Knuckles red and swollen: Hand Rheumatoid Arthritis Signs and Symptoms
Hand Rheumatoid Arthritis Signs and Symptoms
The first signs and symptoms of rheumatoid arthritis (RA) may appear in the small joints of the hands. The fingers, thumbs, and wrists may be painful and swollen, with no clear cause. If left untreated, RA symptoms may become more severe over time, and certain joint deformities may develop.
Rheumatoid Arthritis Overview Video
RA symptoms are often most significant in the body’s smallest joints, such as fingers and toes.
Watch Rheumatoid Arthritis Overview Video
Hallmark Symptoms of RA in the Fingers, Thumbs, and Wrists
Recognizing the signs and symptoms of RA in the hands can help distinguish rheumatoid arthritis from other types of arthritis that affect the hand, such as osteoarthritis and psoriatic arthritis. Keep in mind that these symptoms may be accompanied by pain in other joints as well as fever, fatigue, and a general feeling of being unwell.
Swelling in the finger and wrist joints
RA triggers an inflammatory response that results in a buildup of synovial fluid as well as a thickening of joint tissue in fingers, thumbs, and wrists. The swollen joints may feel tender to the touch.
See How Do Synovial Joints Work?
In contrast to osteoarthritis and many other forms of arthritis, rheumatoid arthritis usually affects both sides of the body equally. For example, inflammation may occur in both the right and left wrists at the same time. Symmetrical inflammation can make mild hand swelling difficult to notice because there is no “normal” hand with which to make a comparison.
Difficulty making a fist
A decrease in the hand joint’s flexibility and strength may make it hard to squeeze the fingers and thumbs into a fist. The authors of one clinical study suggest that difficulty making a fist may be a predictor of developing rheumatoid arthritis.1
Pain and stiffness
People with rheumatoid arthritis often complain of localized pain in the wrists, large knuckles (metacarpophalangeal joints), and/or middle knuckles (proximal interphalangeal joints).
See How Arthritis Causes Joint Pain
Pain and stiffness are often worse in the morning or after periods of inactivity. Simple tasks, such as getting dressed, using a smartphone, or preparing food may become difficult. It may take an hour or so for joints to loosen up.
Flushing of the skin
The skin over the wrist(s) and knuckle(s) may become red and warm to the touch.
Carpal tunnel syndrome
People with rheumatoid arthritis may experience tingling and numbness in their hands and fingers. These symptoms are the result of swelling and inflammation in the carpal tunnel, a narrow channel between bones and ligaments within the wrist through which a major nerve passes.
This major nerve, called the median nerve, and its branches provide feeling to the thumb, index finger, middle finger, and half of the ring finger. When the space in the carpal tunnel decreases, the median nerve becomes squeezed, and a person may feel weakness, numbness, and/or tingling in the thumb, index, middle, and ring fingers.
Read more about Carpal Tunnel Syndrome on Sports-health.com
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Presence of rheumatoid nodules
Hard, rounded bumps made of inflammatory tissue may develop underneath the skin near the affected hand joints. These nodules are not usually painful and may shrink with the use of RA medications. Nodules can develop on fingers and wrists and frequently develop on forearms and elbows.
Malalignment of one or more finger joints
Over time, the destruction of bone and joint tissue may cause fingers and thumbs to become deformed. While the risk of hand deformities is significant, they are not inevitable.
A diagnosing physician will examine a patient’s hands, feet, and any other joints—large or small—that the patient reports as painful.
Read Are My Painful Joints Caused By Rheumatoid Arthritis (RA) or Something Else?
Hand Deformities from Rheumatoid Arthritis
Evidence suggests that hand deformities commonly occur in the first year of rheumatoid arthritis if it goes untreated.2 Moreover, people who experience hand deformities in the first year tend to have more severe cases of the disease. 3
In some cases, hand deformities can be treated. In addition, new rheumatoid arthritis medications have reduced the likelihood that rheumatoid arthritis will cause permanent deformities.
The most common finger and wrist deformities are described below.
The flexor tendons of the hand allow fingers to bend. When a flexor tendon is inflamed it is called tenosynovitis. Tenosynovitis can cause the middle knuckle to become stuck in a bent position. This condition is called trigger finger.
See Trigger Finger (Stenosing Tenosynovitis)
This hand deformity, sometimes called buttonhole deformity, occurs when the middle knuckle (PIP joint) becomes stuck in a bent position while the large knuckle (MCP joint) and outermost knuckle (DIP joint) hyperextend.
Swan’s neck deformity
Swan’s neck deformity occurs when the outermost knuckle (DIP) abnormally flexes, while the middle knuckle (PIP joint) hyperextends. This results in the finger resembling a swan’s neck.
Sometimes called duckbill or Z-thumb, hitchhiker’s thumb occurs when the thumb’s large knuckle (MCP joint) abnormally flexes while the top knuckle (IP joint) hyperextends. Some people think this abnormal bending resembles a Z-shape.
Also called ulnar drift, ulnar deviation refers to when the fingers angle away from the thumb. This deformity occurs when the large knuckles (MCP joints) are so damaged that the fingers begin to dislocate and drift sideways, toward the ulna bone in the forearm.
More than one hand deformity can develop at the same time. For example, a swan’s neck deformity can develop in a middle finger and trigger finger deformity in an index finger.
- 1.Burgers LE, Siljehult F, Ten Brinck RM, et al. Validation of the EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Rheumatology (Oxford). 2017;56(12):2123‐2128. doi: 10.1093/rheumatology/kex324
- 2.Johnsson PM, Eberhardt K. Hand deformities are important signs of disease severity in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2009;48(11):1398‐1401. doi:10.1093/rheumatology/kep253
- 3.Tubiana R, Toth B. Rheumatoid arthritis: clinical types of deformities and management. In: Wynn Parry CB, ed. Clinics in rheumatic diseases Vol. 5. Philadelphia: WB Saunders, 1984:21–47. As cited in Johnsson PM, Eberhardt K. Hand deformities are important signs of disease severity in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2009;48(11):1398‐1401. doi:10.1093/rheumatology/kep253
Pain in knuckles: Causes and treatment options
Throbbing, aching, or shooting pain in the knuckles can result from an injury or an underlying medical condition.
This article discusses four common causes of knuckle pain and their symptoms and treatments.
A knuckle is a finger joint. The knuckles are where the two phalanges, or finger bones, meet each other and where they meet the metacarpals, or hand bones.
Most people have 14 knuckles in each hand, three on each finger, and two on each thumb.
Complex networks of nerves, muscles, tendons, and ligaments allow the knuckles to move, giving rise to precise finger movements, such as typing, holding utensils, and scratching the head.
Typically, four main issues cause knuckle pain.
Injuring any of the structures that make up the knuckles can lead to knuckle pain. Types of knuckle injuries include:
- Strains: including stretched or torn muscles and tendons
- Sprains: stretched or torn ligaments
- Fractured or broken knuckles: can occur when a person punches something or falls on their hand
- Dislocated knuckle: when a phalanx, or finger bone, moves out of its original position
Learn about the differences between a strain and a sprain here.
Symptoms of a knuckle injury
The symptoms of a knuckle injury vary depending on the type and severity of the damage.
People may feel mild to severe pain in the injured knuckle or knuckles. This can feel like a dull ache or a sharp, stabbing sensation.
The pain may worsen with movement.
Symptoms of a strain or sprain near a knuckle include:
- limited flexibility
- stiffness or reduced range of motion
Symptoms of a fractured or broken knuckle include:
- limited or no range of motion
- numbness or tingling in the affected finger
- visible changes, such as swelling and discoloration
- finger appears bent at an abnormal or extreme angle
Treatments for knuckle injuries
People can treat sprains, strains, and other mild knuckle injuries with RICE therapy:
- Rest: Avoid moving or using the injured knuckle while it heals. Consider immobilizing the knuckle in a splint or brace.
- Ice: Apply an ice pack or cold compress on the injured knuckle. This will help reduce swelling and relieve pain.
- Compression: If the knuckle appears swollen, consider wrapping it with a bandage or buddy tape.
- Elevation: Keep the injured finger raised above the heart. This may help reduce swelling.
A healthcare provider can diagnose a fractured, broken, or dislocated knuckle.
They will reset broken bones or maneuver a dislocated phalanx back into place. They may recommend wearing a brace or splint while the knuckle heals.
Over-the-counter (OTC) pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can reduce swelling and pain.
Rheumatoid arthritis (RA) is an autoimmune disease that leads to inflammation in the joints. The Arthritis Foundation state that RA typically affects the joints in the hands, wrists, and knees.
According to an overview article in Medical Principles and Practice, RA initially causes painful swelling in small joints, such as the knuckles, before progressing to larger joints and organs.
Symptoms of RA in the knuckles include:
- tenderness or pain in the knuckles of one or both hands
- knuckles feel stiff, especially in the morning
- pain and stiffness occur in other joints, such as the wrists, knees, or hips
RA can lead to widespread symptoms, such as fatigue and weight loss.
The goals of RA treatment include:
A healthcare provider may recommend one or more of the following treatments for knuckle pain related to RA:
- NSAIDs, immunosuppressants, or corticosteroids to reduce inflammation and pain
- topical pain relievers
- physical therapy to improve joint mobility
- heat therapy to relax the finger muscles and promote joint lubrication
- cold therapy to reduce inflammation and pain
Osteoarthritis (OA) is the most common type of arthritis, affecting more than 32.5 million adults in the United States.
It is an age-related degenerative disease that involves cartilage loss and bone changes. OA can affect any joint in the body, including the knuckles.
OA most often affects the joints at the tip and middle of the fingers. OA can also cause swelling at the base of the thumb.
Symptoms of OA include:
- swelling in multiple knuckles
- deep, aching pain in the affected knuckles
- joint stiffness, especially in the morning
- reduced flexibility and limited range of motion in the affected knuckles
- muscle weakness near the knuckles
- a clicking or popping sound when bending the knuckles
There is no cure for OA. However, combining medication, physical therapy, and lifestyle changes, such as exercise and weight control, can help relieve OA symptoms and prevent long-term complications.
Medications for OA include:
Non-drug therapies for OA include:
- physical therapy exercises to strengthen the joints and reduce stiffness
- surgery to remove damaged cartilage, for example
A ganglion cyst is a round, fluid-filled growth that usually develops on the back of the wrist and the base of the fingers. Ganglion cysts can also appear on the knuckle closest to the tip of the finger.
Only about 10% of ganglion cysts form on joints other than the wrist.
A ganglion cyst may feel painful or tender to the touch. The pain only affects the knuckle where the cyst developed.
A ganglion cyst may resolve suddenly without medical treatment. A healthcare provider may also use a needle to drain a ganglion cyst.
A doctor may need to surgically remove a ganglion cyst if it returns or does not respond to other treatments.
Other causes of knuckle pain
Other possible causes of knuckle pain include:
A doctor or other healthcare provider can diagnose the underlying cause of knuckle pain.
They usually start the diagnosis process by examining the knuckle for signs of inflammation. They may be able to diagnose a broken or dislocated knuckle from a visual inspection alone.
A doctor can confirm a diagnosis or rule out other possible causes of knuckle pain with one or more of the following tests:
Joint aspiration is a procedure where a healthcare provider inserts a needle in the space between a joint. They use the needle to collect joint fluid, which they send to a laboratory for analysis.
Joint aspiration tests can help diagnose RA and gout.
People can treat knuckle pain at home by:
- applying hot and cold compresses to the inflamed or injured knuckle
- resting the fingers by avoiding typing, writing, and other activities that involve the hands
- taking OTC pain relief medication
- gently stretching the fingers
- reducing stress with meditation and deep breathing exercises
The following tips may help a person prevent knuckle pain:
Some causes of knuckle pain resolve with rest and at-home treatments.
However, a person may want to consider seeing a doctor if they have persistent knuckle pain that does not improve despite at-home treatments.
People should also seek medical attention if they experience:
- a potential fractured, broken, or dislocated knuckle
- new or worsening knuckle pain with no apparent cause
- pain or stiffness in other joints
- numbness or tingling in the affected finger that spreads to the hand, wrist, or arm
- visible changes to their knuckle, such as swelling or discoloration
- a painful or tender bump on a knuckle
Knuckle pain due to a minor injury will often heal without medical intervention.
Rest, ice therapy, compression, and elevation are useful methods for treating most mild injuries. A doctor can set and bind a fractured, broken, or dislocated knuckle.
Knuckle pain that persists despite at-home treatments may indicate an underlying condition, such as RA, OA, or a swollen tendon.
In these cases, knuckle pain should resolve after treating the underlying condition.
People can prevent knuckle pain by protecting their fingers and hands during recreational activities.
To help prevent overuse injuries, a person can take frequent breaks from tasks that involve repetitive finger movements, such as typing or writing.
Middle Knuckle Pain in the Finger | Causes and Treatments
Causes of pain in the middle knuckle of the finger
Any condition that causes accumulation of fluid in the tissues of your finger will cause swelling and accompanying pain. Swelling can occur throughout the body due to a variety of causes, but swelling in just one part of the finger has limited triggers. A swollen finger or painful middle knuckle may not seem serious initially, but without prompt medical follow-up and care, your symptoms could worsen.
Pain in the middle knuckle of the finger is often the result of injury and the resulting inflammatory response.
- Rheumatologic: This category includes inflammatory conditions involving the body’s tissues and joints. Conditions such as arthritis and gout cause inflammation that easily brings fluid into the tissues leading to swelling, redness, and tenderness of single fingers and often the big toe.
- Infections: The skin is home to many bacteria that can easily get into the finger via a cut, bite or other puncture. The bacteria will infect the tissues of the finger and cause entrance of fluids into the tissues that result in inflammation, swelling and other associated symptoms. Viral infections can also cause swelling of the finger in people with jobs that require exposure of the finger to body parts such as the mouth (dentists, nurses, healthcare professionals). This condition is known as herpetic whitlow.
The finger is susceptible to many outside forces that can result in pain and injury.
- Trauma: Trauma to the finger that causes pain and swelling can include simple mishaps such as jamming one’s finger on a wall or serious accidents that result in broken bones.
- Weather: Sometimes extremely cold or hot weather can trigger swelling in people with pre-existing conditions such as Raynaud’s syndrome. Observe for any patterns in your finger swelling and tell your doctor in order to investigate an underlying condition.
This list does not constitute medical advice and may not accurately represent what you have.
Non-serious finger injury
Finger injuries are very common & rarely need medical treatment.
Top Symptoms: recent finger injury, finger pain from an injury, swollen finger, severe finger pain
Symptoms that always occur with non-serious finger injury: recent finger injury
Symptoms that never occur with non-serious finger injury: bent or crooked finger
Middle knuckle finger dislocation
The middle knuckle is called the proximal interphalangeal (PIP) joint. A PIP joint dislocation occurs when trauma causes the bones of the finger to dislodge, resulting in a very painful and swollen joint.
Top Symptoms: bent or crooked finger, finger dislocation at the knuckle connected to the palm, pain in the middle knuckle of the finger, finger pain from an injury, swelling of the small knuckle of the dmiddle index finger
Symptoms that always occur with middle knuckle finger dislocation: bent or crooked finger, finger dislocation at the knuckle connected to the palm
Urgency: Primary care doctor
Arthritis is a general term for multiple conditions that cause painful inflammation and stiffness throughout the body. Rheumatoid arthritis (RA) is a chronic condition that is autoimmune in nature, meaning that the body’s immune system which normally protects the body by att..
Psoriatic arthritis is a condition which causes inflammation of the joints. In most circumstances, psoriatic arthritis presents between the ages of 30 and 50 years and occurs after the manifestation of the symptoms of psoriasis, which is a disease of the skin. Psoriatic arthritis..
What Is Dactylitis? Understanding Causes, Symptoms, and Treatments
Most types of arthritis cause swelling, but the swelling of dactylitis is something else all together. “My fingers feel like they are going to burst,” psoriatic arthritis (PsA) patient Emily Terbrock told us on Facebook. This incredibly painful, red, and hot swelling can cause fingers to look like sausages, giving dactylitis the nickname “sausage fingers.”
Dactylitis, though, can be distinguished from regular joint swelling. “Dactylitis is the swelling of an entire digit — finger or toe — rather than just a knuckle within the finger or toe,” says rheumatologist Arthur M. Mandelin II, MD, PhD, associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “Usually, the affected digit is most swollen in the middle and less swollen at the ends, taking on a cigar-shaped appearance.”
Which Types of Arthritis Does Dactylitis Occur With?
Dactylitis is associated with spondyloarthritis, which is an umbrella category of arthritis that notably causes symptoms in the spine, as well as other joints.
“Dactylitis can be associated with all of the spondyloarthropathies, including IBD-related inflammatory polyarthritis and reactive arthritis, but it’s most commonly with psoriatic arthritis,” says Mona Indrees, MD, a rheumatologist at AnMed Health in South Carolina. “Dactylitis can also be seen in other conditions such as sickle cell disease, gout, sarcoidosis, TB, and syphilis.”
These conditions can be differentiated by other clinical features and laboratory tests, says rheumatologist and researcher Dafna Gladman, MD, professor of medicine at the University of Toronto.
Because of the close connection between dactylitis and psoriatic arthritis, its presence can be used to diagnose psoriatic arthritis and distinguish it from other forms of arthritis.
“I have PsA and my first symptom was pain in my finger, which was misdiagnosed as tendinitis for months. It got to the point where my finger couldn’t bend at all, swelled twice its size, and was extremely hot,” Erin Jean Wheller told us on Facebook. “My rheumatologist took one look at me and immediately knew it was [psoriatic] arthritis.”
Other patients also told us dactylitis was one of their first PsA symptoms as well; its presence can be helpful in leading to a quick and accurate diagnosis.
What Causes Dactylitis?
“Dactylitis is caused by uncontrolled inflammation that results from spondyloarthropathies, and can be associated with flaring of the underlying joint disease,” Dr. Idrees says. “The swelling is diffuse and continuous throughout the tissue, affecting tendons, ligaments, synovium — the space that contains the joints and joint capsule — and adjacent soft tissue.” (Here’s more information about synovitis.)
In terms of why there’s such a strong association between dactylitis and psoriatic arthritis, there’s still no definitive answer, but Dr. Mandelin has some ideas. “It isn’t clear why dactylitis happens, but it is likely that its origin is related to the fact that patients with psoriatic arthritis have a tendency to develop inflammation of tendons and the surrounding tendon sheaths in addition to inflammation of the actual joints,” he says.
What Does Dactylitis Feel Like?
Dr. Idrees says the condition is often painful and can also severely limit functionality. The patients we heard from bore this out, describing incredible pain from their hands touching anything at all; a heavy, hot feeling; and not being able to bend or use their fingers.
“When it happens it starts out as a tightness, and eventually gets to the point where the skin is stretched so tight that it becomes itchy,” Lyin Despres described on Facebook. “Each movement of the affected finger is excruciating. It feels as though the nerves are being compressed by the swelling and if you move you will be tortured. You can’t get dressed or undressed, eat, use the bathroom, or do much of anything unassisted when this happens to both hands at the same time.”
