DISEASES OF THE ORGANS OF MOTION (JOINTS AND MUSCLES) : ARTHRITIS(POLYARTHRITIS) SYPHILIS (ARTHRITIS. POLYARTHRITIS SYPHILITICA. ARTHROLUES) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Based on syphilitic infection that causes a specific reaction - hummocky process in the synovial membrane, the epiphyseal sections of bone or articular cartilage. The defeat of the synovial membrane may be due to irritative synovitis in primary gummesson defeat epiphysis or paraartikulyarnye tissues. Depending on the preferential localization humongo process, its prevalence and the reaction of the surrounding tissue, there are various forms of syphilitic arthritis (see also Venereal disease, Syphilis).
For syphilitic diseases of the joints can be installed some of the common symptoms of the disease: high frequency of mono -, the preferential localization in the knee, elbow, ankle, shoulder, groovecruise, jaw joints; pain in fixed locations, worse at night; relatively few expressed by the restrictions of the functions of the joints on the background of their significant objective changes; circular periostitis in the vicinity of the affected joint; resistance localization and persistence during the process, the lack of a characteristic of other etiology of arthritis (rheumatism, non-infectious arthritis) distinct changes ROHE and white blood cells, the failure of treatment with salicylates and the success of specific, in particular, modestou therapy. Significant diagnostic importance, of course, history, other signs of syphilis, positive Wasserman (negative in half of the cases).
Greatest practical importance are the following forms:
1. Syphilis arthralgia (arthralgia syphilitica).
Can meet soon after syphilis infection in the second and third period. The clinical picture is characterized by pain in the joints that appears or worsens at night; objective evidence of joint damage are absent.
2. Syphilitic arthritis (synovitis) serous, sero-fibrinous (arthritis, polyarthritis syphilitica serosa, serofibrinosa).
In connection with the development humongo process in the synovial membrane and the accompanying inflammatory process in the neighboring tissues develops effusion in the joint, its swelling, pain, which often have fixed zone and amplified at night. The joint disease develops acute or subacute in the form of mono - or polyarthritis, with increasing temperature, have different height and stability. The temperature of the skin over the affected joint may also be increased, the function of joints and General condition of the patient suffer a little. At the transition of severe chronic temperature decreases, intra-articular effusion resolved, swelling of the joint and decrease pain, but clearly are fibrotic changes in the articular capsule, more and more often found periostitis, and in some cases deformation of articular sections of bone. Clinical option syphilis serous arthritis syphilis is serous arthritis, have a great resemblance with rheumatic polyarthritis. From rheumatism this form is persistent localization process, night pain intensity, less pronounced dysfunction of the joints, absence of lesions of the heart, sweating, positive effect of salicylates, as well as the characteristic rheumatism changes in white blood cells and ROE.
3. Syphilis osteoarthritis, osteochondritis (osteoarthritis, osteochondrarthritis syphilitica) - hummocky and sclerosomatidae osteochondritis with primary localization humongo process in epiphyseal departments bone, subchondral, subperiostal or in the articular cartilage. Hummocky process leads to destruction of cartilage or bone with subsequent development of circular (around the bone and gum) sclerosis of the bone, as well as circular periostitis near the affected joint. Gommone destruction of bone and circular osteosclerosis evident on the radiograph in the form of oval or round subperiosteal, Podhradie epiphyseal prosvetleni seal bones on the periphery of gum. The radiograph also shows characteristic syphilitic arthritis circular osteoperiostitis and relatively mild osteoporosis. When syphilis knee important diagnostic value gives the increase of the patella. These anatomical changes are manifested persistent pain at fixed locations (respectively localization gum), worse at night, defiguration and deformation of the joint, relatively little disturbance of its functions, as also described above, other common signs of syphilitic arthritis. Part of the synovial membrane in the process, opening the gum in the joint cavity can cause the development of mixed forms of osteoarthritis and synovitis or pietrosu with sootvetstvujushej clinical picture.
Recognition is clear from the above. Differential diagnosis should be based on the above-mentioned common for syphilitic arthritis symptoms and the exclusion of rheumatic, infectious (non-specific) and deforming arthritis.
The outcome of light and medium gravity syphilitic arthritis with timely and proper treatment can be considered quite favorable. The outcome of syphilitic arthritis with great destruction of bone and cartilage and involvement in the process of capsules, as well as the outcome of pietrosu is for the function of the joint is less certain. There may be a significant constraint functions and ankylosis. J
Treatment must be specific (see Treatment of visceral syphilis). An important and permanent place should take Popeye drugs. In the acute and subacute stage syphilitic arthritis local heat treatment in different types (mud, dry-air baths, compresses, and so on) is inappropriate. In order to stimulate useful autohemotherapy (3 - 5 - 8 ml) after 1 - 2 days, blood transfusion 100 - 150 - 200 ml In subacute and chronic forms, as well as for repeated courses protevoepilepticescoe treatment it is advisable to combine it with sulphur baths (Pyatigorsk, Matsesta, Sernovodsk and others). Massage in the acute and subacute forms is not recommended, as it can cause deterioration. As a rule, there is no need for immobilization of joints.