An inflammatory joint disease, which has periods of exacerbation and a progressive course, can appear against the background of many concomitant ailments. Doctors also identify several predisposing factors. The symptomatic picture of chronic arthritis will vary depending on the form of the course of the disease, but there are several common symptoms. Diagnosis and treatment require an integrated approach. Therapy is used medically; additionally, the immobilization of the joint for some time is indicated.
Causes
Arthritis is considered chronic if the symptoms of the disease persist for more than three months. In most cases, the development of pathology is preceded by other illnesses of the disease, which means that sluggish arthritis is a disease that develops a second time. In children and adults, joint inflammation is formed against the background of:
- hypovitaminosis, that is, a lack of one or more vitamins in the body;
- pyelonephritis - a kidney infection that is caused by various bacteria;
- various kinds of allergic reactions;
- sinusitis - inflammation of the sinuses, which occurs as a complication in acute rhinitis, flu, measles and other diseases;
- tuberculosis, that is, an acute infectious disease that causes Koch's bacillus (today tuberculosis, detected on time, is treatable);
- syphilis, which is characterized by a slow course, but in the later stages leads to severe damage to the musculoskeletal system and nervous system;
- psoriasis - a chronic dermatological disease, the symptoms of which are strongly flaky red spots on the skin;
- gonorrhea, characterized by damage to the mucous membrane of the genitourinary tract, intestines, oropharynx and conjunctiva;
- Reiter's syndrome - a complex combination of damage to joints, conjunctiva and genitourinary organs, which occurs due to an autoimmune process as a result of an infectious lesion;
- Behcet's syndrome - a recurring chronic vasculitis occurring with inflammation of the mucous membranes;
- impaired functioning of the endocrine system;
- congenital dislocation of the hip.
The list of possible causes of arthritis is very extensive. The disease can appear against the background of the pathological influence of bacteria, parasites and protozoa, systemic lupus erythematosus, gout, pathologies of the central nervous system, hepatitis C (but the development of the disease against the background of other viral lesions of the liver cannot be ruled out), polychondritis, tonsillitis.
Chronic arthritis often develops in patients who are characterized by the following predisposing factors: unfavorable heredity, excess body weight, prolonged fasting or poor nutrition, prolonged hypothermia, insect bites (when poison enters the joint cavity), and sports activities at a professional level (typical for athletes arthritis of the knee, ankle joint, fingers and wrist), alcohol abuse or prolonged smoking, hormonal imbalance (in adolescence or imaktericheskom period), severe emotional stress, lack of exercise, a constant load on one joint.
Classification
The nature of the development of chronic arthritis may vary, but most often doctors use the following terms to formulate an accurate diagnosis: inflammatory (rheumatoid) arthritis or degenerative. The latter type occurs in the presence of another disease, for example, osteoarthrosis. The basis of the pathology in this case is damage to the cartilage in the joint and joints of bones. In chronic rheumatoid arthritis, the synovial membrane lining the joints from the inside is involved in the pathological process.
There are chronic psoriatic, juvenile, gouty, traumatic, reactive, infectious, gonorrheal arthritis and osteoarthritis according to the source of the disease. Chronic juvenile arthritis is expressed in alarming symptoms for twelve weeks or more. This is a fairly rare form of the disease. Chronic juvenile arthritis occurs in children with a frequency of approximately 0.4 cases per 1000 patients. At risk are babies from two to six years old and adolescents during puberty. In girls, juvenile chronic arthritis is diagnosed more often than in boys. This is confirmed by medical statistics.
Chronic rheumatoid arthritis affects people of different ages, but most often the disease is diagnosed in patients aged 30-35 years. There are approximately two to three times more women among patients than men. In total, 0.5-2% of the population suffer from this disease, in Russia - about 0.6%, but the incidence is increasing. The causes, as a rule, are ARVI, exacerbation of infectious diseases, hypothermia or severe emotional stress.
Reactive arthritis is characterized by asymmetric damage to several joints. Most often, an infection of the genitourinary system or gastrointestinal tract precedes this. Before the appearance of pain in the joints (for a maximum of six weeks), common symptoms may appear: fever and weakness, disturbing changes in the urogenital and musculoskeletal systems, expressed respectively by atypical discharge from the urethra, painful urination, vaginitis in women and lower limb pain, discomfort in the back, difficulty walking.