Does Dactylitis Signal Worsening Disease?
Unfortunately, the presence of dactylitis often denotes more severe disease, Dr. Gladman says. “Digits with dactylitis are more likely to have damage than those without dactylitis,” she says. Dr. Mandelin says it’s important to note, though, that this is just an increased risk, and not a guaranteed outcome. “The take-away message is that patients with dactylitis should probably be watched more closely and have their disease controlled more tightly in order to try to counteract this risk,” he says.
How Is Dactylitis Medically Treated?
Many patients we heard from said once they were diagnosed and found the right medicines for them, their dactylitis subsided. “I have had dactylitis in my fingers and a toe,” Joan Wzontek Alba told us on Facebook. “Now I’m on biologics and haven’t had a sausage finger since I found one that works.”
All three doctors we talked with agreed that biologics are more effective in treating dactylitis than conventional disease-modifying antirheumatic drugs (DMARDs).
“Even if joint disease responds to traditional DMARDS, dactylitis can be resistant, and at that point we may add a biologic,” Dr. Idrees says. “Research so far shows the most effective control of dactylitis comes from the use of biologics, including TNF inhibitors and some of the newer agents like ustekinumab and secukinumab, but one has to weigh the risks versus benefits.”
In addition to biologics, Dr. Mandelin advises patients with dactylitis to strongly consider “the new small-molecule JAK inhibitor agents, as these are clearly more effective against dactylitis than traditional DMARDs such as methotrexate.”
Here are a few more medical tips on treating dactylitis:
- Talk with your doctor to see which medication is right for your symptoms—and make sure you adhere to your medication regimen, Dr. Idrees says.
- If you have psoriatic arthritis, Dr. Mandelin advises to make sure you’re seeing a rheumatologist and a dermatologist, as the disease is complicated and needs to be addressed from all sides. “Psoriatic arthritis is more complex than many other forms of arthritis, and can affect the body in several unusual ways that aren’t always a concern with other forms of arthritis — dactylitis is only one such example,” he says.
- Let your doctor know right away if you experience dactylitis. “It is important to treat dactylitis immediately so that it does not become a chronic problem,” Dr. Gladman advises.
Home Remedies for Dactylitis
In addition to medical treatments, some patients we heard from had suggestions for treating dactylitis at home. Talk to your doctor before trying home remedies.
- Use cold packs or soak hands in cold water.
- Wear compression gloves, or finger sleeves like volleyball and basketball players use.
- Try warm paraffin wax, icy hot, or other warming treatments.
- Keep fingers moving with crochet or knitting, a stress ball, or even just flex and release.
- Do regular range-of-motion exercises for fingers and toes.
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Swollen Finger – Swelling Fingers
A swollen finger can be due to injury or trauma, infection, inflammatory conditions, and other abnormal processes. In some cases, a swollen finger is a symptom of a serious condition that should be immediately evaluated in an emergency setting, such as a broken bone or bacterial infection.
Injury-related causes of a swollen finger or fingers
Finger swelling can be caused by the following conditions:
Degenerative, infectious, inflammatory and autoimmune causes of a swollen finger or fingers
A swollen finger can be associated with inflammatory, infectious and autoimmune conditions including:
Bursitis (inflammation of a bursa sac that protects and cushions joints)
Carpal tunnel syndrome (pressure on the nerve that travels through the wrist)
Cellulitis (bacterial skin infection)
Ganglion cyst (growth or swelling on top of joint or tendon)
Infection, such as Streptococcus aureus bacterial infection
Paronychia (infection around the nail)
Rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)
Septic arthritis (infectious arthritis)
Questions for diagnosing the cause of a swollen finger or fingers
To help diagnose the underlying cause of a swollen finger or fingers, your licensed health care practitioner will ask you several questions related to your symptoms. Questions asked during your examination generally include:
How many fingers are swollen?
Is the whole finger(s) swollen or just a portion of the finger(s)?
When did the finger swelling start?
How long has the finger swelling lasted? Does it come and go?
Have you had any recent infections or injuries to the affected finger(s)?
Do you have pain or any other symptoms?
What are the potential complications of a swollen finger?
Complications associated with a swollen finger can be progressive and vary depending on the underlying cause. Because swelling can be due to a serious infection or other disease, failure to seek treatment can result in complications and permanent damage. It is important to visit your health care provider when you experience any kind of persistent swelling, pain, or other unusual symptoms related to your fingers or hands. Once the underlying cause is diagnosed, you should follow the treatment plan you and your health care provider design specifically for you to lower your risk of potential complications including:
What Causes Knuckle Pain? | Why Do My Knuckles Hurt?
Pain in your knuckle can arise from a number of different causes. Knuckle pain may develop as a result of conditions affecting any of the structures in the knuckle, including skin, nerves, muscles, joints, tendons, bones, ligaments, blood vessels, and connective tissue. Injury from trauma and osteoarthritis are common causes of knuckle pain.
You might describe your knuckle pain as sharp, stabbing, dull or throbbing. Your knuckle pain may be mild to severe in intensity and occur only at certain times of day or when you perform certain activities. Moving your knuckle or joints near it may either worsen or relieve the pain. With severe pain related to traumatic injuries, it may be impossible to move the affected knuckle at all.
In some cases, knuckle pain due to injury is localized to only one knuckle. In many cases, several knuckles may be affected. Inflammation within the knuckle causes swelling and pain. Further, rheumatoid arthritis, a chronic autoimmune disease characterized by joint inflammation, and other arthritis-related conditions are associated with knuckle pain, again due to inflammation and swelling.
Knuckle pain may be recent in origin (acute) or may develop over time (chronic). In some situations, knuckle pain can occur as a result of chronic medical conditions you may have that affects your entire body, such as arthritis, vascular disease, or diabetes).
Although life-threatening complications of knuckle pain are rare, seek immediate medical care (call 911) if you have injuries that involve profuse bleeding or tissue damage. In rare cases, infections of the bone (osteomyelitis) or skin and soft tissues (cellulitis) of the knuckle can spread throughout the body, resulting in shock and organ failure. Another rare but potentially life-threatening cause of knuckle pain is cancer of the bones or soft tissues.
If your knuckle injury or condition is persistent, recurrent, or causes you concern, seek prompt medical care.
Finger Arthritis: Signs, Symptoms, and Treatment
Our fingers are important! We use them from the moment we wake up to brush our teeth, from the emails we send, to the cooking we do every day. When our fingers don’t work the way we want them to, everyday tasks become difficult and painful. So what can we do when our finger joints begin to fail?
Illustration by Cindy Chung, Verywell
Types of Finger Arthritis
There are three types of arthritis that commonly affect the fingers:
- Osteoarthritis: Osteoarthritis, also called wear-and-tear arthritis, is the most common type of finger arthritis. In people with osteoarthritis, the normal cartilage is steadily worn away, exposing bare bone at the joints. The most frequently affected joints in the hand are the knuckles of the mid-finger and fingertip (the PIP and DIP joints) and the joint at the base of the thumb.
- Rheumatoid arthritis: Rheumatoid arthritis causes a different type of joint destruction. Rheumatoid arthritis is a systemic autoimmune condition that can cause a number of problems. Among these, rheumatoid arthritis can cause inflammation of the soft-tissue surrounding joints. The most commonly affected joints in the hand are the knuckles at the base of the fingers (the MCP joints).
- Gout: Gout is a condition that occurs when crystals develop within the joints of your body. These crystals form as a result of the body not properly metabolizing a substance called uric acid. When uric acid accumulates, these crystals can form in one or more joints. While the big toe is the most commonly affected part of the body, finger joints can also be involved.
Other types of arthritis can also cause problems in the finger joints, but the vast majority of people with finger arthritis have one of the aforementioned problems.
Finger Arthritis Symptoms
Symptoms of finger arthritis include:
Patients with osteoarthritis often develop lumps or nodules around the knuckles of the fingers. These lumps are called Heberden’s nodes (when around the more distant knuckle) or Bouchard’s nodes (when around the closer knuckle) and actually consist of bone spurs around the joints.
These knuckles often become enlarged, swollen, and stiff. People often complain that their rings do not fit or can’t be removed.
Patients with rheumatoid arthritis often have the aforementioned symptoms, but can also have more complex deformities of the hands. The fingers may begin to shift from their normal position and drift away from the thumb.
A joint is the part of your body where two bones come together. Arthritis is a problem that causes damage to the normally smooth joint surfaces. These junctions have special surfaces to allow smooth movement between the adjoining bones.
This smooth surface is cartilage, and when the cartilage is damaged, arthritis is the condition that results. When our fingers can’t bend and move like we expect, all of those activities become difficult.
Early treatments of finger arthritis are focused on managing the symptoms in an effort to avoid surgery. Treatment options include:
- Anti-Inflammatory medications: These medications can help treat the pain of finger arthritis, and also help decrease inflammation and swelling around the joints. While you should always check with your doctor before starting any new medication, these are often prescribed for joint pains in the fingers.
- Joint supplements: Joint supplements consist of glucosamine and chondroitin, two of the major building blocks of normal cartilage. These supplements are very safe to use, although the clinical data to support their use is weak. That said, many people can find them helpful.
- Cortisone injections: Cortisone is a more powerful anti-inflammatory medication and can be useful in limited applications in the hand. While cortisone injections are generally not good to perform frequently, an occasional shot may help calm a flare of arthritis.
- Hand therapy: Hand therapy, usually performed by an occupational therapist, is helpful to maintain motion and prevent stiffening of the joints.
- Ice and heat treatment: Joint stiffness and range of motion can be improved by ice and heat treatments. Most people with finger arthritis find warming the hands with a warm washcloth or under moderately hot water is most helpful at relieving the stiffness of arthritic fingers.
- Splints: Splinting helps to relax and rest the joints. Splinting should be done for limited periods of time to allow for relief without allowing the joint to stiffen.
If these treatments fail, then surgery may be necessary. In the fingers, several procedures may be done, including removing the bone spurs, fusing the joint, and replacing the joint.
The most common surgery is a finger joint fusion. This procedure holds the joint in a fixed position to prevent any further motion at the affected joint. While the joint is then stiff forever, the pain is usually alleviated. Furthermore, during finger joint fusion surgery, your doctor can straighten any deformity and remove bone spurs.
Finger joint replacement can be a very effective procedure in some individuals. People who have an artificial finger joint can maintain mobility of the joint without the pain of arthritis. Furthermore, the same deformities and bone spurs can be addressed during this surgical procedure.
In general, finger joint replacement is only considered in more sedentary or elderly individuals, as they are not designed for strenuous activity or heavy labor. The implants, which may be made of metal, plastic, ceramic, or a combination of materials, can wear out over time and need to be protected from too much activity.
90,000 Rheumatoid arthritis of the legs: treatment and symptoms
Rheumatoid arthritis is a systemic rheumatic disease that can lead to chronic inflammation and severe irreversible erosive and destructive damage to the joints, as well as damage to internal organs.
Rheumatoid arthritis has a autoimmune origin, that is, in essence, it is an inadequate response of the body to any irritating factors, when immune cells (lymphocytes) perceive the body’s own cells as foreign and attack them.
The disease is characterized by chronic synovitis (erosive inflammation of the joints), as a result of which connective tissue and other articular elements are destroyed. Usually, the synovial membranes of the small joints of the toes are initially affected.
Rheumatoid arthritis can occur in patients of different ages (usually 30+, although children also get sick). At the same time, it is noted that women suffer from rheumatoid arthritis almost 5 times more often, although they tolerate it somewhat easier than the male sex.In the absence of adequate therapy, there is a high risk of disability in patients in the first 5 years of illness.
The etiology of rheumatoid arthritis is not fully understood, but researchers believe that hereditary predisposition is often decisive. At the same time, the pathological process is infectious in nature and affects an increase in ESR and the number of leukocytes, which is associated with the introduction of infectious agents into the body that provoke a failure of immunity, and creates immune complexes of antibodies that accumulate in the joint area, causing the disease.
It was revealed that, as a rule, the onset of rheumatoid arthritis in almost half of the cases is preceded by influenza, tonsillitis or other acute respiratory diseases, as well as hypothermia, trauma, stress, hormonal changes and other negative provocative factors.
Rheumatoid arthritis of the legs is extremely dangerous not only with the loss of motor functions, but also with the risk of death due to complications, including renal failure. This is a really insidious disease, as it can almost asymptomatically destroy the body for many months until it manifests itself in full force, when the treatment is no longer so effective.Therefore, it is vitally important to begin examination and high-quality treatment of joints from the first signs of the disease, without waiting for the progression of leg arthritis.
Rheumatoid arthritis of the legs – symptoms
It is difficult to confuse rheumatoid arthritis of the legs with any other disease, since it has a rather peculiar and pronounced symptomatic picture. Main symptoms:
- Pain in the joints of the legs. More often the pain bothers the patient in the first half of the day, then it can disappear and reappear at night, gradually increasing by the morning
- Morning stiffness in the joints, reminiscent of the “clenching” of the legs with tight boots.When a person “walks”, the stiffness is weakened or disappears altogether.
- Swelling, swelling, redness in the leg, at the site of inflammation and deformity.
- Muscle stiffness and limited movement of the leg joints.
- The lesion of the joints of the legs, as a rule, is symmetrical. The fingertips are painful to pressure.
- Arthritis of the legs usually starts from the small joints of the fingers, as the disease progresses, the inflammation moves to the large joints – the knee joint, ankle).Sometimes the opposite happens – rheumatoid arthritis begins in large joints, and with the development of the disease, arthritis affects the toes (in elderly patients).
- The so-called rheumatoid nodules about the size of a pea are found in the place of the bends of the leg in rheumatoid arthritis. They can grow or shrink, disappear and reappear. They are visible through the skin, the patient is not disturbed, there is no pain.
- Rheumatoid arthritis is accompanied by signs of general intoxication of the body.The patient experiences loss of energy, weakness, fatigue, and poor appetite for a long time. Body temperature can jump, lymph nodes – increase. The patient often loses pounds. In general, feeling unwell often resembles the flu.
- With the gradual progression of arthritis, persistent deformation of the joints of the legs, including the foot, occurs. In the legs, blood circulation worsens, the connection of the nerves with the central nervous system is weakened, the skin becomes pale, the muscles of the legs can atrophy.
- In young children, attention should be paid to limping, irritability, tearfulness, refusal to eat. All of this may be indicative of arthritis affecting the legs. Arthritis treatment should be started immediately. But it must be preceded by a professional diagnosis of rheumatoid arthritis.
Diagnosis of rheumatoid arthritis and its methods
The difference between rheumatoid arthritis and other types of arthritis is that it is a systemic disease that affects not only the musculoskeletal system, but also other organs.Often, the variety of manifestations of rheumatoid arthritis and the absence of specific signs at the initial stage of the disease complicate the diagnosis.
A vivid clinical picture of rheumatoid arthritis of the legs sometimes becomes visible only after 1-2 years after the onset of the disease. At the same time, an experienced specialist will definitely consider the patient’s condition in a comprehensive manner and draw the right conclusions in order to start treatment for rheumatoid arthritis of the legs as early as possible, when the chances of a successful result are incomparably higher.
What diagnostic criteria does the doctor pay attention to?
- Prolonged morning stiffness in the legs. About an hour after getting out of bed with rheumatoid arthritis, the legs feel awkward and mobility is impaired.
- As a rule, rheumatoid arthritis affects the joints of both legs, that is, it manifests itself symmetrically. This is a distinctive feature of the rheumatoid form of joint inflammation.
- The inflammatory process covers more than three groups of joints.More often the small joints become inflamed and begin to hurt – that is, the toes, then the inflammation spreads and rises to the large joints of the legs: ankle, knees. In some cases, arthritis can immediately affect large joints.
- The presence of symptoms of reactive inflammation: pain in the joints of the legs, swelling, swelling of soft tissues near the diseased joint, redness. In the bone tissue, during the research, pathological changes are found, in the cavity of large joints – the accumulation of fluid (exudate).
- In the place of flexion-extension of the joints, rheumatoid nodules are objectively visible – bumps, seals characteristic of rheumatoid arthritis of the legs and other joints.
- Biochemical, immunological, general blood test. It may show anemia (it is noted that the amount of iron in the bone tissue, on the contrary, increases), increased ESR (ESR), indicating an inflammatory process. In addition, if rheumatoid arthritis is suspected, the level of leukocytes, platelets, fibrinogen, seromucoid, cryoglobulins, the presence and activity of C-reactive protein is determined.
- A blood test for rheumatoid factor is positive. A blood sample is taken from a vein. At the same time, a positive rheumatoid test can also be detected in other diseases: heart, liver and others. Also, a negative result does not prove one hundred percent absence of the disease – for example, at the initial stage, rheumatoid arthritis can flow imperceptibly, without showing a clinical picture. At one point, the condition with arthritis can deteriorate sharply, and then the rheumatoid factor becomes positive.Therefore, the analysis cannot be the only basis for the diagnosis of rheumatoid arthritis; a comprehensive check is required.
- X-ray shows osteoporosis (porosity) and bone erosion, which indicates the correct diagnosis of rheumatoid arthritis of the legs.
- Arthroscopy helps to detect uneven changes in the elements of the joint in arthritis, to see the growth of the synovium and to reveal the extent of narrowing of the joint space. The procedure removes pathological joint fluid, which contains particles of cartilage tissue, film and fibrin (adhesion-forming protein).
- MRI of the joints of the legs with arthritis (magnetic resonance imaging) makes it possible to accurately diagnose rheumatoid arthritis of the legs at an early stage.
- ACCP is a specific laboratory and clinical marker of rheumatoid arthritis, including legs. Recognized as a reliable and accurate indicator. It is the detection in the blood of antibodies to cyclic citrulinated polypeptide (CCP), which is involved in maintaining the healthy state of joint tissues. If there is a failure in the immune system, the body begins to treat the CCP as a foreign dangerous element and urgently produces special antibodies to combat it, in fact, acting against itself, it is not without reason that the disease is classified as autoimmune.Antibodies to CCP are found even at the earliest stage of arthritis and even in rheumatoid factor negative patients. Perhaps this is the most important and most informative criterion for diagnosing rheumatoid arthritis of the joints of the legs.
The patient does not have to have all these signs of arthritis, four are enough for the doctor to suggest rheumatoid arthritis of the joints of the legs. In this case, these symptoms should be present for at least 6 weeks. Further, the doctor prescribes additional laboratory tests, instrumental examinations, consultations of other specialists – a pulmonologist, a cardiologist, a gastroenterologist.And only after a comprehensive examination for arthritis and the identification of symptoms, the diagnosis can be made definitively.
If rheumatoid arthritis is chronic, then it is not possible to completely cure it. This means that all your life you will have to carry out many appointments, periodically undergo therapeutic courses with medicines and physiotherapeutic agents, and lead a healthy lifestyle.If the diagnosis is confirmed, you need to be patient and clearly tune in to conscientious and regular treatment of arthritis and adherence to recommendations. A properly designed joint treatment program will reduce the intensity of pain in the legs, reduce inflammation, and improve mobility. In this case, the main goal is to bring rheumatoid arthritis of the legs into a state of stable and long-term remission.
