Knee arthritis is an inflammatory disease that affects the joint and periarticular tissues. If untreated, inflammation engulfs adjacent tissues and can spread.
In this regard, it is extremely important to carry out a differential diagnosis and make a correct diagnosis.
There are several basic forms of arthritis:
- Infectious . This form occurs when an infection is introduced through open wounds (external path) or through the blood (internal path) with an infectious disease.
- Post-traumatic . It develops as a result of chronic overload of the knee joints (hereinafter referred to as KJ), due to falls, bumps, bruises.
- Rheumatoid . It stands out as a separate item as the most dangerous form for its widespread manifestations. It is caused by the body’s autoimmune aggression as a result of a violation of protective mechanisms. In this case, antibodies (hereinafter – AT) themselves destroy the structures of the joint.
- Septic . For this form, a characteristic symptom is an acute onset and pronounced swelling of the periarticular tissues.
- Gouty . It is caused by a violation of metabolic processes in the body. As a result of these disorders, salt crystals with sharp edges (osteophytes) are formed in the bag of the KS. These growths systematically injure tissues and lead to regular inflammatory reactions and pain.
It is worthwhile to carry out the differential separately. diagnostics with arthrosis of the CS:
- both conditions are characterized by stiffness, soreness and limited function of the joint, but local hyperemia and swelling are also expressed in arthritis.
- in the case of arthritis, inflammation is the main damaging factor in the development of pathology, in the case of arthrosis, inflammation is a consequence that contributes to the development of destructive-degenerative changes (hereinafter – DDI) of bone structures.
- arthritis is a reversible condition, during the treatment of which a full restoration of the function of the joint is achieved, with arthrosis, the development of the existing changes can only be slowed down, but the pathology is prone to progression.
Causes of occurrence
Now knowing that one of the main reasons for the development of arthritis is infectious diseases, let’s talk in more detail about which organisms are destructive:
- gram-negative bacteria;
- Reiter’s disease (more often affects the hip joints, but in a fraction of cases, CS is also involved in the process);
- helminthic and protozoal invasions;
As for arthritis of a non-infectious nature, their development is due to many factors:
- DDI of cartilaginous structures (age factor).
- Injuries of varying severity and their complications.
- Inflammatory processes in tissues close to the articular capsule 4. Genetic
- Impaired calcium metabolism (eg, rickets).
- Behcet’s disease.
- Bechterew’s disease.
- Capillary toxicosis.
Arthritis disease statistics
Despite the fact that arthritis is a very common disease, collecting statistics on it is not easy. Many people ignore the symptoms of the disease, referring to the fact that such manifestations are “natural” at a certain age. In the United States, there are about 314 million people diagnosed with arthritis and about 39-42 million cases are reported during the year.
The issue of rheumatoid arthritis (hereinafter referred to as RA) is also acute. According to statistics, about 1.3 million Americans are susceptible to this disease, which is equivalent to 41 cases per 100 thousand population. Women suffer from pathology 2-3 times more often than men, and the life risk is: 3.6% for women and 1.7% for men. Worldwide, the prevalence of the disease is 0.5-1% (up to 5% among the elderly).
The symptomatology of arthritis largely depends on the underlying cause. Acute begin suddenly and, unlike chronic, are characterized by severe intoxication. A clear symptom expressed in arthritis of any etiology is pain. At the onset of the disease, it may be small, and appear during exercise.
However, there are a number of non-specific signs that are characteristic of arthritis of any genesis. Symptoms can be traced more clearly at a certain stage:
- Initial. The articular cartilage is not significantly damaged. It manifests itself in slight pain with active movements, with a slight limp. There is no limitation of mobility, and the pain goes away at rest. There is moderate swelling with unchanged skin. The temperature can reach 37.3-37.5 degrees.
- Pathological changes are more noticeable, swelling and pain increase with limited mobility. X-ray shows erosion, drying out of the hyaline cartilage with a thickening of the capsule, narrowing of its lumen. The temperature can rise to 38.5.
- Terminal. DDI of articular and bone tissues is characteristic. The inflammation leads to sustained muscle tension and subsequent muscle atrophy. X-rays show a narrowing of the joint space and overgrowth of osteophytes. The joint reacts to changes in the weather (weather dependence). The temperature rises to 39.0 and above.
Taking into account the multiplicity of causes provoking the development of arthritis, some forms were especially actively studied by doctors in order to develop an optimal diagnostic algorithm.
Juvenile arthritis (hereinafter – JA) is one of the most disabling rheumatic diseases of childhood.
Clinical blood test
- JA with systemic onset – pronounced leukocytosis (30-50 thousand) with a neutrophilic shift to the left (up to 30% of stab leukocytes). ESR increases to 50-80 mm / h, hypochromic anemia, thrombocytosis.
- Juvenile polyarthritis, JRA – hypochromic anemia, neutrophilic leukocytosis (up to 15 * 109 / l), ESR> 40 mm / h.
- Pauciarticular juvenile arthritis – usually laboratory values remain normal, but sometimes there are typical changes characteristic of JA.
