pain, sometimes a small tumor, accelerated ROHE. Through different periods of time under the influence of the number of points (sore throat, flu, cold or other) in most cases, relapses occur. Captured the same (often) or newer (less) joints. This attack is deployed acute or somewhat milder, but is more long and sluggish and usually ends with one or other residual effects in the joints and periarticular tissues. Rich fibrin exudate is not fully absorbed and creates conditions for the formation of intra-articular adhesions; young granulation tissue with synovial membrane may extend to the cartilage and bone and lead to the formation of ankylosis; proliferative process leads to the thickening of the capsule. During this period the organization inflammatory products (second period), the joint appears to be increased, deregulirovannym, periarticular tissue and swollen capsule to be sealed, a kind of springy palpation, mobility significantly limited in the joints and periarticular tissues is the crunch. The skin over the affected joints pale, bluish-gray color, it seems maseribane, swollen, its temperature is usually slightly increased. Further atrophy of the skin increases, and the skin often looks pale, thin, glossy, parchment, with distinctly protruding veins. Periods resorption of exudate and new outbreaks are accompanied by remission, exazerbation temperature, which may from time to time, sometimes for several months and even years, to be normal or subfebrile. However, ROHE, usually much faster, which has important diagnostic value. Blood hypochromic anemia, normal number of leukocytes or small leukocytosis, increasing during exacerbations. The transformation of granulation tissue into fibrous accompanied by the development of ankylosis, subluxations, constraint functions, contractures. Bright is atrophy of the concerned muscles, progressing the faster the doctor spares aching joints and the more insistent he spends the rest mode. Subluxations and contractures in the metacarpophalangeal and interphalangeal joints often cause a characteristic brush in the form of floatingnicks walrus (the deviation of the fingers at the ulnar side). Ankylosauria in the knee, elbow, hip joints is accompanied by flexion, shoulder - bringing. On the radiograph at this stage of the disease - the narrowing of the joint space, significant osteoporosis, the veiling of the joints (fibrous ankylosis). In the comparatively rare cases described form of infectoria develop without preceding acute exudative phenomena.
3. Fibrous ankylosing infectious chronic nonspecific polyarthritis may be the final (third) stage of acute exudative polyarthritis. However, in some cases, from the beginning, he develops as a chronic slowly, gradually emerging ankylosing arthritis (literary synonyms: primary chronic progressive polyarthritis, dry arthritis, rheumatoid arthritis). This form is more common in women in menopause and generally after the age of 40 years, and therefore is the main feature of this form is a slow, almost imperceptible start, slow progression, no bright inflammatory exudative manifestations (dry arthritis), significant increases in temperature, leukocytosis, and so on, Quietly and with little pain, especially after cooling, a slight swelling of the interphalangeal and metacarpophalangeal, less wrist and other joints. The function of the joints is not broken or disturbed very little. Occasionally the swelling and pain increase, sometimes decrease, but each time increasing defigure, tightness, pain and limited mobility. Body temperature is normal or subfebrile, blood slight leukocytosis, often leukopenia. ROHE accelerated unnaturally small sign of inflammation. In the final stages of the ankylosis, subluxation, contracture, muscle atrophy and skin. On the radiograph - osteoporosis, narrowing of the joint space, sometimes uneven outlines of the epiphyses, small bone razresheniya, in some cases, signs of fibrous or bone ankylosis.
Described forms represent only the most clearly defined options infectation, between which is located the bulk of many clinical variants of the disease. In particular, called "the disease of still's" most authors imply infektartrit in children. Disease of childhood can go into youthful and more Mature and acquire basic clinical features of infectoria adults. The disease is still different from infectoria adults mainly distinct enlargement of the spleen and lymph nodes.
In the stage of acute inflammation (acute serous, sero-fibrinous arthritis) should be differentsirovat from rheumatism, from which infektartrit is more resistant inflammation, absence of heart failure (in most cases), failure of salicylic treatment, more rapid and more sustainable ROE, the rapid development of contractures or ankylosis, animeseries, coming fast muscle atrophy, more significant osteoporosis.
In subacute exudative-proliferative infectious polyarthritis have to differentsirovat with brucellosis, dysentery, generalnym polyarthritis.
Recognition is difficult in respect of deforming arthritis, which usually excludes the value of focal infection, no signs of inflammation (fever, ROHE, leukocytosis), as a rule, no ankylosis and notable limitations.
The best results provide complex pathogenetic treatment. It should include:
1) the finding of chronic infection and its reorganization, possibly radical;
2) impact on overall immunobiological reactivity of the organism;
3) the impact on the local inflammatory process in the joints;
4) functional movement therapy.
The finding of chronic infection (tonsillitis, sinusitis, carious teeth, cholecystitis, pielet and others) and sanitation are the main constituents of the treatment process.
In the acute stage bed, a comfortable position for the joints, compresses and pain ointments on the affected joints (chloroform, Ichthyol, balanoe oil, alcohol, camphor and others), piramidon 0.25 five or six times a day for 5 to 6 days. To remove the pain of symptom complex and acute inflammatory reactions - multiple UV exposures in erythema doses (5 to 8 exposures in 1 to 2 days area of 600 - 800 cm2). After the elimination of critical phenomena - sollux 1 to 2 times a day, and then more vigorous therapy (diathermy, paraffin, mud applications) daily in combination with physical therapy and massage of the affected muscles. Recently tested on a large material following treatment. In the acute or subacute stage alfasol or sulfathiazole by 4,0 - 5,0 per day, only 30 - 40 - 50, At the same time removes the source of infection. Then after 2 to 3 days after cessation of the administration of sulfonamides 5 - 8 ultraviolet irradiation in erythema doses (1 to 2 days to the affected joints and other plots of 600 - 800 cm2). On the subsidence of the inflammatory and exudative phenomena thermotherapy: first, in order to test sollux 1 - 2 times a day for several days, then more energetic therapy in the form of paraffin or mud applications (temperature paraffin 56 - 60º, dirt, 40 - 43 - 46º daily or 2 to 3, applications in succession, and then rest day; 15 to 20 applications per course). As soon as you find the favourable response to heat treatment, it is necessary to include therapeutic exercises and massage of the affected muscles. Further complicating the complexes of physical therapy, mechanotherapy, labour processes carried out persistently and systematically. As a rule, require repeated courses thermotherapy, therapeutic exercises and massage. In subacute and low current processes can successfully be applied sulfur pools (natural or artificial) first low concentrations (50 - 100 mg H2S), and then more strong (100 - 150 mg of H2S), temperature 35 - 37 ° , duration 10 - 12 minutes, a day or a bath two days in a row, then a rest day, 14 - 18 baths on the course. When often recurrent, persistent forms beyond the specified property, it is necessary to spend 2 - 3 blood transfusion in 100 to 150 ml and then apply full or reduced complexes against persistent focal infection is prescribed penicillin. When resistant, not be described treatment of acute exudative forms recommended krizanol according to the recipe of 17.5 - 35 mg per injection over 1 to 2 days, 800 - 1 200 mg per treatment course. Most recently abroad attempts to treat the arthritis endocrine drugs (cortisone and adrenocorticotropic hormone).