In no case should arthritis treatment be uncontrolled – the consequences can be too severe and unpredictable.Constant supervision of the attending physician is necessary!
Rheumatoid arthritis requires a comprehensive multi-component treatment approach. The key elements of arthritis therapy are medications of various groups – anti-inflammatory, cytostatics. Physiotherapy is also of great importance. Physical therapy and massage of a sore leg have effective properties for arthritis.
If arthritis is in an extremely neglected state, destruction and deformations are catastrophic, then conservative treatment seems ineffective and a choice can be made in favor of surgery and replacement of the joint with a prosthesis.
NSAIDs – non-steroidal anti-inflammatory drugs. They are aimed at eliminating inflammation, relieve pain well, but do not eliminate the causes of arthritis. These are symptomatic drugs that are dangerous to abuse. Long-term use can cause side problems not only with the joints. The dosage prescribed by the specialist should be strictly observed. Attention: drugs of the NSAID group are not compatible with each other! You cannot take multiple funds at once!
Basic drugs – drugs that help a patient with arthritis to lead a relatively normal existence, to establish vital functions, reducing the pathological manifestations of joint disease – inflammation, pain syndrome, restoring the affected areas of the joint to integrity and slowing down destruction.
Biological group drugs (biological response modifiers in the form of injections). They reduce the degree of inflammation, act quickly, usually the result is visible after 2 weeks to a month. Their disadvantage is that they can suppress the immune system and, unfortunately, are very expensive. Their treatment is prescribed in case of ineffectiveness or intolerance of the basic funds.
Glucocorticoid hormones. Possesses a powerful anti-inflammatory effect against arthritis.They quickly return to working capacity and eliminate the symptoms of rheumatoid arthritis of the legs: pain, joint stiffness, swelling in the leg, swelling. They are used as a last resort when the patient has practically lost his motor abilities and he is very unwell. They are taken for a short time, in order to switch back to safer, long-term drugs with a slower cumulative effect. Long-term intake of glucocorticoids is fraught with versatile side harm: osteoporosis, cataracts, weight gain, and a decrease in the body’s immune forces.
Analgesics. They have an analgesic and anti-inflammatory effect in arthritis. Basically, non-narcotic drugs (tablets, injections, ointments) are prescribed, but in exceptional cases they resort to narcotic drugs – urgently, one-time, under strict medical supervision, so that dependence does not form.
Physiotherapy for arthritis
With rheumatoid arthritis of the legs, physiotherapy procedures must be included in the joint treatment plan.Treating joints with physiotherapy is simple and safe. Depending on the characteristics of the course of the disease, the specialist prescribes treatment methods from the following list:
- magnetic therapy,
- laser therapy,
- mud therapy,
Electrophoresis is used in the treatment of direct current as a conductor of medicinal substances (for example, novocaine, prednisolone) deep into the joint.The method helps to eliminate pain in the legs, reduce swelling around the joint, activate blood circulation and lymph circulation, accelerate the outflow of decay products, helps in the resorption of accumulated exudate, enhances the absorption of drugs, useful elements.
Magnetotherapy – treatment with a magnetic field, a popular and affordable method of physiotherapy for leg arthritis with a minimum of contraindications. It is widely applicable not only in clinical, but also at home due to portable devices based on a magnetic field.Treatment with magnetic impulse fields stimulates blood flow and metabolic processes in the joints, dilates blood vessels in the legs, helps deliver nutrition, oxygen and drugs to the joint, remove harmful metabolites, remove unpleasant symptoms, and promotes remission and recovery.
Laser therapy has a regenerating effect, improves local immunity and relieves inflammation in the joint area. Forbidden in diabetes.
UHF – the effect of an ultra-high-frequency electromagnetic field on a sore joint.During treatment, it helps in relieving pain, edema, inflammation in arthritis, and normalizes vascular permeability.
Ultrasound relieves inflammation, redness, swelling, joint pain. Affects the regeneration of damaged tissues. Strengthens blood circulation. Helps to expand the range of motion in the leg joint.
Ultraviolet . Radiation helps to reduce pain and inflammation, actively helps in the synthesis of vitamin D, which is important for bone and joint balance.
Massage. Significantly stimulates local blood circulation in the joint in case of arthritis, relieves muscle tension, participates in the establishment of metabolism, prevents adhesions, ankylosis. It is allowed only during the period of remission, when there is no inflammation!
Treatment with mud. This is a type of heating, in which bioactive substances contained in therapeutic mud are delivered to the affected area. The procedure is capable of providing anti-pain, anti-inflammatory and restorative effects in case of joint diseases.
Balneotherapy. Healing baths (iodine-bromine, radon, coniferous) improve overall health, promote recovery processes in rheumatoid arthritis of the legs, promote the fastest recovery of joint tissues, remove toxic substances from the joint area, improve blood circulation and joint mobility.
Any chronic joint disease, including rheumatoid arthritis of the legs, requires a serious revision and adjustment of the lifestyle – activity, nutrition, behavior.
Of course, quitting bad habits (taking alcohol and smoking) should happen by default. In addition, you should stop drinking coffee and switch to a special dietary diet, which means giving up fatty meat, potatoes, citrus fruits, and a number of cereals. It is desirable to increase the amount of fermented milk products and carotene-containing products (carrots, pumpkin).
These are the primary general recommendations for food intake for arthritis, and more detailed rules will be set by the attending physician, who will take into account all the nuances of the course of joint disease, concomitant diagnoses, age and other characteristics of a particular patient.
It is important to reduce the stress on the sore joints of the legs, which will require weight loss. Both diet and balanced, carefully selected exercise will help in this.
A correct lifestyle and adherence to all medical prescriptions for complex treatment of leg joints are designed to help avoid the rapid progression and complications of rheumatoid arthritis and enable the patient to maintain an acceptable quality of life.But treating rheumatoid arthritis will take a long time and hard.
Follow all the recommendations of the attending physician and be healthy!
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90,000 Arthritis: Causes, Symptoms and Treatment | Health Blog
Pain during movement can be caused by a wide variety of diseases. The reason may be trauma, nerve diseases, tumors, congenital structural anomalies. A common culprit for pain in adults is arthritis, an inflammation of the joints.
What is arthritis?
This name is understood as a whole group of diseases in which inflammation spreads to all parts of the joint. The disease can occur in one joint or in several, with acute pain or in a chronic form, as well as provoke tissue destruction.
The disease has two classifications. By involvement:
- monoarthritis – inflammation occurs in only one joint;
- polyarthritis covers several joints at once (the same on both sides or random in different parts of the body).
- Acute – begins suddenly and is accompanied by severe pain;
- Chronic – develops rather slowly, may appear after an acute form with insufficient treatment.
There is also an international rheumatological classification, in which the following types of arthritis are distinguished:
- infectious – with the development of the disease after infection;
- dystrophic – caused by the destruction of joints and bones;
- traumatic – after mechanical damage to the joint;
- associated with other diseases of the organism – can be caused by tumors, diseases of the digestive tract and others.
Symptoms of arthritis. How to distinguish one species from another?
Despite the various manifestations, some symptoms of arthritis always appear. Regardless of what caused the disease, the patient observes:
- edema and swelling around the affected joint,
- redness of the skin and an increase in its temperature,
- limitation of movement in the joint, accompanied by crunching and pain.
In addition, there are symptoms that can be used to distinguish types of arthritis from each other.They depend on the cause and nature of the course:
- with chronic arthritis deformity of diseased joints begins;
- infectious arthritis is accompanied by fever, chills, weakness and headache;
- dystrophic arthritis develops slowly, joint pain gradually increases. It can spread not only to the limbs, but also to the spine;
- traumatic arthritis is similar in symptoms to dystrophic arthritis, but its development is preceded by serious injury or constant stress on the joint;
- In case of arthritis caused by allergies, tumors, disorders of the gastrointestinal tract, all the symptoms that caused the disease will be observed.
If, in addition to the listed symptoms, there are tears of muscles and tendons, as well as numbness of the extremities, the disease has started and complications have begun that require immediate treatment.
Causes of the disease
Some causes of arthritis lie in poor lifestyle choices:
- insufficient amount of nutrients and vitamins,
- unbalanced diet,
- alcohol consumption,
- stress on joints.
Others are more serious and are unlikely to be avoided with routine prophylaxis:
- bacterial, fungal, viral infections;
- constant interaction with allergens;
- joint injuries;
- diseases of the nervous and immune systems;
- metabolic disorders;
- endocrine gland pathology;
- hereditary predisposition;
- some diseases: gout, gonorrhea, tuberculosis.
Women suffer from arthritis more often than men.Constant stress, past illnesses and surgical interventions often provoke the first attacks of arthritis. Also, the risk of getting sick increases with age.
What does the diagnosis of arthritis include?
Arthritis manifests itself very clearly – even a layman will notice it. To accurately determine the causes of the disease, after a visual examination, the doctor may prescribe the following procedures:
- general analysis of blood and urine will show the presence of infections and the degree of inflammatory processes;
- analysis of synovial fluid – it can be used to determine the presence of inflammatory and septic processes;
- arthroscopy – endoscopic insertion of a sensor into the articular cavity for visual examination;
- Ultrasound of the joints will help determine the extent of the lesion and detect the main areas of the disease;
- X-ray of the joint and limb will show the condition of the bones and joints, reveal the changes caused by arthritis;
- Computed tomography of the joint is one of the best tools for assessing the condition of bones and joints;
- Magnetic resonance imaging will help examine the condition of the bones and joints, as well as the surrounding tissues.
If arthritis is accompanied by abdominal discomfort, headaches, weakness – be sure to tell your doctor about it. This may indicate a serious illness in which joint inflammation is just one of the symptoms.
How is the treatment going?
Therapy includes getting rid of the pain syndrome, eliminating the cause of the disease and restoring the diseased joint.
- the doctor can prescribe painkillers and anti-inflammatory drugs,
- in advanced cases, they perform operations to restore destroyed joints,
- physiotherapy procedures have proven themselves well: massage, ultrasound therapy, laser therapy,
- many patients are advised to do light gymnastics: it should be developed by a doctor Exercise therapy taking into account the course of the disease.
Arthritis treatment cannot be complete without lifestyle changes: pay attention to the quality of your diet, avoid weight gain, and avoid alcohol and high amounts of salt.
If you start therapy in the initial stages, the disease can be easily treated. The most important thing is to pay attention to all changes in the body in order to consult a doctor in time and prevent the development of complications.
90,000 types, stages, symptoms and signs
Healthy joints are a luxury that is difficult to appreciate for someone who has never had pain when walking or has difficulty raising an arm or leg, turning around or sitting down.Meanwhile, millions of people around the world each year seek help from orthopedic surgeons with similar complaints.
Epidemiology of joint diseases
About 30% of people sooner or later encounter joint pathology: even if in their youth they managed to avoid injuries or serious diseases, by old age the skeleton’s “shelf life” comes to an end. In addition to elderly people, those at risk are those who inherited weak joints of the bones, as well as athletes, workers suffering from obesity, diabetes and other chronic diseases.
Joint diseases such as juvenile rheumatoid arthritis occur mainly in minors. Others, such as gout, are considered “aristocratic ailments”: they develop from excess meat, red wine and chocolate in the diet. It is known that inflammation of the joints associated with hormonal fluctuations is usually detected in the fairer sex. In men, traumatic injuries of the joints most often occur. In a word, joint diseases can threaten a person, regardless of social status, habits, age and gender.
The main groups of joint diseases by the nature of the lesion
Diseases of the joints are classified by the nature of the pathological process.
Inflammatory and infectious diseases of the joints
In this case, the cause of the disease is an inflammatory reaction in response to an infectious, autoimmune or allergic process. The disease makes itself felt with pain and swelling in the joint. Symptoms can reach maximum severity in a few hours and then recede indefinitely.But behind a period of imaginary well-being, there is a hidden development of the pathological process.
Some arthritis are manifested primarily not by pain, but by morning stiffness, fever, a rash on the skin over the joint, or manifestations of a primary disease complicated by damage to the musculoskeletal system (for example, disorders of the genitourinary system – in Reiter’s disease and gonorrheal arthritis).
The stages of the inflammatory pathology of the joint can be distinguished through X-ray examination.So, at the beginning of the disease, no significant abnormalities are found in the images, with the second degree of arthritis, signs of destruction of bone and cartilage tissue appear. At the third degree, the doctor will see a deformation of the joint – by this moment the patient feels pronounced restrictions on mobility. Finally, the fourth degree of arthritis is accompanied by total changes in the joint: only surgeons can help the patient.
This group of pathologies, along with rheumatoid arthritis (in which the body’s immune system destroys the joints), includes infectious-allergic arthritis, ankylosing spondylitis, Goff’s disease, gout, psoriatic arthritis, etc.
The main prevention of arthritis is the prevention of infections by vaccination and other protective measures against diseases that can be complicated by bacterial infection of the joint (gonorrhea, scarlet fever, tonsillitis, etc.)
These diseases usually affect the elderly: they are associated with wear and tear of the joint, which leads to the destruction of the cartilage responsible for shock absorption during work.Another factor in the development of degenerative diseases is osteoporosis, in which bone density decreases.
Degenerative diseases appear gradually: the first sign will be short-term pain after a tiring day on your feet. Over time, the pain in the joint will cease to subside after rest, and the movement in the joint will become limited. Sometimes swelling occurs in the affected area, and the joint aches when the weather changes and at night.
The severity of arthrosis is determined by examination and radiography.At the beginning of the process, only a slight reduction in the height of the gap between the bones due to thinning of the cartilaginous tissue is noticeable in the images. In the second degree, the doctor will record a decrease in the joint cavity by a third of the norm and the appearance of bone outgrowths or areas of dead cartilage. Finally, stage 3 of arthrosis is characterized by deep, irreversible deformities of the joint, up to ankylosis – bone fusion.
The most common cause of disability among all joint diseases is osteoarthritis deformans, mainly affecting the hip and knee joints.Also, the source of the problem may be intervertebral osteochondrosis – a typical disease of office workers.
Experts note that yoga, a set of exercises that strengthens ligaments and muscles through static loads, can be an excellent prevention of age-related changes in the joints. Recently, scientists have found that daily 12-minute yoga classes for 10 years increase the density of the bones of the hip and spine, which eliminates osteoporosis and arthrosis, preventing fractures in old age.
Congenital joint pathologies
Congenital joint diseases attract attention from the very first days of a baby’s life: the possible consequences of a developmental disability for a child’s health depend on therapeutic measures. So, in infants, congenital dislocation of the hip is often detected, which is often combined with dysplasia of the hip joint. Left unattended, this ailment will lead to gait and posture problems. However, timely intervention of an orthopedist will allow to correct congenital hip dislocation conservatively, without surgery.
Another common congenital joint pathology is Marfan’s syndrome, which includes a complex of disorders in the development of internal organs. Patients with Marfan syndrome have extremely flexible joints, poor posture, and a keeled chest. These are tall, thin, sickly people who, as a rule, end up in emergency rooms with dislocations and fractures. Subject to the recommendations of a doctor, they can live a long time without experiencing severe health problems.
Diseases of the periarticular tissues
Diseases from this group do not affect the joint itself, however, if untreated, they can worsen its work.This includes inflammation of the tendons (tendinitis), bursae (bursitis), ligaments (ligamentitis), fascia (fibrositis). Sometimes the source of the pathological process is inflammation in the joint itself, but much more often the cause of the development of such ailments is physical exertion and “chilling” of the neck or limbs.
Symptoms of diseases of the periarticular tissues have peculiarities: unlike the pathology of the joints, pain in the ligaments, tendons and joint capsules is felt only with active movements and is absent when the limb is exposed to the office of a doctor or masseur.With arthritis, patients complain of “diffuse” pain, and with damage to the periarticular tissues, they can indicate a specific point where the pain is maximum. X-rays and MRIs make it possible to finally verify the nature of the disease and prescribe treatment.
Types of joint diseases at the site of localization
Many joint diseases have their own “favorite” localization, so that the doctor can make a preliminary diagnosis even before obtaining the results of medical imaging.
- Diseases of the shoulder joint often occur in people who earn a living by physical labor, or in those who are regulars in gyms.The most obvious causes of shoulder pain are periarthritis of the scapula and osteochondrosis of the cervical spine. In some cases, osteoarthritis or arthritis of the shoulder joint is found.
- Diseases of the elbow joint are also common concerns for athletes (epicondylitis). Sometimes discomfort and limited mobility in this area are caused by osteochondritis exfoliation, deforming osteoarthritis and inflammation of the muscles of the arm.
- The joints of the hand (fingers) become inflamed in rheumatoid arthritis.It can manifest itself as a “tight glove syndrome”: in the morning it is difficult to stretch the hands, restoring their mobility. A feature of this disease is the simultaneous defeat of both hands. Often in the practice of orthopedists are cases of arthrosis and tendon lesions that occur in musicians and representatives of professions associated with fine motor skills (engravers, jewelers, etc.), as well as those who daily and long work with the keyboard.
- A ubiquitous disease of the hip joint is coxarthrosis, which is characteristic of the elderly.Also, elderly patients often face osteoporosis – a softening of the structure of the femur, fraught with a pathological fracture of its neck. Bursitis and tendinitis of the hip joint is diagnosed in athletes – runners and football players.
- Diseases of the knee joint are observed in people of all ages. In children, infectious and rheumatoid arthritis is more often diagnosed, in mature sports people – lesions of the ligamentous apparatus and meniscus trauma, and after 50 years, gonarthrosis, a degenerative lesion of the knee joint, comes first.
- Ankle pain may result from arthritis or subluxation. Such pathologies are typical for athletes, dancers and women who wear high-heeled shoes every day. Ankle arthrosis (as well as coxarthrosis and gonarthrosis) affects many obese people.
Types of joint diseases according to traditional Chinese medicine
Traditional Chinese medicine (TCM) provides an alternative view of the nature of joint diseases.According to her, rheumatism, rheumatoid arthritis and osteoarthritis are manifestations of “B syndrome” – an obstacle that affects bones and joints. “Syndrome B” occurs due to the influence of pathogenic factors. They enter the body, settle in muscles, tendons and joints, and then block the normal flow of vital energy Qi and blood through energy channels (meridians). All this causes pain, stiffness, inflammation, and deformation of bones and joints.
What pathogens cause B’s syndrome?
- Wind calls the “wandering B”.Acute joint pain begins and ends quickly, but can travel throughout the body, limiting the range of comfortable movement. The patient’s pulse becomes floating, and the tongue becomes covered with a thin white coating.
- Cold causes “painful B”. Severe joint pain leads to stiffness of movement. The pain is especially pronounced when the ambient temperature drops. At the same time, the pulse becomes tense. Painful B may also develop a white coating on the tongue.With the onset of warmth, a person’s condition improves.
- Dampness calls fixed B. The pain is accompanied by a feeling of heaviness, numbness, or edema in the affected area. Pulse – floating, tongue – with a greasy coating.