Immunological and immunogenetic analysis
- JA with systemic onset – the content of CRP, IgM and IgG increases.
- Juvenile polyarthritis – sometimes positive ANF (antinuclear factor), RF is negative. Increased CRP, IgM and IgG indices.
- Pauciarticular juvenile arthritis – 80% of cases are positive for ANF, RF – negative, a high titer of HLA A2 is found.
X-ray examination of joints
Changes in bone structures are looked at by Stein-Broker.
- stage – epiphyseal osteoporosis is observed.
- stage – osteoporosis is connected with the disfiguring of the cartilage, narrowing of the joint space, single erosion.
- stage – DDI of cartilage tissue and bone, bone-cartilaginous erosions, subluxations in the joints are formed.
- stage – similar to III with the inclusion of fibrous or bone ankylosis. Reactive arthritis (hereinafter – ReA)
Patient examination scheme
- clinical blood test;
- proteinogram (total protein and protein fractions);
- CEC titer;
- immunological markers of RA;
- immunological markers of SLE – antinuclear factor, antibodies to DNA, LE cells;
- HLA typing (HLA B-27);
- diagnostics of intestinal infections and latent urinary infections (PCR, RNGA, RIF);
- X-ray of the affected joints, sacroiliac joints, spine.
With prolonged course of ReA, laboratory parameters similar to JA are always found: increased ESR, dysproteinemia, hyperimmunoglobulinemia, high CEC titer.
One of the most important diagnostic signs of ReA is seronegativeness for the immunological markers of RA and SLE.
Knee arthritis treatment
To achieve the maximum therapeutic effect, an integrated approach should be followed in the treatment of arthritis.
- NSAIDs. With their help, it is possible to stop the pain syndrome, especially at night. Among the many drugs, none has shown specific benefits, which means that any NSAID drug is suitable for use.
- Glucocorticosteroids (GCS). Usually not prescribed, only in short courses if the course of arthritis affects the activity of the CVS.
- Antibiotics In short courses (1-2 weeks) against a specific pathogen.
- Chondroprotectors. They are prescribed to restore the integrity of the articular cartilage. However, numerous studies (for example, data from 10 large studies in the British Medical Journal) show no effect even when compared with placebo!
- Hyaluronic acid An important element of cartilage tissue. It is injected into the joint cavity, creating a protective effect and preventing the joint from further damage. However, therapy does not involve stimulation of one’s own acid, therefore, it seems to be very expensive (from 30 to 250 thousand rubles annually).
Vibroacoustic therapy – is the transmission of sound micro-vibration using a special medical device. It creates such micro-vibrations that, with their physical characteristics, are identical to those that create muscle tissue at maximum static physical stress. In short, this therapy is a direct alternative to exercise.
- Improving lymph flow in the affected area, which contributes to accelerated tissue cleansing, has an anti-inflammatory effect.
- Improves blood flow and, consequently, nutrition of the treated area.
- It has a beneficial effect on the nerve pathways with prolonged exposure.
- Promotes the release of joint lubrication.
Galvanization and electrophoresis
The essence of the procedure is to activate the blood supply to the articular tissues in chronic arthritis. In the area of exposure, vasodilation occurs, enhancing blood supply, improving recovery processes.
The affected joint is exposed to a continuous or pulsed electric field. For the knees, low-thermal doses are used at a current power of 20-30 W.
The procedure is aimed at reducing swelling, activating regenerative processes in the joint, improving nutrition and blood supply. The method allows you to achieve long-term remission.
Infrared laser therapy
Using a laser applicator, they act on biologically active points located along the lateral surfaces of the knee joint.
The procedure activates blood flow, reduces pain sensitivity, and stimulates healing processes.
The method optimizes and accelerates the biochemical processes in the articular tissues, accelerates the healing process, and reduces swelling.
Hydrogen sulfide and radon baths, peloid therapy, massage, manual therapy have also proven themselves well.
Exercise therapy for arthritis
Particular attention is drawn to physiotherapy exercises in the acute period of the disease. The main goal is to improve local blood and lymph circulation, relax tense muscles, relieve pain.
Endoprosthetics for arthritis
The main indications for knee replacement for arthritis are:
- Deforming arthrosis developed as a result of chronic inflammation.
- Rheumatoid arthritis.
Most often, in these cases, total arthroplasty is performed. At the initial stages of the development of degenerative processes, the method of unicompartmental arthroplasty is used.
- The most important factor in the favorable control of the disease is the control of BMI (body mass index), due to which the axial load on the joints is reduced. You should refuse foods rich in starch and sugar (potatoes, sweets, sweet flour products). 2. It is worth adding more vegetables and fruits: apples, sea buckthorn, mountain ash, black currant, plums.
- Introduce fatty fish into the diet: tuna, salmon, cod, sardines, trout, herring.
- Rejection of bad habits.
- Taking vitamins.
- Leading a healthy lifestyle.
- Strengthening the immune system.
- Maintain an active lifestyle (preferably with regular exercise).