Chronic gouty arthritis usually occurs after gout and in the joint where several articular attacks have been observed. It usually develops in people who are predisposed to gout, and a potential patient may not even be aware of his unfavorable heredity. If, for example, parents lead a healthy lifestyle, then the disease may not manifest itself, but it will be transmitted to the child in a latent (hidden) form. A potential patient can provoke a disease in himself if he leads a not entirely healthy lifestyle. A typical patient with this diagnosis is a complete man who abuses alcoholic beverages and consumes a lot of meat, smoked dishes, offal.
Stages of exacerbation
As the disease progresses, chronic arthritis passes through several degrees of severity. Initial usually asymptomatic. Complaints about stiffness of movements can sometimes be noted. Often the disease is diagnosed in children at this stage. Moderate is characterized by the beginning of the development of erosion on the bone. Pain, swelling and swelling in the affected area appear. A severe degree is expressed in severe deformation of the joint. Its direct function is disrupted, and the patient makes any movements with great difficulty. A complicated degree is diagnosed when irreversible changes in the bones and joints are detected.
For chronic rheumatoid arthritis, such a classification is also used. With monoarthritis, only one joint is affected, oligoarthritis is characterized by inflammation of a maximum of three joints, polyarthritis is a condition when the inflammatory process affects many joints. Most often, the pathology is localized in the knee or ankle, joints of the fingers and hands, shoulder, pelvis, the temporomandibular joint often suffers. Chronic arthritis can affect several joints at once.
Symptomatology
Each of the many varieties of arthritis has its own clinical picture. For example, juvenile chronic arthritis in children is characterized by the following symptoms:
- severe joint pain;
- slowing down the physical development of the child;
- temperature rise;
- joint deformation;
- an increase in the size of the spleen and liver;
- shortening of limbs;
- impaired functioning of the affected joint;
- skin rash in the affected area;
- visual impairment.
With rheumatoid arthritis, patients note increased sweating, severe fatigue, constant weakness, stiffness in the morning, which occurs during the day, weight loss, fever, numbness of the legs and arms, fear of bright light, chest pain when breathing, the symmetry of the inflammatory process and deformation of the fingers.
Chronic arthritis (according to ICD 10 code M12) of the gouty type is characterized by prolonged attacks of gout, quite frequent, the deformation is pronounced. Patients note manifestations of urolithiasis and other pathologies that affect the functioning of the kidneys, redness and swelling of the affected area.
With psoriatic arthritis, red spots appear in the scalp, the skin peels and itches, the fingers thicken, the joints are usually affected asymmetrically, the integrity of the nail plates may be impaired. Among the symptoms of reactive chronic arthritis can be listed constant malaise and weakness, fever, frequent headaches, the appearance of crunch in the joints, burning sensation during urination.
With arthritis of the TMJ (temporomandibular joint), pathological noises are heard, aching pain appears, which intensifies with exertion, and the cracking and clicking of the joints are distinct. The patient may complain of discomfort while chewing food. The doctor notes the retraction of the lips and the severity of the nasolabial folds, asymmetry in the direction of the affected joint and a decrease in the height of the lower part of the face. Traumatic and osteoarthritis are expressed by discomfort and crunch in the area of the damaged joint.
Diagnostic Methods
The diagnosis is confirmed by a comprehensive examination of the patient who complained of joint pain. Diagnostics includes collecting complaints, conducting a general examination, laboratory and instrumental procedures. Acute or chronic arthritis can be adequately diagnosed by a general practitioner or pediatrician (but a general practitioner will still refer the patient to a specialist to confirm a preliminary diagnosis and provide more qualified treatment), an infectious disease specialist, traumatologist, TB specialist, rheumatologist and dermatologist.
First, the specialist will study the patient’s medical history and collect a medical history (data on the presence of bad habits, heredity, diet and working conditions), and conduct a thorough examination. During the examination, joint mobility, the severity of symptoms are assessed, rheumatism tests are carried out and the severity of the disease is determined.
Among laboratory diagnostic procedures, general blood and urine tests, blood biochemistry, immunological and enzyme immunoassay are prescribed. The patient will be referred for ultrasound, CT or MRI to get a clear picture of the lesion, an x-ray in several projections, which will determine the stage of the course and the type of disease. As additional instrumental diagnostic methods, the doctor may recommend undergoing myelography, biopsy of the synovial membrane, puncture of the affected joint, arthroscopy or arthrography to assess the condition of the cartilage tissue.