- Heat causes “Bi heat”. Heat reduces the flow of blood and vital energy chi through the joints, thereby impairing their function. This causes inflammation and swelling in the joint. The tongue becomes covered with a red-yellow coating, and the pulse becomes fast.
- Pathogen combinations:
- Wind, cold and damp. Delay of wind, cold and dampness in the meridians hinders the outflow of Qi and blood. Excess cold is manifested by stagnation of vital energy and blood. With this combination, severe pain and swelling of the joint occurs, a tense pulse is observed, as well as a pale tongue with a white coating.
- Wind, dampness and heat. Pathogens block the movement of qi and blood, affecting muscles and skin. The joints become red and swollen.In addition, pain often develops, which can be accompanied by heaviness and fever. The tongue becomes covered with a red-yellow coating, and the pulse becomes fast.
- Deficiency of blood in the liver and kidneys, sputum. Qi and blood deficiencies cause long-term joint pain accompanied by swelling, inflammation, knee pain and deformity. Pain syndrome restricts movement. Internal accumulation of phlegm and stagnation manifests itself as subcutaneous nodules. In this case, the person has a state of exhaustion, lethargy, dizziness and blurred vision.The pulse becomes uneven, the tongue darkens and becomes covered with a thin coating.
Treatment of joint diseases in Chinese medicine is aimed at dissipating wind, cold, heat, as well as converting dampness and restoring the flow of Qi and blood. This is helped by acupuncture, moxibustion (warming up with wormwood cigars) and acupressure.
Remember to be alert to any symptoms — pain, stiffness, swelling, rash, or crunching sound when moving.The overwhelming majority of joint diseases can be successfully treated at the initial stages, however, in a neglected state of the disease, they can disrupt life and professional plans, requiring expensive surgical intervention and complex rehabilitation measures.
Arthritis: description of the disease, causes, symptoms, cost of treatment in Moscow
Arthritis is an inflammatory disease of the joints. Unpleasant and painful sensations in a person appear with active movement, flexion, extension, walking (with an inflammatory process in the joints of the leg).In some cases, redness appears on the skin, which is located in the area of the diseased joint, the person’s body temperature rises. With inflammation of one joint, the disease is called monoarthritis, with inflammation of several joints – polyarthritis. Left untreated, arthritis of the joints increases the risk of damage to all joint tissues. Namely: bones, cartilage, ligaments, tendons, surrounding muscles, synovium. In the event of a sudden onset of the disease, the patient is diagnosed with acute arthritis.If the disease progresses slowly, we are talking about chronic arthritis.
Given the causes of the disease, the signs of arthritis are different. With reactive arthritis, weakness and malaise appear. This is a manifestation of the initial stage of the disease. A headache may appear, an increase in body temperature of more than 38 degrees. A distinctive feature of reactive arthritis is an asymmetric lesion of the joints of the legs. In addition, symptoms of the inflammatory process in the genitourinary system appear.A person feels a burning sensation when emptying the bladder.
Symmetrical joint damage occurs in rheumatoid arthritis. They become swollen and inflamed. Painful sensations intensify at night, almost in the morning. At the initial stage of the disease, exercise will help eliminate discomfort. As arthritis progresses, this method will become ineffective. After the defeat of small joints, large ones are affected. During this period, the formation of characteristic nodes occurs.They are presented in the form of small dense formations that are located in the place where the joint bends. The patient notes the presence of general malaise, deterioration in appetite, weakness. When the disease worsens, the body temperature may rise. In some cases, the upper and lower extremities may become numb, and painful sensations in the chest area may appear when breathing. Also, the salivary glands become inflamed.
The onset of infectious arthritis is characterized by an acute onset.Among the symptoms of arthritis, one can distinguish an increase in body temperature of more than 39 degrees, chills, headache and muscle pain. You can find the appearance of nausea, vomiting. The affected joint will swell and change shape. An increase in painful sensations is observed when moving. The pain can be transmitted to the part of the body that is located near the affected joint. The area of skin near the affected joint will be hot.
With psoriatic arthritis, symptoms will develop gradually.The affected area swells, the temperature rises in it. The hairy part of the head and skin is covered with red spots. These spots are itchy and flaky. In addition, the nail plate is affected, and their splitting occurs. This type of arthritis is characterized by damage to any joint. In most cases, the fingers are affected. Painful sensations at the initial stage may not appear, be present only in the morning.
With osteoarthritis, the disease progresses slowly and gradually.A characteristic symptom is the presence of a crunch. The disease affects the joints of the upper or lower extremities, the spine. Similarly, a traumatic type of arthritis appears. Manifest painful sensations, swelling, crunching in the area of the inflammatory process.
Why does the disease appear
The main and exact cause of arthritis has not yet been determined. Based on the statements of some doctors, it can be concluded that the disease appears in the presence of infection, injury or allergy.Also, the disease provokes a disturbed metabolism, diseases of the central nervous system, vitamin deficiency.
With the impaired functioning of the immune system, persistent arthritis develops, joints are destroyed. The onset of autoimmune arthritis occurs after infection. In this case, microbes serve as indirect disease provocateurs. When the immune system fails, the immune system attacks those cells that are infected. First of all, symptoms appear on the hands, then on the remaining joints.Without treatment for arthritis, a person can face lifelong disability.
Given the types and origin of arthritis, the following reasons are distinguished:
If a person is engaged in a professional sport, when the joints are exposed to constant excessive stress.
With congenital dislocation of the hip.
The presence of diseases of the central nervous system.
Penetration of harmful bacteria, fungi, viruses into the body.
With diagnosed tuberculosis, gonorrhea, dysentery, gout.
If the endocrine system has ceased to function normally. This includes hormonal changes in the female body during menopause.
With a genetic predisposition.
If the body lacks vitamins, a person does not observe proper nutrition.
Excessive alcohol consumption.
Regular hypothermia of the body.
To make an accurate diagnosis and determine the type of disease, the use of an integrated approach is implied. It consists of an examination, obtaining laboratory data and an instrumental diagnostic method. If a person has any signs of arthritis, it is imperative to visit a rheumatologist, traumatologist, infectious disease specialist, phthisiatrician and dermatologist.Each specialist conducts a conversation with a person, on the basis of which a detailed history of the disease is collected. At the end of the interview, a qualified doctor examines the affected joints, checks their sensitivity. It also determines how mobile they are. Then the patient in the laboratory takes the necessary tests.
Specific blood counts contribute to a preliminary diagnosis:
On the basis of a general blood test, it is determined with what speed the erythrocytes are deposited.In the acute stage of the disease, this indicator will increase. If arthritis is bacterial in nature, leukocytes will increase, if allergic – eosinophils.
Based on a biochemical blood test, uric and sialic acid is determined. If arthritis is provoked by gout, these indicators will be increased.
On the basis of immunological parameters, the presence of rheumatoid arthritis can be determined.This is evidenced by an increase in rheumatoid factor, the number of antinuclear antibodies and the circulating immune complex.
Instrumental diagnostic methods:
An X-ray examination is performed (frontal, lateral and oblique projection). Thanks to this method, you can determine the stage of arthritis and its type. The x-ray shows damage to the joint, the localization of the inflammatory process that affected the bone tissue, as well as the presence of various neoplasms and degenerative changes.
With the help of ultrasound diagnostics, it is determined how much the large joints are affected (shoulder, knee, elbow).
Computed tomography helps to examine the joint in several projections (transverse and longitudinal). In addition, this method determines the state of the soft tissues.
Another effective method is magnetic resonance imaging.With the help of mri, you can carefully examine the condition of the bone structures and soft tissues. The main indications for magnetic resonance imaging include damage to the intervertebral disc, nerve, ligament, etc.
Arthroscopy is an invasive endoscopic diagnostic method. It is used to study the condition of the knee joint. In some cases, during arthroscopy, biopsies of the affected tissue and joint fluid are performed, which are then carefully examined.
Contrast arthrography helps to study the condition of cartilage tissue. In addition, this method will help to study soft tissue and surrounding joints. Contraindications are acute arthritis and iodine sensitivity.
With the help of myelography, you can study the state of the spine, spinal cord, roots. This method is used in conjunction with computed tomography.
Who is at risk
Osteoarthritis, in most cases, affects people who regularly put excessive stress on their joints. Sellers, teachers, surgeons, hairdressers are more likely to develop acute arthritis of the spine. Football players are faced with lesions of the hip joints, boxers – with lesions of the joints of the hand. Also, this type of arthritis can occur in a smoker or obese person.
The onset of gouty arthritis is most often observed in men over 60 years of age. In addition, include people with hypertension, obesity, alcohol abuse, impaired kidney function.
The development of rheumatoid arthritis occurs in women and those people whose close relatives are faced with this disease. Infectious arthritis is most commonly diagnosed in a person with the immunodeficiency virus or gonorrhea.Also, arthritis of an infectious nature affects people who have been diagnosed with cancer, diabetes mellitus, and lupus erythematosus. Traumatic arthritis affects professional athletes. As a result of the regular formation of microcracks in the joint, an inflammatory process develops.
Degree of disease
At the initial stage of the disease, there are no symptoms, the body becomes infected. The main features that require special attention include:
The presence of stiffness of movements.It manifests itself in the morning. A person cannot turn on a water tap or gas valve.
If the ankle is affected, the usual shoes press and cause discomfort. This is due to the swelling. If you bend and unbend the ankle joint, there will be sharp painful sensations.
With psoriatic arthritis, pain appears at night and disappears in the morning.
When the shoulder or knee joint is affected, the pain quickly disappears.
The initial stage of arthritis is easily detected in young children. They stop running, play outdoor games, and fall when walking.
With the onset of the second stage of the disease, pathological processes begin to develop. Erosion occurs on the bones.The joint tissues become thinner. In addition, the following symptoms appear:
The place near the affected joint swells, a crunch appears.
With the defeat of the knee joint, the skin becomes red, hot. The intensity of the discomfort increases in the morning.
In parallel with crunching and swelling, severe soreness appears, which intensifies at night.
Painful sensations in arthritis of the hip joint can be transmitted to the knee area, as a result of which a person begins to limp when walking.
If a shoulder joint is affected by the disease, it will be difficult to raise the arm.
If arthritis is a consequence of psoriasis, the patient has swelling of the thumbs and toes.In this place, uric acid salts accumulate.
At the third stage, the following symptoms appear:
After the X-ray examination, the presence of severe deformity of the joints is determined.
The patient is assigned a certain disability group.
There is a limitation of mobility, a person can hardly move.
The ability to move the hand gradually disappears.
Painful sensations do not disappear even in a calm state.
Muscle spasm helps to fix the limbs in the wrong position. As a result, the joints are deformed more intensively.
If stage 4 arthritis occurs, this means that the change that has occurred in the bone or joint is irreversible.A person with ankle arthritis loses the ability to move independently. If the knee joint is affected, muscle contracture forms around it. Painful sensations accompany a person constantly, regardless of the time of day. Due to the increased intensity of pain, the person regularly takes pain relievers.
A short guide to rheumatism – Venäjän kielinen reuma-aapinen
A short guide to rheumatism
Translation of information on rheumatic diseases was made from the page:
Suomen Reumaliitto Ry
http: // www.reumaliitto.fi/reuma-aapinen/reumataudit/
1. FIBROMIALGIA, 2. PADAGRA, 3. CHILD RHEUMATISM, 4. LYMBORELLIOSIS, 5. SYSTEMIC DISEASE OF THE CONNECTIVE TISSUE, 6. JOINT RHESIS II, 9. JOINT HYPERMOBILITY, 10. OSTEOPOROSIS, 11. RHEUMATIC POLYMIALGIA, 12. POLYMYOSITIS, 13. REACTIVE ARTHRITIS AND REITER’S SYNDROME, 14. SPINE RHEUMATISM AND BEKHTEREV’S DISEASE 15. HEREDITAL DISEASE OF CONNECTIVE TISSUE 16. SHEGRIN’S SYNDROME 17. SERONEGATIVE SPONDYLO 18.SYSTEMIC LUPUS ERYTEMATOSUS (SLE) 19. SYSTEMIC SCLEROSIS (SYSTEMIC SCLERODERMIA) 20. VASCULITIS
1. FIBROMYALGIA (MUSCLE RHEUMATISM)
Fibro means connective tissue, and myalgia means pain in muscles. Fibromyalgia causes pain in muscles, connective and extra-articular soft tissues. In addition to pain in the musculoskeletal system, patients suffer from various sleep disorders: shallow sleep, frequent awakenings at night, a feeling of weakness and physical exhaustion in the morning.In addition, they have different types of mental and neurological symptoms, which can be very varied.
More often middle-aged and elderly women suffer from the disease. Fibromyalgia is estimated to occur in 2 to 5% of the population, and is rare in children and young people.
The causes of fibromyalgia are still not entirely clear. The onset of symptoms is influenced by many factors, due to which the disease develops in the form of various changes on the part of the central nervous system (CNS).In many patients, symptoms occur in conjunction with infection, trauma, or other painful situations. Sometimes local pains turn into general pain sensitivity. Some patients suffer from joint hypermobility; in others, social or mental problems are added to the symptoms. Other comorbidities are common in patients with fibromyalgia.
One of the causes of fibromyalgia is long-term stress, which causes a bad mood and feelings of depression.Stress can be caused by repetitive and prolonged external stimuli: work, feelings of dissatisfaction, rush, movement, noise, human relations, money problems, or unemployment. Fibromyalgia patients show the same hormonal changes as people suffering from long-term stress. It remains to be seen whether stress or depression and anxiety is more likely the cause of fibromyalgia than the cause of fibromyalgia.
Another cause of illness is lack of sleep or poor quality sleep.During deep sleep, the pituitary gland produces growth hormone, which has an anabolic (tissue-strengthening) effect. If there is a lack of deep sleep, no growth hormone is released. In patients, a decrease in the release of growth hormone was confirmed. At the same time, symptoms similar to fibromyalgia were identified in laboratory conditions, when normal sleep was simply disturbed in the studied people.
Stress, sleep disturbances and other causes affecting hormone secretion disorders can affect the central nervous system in such a way that pain increases.Patients often experience personal and social pressure that manifests itself in the form of physical symptoms, often in the form of pain.
The most important symptom of fibromyalgia is prolonged pain in different parts of the body, the nature of which is influenced by various external stimuli. Patients describe pains: pinching, burning, cutting, aching, deep, exhausting, monotonous. The pain is exacerbated by cold, moisture, drafts and mental stress. In the sauna, the pain decreases, but after the sauna it intensifies again.
For patients with fibromyalgia, fatigue, fatigue, weakness, edema and a feeling of stiffness are also characteristic. In addition to pain in the musculoskeletal system, headaches, abdominal pain, pain during menstruation and urination may occur. Many patients experience joint swelling, although the doctor does not diagnose this. Patients get tired quickly with exertion. And almost all patients complain of sleep deprivation.
Diagnosis of fibromyalgia is based on patient complaints and medical clinical research.To confirm the disease, a large group of other diseases are taken into account, which also cause pain symptoms. Other diseases do not rule out the possibility of fibromyalgia.
In a conversation with a patient, the doctor pays special attention to both the nature of pain in different situations and the quality of sleep. During a medical examination, a painful reaction is noted in known sensitive points on the body. Some parts of the body are very painful. For fibromyalgia, there are no changes in blood tests.
If necessary, conduct additional research to rule out other illnesses that cause fatigue and pain, such as anemia, thyroid dysfunction, muscle aches, or menopause symptoms. Joint hypermobility also requires examination.
Often, people with fibromyalgia have comorbidities, which can be, for example, inflammation of the intestines, bladder, endometriosis, headaches, signs of fatigue and depression. Especially in the elderly, fibromyalgia can occur concurrently with coronary artery disease, diabetes, joint damage, and articular rheumatism.This is called secondary fibromyalgia.
Fibromyalgia does not have a single treatment that is suitable for everyone and brings results. the causes of the disease are different. The patient’s own opinion on the results of treatment is very important.
Planning, implementation and monitoring of treatment outcomes is the basic prerequisite for close and trusting collaboration between patient and doctor. It is important to stop further unnecessary additional research, which in the worst case leads to unnecessary surgery.The best way to treat a patient with fibromyalgia is a polyclinic doctor who is well aware of his problems.
Learning about fibromyalgia is the foundation of treatment. If possible, at an early stage, the patient should undergo a rehabilitation course designed for patients with fibromyalgia. Usually it is possible to combine it with work. Group training gives good results. The courses help to reduce the fatigue associated with the disease, support self-medication and training. Avoiding stress and improving mood with warm baths, massage and other physical therapy, as well as group discussion and psychological support, are the only treatment lines.For some, hardening of the body (swimming in an ice hole, cold chambers) and a gradual increase in physical activity are suitable.
Physical education should be administered carefully. Suitable sports: walking, pole walking, aqua aerobics, cycling, dancing and skiing. Physical activity is aimed at activating the body’s own defense mechanisms that relieve pain.
There is no specific drug for the treatment of fibromyalgia yet. Medications that improve sleep and mood, such as amitriptyline, can be tried as drug treatments.Treatment should be started in small doses to reduce side effects. The benefits of such treatment are observed only after a few weeks. There is little effect from conventional painkillers, sometimes paracetamol helps. The benefits of medication should outweigh the side effects. For some patients, medications that affect the central nervous system are suitable for relieving pain of nervous origin. If fibromyalgia is associated with prolonged insomnia, depression, or other mental symptoms, the patient needs psychiatric help.
The prognosis is favorable, although there is no improving treatment. The symptoms of fibromyalgia persist for years and decades, but damage to organs or tissues of the body does not occur and the disease is quite compatible with life. Many retire early for other reasons. At present, officials dealing with pension issues do not consider fibromyalgia to be a cause of disability and retirement.
2. PADAGRA (Greek podos – leg, Greek agra – seizure, literally “foot in a trap”)
Padagra fall ill more often than middle-aged men.In Finland, padagroy affects about 30,000 people. The onset of the disease may be due to a change in life habits and an increase in alcohol consumption, small doses of aspirin and diuretics.
Padagra is a disease caused by disorders of purine metabolism, leading to an increase in the level of uric acid (urates) in the blood and their deposition in tissues, articular cartilage, epiphyses of bones, periarticular tissues, kidneys and other organs. An increase in uric acid levels (hyperurecaemia) can cause kidney failure.
Against the background of padagra, there may be disorders in the activity of enzymes, which are inherited. The cause of the disease can be malnutrition, overeating, alcohol consumption, especially beer, obesity, diabetes mellitus, high levels of blood fats and arterial hypertension. Padagra can also develop as a side disease with diuretics and aspirin. Sometimes padagra manifests itself together with renal failure or blood disorders.
The first symptom of padagra is acute inflammation in the joint of the big toe.Later, other joints become inflamed – the knees, the cervical spine and the joints of the fingers. Padagra causes permanent joint changes and crystallization of uric acid in soft tissues (tophus), kidney diseases can join them. Nowadays, padagra very rarely leads to disability.
Symptoms appear more often with stress on the inflamed joint or with alcohol and purine-containing foods. The joint becomes hot, red and very painful. The picture of the disease is not always typical.Within a week, the inflammation goes away on its own, but with treatment – faster.
When diagnosing a padagra, the doctor identifies typical symptoms and changes in the patient’s diet. The diagnosis is confirmed by examining the joint fluid, in which urate crystals are visible under a microscope. In patients with padagra, uric acid values are usually high. On the other hand, they can be high in healthy people. Low rates also do not exclude the possibility of a disease with padagra.When researching, it is important to check the functioning of the kidneys in order to exclude disruption of their activity.
As a treatment for an acute attack of padagra, cold, pain relievers and anti-inflammatory drugs, and rest are used. Intensive treatment for an acute attack of padagra is intra-articular administration of cortisone.
The most important element of treatment is the balance of medication intake, lifestyle and especially the patient’s nutrition. When planning treatment, it is also necessary to consult a dietitian.Moderate weight loss can be maintained if necessary with proper nutrition.
The diet should be followed after the first attack of padagra. The diet prohibits foods that produce uric acid and can significantly reduce the intake of essential drugs.
But sometimes diet alone is not enough to cure. Then, after the third attack of padagra, drug treatment is started, which reduces the synthesis of uric acid in the blood. In such cases, allopurinol is effective.Treatment with allopurinol can only be started after confirmation of the diagnosis of padagra. Its side effect can be liver dysfunction and changes in the blood picture, therefore, treatment is carried out under the supervision of blood tests. If there were no seizures during the year against the background of treatment, you can stop taking the drug.
With proper treatment, the prognosis for padagr is good, but if for some reason it is impossible to use allopurinol, problems may arise. Failure to follow the diet can also be the reason for the failure of treatment.
Patients with padagra need to have a list of various foods that contain purine. It can be found in pharmacies and on the internet. Below is a brief overview of the most important foods.
Products containing quite a lot of purine are completely prohibited:
peas, beans, soybeans, mushrooms, asparagus
Other harmful substances:
all alcoholic beverages (prevent the excretion of uric acid), especially beer
aspirin-containing antipyretic drugs
Approved foods containing a small amount of purine:
eggs, fats, sugar
fruits, almost all vegetables, potatoes
coffee, tea, cocoa, spices
Children’s rheumatism is an inflammation of the joints that occurs for unknown reasons in children under 16 years of age, and which lasts more than six weeks. The definition of the disease is conditional, because the causes of its occurrence are unknown, the same symptoms of the disease can occur after 16 years. Children who become ill later retain their original diagnosis.
Children’s rheumatism is currently divided into seven subtypes. For all types, the name is used for childhood rheumatism or juvenile idiopathic arthritis.Every year in Finland, 100-150 children fall ill, half of whom are under 5 years old.
The cause is unknown. Perhaps there are several of them, and hereditary factors increase the risk of getting some form of rheumatism. Children’s rheumatism is not directly inherited, and does not behave like an infectious disease. Children’s rheumatism includes childhood diseases (oligoarthritis) or forms similar to diseases of adults (articular rheumatism, articular psoriasis, spinal rheumatism).
Usually the first symptom of childhood rheumatism is morning joint stiffness, which is immediately noticed by parents. Inflexibility can manifest itself either in all or only in diseased joints. Children limp or protect their joints due to pain. They may also have trouble sleeping. However, young children may not always be able to describe pain in words. Often, pain is manifested by a bad mood and the protection of a sore joint. Sometimes the knee or other joint swells so much that it is easy to notice.Fever and slight skin inflammation on the body are the initial symptoms of childhood rheumatism.
The course of the disease
The complexity of childhood rheumatism in its variability. The disease drags on and eats away at the cartilage of the joints, bones and ligaments. As a result, the joints swell and their work is limited. Currently, complete ossification of the joints does not occur. Inflammation of the eyes can go unnoticed, up to complete loss of vision.
In patients with childhood rheumatism, developmental delays may also appear.Growth can be slowed down by severe illness or high-dose cortisone treatment. Overgrowth of bones begins in a swollen joint, for example, in the lower jaw, legs, ankles, wrists, and toes. Especially in the knees, this can be manifested by an asymmetrical limb length or its incorrect position. If left untreated, childhood rheumatism can cause life-threatening heart inflammation and kidney disease.
The main symptom of childhood rheumatism is swelling of one or more joints, lasting over six weeks.The child feels tired, cries, he may have a skin rash and fever. Blood inflammation and CRP may be elevated. When making a diagnosis, rheumatic factor and the presence of antibodies in the blood are also examined. If the blood test for antibodies is positive, then with a high probability we are talking about childhood rheumatism or systemic connective tissue disease. Since heredity is an important factor, it is necessary to find out from the parents whether there were joint diseases or psoriasis in the family.
Pediatric rheumatism is diagnosed and monitored in university hospitals and the Heinola rheumatology hospital by a specialist doctor. Treatment and rehabilitation of patients is carried out in the children’s department of the rheumatological hospital.
The goal of the treatment is to reduce symptoms and normalize the parameters of inflammation in the blood (ESR, CRP), which are achieved through the selection of individual drug treatment and exercise therapy in everyday life. In difficult cases, more serious treatment is required.
Usually a complex approach is used in the treatment of childhood rheumatism. Thanks to the use of strong medicines, the results are faster and the treatment time can be shortened.
Pediatric rheumatism is treated with the same medicines as adults. With long-term treatment, methotrexate is used – a drug that affects cell growth. Currently, childhood rheumatism can be treated with biological TNF – alpha drugs. Supportive therapy – cortisone drugs.
Treatment of childhood rheumatism is aimed at ensuring the normal growth of the child. Correct positioning of the limbs can be assisted by applying splints and splints. In young patients, the growth of the lower jaw and teeth is monitored and the eyes are regularly examined. The physiotherapist develops individual programs to maintain joint mobility and strengthen muscles. The rehabilitation program includes providing conditions for the child to receive primary education.
Modern methods of treatment significantly improve the prognosis of childhood rheumatism.Lifetime disability and premature mortality are rare. Amyloidosis (a violation of the body’s protein metabolism) no longer occurs. The majority of patients are able to lead a normal working life with the help of treatment.
Classification of childhood rheumatism
Common childhood rheumatism
Ø fever, skin inflammation, inflammation of the lymph nodes, symptoms of internal diseases
Oligoarthritis (inflammation of rare joints)
Ø from 1 to 4 diseased joints
Seronegative polyarthritis 9000 Ø no rheumatic factor in the blood, 5 or more joint pains
Adult-type articular rheumatism
Ø “seropositive polyarthritis”
Ø rheumatic factor present in the blood, 5 or more joint pains
Ø cutaneous psoriasis and inflammation of the joints
Ø pronounced psoriatic changes in the nails without skin symptoms, sausage-like inflammation of the fingers and toes, psoriasis in the closest relatives
Rheumatism of the spine
Ø “arthritis joining enthesitis” enthesitis (damage to the ligamentous apparatus).If only one of these symptoms is present, then there should also be two more of the following: pain in the sacrum and lower back, positive HLA-B27 antigen, rheumatism of the spine in one of the close relatives, eye inflammation, boy over 8 years old.
Other forms of the disease
Ø childhood rheumatism, which is not included in other groups
4. LYMBORELLIOSIS (Lyme disease or tick-borne borreliosis)
Lyme disease is an infectious disease transmitted through a tick bite.The causative agent Borrelia burgdorferi is a bacterium belonging to the spirochete class. Lyme disease has no connection with childhood rheumatism or rheumatic diseases.
In Finland, natural foci of Lyme disease are found mainly on islands and coastlines, although ticks also live throughout the country, including Lapland. But not all ticks carry the Borrelia bacteria. On average, the bite of only one tick in 50-100 cases causes disease. Every year in Finland, about 3000 people get sick from tick bites, and 10-20% of them – Lyme disease.The disease can manifest itself as a rapidly passing skin inflammation.
Lyme disease can be prevented by avoiding tick bites. Ticks settle in humid places where children often play, so their skin should be examined in the evenings. This also applies to adults living in natural foci. Ticks are removed from the skin, for example, with tick-borne tweezers purchased from a pharmacy. The best way to remove it is to grab the tick as close to the skin as possible and gently pull it out in a circular motion.
Most tick bites are asymptomatic. If a person is bitten by a tick, it must be quickly removed from the skin, because it can carry the Borrelia bacteria. In this case, after a few days, redness of the skin appears around the bite, which spreads in a circle from the site of the bite (erythema annulus). Bacteria that enter the body can cause a cold-like illness, which is combined with fever, fatigue and muscle pain. This is the initial stage of Lyme disease, and antibiotics are used to treat it.
Course of the disease
If untreated, the disease can manifest itself in different parts of the body months or even years after infection. These can be symptoms of damage to the musculoskeletal system (muscle pain and stiffness), edema of one or more joints, in severe cases – symptoms of CNS damage: facial paralysis and paralysis of various nerves, meningitis, neurological pain symptoms. Prolonged muscle pain resembles complex fibromyalgia. In disease caused by a Borrelia bacterium, chronic inflammation of the skin, eyes and heart muscle can be observed.
The initial phase of Lyme disease is confirmed by inflammation of the skin around the tick bite, which does not appear in later stages. The only symptom may be, for example, swelling of the knee joints. At this stage, the doctor tries to rule out other diseases and confirm borelliasis with blood tests. The study of the results of laboratory tests sometimes requires an examination in the infectious diseases department of the district hospital. In the diagnosis, information about previous tick bites, for example, a month ago, is very helpful.
A simple tick bite does not require any treatment. If inflammation spreads around the bite, see a doctor immediately. After an obvious bite, antibiotics are prescribed for two weeks to treat borrellia cutaneous inflammation. The infection responds well to treatment and late symptoms do not appear. If the initial phase remains untreated and the patient develops true Lyme disease, then long-term and debilitating antibiotic treatment is required, which is most often carried out in a hospital setting.
As a rule, patients are cured of Lyme disease. In this disease, the inflammation of the joints is benign and does not lead to their destruction, but the pain can last a long time. In young children, the disease is more severe. For years, persistent symptoms of CNS inflammation are rare. They may mimic the symptoms of fibromyalgia.
5. SYSTEMIC CONNECTIVE TISSUE DISEASE
Patients with systemic connective tissue disease show symptoms of many rheumatic diseases.They may resemble systemic sclerosis, an autoimmune disease, or polymyositis and joint inflammation. Many diseases can begin with symptoms similar to systemic connective tissue disease, which need to be clarified later. Most of the patients are women over 40 years of age.
The causes are unknown, but the occurrence of the disease is influenced by heredity.
Usually the disease begins with general symptoms such as fatigue, fever, muscle and joint pain.Almost all patients have Raynaud’s symptom (blanching of the fingers). The hands may swell so that the fingers take on the shape of sausages. The skin of the hands becomes denser and later atrophies. The patient may have skin inflammation and swelling in the joints, similar to articular rheumatism.
Course of the disease
The disease usually either disappears or turns into some clearly expressed disease – articular rheumatism, systemic sclerosis, immune disease or polymyositis. The disease causes changes in internal organs such as the lungs, heart and kidneys.
Diagnostics is carried out on the basis of the patient’s history and blood tests.
Treatment is individualized according to the patient’s symptoms. As a treatment, cortisone drugs and antirheumatic drugs methotrexate, hydroxyclorokine are used. If the patient has pale fingers, a vasoconstrictor such as nifedepine is recommended, but it is best to keep the hands warm.
Symptoms of the disease can last for years.The prognosis depends on the direction of development of the disease. If the disease does not affect the internal organs, the prognosis is favorable.
6. PSORIASIS OF THE JOINTS (psoriatic arthritis)
Psoriasis (squamous lichen) is a chronic dermatosis characterized by scaly skin rashes. Approximately 2% of the Finnish population suffers from psoriasis. Of these, only 10% have joint inflammation. Half of those with complex cutaneous psoriasis also have joint psoriasis. It occurs in both women and men.Sometimes the picture of the disease is similar to psoriasis of the joints and is diagnosed in patients who do not have skin inflammation. The disease is inherited.
The causes of psoriasis are unknown, and it has not been investigated why patients with skin diseases often exhibit joint symptoms. In psoriasis, the regulation of the body’s immunological defenses is disrupted, and skin inflammations appear, for example, after infection, with skin lesions or after burns.
Psoriasis is a hereditary disease.If both parents have psoriasis, the child’s risk of developing the disease is about 50%. If only one – the risk of developing the disease is reduced to 20%. Joint psoriasis is much less common.
There are 4 different forms of joint psoriasis. The most common form is inflammation of several joints with symptoms of sharpening of the first phalanges of the fingers of the extremities, which can also manifest themselves. Another form of the disease is less common, usually inflammation of a large joint.It can only be inflammation of one knee without other joint symptoms. A disease resembling spinal rheumatism is rare.
With articular psoriasis, the heel or the Achilles tendon swell, sometimes the finger or toe swells in the form of a sausage (dactylitis, sausage-like toe). Symptoms of sharpening of the phalangeal joints of the fingers are manifested in conjunction with psoriatic changes in the nails.
Course of the disease
In a patient with psoriasis, joint disease develops over time.Often cutaneous psoriasis is only confirmed if a person seeks a doctor for joint symptoms or nail changes. Usually, joint symptoms appear at the age of 30-50, although skin inflammation in this case has already lasted for many years. Articular psoriasis also occurs in children, but it is quite rare.
Psoriasis of the joints can be suspected if the patient has cutaneous psoriasis and inflammation of one or more joints. The skin inflammation can be quite extensive or limited to the nails only.Sometimes it appears on the scalp as scaly patches.
In psoriasis of the joints in the blood tests there are no increased indicators of inflammation (ESR, CRP) and rheumatic factor, as in articular rheumatism.
X-ray in the joints showed the same erosive changes as in articular rheumatism. In patients, the pointed phalanges of the joints of the fingers are eaten away. Mutilating, disfiguring arthritis caused by the destruction of the bone tissue of the phalanges of the fingers is quite rare.
Timely treatment of skin manifestations of the disease and sunlight also relieve joint symptoms. Strengthening the physical condition of joints and muscles is suitable as an initial treatment. For more help, you can contact the hospital’s rehabilitation department.
Paracetamol or anti-inflammatory and pain relievers are used to relieve pain symptoms. If the inflammation of the joints is prolonged or if the X-ray shows changes in the joints, the same medications are used as treatment as in the initial treatment of articular rheumatism.Methotrexate is effective for inflammation of the skin and is better for treating articular psoriasis than for treating articular rheumatism. A similar new generation drug is leflunomide. For mild articular psoriasis, sulfasalicylates should be tried first to eliminate joint symptoms. Cyclosporine is suitable for the treatment of both complex skin inflammations and for the treatment of joint inflammation. Cortisone injections are used to treat swollen joints. With mutilating, disfiguring arthritis, arthroplasty or endoprosthetics are performed.
Complex articular and cutaneous psoriasis can also be treated with biological rheumatic drugs. Currently, TNFα inhibitors (blockers) are used in Finland: infliximab, adalimumab, etanercept. They quickly relieve inflammation. The patient can inject adalimumab and etanercept himself. Infliximab is administered to the patient by intravenous drip in a hospital.
On average, joint psoriasis is a milder disease than joint rheumatism. The long-term prognosis is often very good.Treatment of complex diseases that cause changes in the joints should be carried out as soon as possible. Medical therapy in the initial stage of the disease is more effective. If left untreated, psoriasis of the joints can lead to disability, destruction of the joints, or stiffness of the spine.
7. JOINT RHEUMATISM
Joint rheumatism (rheumatoid arthritis, arthritis rheumatoides) is a common inflammatory disease of the joints. Every year 1,700 Finns fall ill with it, usually women 60-70 years old, less often young men.There are approximately 35,000 people with articular rheumatism in Finland.
The causes of articular rheumatism are unknown, but it is included in the so-called autoimmune diseases, in which the body’s immunological defense is directed against its own tissues. Articular rheumatism is not a hereditary disease, and susceptibility to it is weakly inherited. Smoking, the postpartum period, all kinds of infections, mental factors and joint injuries contribute to the occurrence of articular rheumatism.There are no clear links between nutrition and the onset of the disease, but during treatment, attention should be paid to a healthy diet.
At first, changes in the body can begin not in the joints, but in other places. With inflammation, the articular membrane thickens, new blood vessels grow in it, and inflammatory cells circulate in the tissues. Active inflammatory cells release immune complexes (interleukins, prostaglandins, Tnf-alpha) into the environment that cause inflammation in the body: fatigue, fever, increased blood counts and CRP.
Inflamed tissue grows and expands along the surface of the articular cartilage and bones. It gradually eats away at healthy cartilage, bones and joint ligaments. In this regard, the structure of the joint is destroyed, and its work is disrupted.
Articular rheumatism begins with mild joint pain that manifests itself in the morning as soreness and stiffness in the fingers or toes. A visible symptom is joint edema, which occurs with an increase in the amount of articular fluid and a thickening of the articular membrane.With severe inflammation, the joint turns red and becomes hot. The swelling begins most often in the fingers and wrists. Articular rheumatism is usually a symmetrical disease of the joints of the fingers and toes, but it can spread to all joints of the limbs, as well as to the jaw joints and the cervical spine. It usually does not appear in the first phalanges of the fingers and the lower back. In the initial stage, the disease causes a deterioration in the general condition, a feeling of malaise, fatigue and joint stiffness in the morning.
Course of the disease
If the body’s resistance overcomes the disease, the symptoms of articular rheumatism disappear at all or do not appear for a long time.Most often, articular rheumatism is a disease that lasts for decades. Cartilage erosion begins within a few months from the onset of the disease. Over the years, erosion expands and captures more joints.
Most of all, patients suffer from damage to the large joints of the extremities (hip, knee, shoulder joint) and the cervical spine. Joint movement is difficult, but patients suffer much more pain. The pain is manifested by increased sensitivity of the joints, however, in the initial stage it is not very significant.
With prolonged articular rheumatism, symptoms also appear in other organs. Prolonged inflammation dries out tissues: the skin becomes thinner, muscles die off, bones break, and blood hemoglobin decreases. Dryness of the mucous membranes of the eyes, mouth and genitals comes from Schengren’s syndrome. Friction can cause rheumatic bumps to grow in the elbows, fingers and toes. Blanching of the fingers or Raynaud’s symptom is a signal of vascular disease. Pleurisy and rheumatic nodes develop in the lungs, and sometimes serious pulmonary changes occur.Amyloidosis (impaired protein metabolism) occurs as a result of prolonged active inflammation, but kidney damage caused by it is currently rare.
At the onset of the disease, articular rheumatism is difficult to diagnose. If articular rheumatism is suspected, the patient is referred to a specialist doctor. Symptoms of the disease are obvious swelling of the joints, especially fingers and wrists, sensitivity of the ball of the foot, increased blood inflammation (ESR, CRP) and rheumatic factor.Articular rheumatism is assessed according to seven criteria. If four of the seven criteria are met, the patient is diagnosed with articular rheumatism, and active treatment should be started as early as possible.