Treatment tactics
Chronic arthritis of the knee joint or other localization is treated differently depending on the type and severity of the disease. Symptomatic treatment is possible only in some forms, for example, with psoriatic, purulent or gouty arthritis. In other cases, the tactics of conducting the patient is selected purely individually. Treatment usually includes the use of anti-inflammatory drugs (Diclofenac, Ibufen), short-term immobilization of the joint, the introduction of glucocorticosteroids (Dexamethasone, Prednisolone) in the form of intra-articular injections. Recommended course of therapeutic massage, physical education and exercise therapy, spa treatment, physiotherapy (balneotherapy). Orthopedic appliances are also used.
The main indications for surgical intervention are joint deformation, functional impairment, and destructive lesions. Surgical therapy involves prosthetics, arthroscopic synovectomy, arthroplasty. To support joints on an ongoing basis, the diet is enriched with dairy and sour-milk products, dietary varieties of meat, poultry or fish, nuts and cereals, fresh fruits and vegetables.
Arthritis in children
In children, arthritis can develop and worsen. Sadly, even babies can be affected. In this case, it is quite difficult to diagnose the disease, because children can not always objectively assess their condition. The child may remain silent about the pain, but become moody, stop making active movements, and begin to refuse food. Notice the swelling also does not always work. But there are signs by which arthritis can be determined in childhood. Usually the child stops making unnecessary movements, and if forced to move, he becomes active. Obvious signs of illness are lameness or stiffness in the morning.
The causes of chronic arthritis in children are many. As a rule, pathology appears due to injuries, diseases of the nervous system, metabolic disorders, adverse heredity, lack of vitamins and nutrients, and malfunctions of the immune system. The cause may be a previous infection. Effective treatment of chronic arthritis in children begins with the identification of the cause and a full examination.
Therapy can be carried out both at home and in a hospital. The treatment is long, it takes several years in severe cases, and with inadequate therapy or its complete absence, arthritis becomes a lifelong disease. Treatment includes medication, therapeutic massage and physical education, physiotherapy. It is advisable to carry out spa treatment during remission and with minimal activity. Therapy may include the use of tires to limit movement. In severe cases, surgery is needed.
Arthritis is difficult to diagnose at an early stage, but it is important to know that the sooner treatment is started, the more effective and successful it will be. You need to pay attention to the child. In case of any ailments, you should immediately consult a doctor (pediatric rheumatologist). Adequate treatment will be prescribed based on an accurate diagnosis, the age of the child and general health. This will help eliminate the symptoms, and in the best case, achieve recovery.
The most common and severe form of arthritis in children is juvenile (juvenile). This disease requires regular prevention of exacerbation and the longest treatment. Traditional drugs that are used as part of drug therapy have many side effects: gastritis, stomach ulcer, high acidity. Today there is an alternative method: treatment by administering homeopathic medicines to acupuncture points. This method of therapy has proven itself in Europe, but in Russia it is only being popularized. The introduction of homeopathy is good in that it causes a positive trend, but does not provoke the appearance of side effects, which is especially important in the treatment of children.
Possible complications
Chronic arthritis (ICD 10: M13 - other arthritis, M13.0 - polyarthritis, M13.1 - monoarthritis) can cause various consequences. Among the most common complications are kidney failure, vasculitis (a group of diseases associated with inflammation and destruction of the walls of the blood vessels), pulmonitis (inflammatory disease of the lungs), myocarditis (damage to the myocardial muscle), pericarditis, synovitis (fluid accumulation in the joint cavity), pleurisy ( inflammation of the membrane surrounding the lungs), uveitis, which can cause blindness, secondary osteoarthritis. In severe cases, complete disability and limited mobility are possible.
Forecast
If treatment of chronic arthritis is started on time, then the prognosis in most cases is favorable. The disease cannot be cured completely, but a significant duration of the period of remission can be achieved. It is necessary to strictly observe all the recommendations of the doctor, which will help to avoid exacerbation and disability of the patient. From time to time, it is recommended to undergo spa treatment, a course of massage and physiotherapy procedures.
The prognosis also depends on the general health of the patient, the severity of the disease and the presence of concomitant diseases. , . , , .
Preventive measures
In order to avoid chronic arthritis (especially with adverse heredity), it is necessary to completely abandon addictions, engage in feasible sports and eat rationally, keep body weight within normal limits, and prevent hypothermia. It is strongly recommended that early diagnosis and comprehensive treatment of all possible diseases that can cause joint damage. Several times a year, a routine examination should be performed at the district clinic or private medical center. Do not give up medical evidence due to lack of time or simple reluctance. This will help keep the joints healthy (and normal motor activity) for as long as possible.