Symptoms of immunological disorders are confirmed by rheumatic factor in the blood, and sometimes antibodies. The rheumatic factor was detected not in all patients with articular rheumatism. It can also be found in people with other diseases or in perfectly healthy people. Therefore, the diagnosis of articular rheumatism is radically independent of the presence of a rheumatic factor.
Classification of articular rheumatism:
morning stiffness of the joints for at least one hour
swelling of at least three joints
swelling of the arm joint
symmetric swelling of the joint
rheumatic bumps rheumatic cones rheumatic factor
X-ray visible injuries in the joints
Treatment of articular rheumatism should be multifaceted. It is important for patients with chronic diseases to know more about the disease and the possibilities of its treatment.
The course of articular rheumatism does not allow it to be influenced by other means than drugs. Sometimes surgery and physical therapy are required to prevent disability. Effective medical treatment is especially important in the early stages and when joint destruction is progressing.
At the initial stage, the treatment includes, first of all, drugs that slow down the course of the disease. In the complex treatment of articular rheumatism, methotrexate, sulfasalicylate, hydroxyclorokine, gold preparations, leflunomide and cyclosporine are used; biological drugs can be tried.Despite the side effects, the benefits they bring are much greater than the harm. Treatment started early is more effective.
Most patients require pain relievers (paracetamol, anti-inflammatory drugs). They do not inhibit the development of the disease, but good pain relief improves the quality of life. Cortisone medications are used as supportive therapy to relieve pain as well as keep joints working. Cortisone injections directly into the joint temporarily relieve swelling and significantly improve mobility.The attending physician should have the cortisone syringes needed by the patient ready.
Surgical treatment can be used to remove inflamed tissues not susceptible to drugs from a joint or from a tendon, as well as to correct an already damaged joint. Often, an artificial joint can prevent the development of a disability.
Physiotherapy is used to treat pain and keep the joints moving with the help of special exercises. In the active phase, it is necessary to maintain the mobility of the joints and the physical condition of the muscles.
A specialist doctor teaches gentle motor skills. Various splints are used to reduce joint pain and prevent joint misalignment.
Rehabilitation supports work and physical activity. In rehabilitation courses, immediately after the detection of the disease, patients receive information about the disease and its impact on daily life. Sufficient attention should be paid to the professional rehabilitation of the working population and youth. KELA organizes rehabilitation in especially difficult cases.
At the initial stage of articular rheumatism, it is rather difficult to make a prognosis. Therefore, even mild symptoms of articular rheumatism should be taken seriously. Currently, most of the patients are living a normal life, starting a family and retaining their ability to work. Although there is an improving treatment, articular rheumatism progresses for decades and destroys the joints, but there is no threat of complete loss of motor activity.
8. JOINT RHEUMATISM II
Arthrosis or osteoarthritis is a common disease of the joints.It is associated with an increase in the average age of the population. Almost every pensioner has osteoarthritis, but only some of them cause significant harm to health. Due to the inability of older people to move independently, society incurs significant costs. To preserve the motor ability of the elderly, thousands of hip and knee replacements are performed in Finland every year.
More often arthrosis manifests itself in the interdigital joints of the foot, the first metatarsophalangeal joint of the hand, in the joints of the spine, but arthrosis of the hip and knee joints brings the greatest harm to health.
The occurrence of arthrosis of large joints is promoted by old age, hard work, sports with stress on the joints, obesity, injuries and inflammations of the joints, heredity. A big problem is weight gain, which causes and always complicates most of the knee arthrosis. Arthrosis of the toes and hand is, for the most part, a hereditary disease.
At the initial stage of arthrosis, the most important symptom is pain, which intensifies when starting to move after rest (starting pain).The primary pain arises when going down the stairs, then pain when going up is added to it. With the development of the disease, the range of motion of the joint decreases. The knees are turned to the sides, and bow-legged appears. In the fingers, in the place of the joints, bone cones grow. The uneven cartilaginous surfaces of the joints crunch when moving.
Osteoarthritis worsens gradually over the years. Problems depend on the affected joint. Arthrosis of the spine leads to the formation of bone spurs and compression of the nerves coming out of the spinal cord, as a result of which the back pain passes into the legs (sciatica).Osteoarthritis of the hip and knee joints complicates movement and can cause severe pain.
Course of the disease
At the onset of arthrosis, the smooth cartilage covering the surface of the joint begins to decompose. The body reacts to this by overgrowing the bone tissue of the cartilage. The joints become firm and in contact with each other, and their range of motion decreases. Usually the joint takes a forced position. Gradually, the inner surface covering the articular membrane of the damaged joint becomes irritated and inflamed.Fluid builds up in the joint and may turn red. The joint becomes inflamed and arthrosis progresses.
The doctor makes a diagnosis of arthrosis based on symptoms and X-rays. However, multiple arthrosis can be mistakenly treated like gout or articular rheumatism. A blood test does not diagnose arthrosis.
Arthrosis cannot be cured. First of all, paracetamol and, if necessary, anti-inflammatory drugs are used as anesthesia.Some are helped by glucosamine. Anti-rheumatic gel ointments containing anti-inflammatory drugs help with arthrosis of the fingers. Your doctor may inject cortisone medications into irritated and swollen joints. Arthrosis of the knees can be treated with hyaluronate injections. Complex and painful arthrosis of the hip and knee joints is treated by surgery.
Too much stress on sore joints should be avoided. A wand or rollator and high-legged chairs make everyday life easier.You should also stop carrying heavy loads.
Weight management is an important part of treatment because excess weight, first of all, loads the joints. Joint performance is supported by movement, and muscle condition is maintained by regular physiotherapy exercises. Exercise is essential to straighten your hip and knee joints. To straighten your knees, you can exercise while sitting on a chair. If pain is felt, straightening movements can be done while lying on your back, with a pillow under your knees. A cold compress in the acute phase soothes sore and painful joints.In the calm phase of the disease, warming the joints brings a sense of relief. When treating arthrosis of the fingers, regular exercise keeps them mobile.
Most patients are coping well with their illness. More painful are diseases that begin at a young age and in several joints at the same time. Osteoarthritis causes a deterioration in normal life. The increase in the overweight of the population is the cause of arthrosis in the future. Joint replacement surgery can avoid the patient’s disability.
9. JOINT HYPERMOBILITY
Joint hypermobility is a set of symptoms in which the joints have an abnormally wide range of motion. Joint hypermobility is especially pronounced in children and young women. It is rare in the elderly. Some professions (musician, acrobat) benefit from a wide range of joint motion, but it can be harmful to the joints.
The weakening or tension of the articular ligaments in people is different.Probably, there are differences in the structure of the binding protein, collagen, and connective tissue. Joint hypermobility is often hereditary. It is difficult to distinguish it from Ehlers-Danlos syndrome (skin hyperelasticity).
Joint hypermobility is not necessarily harmful. A common symptom is pain that is localized in the joints (hip, knee, shoulder, wrist) or back. Common pain conditions are easily interpreted as fibromyalgia, one of the causes of which may be hypermobility of a joint.In complex forms of the disease, the joints can easily twist. Hernia, varicose veins, impaired venous circulation, prolapse of the uterus and urinary problems can also join the complex of symptoms. Hypermobility can lead to arthrosis.
Joint hypermobility is determined using the Beighton scale. If a person has five criteria out of eleven, the joints are considered hyper-movable.
passive dorsiflexion of the little finger more than 90 ° (left and right hand)
passive adduction of the thumb to the flexor surface of the forearm (left and right hand)
hyperextension of the elbow joints more than 10 ° (left and right arm) )
overextension of the knees more than 10 ° (left and right legs)
bending forward without bending the knees, with palms touching the floor
The patient should be aware of the origin of the symptoms.There is no complete cure, but symptoms can be relieved with joint and muscle exercise therapy. Activities that increase the risks and lead to a wide range of motion of the joints and dislocations should be discontinued. Conventional pain relievers relieve pain. Joint hypermobility should be considered when choosing a profession.
With age, the range of motion of the joints decreases. This improves the long-term prognosis.
Osteoporosis is a progressive decrease in bone density, leading to a decrease in bone strength and an increase in the likelihood of fracture. After age 30, bone density begins to slowly decrease. Older people are at increased risk of bone fractures from falls. In Finland, more than 400,000 people suffer from osteoporosis, most of whom are women over 50.
Age-related decrease in bone density is a normal physiological process.But a sharp decrease in bone density leads to osteoporosis. Osteoporosis is more common in women than in men. The risk of the disease in women increases during the climacteric period, when the production of female sex hormones (estrogens), which regulate bone metabolism and prevent osteoporosis, decreases. A short period of puberty (late onset and early end of menstruation) is also a cause of osteoporosis.
A lean physique, lack of exercise, vitamin D (sunlight) and / or calcium, smoking, excessive salt intake, bowel disease, rheumatism, diabetes, kidney disease, and certain medications (cortisone, antiepileptic drugs) increase the risk of osteoporosis.Overweight, although it is a dangerous disease, to some extent protects against osteoporosis. The predisposition to osteoporosis is hereditary.
Osteoporosis is asymptomatic. Problems arise with bone fractures, the most common of which are vertebral fractures. In this case, height decreases and posture changes. Fractures of the femoral neck are considered complex. Over the past 15 years, the number of upper femoral neck fractures has doubled in Finland.Although fractures caused by osteoporosis are treated with surgery, the quality of life of older people is impaired.
An experienced doctor can quickly diagnose an elderly person by measuring their height. If over the years the growth has decreased by more than 5 centimeters, and the posture has become stooped, the diagnosis is correct.
Bone density can be measured. The measurement is made based on an analysis of the bones of the back and upper thigh bone.
Hospitals and private clinics have devices for examining osteoporosis.Based on international criteria, women are diagnosed with a bone density below 2.5 units. standard deviation than at a young age. For men, the border is 3 units. standard deviation.
A conventional bone X-ray can be used to assess the initial stage of osteoporosis. The X-ray shows a fracture of the bones of the spine. Density is measured by ultrasound examination of the calcaneus, but in this way it is impossible to establish the exact location of the fracture.
Osteoporosis can be prevented. Young girls need to increase bone density and build bone mass that protects against possible fractures as they age.
Ÿ Constantly move
Ÿ Lose weight carefully and avoid a sharp drop in weight
Ÿ Go outdoors more often, so you get vitamin D
Ÿ Diet should include milk and cheese, forest fish
Ÿ Do not smoke
Ÿ Consume a limited amount of salt
Ÿ Brew tea, which contains Florid, which strengthens bones
Ÿ Women over 40 are recommended to be tested for the presence of estrogen
Ÿ In the dark, people over 50 For years it is recommended to take vitamin D and calcium
Ÿ Falling is especially dangerous in old age, therefore it is recommended to wear special clothing protecting bones.
Osteoporosis is difficult to treat because bone is slowly renewing itself. Cortisone treatment is given to people who have had fractures and their bone density is constantly decreasing.
Treatment provides adequate vitamin D and calcium intake. The daily intake of calcium is 800 mg, it is contained, for example, in three glasses of milk or kefir. Cheese and other dairy products are also good sources of calcium.
Vitamin D is obtained by a person under the sun, as well as from food, for example, fish and mushrooms are rich in vitamin D.For people over 70, it is recommended to take 15 micrograms of vitamin D daily (600 units). This amount is difficult to obtain from food, which is why it is prescribed for older people in the form of dietary supplements.
The drug treatment of osteoporosis is constantly evolving. Treatment is lengthy and quite expensive. An important drug group is bisphosphonates (alendronate, etidronate, residronate and ibandronic acid). Currently, the dosage of drugs is calculated so that they need to be taken no more often than once a week or month.Medicines come in the form of a nasal spray. Also, women can take drugs containing the hormone estrogen or drugs that act in the same way (raloxifene). In difficult cases, strontium and teriparatide are used.
11. RHEUMATIC POLYMIALGIA
Polymealgia is a fairly common disease that causes muscle pain. Poly means a lot, myalgia means muscle pain.
The causes of the disease are not clear, but a viral infection can provoke the disease.Most often women get sick with polymyalgia after 50 years.
Symptoms of the disease appear rather slowly. Pain and numbness (stiffness) appear in the muscles of the neck, shoulders, lower back and hips. Muscles become tender and sore when moved and touched. Swelling of the joints is rare. Due to the appearance of muscle and joint pain, it is difficult to get up in the morning. The patient may also have fatigue and fever. In the blood test, the indicators of inflammation are increased, so a previously healthy and vigorous person feels seriously ill.
Often arterial inflammation joins the muscular form of rheumatism. Inflammation of the temporal artery causes pain in the temples or cheeks, such as when chewing food. An inflamed artery can sometimes be seen in the temple area, it is tense and enlarged. There may be no pulse in the artery. It is important to detect temporal artery inflammation (temporal artery) in time, because a branch of the temporal artery goes to the base of the eyes. Obstruction of the temporal artery can lead to loss of vision.
The doctor makes a diagnosis based on the symptoms of the disease, the patient’s age, pain, general condition and blood test. Elderly people are prescribed other types of examinations. If an inflammation of the temporal artery is suspected, the patient is referred to the Central Hospital for examination.
Cortisone preparations are prescribed for the treatment of polymyalgia. Treatment lasts at least a year and the dose of cortisone is gradually reduced based on observations of the course of the disease, symptoms, and blood counts.Other drugs are also used for treatment, such as methotrexate. Inflammation of the temporal artery is treated in a hospital.
The forecast of polymyalgia is good. With the right approach to treatment, in a few years health returns to almost all sick people.
Polymyositis is a rather rare inflammatory muscle disease that manifests itself both together with rheumatism and an independent connective tissue disease.Also, the disease includes cutaneous and inclusive myositis.
Approximately 20 people fall ill every year in Finland. Adults are more likely to get sick, but the cutaneous form of myositis is also found in children.
The causes of myositis are unknown, but obviously, we are talking about a dysfunction of the autoimmune system, as in other systemic diseases of the connective tissues. Muscle inflammation can present with mild articular rheumatism, Shegrin’s disease, or SLE symptoms.The cutaneous form of myositis can occur in the presence of cancer.
An important symptom of polymyositis is muscle weakness. Symptoms usually develop slowly, and pain first appears in the thigh, hip, and shoulder muscles. Difficulty getting up and raising arms up. Also, patients have difficulty swallowing food. With the cutaneous form of myositis, symptoms appear on the skin of the hands and face. Inclusive myositis manifests itself more slowly than other forms of myositis.In children, after inflammation, calcium is deposited in the scar tissue. The inflammation causes fatigue, weight loss, and fever.
The diagnosis of myositis is based on a blood test. A biopsy is also done. If necessary, electroneuromyography (ENMG) and magnetic resonance imaging are done. Elderly people, if necessary, undergo additional examination.
Treatment begins in the hospital with fairly high doses of cortisone.If cortisone treatment is not enough, methotrexate is given. In difficult cases, new biological rheumatic drugs are prescribed.
The treatment lasts for years, so it is important to keep your muscles in shape.
Previously, myositis was a dangerous disease, but now it can be completely cured of it.
13. REACTIVE ARTHRITIS AND REITER’S SYNDROME
Infectious diseases of the bowel, urinary tract or sexually transmitted infections can cause inflammation of the joints.In the future, this leads to reactive inflammation of the joints (arthritis), that is, the body’s immunological response to infection. With Reiter’s syndrome, patients may have inflammation of the mucous membrane of the eyes, skin or mouth, genitals, or urinary tract.
The lining of the joint reacts with inflammation to bacteria-infections. The body makes antibodies (immune response) against itself. Reactive joint inflammation begins, for example, with chlamydia, salmonella, or a common bowel disorder.There is a high risk of intestinal infections in large tourist centers in hot countries.
The disease has a hereditary predisposition. HLA-B27 antigen was found in most of the patients. Reactive arthritis mainly affects young people.
Symptoms of reactive arthritis begin one week after an intestinal or venereal infection and are manifested by pain and swelling of the joints. The initial infection usually goes away. The disease is manifested by inflammation of several joints.Usually the lower limbs are affected more often than the upper ones. Also, the sacrum and ilium become painful.
Reactive arthritis and Reiter’s syndrome cause flaky redness of the skin on the feet, toes and genital mucosa (balanitis). Also, patients may have redness of the mucous membrane of the eyes or inflammation of the ureters. Fever and fatigue are common symptoms of the disease. A blood test indicates the presence of an infection in the body.
Reactive arthritis can be easily diagnosed if the patient has recently had a venereal or intestinal infection.Sometimes there are few or no symptoms of infection. Then the causes of the infection are found out by culture or blood test for antibodies. Sometimes it becomes necessary to exclude other diseases, such as incipient articular rheumatism.
An ECG is also done because there is a risk of heart inflammation.
An infection that causes joint inflammation is treated with antibiotics. Chlamydia treatment is also prescribed. Anti-inflammatory drugs, pain relievers, and sometimes cortisone-containing drugs are given as injections into the affected joint or as pills.Swollen joints should not be overloaded, but supportive exercise is not contraindicated.
Cold treatments such as an ice pack can also be used to relieve inflammation and pain.
If during several months the inflammation of the joints does not go away, then rheumatic drugs are prescribed, one of them is sulfasalacin.
Re-inflammation can be avoided by safe sexual intercourse, good hygiene and good nutrition.
Reactive arthritis usually heals in a few months, but joint pain can last for a long time.After a sexually transmitted infection, the disease is more difficult to treat than after an intestinal infection. Individuals with the HLA-B 27 antigen are at increased risk of re-disease.
In some patients, reactive arthritis turns into a chronic form of rheumatism, spondylatropathy (ankylosing spondylitis), for example, with rheumatism of the spine.
14. RHEUMATISM OF THE SPINE AND BEKHTEREV’S DISEASE
Rheumatism of the spine is a long-term inflammatory disease of the spine, sometimes manifested in the joints of the extremities.In addition, it can cause inflammation in the attachment points of the tendons and in the eyes. Sometimes the inflammation can be in the heart or on the walls of the aorta. Spinal rheumatism refers to spondylatropathy.
Rheumatism of the spine occurs equally often in both men and women, but in men the disease is more serious. Most of the patients in the hospital are men. Almost all women with spinal rheumatism are unaware of their illness. Heredity is a risk factor.In Finland, about 10,000 patients with rheumatism of the spine need treatment. But according to statistics, patients with rheumatism of the spine can make up one percent of the total population.
The causes of the disease are unknown, but infectious diseases are one of the factors. Spinal rheumatism may appear after suffering from reactive arthritis. In 95% of patients with rheumatism of the spine, the hereditary antigen HLA-B27 was found.
A young man who starts waking up at night with pain in the lumbar region is a typical patient.The pain can radiate to the back of the thigh. Your back won’t bend in the morning, but a little exercise will ease the pain. In half of the patients, the joints of the arms and legs also become inflamed, the knees, legs and hips swell. Sometimes the disease begins with swelling of the joints of the hands and feet, less often with eye inflammation. Quite often, the disease is accompanied by chest pain.
Symptoms of spinal rheumatism may be short-lived. Sometimes the disease manifests itself again after a while. There are pains in the spine when bending forward.Bone bridges grow between the vertebrae. Posture changes and the flexibility of the spine decreases. The joints of the arms and legs are also affected. The joints of the hips, knees and shoulders are especially affected.
At the next stage of the disease, some patients develop eye inflammation – iritis. One or two out of a hundred patients with rheumatism of the spine subsequently develop inflammation of the heart.
Due to the fact that back pain is common, the diagnosis of rheumatism of the spine is very easy to miss.At the initial stage of the disease, the flexibility of the spine is in good shape, but over time, the back grows numb and the flexibility of the spine deteriorates. Sometimes the diagnosis of rheumatism of the spine can be made only five or even ten years after the first symptoms of the disease appear.
The disease is confirmed by an X-ray of the sacral spine, which shows inflammatory changes. In the early stages, you can take a magnetic image. Later, bone bridges (syndesmophytes) are visible between the vertebrae.The blood test shows high levels of inflammation and low hemoglobin. In some cases, the blood test may be normal. There is no rheumatic factor in the blood. A test for the presence of the HLA-B27 antigen is prescribed.
Exercise is important in the treatment of back rheumatism. Rheumatism affects the spine and a forward bend is formed. By exercising daily, you can maintain good posture and flexibility in the spine. Straighten your back at least once a day.This can be done by approaching a wall, pressing your heels, buttocks and shoulders against it. The chest can be kept in good condition by taking deep breaths and exhales. It is advisable to direct the patient to physical education and explain what needs to be done to keep the body in good shape. Classes with a professional instructor are especially important for young patients.
For mild forms of the disease, pain relievers and anti-inflammatory drugs are prescribed. Sulfasalacin is prescribed to prevent the development of the disease in the spine.Other medications are also prescribed. For example, new biological antirheumatic drugs that are effective in the treatment of rheumatism. If rheumatism affects the joints of the hips and knees, then the patients undergo joint replacement surgery.
Pain and redness of the eyes can be a sign of inflammation, for this it is recommended to consult an ophthalmologist.
Good treatment is prevention. Spinal rheumatism is not cured, but it can be prevented.The acute period of the disease rarely occurs in people over 40 years of age. Most people retain their working ability, and only a small proportion of those who fall ill are disabled.
15. HEREDITARY DISEASE OF CONNECTING TISSUE
Connective tissue connects all tissues in the body, it consists of cells, fibers, water and intercellular substance. Connective tissue fibers are proteins or proteins, the structure of which is inherited from the father and mother. If there was an error in the genes of the parents, then in the new, born gene there will also be an error, which will lead to the appearance of the disease.
Collagen is a protein in the body. They are tough fibers that can withstand stretching. Tendons, ligaments and muscular membranes are formed from collagen, and collagen is also found in other tissues. There are many types of collagen. Collagen I is found in bone tissue, collagen II – in cartilage tissue.
Elastin are fibers that stretch like rubber. Elastic fibers wrap around fibrillins like fishnet tights wrap around a woman’s leg. In all protein fibers, hereditary diseases caused by an error in genes can manifest.
Ehlers-Danlos Syndrome (EDS)
There are about 1000 patients with EDS in Finland.
The cause of the disease is heredity. If the parents of the child are sick with Ehlers-Danlos syndrome, then the probability of the child’s illness increases by 50%. But it is possible that the affected gene of one of the parents will never lead to the disease. If the genes are affected in both parents, then the child’s chance of getting sick is one in four. Ehlers-Danlos Syndrome is a group of inherited connective tissue disorders that affect the skin, joints and blood vessels, causing them to stretch.With this syndrome, there are disorders in the structure of collagen.
The symptoms of the disease are varied: easily damaged elastic skin, hyper-movable joints, varicose veins, hernias, ruptured blood vessel walls, inflammation of the gums and tooth loss. Symptoms depend on the type of disease.
Courses for EDS patients are organized at the Apila Rehabilitation Center, where people with this disease are helped to cope with their difficulties and problems: pain, joint flexibility, dental problems, muscle weakness, bruising and bleeding, slow wound healing and scarring, problems bowel dislocation, fatigue and swelling.In women, miscarriage prevention.
Types of EDS-syndrome
Currently, EDS-syndrome is divided into different forms of the disease.
Hypermobility – hypermobility (formerly type III)
The main symptom of the hypermobile type is increased mobility in large and small joints, sometimes dislocations and pain. The skin is stretchy and velvety. The disease can manifest itself in relatives.
Classic form of EDS (earlier forms I and II)
In the classic form of the disease in patients, the skin is soft and velvety, pronounced elasticity of the skin, a tendency to damage with minor trauma, as well as the formation of bruises or hematomas, scars, subcutaneous pseudotumors, increased mobility in large and small joints, frequent varicose veins.Patients also have inguinal and diaphragmatic hernias, bruising, muscle weakness, hemorrhoids, and gum disease. The disease is hereditary.
Vascular form (formerly form IV)
In patients, this form of the disease is manifested by joint hypermobility. Vessels are easily damaged because the vascular walls are weak, which is vasculitis, that is, inflammation of the vascular walls.
The skin of these people is thin, transparent with translucent vessels. Bruises easily.
EDS kyphoscoliosis (formerly type VI)
Kyphoscoliosis is a rare disease, but the affected gene is currently being investigated. This disease affects about 60 people on Earth. They have severe muscle weakness, which leads to incorrect posture of the spine – scoliosis. In some cases, there may be increased eye vulnerability and corneal thinning.
Arthrochalasia type EDS (formerly types VII A and VII B)
In a rare form of arthrochalasia type EDS, there are strong changes in the connective tissues that weaken the joints, make the skin easily damaged, lead to inflammation of the joints, brittle bones and orthopedic problems.About 30 people are sick on Earth.
Dermatosparaxis EDS (formerly type VII C)
Severe skin vulnerability and its increased elasticity. One gets the impression that there is a lot of skin. Scars and hernias are common. Pregnant women are at risk of premature birth due to the weak membrane of the fetus.
It is impossible to change the gene and eliminate the cause of the disease. Treatment is aimed at reducing symptoms and preventing them from worsening.
It is important to determine the cause of the disease and to provide the patient with complete information about the disease. Knowing about the nature of the disease, the patient himself plans his life so that the disease does not affect her. When choosing a profession, young people should take their illness into account.
For joint pain, you can take paracetamol and anti-inflammatory drugs. For large joint lesions, joint implantation operations are performed.
Before surgery, EDS patients need to tell the surgeon about their illness in order to avoid complications during wound healing.
There are a number of different tools that can help EDS patients in their daily lives. By avoiding dangerous situations, you can keep your joints intact. Supportive elastic bandages can be worn around the joints. Muscles need to be strengthened. The skin should be moisturized with creams. It is recommended to wear supportive tights and golf to prevent varicose veins. Regular visits to the dentist can help prevent dental problems.
Patients themselves know how important it is to receive information about the nature of the disease.A calm life, rest and relaxation, as well as the support of loved ones help to overcome life’s difficulties. It is necessary to avoid sudden movements, use tight bandages for joints, regularly take medication, eat right, try Reiki treatment, yoga, zonotherapy and lymphomassage. Try to do everything that you can and can do.
Other damage to the structure of collagen
Stickler syndrome is a fairly common disease that is caused by a violation of the structure of type II collagen.The disease is often mild. Stickler’s syndrome is a complex of hereditary abnormalities of the eyes and joints. The first symptoms appear in childhood: congenital severe myopia, often blindness, cataracts, secondary glaucoma, chronic uveitis, keratopathy, wrinkling of the eyeball develop in the blind eye. Joints become hyper-flexible, painful, and prone to fracture. In some cases, violations in the structure of the face are noted: a small chin, split jaws.
Connective tissue dysplasia (MED) is caused by a structural disorder of type IX collagen. These abnormalities in the structure of articular cartilage lead to growth retardation and joint destruction.
Imperfect osteogenesis is a bone disease caused by a type I collagen mutation that can cause fetal death while still in the uterus. In a mild form of the disease, bones are weak and break easily. In addition, there may be problems in the connective membrane of the eyes, hearing problems and deafness.
Other genetic problems of protein fibers
Williams syndrome is a syndrome that occurs as a consequence of the chromosomal abnormality of elastin. Elastin and collagen form a fibrous protein, with the help of which the walls of blood vessels, lungs and other organs are able to stretch. This disease affects one child in 20,000. They develop problems in the cardiovascular system. The aorta and pulmonary artery is narrowed already in childhood, later there are problems with blood pressure. Children are born small, feeding problems, colic appear.Also, there are changes in the structure of the teeth (large gaps between the teeth), weak muscles, hypermobility of the joints. In adults, the joints are less mobile.
Marfan syndrome is caused by a change in fibrillin type I. Fibrillin is a fibrous protein.
In connective tissue, it forms a protective mesh around elastin. In addition to the characteristic changes in the organs of the musculoskeletal system (elongated bones of the skeleton, hypermobility of the joints), pathology is observed in the organs of vision and the cardiovascular system.
16. SHEGRIN’S SYNDROME
Shegrin’s syndrome is a systemic autoimmune disease characterized by dryness of the mucous membranes of the eyes, mouth and genitals caused by damage to the lacrimal, salivary and genital glands. Most often, women are ill. Shegrin’s syndrome affects people over 50 years of age. There is no reliable information about the disease, but according to experts, 3-4% of adults suffer from Shegrin’s syndrome.
The basis of the mechanisms of the development of the disease is considered to be autoimmune disorders, in which the immune system opposes its own tissues.The syndrome can develop independently (primaarinen) or together with other rheumatic autoimmune diseases, in particular, articular rheumatism (sekundaarinen). One of the causes of the disease is considered to be a change in sex hormones, because most of the sick are women.
With Shegrin’s syndrome, dryness of the mucous membranes appears. The first signs of the disease are irritation and dryness in the eyes. There is a dry mouth and difficulty in swallowing food, there is a need to drink food.The voice sits down. Due to the decrease in salivation, caries forms on the teeth and the gums become inflamed. Inflammation of the salivary glands may occur. Dry skin causes itching. Dry nose and dry cough appear. In women, dryness of the mucous membranes of the genitals appears. Disorders of the glands of the stomach and intestines cause malabsorption of iron and vitamin B12.
In Shegrin’s syndrome, fatigue appears, joint pain resembles fibromyalgia, skin irritation and fever appear. Possible kidney disease, swelling of the lymphatic glands and disorders of the nervous system.
With Shegrin’s syndrome, the risk of cancer of the lymphatic glands (lymphoma) increases. With severe edema of the lymphatic and salivary glands, it becomes necessary to examine them.
Shegrin’s syndrome is determined by the dryness of the mucous membranes typical of this disease. Tear production is measured by the Schirmer test, which examines the rate at which absorbent paper becomes wet behind the lower eyelid. The secretion of salivary fluid is measured by the collection of saliva. Microscopic examination of the lips indicates the presence of an inflammatory process.Blood levels of inflammation are elevated. Almost all patients have rheumatic factor of Shegrin’s syndrome and antibodies in their blood.
In the elderly, dryness of the mucous membranes is an age-related indicator and is not a symptom of Shegrin’s disease.
If rheumatism of the joints or another disease of rheumatism is included in the secondary Shegrin’s syndrome, then it is treated in the usual way. Dysfunction of the glands in Shegrin’s syndrome is incurable, but moisturizing can alleviate dry mucous membranes.
Moisturizing eye drops and safety glasses prevent dry eyes. The indoor air should not be very dry. Moisturizing drops are instilled regularly at regular intervals. The use of xylitol chewing gum, as well as medications such as pilocarpine and bromhexidine, increase saliva production. It is necessary to monitor the condition of the teeth. Fungal infections of the mouth and genitals need to be treated with antifungal medications. The female genitals are treated with special moisturizers.
Primary Shegrin’s syndrome is treated with low doses of cortisone. In difficult cases, methotrexate and other newer rheumatic drugs are prescribed.
Shegrin’s syndrome is not cured. Treatment slows the progression of the disease, but you need to learn to live with the disease. Disability caused by illness is rare. Prevention is more influenced by the nature of the course of the primary disease or rheumatism than dryness of the mucous membranes.
17. SERONEGATIVE SPONDYLOARTHRITIS
Spondyloarthritis defines a group of diseases, the exact diagnosis can not always be determined.We are talking about seronegative rheumatism of the spine, with spondyloarthritis there is no rheumatic factor in the blood, but there is a tendency to cause inflammation in the joints of the spine.
rheumatism of the spine (Spondylarthritis ancylopoetica, ankylosing spondylitis)
reactive inflammation of the joints and Reiter’s disease
ulcerative inflammation of the large intestine and Cronin’s disease
part of psoriasis
diseases can cause inflammation in the joints of the limbs and spine.A feature of these diseases is inflammation of the intermediate joint between the sacrum and the ilium (sacroilitis). During examination, the hereditary antigen HLA-B27 is found in patients. Usually these diseases develop at a young age, inflammation of the eyes (iritis), heart and aortic walls appear. All symptoms are rare at the same time. At the beginning of the disease, inflammation of the joints brings problems and pains, but later they can disappear even without treatment.
Spondyloarthritis manifests itself like other rheumatic diseases.Perhaps the cause is a previous intestinal or venereal infection, as with reactive inflammation of the joints. The hereditary factor is of great importance.
Finns live in cold climates and the presence of the HLA-B27 antigen is quite common. 15% of Finns have the HLA-B27 antigen, while only 8% of Central Europeans, 1% of Japanese, and even less of South American Indians. People with the HLA-B27 antigen in their bodies have a hundred times higher risk of developing spondyloarthritis than others.
Spondyloarthritis is a long-term illness, but it rarely causes disability. In mild forms of the disease, the patient is treated with small doses of drugs. In difficult cases, biological rheumatic drugs are prescribed.
18. SYSTEMIC LUPUS ERYTEMATOSUS (SLE)
Systemic lupus erytematosus (SLE) is a systemic autoimmune disease of the connective tissue. The body produces antibodies, which, instead of protecting, attack the connective tissues of the body.Symptoms of the disease appear in different parts of the body. There are about 2,000 SLE cases in Finland, 90% of whom are women. Half of them are under the age of 30. In older people, the disease is mild.
The causes of the disease are unknown. In women in adulthood, sex hormones affect the disease. Heredity also affects the disease. Certain medications (hydralazine, procainamide), chemicals, and ultraviolet light increase the risk of SLE.
Common symptoms of SLE disease are fatigue, weight loss and fever. Skin rashes appear on exposed parts of the body, caused by exposure to sunlight. A red butterfly-shaped rash appears on the face around the nose. Joint pain and inflammation, hair loss, mouth ulcers, kidney disease, inflammation of the membranes of the lungs and heart, and neurological diseases. Pain or rheumatic inflammation in the joints manifests itself in almost all patients, skin rashes – in a fairly large part of the sick, and kidney disease – in almost half.The joints are not destroyed, but they can become deformed. The symptoms of the disease are manifested differently in different people. Most often, the disease is mild and does not affect the patient’s lifestyle. It is quite difficult to identify the form of the disease.
The diagnosis of the disease is made on the basis of symptoms and laboratory tests. There are 11 criteria for disease. If 4 or more criteria are manifested in the disease, then the diagnosis of systemic lupus erytematosus is correct.The calculation of the criteria is more theoretical. In the analysis of blood, the indicators of inflammation increase, but as with other diseases of rheumatism, the CRP is not increased. Almost all patients have antibodies in their blood. By the quantity and quality of antibodies, the stage of the disease and the result of treatment can be assessed. Leukocytes and platelets may be lowered. Anemia is possible.
Mild forms of SLE do not require treatment. The sick person takes care of himself, avoiding the sun’s rays and using protective creams.It is enough to get by with weak drugs, for example, small doses of cortisone and hydroxychloroquine. In difficult cases, the patient is given large doses of cortisone.
Pregnancy can cause problems. It is recommended to consult a rheumatologist about the observation and treatment of SLE disease during pregnancy. Infections can also cause complications. The reason for the rise in temperature must be found out in order to know whether it is caused by an infection or an exacerbation of SLE disease.Treatment is directed at the affected organ. Almost always resembles treatment for osteoporosis.
Prevention of systemic lupus erytematosus is constantly evolving. The disease is dangerous for people with serious diseases of the kidneys, lungs or central nervous system. With age, the disease subsides. SLE- drug-induced illness resolves with drug withdrawal.
1. Red butterfly rash on nose and cheeks
2.Scaly redness on the skin
3. Redness of the skin under the influence of sunlight
4. Ulcers in the mouth
5. Inflammation of the joints
6. Inflammation of the membranes of the lungs and heart
7. Kidney diseases
8. Neurological symptoms or psychosis)
9. Blood changes (anemia, decrease in leukocytes or platelets)
10.Immune changes in the blood (DNA, false positive cardiolipini test)
19. SYSTEM SCLEROSIS (SYSTEMIC SCLERODERMIA)
Systemic sclerosis is a rheumatic disease of the connective tissues. One of the forms of the disease is scleroderma (sclero is hard, dermis is skin). With this disease, the skin becomes rough. Also, the connective tissue of internal organs is scarred, but this symptom is rare. In Finland, 20-50 people fall ill every year, most of them are women.Children rarely get sick.
The cause of systemic sclerosis is unknown, but many chemicals can cause the disease. For example, in 1981 in Spain there was a wave of this disease caused by low-quality vegetable oil. A substandard tryptophan marketed as a natural product caused a second epidemic at the end of the same decade. Also, coal and silica dust, vinyl chloride, triclorothylene and other chemicals can cause disease. Silicone implants are one of the suspected causes.In most patients, the causes of the disease are unknown.
The disease begins with circulatory disorders of the fingers and toes. Raynaud’s symptom appears when the vessels contract so strongly that the fingers turn white at a cool ambient temperature. Skin changes appear on the fingers. The skin of the fingers swells and hardens. Skin wrinkles and folds disappear. Over the years, the skin becomes thin and taut, sometimes calcium is deposited in the skin. Symptoms can spread throughout the body, and the skin becomes denser and deformed.The muscles of the face become immobile and the mouth contracts. The dilated subcutaneous vessels are visible.
Scleroderma can affect not only the skin, but also the internal organs. If the esophagus is affected, there are problems with swallowing. With damage to the lungs, kidneys and intestines, serious health problems appear. These diseases also include such unusual forms of the disease as eosinophilic faskitis. When the inflammation subsides, the skin will scar and resemble an orange peel.
A common form of systemic sclerosis is CREST (from calcinosis – skin hardening), Raynaud’s symptom, esophagus (scarring of the esophagus), sclerodactyly and telagniectasia, that is, dilation of the subcutaneous vessels.
The diagnosis is based on the picture of the disease. Indicators of rheumatism and antibodies are found in the patient’s blood. CREST detects the antibodies characteristic of this disease.
Treatment of systemic sclerosis is difficult because there is not enough effective medicine. The patient needs to protect the skin from the cold. Stop smoking. Vasodilators (nifedipine) are prescribed. Moisturizers are used to prevent dry skin.To maintain the mobility of the fingers, it is necessary to do gymnastics for the hands.
Rheumatic drugs are being tested, but their effect remains negligible. Penisillamine and cyclosporine are widely used. When treating internal organs, symptomatic medications are prescribed.
An important role in the prevention of systemic sclerosis is to limit the disease to the cutaneous stage, when other organs are not yet affected. Over time, the skin softens and the disease becomes mild.But damage to the lungs and kidneys remains a serious disease.
Vasculitis is an inflammation of the walls of blood vessels. The consequences of vasculitis depend on the number of affected vessels and sites of inflammation. In severe cases, vasculitis causes blood circulation problems. This leads to bleeding or tissue death.
Vasculitis is classified based on the size of the vessels involved. Vasculitis affects the temporal artery, cutaneous vasculitis, small blood vessels. With temporal arteritis, large and multinucleated cells are visible in the wall of the temporal artery under a microscope, due to which the disease has received its second name – giant cell arteritis.
Vasculitis is often manifested by rare diseases such as polyarteritis nodosa. As well as Shenlein-Genoch purpura, Churg-Strauss syndrome, Kawasaki disease, Wegener’s granulomatosis, and Takayashi’s arteritis.
The causes of the disease can be infections, tissue damage, foreign substances that cause immune reactions in the body. The mechanism of the appearance of vasculitis has not been determined. Heredity matters too. Vasculitis can be either an independent disease or belong to a group of rheumatisms such as articular rheumatism or SLE disease.
Vasculitis is characterized by fever and weight loss. Due to vascular diseases, skin rashes of various types appear. Typical symptoms of the disease are muscle and joint pain, disturbances in the peripheral nervous system, nosebleeds, coughing up blood, blood in the urine, and abdominal pain.
Half of the patients diagnosed with vasculitis and temporal arteritis show symptoms of polymyalgia. Symptoms of arteritis include headaches in the temporal region and pain in the cheekbones when chewing.With the disease, there is a risk of ocular artery blockage and loss of vision, so treatment should be started as soon as possible. Mostly elderly people get sick.
Takayashi’s disease affects the aorta and the blood vessels emanating from it. The main symptom of the disease is circulatory disorders. The diagnosis is difficult. Mostly young women get sick.
Polyarteritis nodosa is a rare condition in which inflammatory plaques form on the walls of the arteries.It manifests itself in young people. There are serious changes in the internal organs, the diagnosis is clarified during the operation.
The initial symptoms of Wegener’s granulomatosis are upper airway disturbances, sinus inflammation, nasal congestion and nosebleeds. There may also be otitis media and deafness, impaired vision. Complex forms include kidney and lung damage. Some forms of the disease are rather mild. ANCA antibodies are present in the blood.
With secondary vasculitis in combination with other autoimmune diseases, symptoms begin with lesions of small skin vessels. Wounds and necrosis form on the skin of the legs or arms.
Diagnosis is based on symptoms and skin biopsy. X-rays of the blood vessels (angiography) reveal vasculitis. Also, the diagnosis is based on laboratory tests. CRH increased.
Treatment is aimed at eliminating the cause of vasculitis.First, the inflammation of the blood vessels is removed with drugs. After its termination, the underlying disease is treated more effectively. Cortisone is prescribed. Cytostatic agents are often used along with it. In critical situations, large doses of cortisone are prescribed. Biological medicinal products give good results.
The prognosis of vasculitis improves with the development of treatment methods. In a large proportion of patients, symptoms improve. Although sometimes the disease can become severe.Extensive lesions of internal organs give a poor prognosis of the disease and urgent hospitalization.
© 2016 Lappeenrannan reumayhdistys ry.
Treatment of ankle arthrosis | ortoped-klinik.com
Treatment of ankle arthrosis
Ankle arthrosis is a thinning of the cartilage layer, often caused by deformities of the talus (Talus). In this regard, there are a number of specific treatments aimed at preserving it.© www.ortoped.klinik.com
Osteoarthritis (wear) of the ankle joint is usually observed in young patients. However, this joint is less affected by arthrosis than the hip or knee joints.
Therefore, this disease most often occurs for specific reasons (eg accident, injury). And only 5% -10% of all arthrosis of the ankle are formed without obvious reasons (primary arthrosis).
What complaints does arthrosis of the ankle joint cause?
With this disease, the patient feels a starting pain that begins after a state of rest, and then disappears when moving.The joint “rusts” and often looks swollen. In progressive stages, mobility is limited, and after physical exertion, the patient feels pain in the foot even after a few days. When walking, pain in the ankle joint increases, which indicates a gradual deterioration in the quality of human life.
Movements associated with uneven loads on the joint (eg running or tennis) become completely unbearable. The pain gets worse and the joint is very hard.
Osteoarthritis of the upper ankle is also a common disease and is treated at the highest level by the foot specialists at our clinic in Freiburg.One of the main clinical symptoms of the last stage of arthrosis is pain in the joint, as well as a decrease in its mobility. In this case, our specialists in Freiburg perform arthroplasty or arthrodesis, an operation to create complete immobility of the joint. This treatment helps patients suffering from severe disease to maintain mobility in their daily life.
Causes of arthrosis: Deformity or the result of trauma
Osteoarthritis is a wear-and-tear condition affecting both the upper and lower ankle joints.Unlike arthrosis of the knee and hip joints, this type of arthrosis occurs as a result of previous injuries to the ankle.
For this reason, more than 90% of arthrosis of the ankle occurs already in the traumatized state, that is, after the trauma. In this case, we are talking about a secondary type of arthrosis of the ankle joint, characterized by a gradual loss of cartilage resistance and an increase in the load on it.
In this article we will tell you about the most important causes of ankle arthrosis.
In addition, we would like to present to your attention the treatment, with the help of which our specialists have repeatedly managed to stop or significantly slow down the process of joint wear. The treatment offered at our clinic in Freiburg is aimed at preserving and improving the quality of life of our patients.
The treatment of accidental injuries allows us more and more to provide high-quality therapies aimed at preserving the ankle joints.
Modern treatment with high-tech equipment contributes to the restoration of even the initial damage to the cartilage, as well as the cessation of its wear. Thus, our specialists in Freiburg offer highly effective methods for the regeneration of cartilage tissue, aimed at restoring the patient’s health.
Studies in arthrosis of the ankle joints:
- Articular cartilage: One of the main functions of the articular cartilage is to ensure the sliding of the articular surfaces, as well as the even distribution of the load under the influence of various mechanical factors.
- Along with the cartilage, the bone tissue underneath also changes.
- Tendons and ligaments that connect muscles to bones and provide joint stability.
- Axial load and deformations of the bones of the foot – primarily the talus and calcaneus, as well as the “fork” of the ankle joints, formed by the lateral and medial ankle
- Synovial membrane (synovial membrane that produces viscoelastic lubrication in the joint).
- Joint gap.
Osteoarthritis is a collective term used to describe wear and tear in the joints.
When we have a stomach ache, for example, we do not know the cause of the pain. Likewise in the case of arthrosis of the ankle: The term Arthrosis of the ankle does not give any information about the causes of the disease. However, the treatment at our clinic in Freiburg is at such a high level that our foot specialists are able to determine the cause of the pain.Among the most common causes of this disease, our doctors note intra-articular mouse (arthremphitis), axial deformity, as well as sprain.
Thus, this type of arthrosis can occur in humans for various reasons. All these different causes of arthrosis and the clinical picture of arthrosis are united by the end stage of the disease: The fact of wear in the ankle joint due to degeneration and destruction of cartilage tissue on the articular surfaces.
Who suffers from ankle arthrosis?
How often do sports injuries cause ankle deformities?
- Volleyball 40%
- Basketball 39%
- Football 36%
- Springboard 31%
- Running / Walking 30%
Osteoarthritis of the ankle joints is a rather rare disease.Compared to arthrosis of the hip and knee joints, cases of arthrosis of the ankle joints are less common. Increasingly, young patients suffer from this ailment. Ankle arthrosis is less common in older patients. In most cases, ankle arthrosis is caused by trauma. In addition, deformities are noted in patients with this disease, as well as Joint Hypermobility Syndrome (HMS). For this reason, the treatment of this disease is carried out by experienced and qualified orthopedic and traumatologists in our clinic, who have repeatedly proved that orthopedics and traumatology in Germany are at the highest level.In order for the treatment of arthrosis to be successful, our specialists carry out an accurate analysis of the deformities of the ankle joints, as well as the restoration of the axial load.
We draw your attention to the fact that without an accurate diagnosis of the causes of arthrosis, we can only treat the symptoms of the disease, that is, only to alleviate the pain caused by arthrosis.
Fig. 2 The ankle joint is made up of three bones: peroneal, tibial and talus. The connection between the distal fibula and tibia (ankle) is called the tibiofibular syndesmosis and is made by ligaments.Together, the shin bones form the ankle fork and grip the talus. In the lower part of the ankle joint, the main role is played by the talus: from below it is connected to the calcaneus, and from the front – to the scaphoid. With the help of these joints, the talus (lat. Talus) transfers body weight to the entire foot. Like the articular surfaces of the fibula and tibia, the talus of the foot is covered with articular cartilage. Deformation of the talus (lat. Talus) increases the likelihood of arthrosis.The stability of the ankle joints is very important. © Viewmedica
Osteoarthritis of the ankle is a consequence of trauma
Causes of arthrosis in the ankle joint
- Deformities due to rupture of ligaments
- Damage to bones and articular cartilage due to rupture of ligaments
- Excessive stress on the joint due to sports or being overweight
- Sedentary lifestyle
- Injuries and violations of the axis of the lower extremities due to foot deformities (clubfoot, flat feet).
- Foot deformities after trauma
- Inflammatory processes (rheumatism).
- Neurological reasons, e.g. polyneuropathy or nerve damage.
- Metabolic disorders: Gout, hemochromatosis, diabetes mellitus
The upper ankle joint is affected by arthrosis most often due to injuries resulting from an accident. Such injuries include injuries to the ligaments of the upper ankle joint after dislocation, as well as injuries of the ankle joints after fracture.Arthrosis can also occur as a result of improper fusion of bone fractures distant from the ankle. For this reason, excessive pressure is exerted on the articular cartilage. Typically, these injuries accumulate over the years.
In addition to the acquired causes of arthrosis, there are genetically determined abnormalities: Congenital clubfoot, flat feet, or a hollow foot.
Arthrosis of the ankle due to rupture of the external ligaments
Fig. 3 In case of complaints of pain in the foot, we first of all carry out a test to determine the direction of instability.With instability of the lateral lateral ligaments, the talus is displaced and subjected to improper loads. Often, in order to check how successful conservative treatment will be, this clinical test is not performed after a rupture of the lateral lateral ligaments. © Gelenk-Klinik
Today, the treatment of ruptures of the external ligaments of the ankle joint is carried out using the immobilization technique with a special orthopedic prosthesis. For about 20% of patients, this treatment does not bring the desired result, and ligament instability remains.It is the rupture of the external ligaments that leads to instability of rotation of the talus, which can cause arthrosis of the ankle joint in patients leading a sports lifestyle. However, in order for the treatment of arthrosis to be successful, this diagnosis must be carried out long before the beginning of the patient’s complaints. Despite this, this clinical test is an important element of treatment for patients already suffering from arthrosis.
Fig. 4 Strengthening the posterior tibial artery in case of instability of the external ligaments using Terra-Band – simulators for physical methods of rehabilitation and functional training.With this exercise, as well as other exercises, effective treatment and prevention of arthrosis is ensured. © Gelenk-Klinik
In most cases, surgical treatment of this ailment is not necessary. The most suitable treatment for ankle lateral ligament instability is physical therapy, as well as self-training. Only in some cases, our specialists carry out surgical treatment.
Unfortunately, patients who choose conservative treatment for ruptures of the lateral lateral ligaments very often exclude additional examinations necessary to diagnose residual instability when therapeutic treatment is still possible.
The central role of the ligaments in the functionality of the talus
Below is a schematic representation of the talus (top view). The tibia and fibula are marked in yellow. The talus takes on the weight of a person’s body while walking. However, not a single tendon is attached to it, and it does not have a muscle sheath. The position of the talus is held only with the help of ligaments. Only the position of the ligaments and joints surrounding the bone plays a decisive role in restoring its functionality.Therefore, when diagnosing arthrosis of the ankle joint, we pay special attention to patients and take special care.
Purple: Talus; yellow left: fibula; yellow right: Tibia.
Fig. 5 The position of the talus (purple: talus, yellow: fibula and tibia) is also determined by the ligaments surrounding the ankle. © Gelenk-Klinik
Fig. 6: Rupture of the lateral lateral ligament destabilizes the talus and results in a protrusion on the lateral (outer) surface of the talus body.(purple: talus, yellow: fibula and tibia) © Gelenk-Klinik
Fig. 7: Rupture of the tibial collateral ligament destabilizes the talus and results in a protrusion of the deltoid (medial) malleolus. © Gelenk-Klinik
Fig. 8: The most dramatic change in the biomechanics of the talus is caused by the simultaneous rupture of the internal and external collateral ligaments. © Gelenk-Klinik
Stages and morphology of ankle arthrosis
Why is ligament instability the cause of arthrosis?
Loose ligaments and tendons are often the source of chronic pain and joint weakness.The optimal position of the articular surfaces relative to each other is violated. At some points, the articular cartilage is overloaded and worn out. Due to the loss of the joint space, the deformity increases, the patient falls into the so-called “vicious circle”.
As in other cases, wear and tear of the joints leads to degeneration of cartilaginous tissue and, thus, to a narrowing of the joint space.
The joint gap is an element of the joints that is invisible on the radiograph. With sufficient development of the joint space, the bones that form the ankle joint are at a distance from each other, that is, they form the joint space.
In the event of the disappearance of the joint space due to arthrosis and abrasion of the articular cartilage, the load on the adjacent bone tissue increases, and the process of cartilage wear is accelerated. Despite the fact that this ailment does not pose a threat to the patient’s life, it is one of the main causes of premature disability, as well as chronic pain, which significantly reduces the quality of life of patients.
The cushioning function of the articular cartilage of the ankle joint is gradually deteriorating.For this reason, the patient begins to develop inflammation accompanied by swelling of the ankle.
As a result, the bones begin to touch each other in the place where the joints covered them, friction between them increases, and their movement relative to each other is accompanied by a specific crackle, which leads to excessive osteogenesis (bone spur or osteophytes – bone growths) on the ankle joint.
The above mentioned bone spurs are the result of trauma to the articular cartilage and indicate the onset of arthrosis of the ankle joint.
Why are cases of arthrosis of the ankle joint less common than cases of arthrosis of the knee joints?
- The articular cartilage of the ankle is more resistant to destructive changes.
- The articular cartilage of the ankle regenerates slightly better than the articular cartilage in the knee joint.
- The talus is in close contact with the articular surface of the ankle fork, which is a fundamentally important fact for load distribution.Joints with high congruence are more stable.
Conservative treatment (treatment without surgery) is aimed at slowing down the course of the disease. Basically, this treatment is a means of restoring joint stability. Physiotherapy treatment of arthrosis, especially in a specialized orthopedic or trauma room, with the help of a special set of exercises, helps to improve the condition of the ankle. In addition, physiotherapy accelerates the regeneration of cartilage after damage.
Another effective method is the use of special orthopedic shoes, which reduce pain, compensate for gait disorders and optimize joint positions.
Depending on the diagnosis, our specialists use various surgical treatments that can slow down the development of the disease or eliminate existing damage.
Stages of cartilage wear in case of ankle arthrosis
Changes in cartilage in case of arthrosis in the ankle joint
- Stage 0: Smooth and slippery healthy cartilage.
- 1st stage: Chondromalacia (softening) of the articular cartilage, disorders of the cartilage structure.
- 2nd stage: Moderate disorders of the connective tissue of the articular cartilage
- 3rd stage: Cracks on the articular surface, tuberosity.
- 4th stage: Thinning of the cartilage up to the disappearance, dissociation of the cartilage.
Osteoarthritis of the upper ankle joint develops over several years.At the initial stage of arthrosis, damage to the articular cartilage is observed, which gradually reduces the ability of the joints to take on certain loads.
The surface of unhealthy cartilage is more bumpy than that of healthy cartilage, which leads to its more rapid thinning in the joint. The articular cartilage changes in color – instead of white, it becomes yellowish.
At the initial stage of arthrosis, limited endurance of the joints is noticeable only under such strong loads as, for example, football, tennis or contact sports.In the progressive stages of arthrosis, the abrasion of cartilage can also begin as a result of normal daily activities.
Friction of smooth surfaces of cartilage in a healthy joint is only a small fraction of friction when sliding two ice cubes.
With the appearance of tuberosity or complete destruction of the articular surface, friction increases significantly. Over time, in addition to the sliding function, the articular cartilage also loses its shock-absorbing function.
Since, due to the inflammatory reaction in the joint, the damage to the cartilage progresses, its detached particles support the wear process.
Weakening cartilage poorly absorbs the load and does not provide sliding, as a result of which bone growths (osteophytes) form on the ankle joint, limiting its mobility.
Classification: Primary and secondary arthrosis of the ankle
In modern medicine, there are two types of ankle arthrosis:
- Primary arthrosis
- Secondary arthrosis
Classification for reasons:
- Postponed accidents.
- Rheumatic diseases.
- Infectious diseases.
- Loss of motor ability (paralysis).
Primary arthrosis occurs for no apparent reason and is a fairly rare disease. The causes of primary arthrosis to this day remain unclear. Perhaps, in this case, the disease occurs as a result of traumatic injuries and degenerative changes in the articular cartilage.
Much more often than with arthrosis of large joints (eg.knee or hip), the appearance of arthrosis of the ankle has a specific cause.
Secondary arthrosis can occur for various reasons, but most cases of arthrosis of the ankle are preceded by trauma.
Clinical diagnosis of arthrosis of the ankle joint: Talk with a doctor, examination and treatment
Ankle pain and swelling are the most common reasons for a patient to see a doctor.The appearance of pain after physical exertion, that is, immediately after playing sports or walking, indicates the initial stage of arthrosis in the ankle joint. Pain at rest or prolonged pain in the joint indicates a progressive stage of arthrosis of the ankle joint.
An additional sign of ankle arthrosis is premature fatigue after physical exertion.
With diseases of the ankle joints, the patient feels only short-term pain after playing sports or after walking.Complaints only increase over time. In addition, patients experience a significant decrease in physical endurance. In addition, repeated inflammation of the joint capsule negatively affects the mobility of the joints, as a result of which the patient begins to limp so that his weight mainly falls on the healthy leg.
Depending on the extent of the ankle injury, the patient may experience various complaints. Usually, at the initial stage of arthrosis, the patient occasionally experiences pain and fatigue in the joint.
Pain in the ankle joint after a long rest is a fairly typical phenomenon. Only at the progressive stage of arthrosis of the ankle joint pain occurs after physical exertion or at rest at night.
In addition, diseases of the ankle joints gradually reduce the quality of life of patients. This disease can lead to the fact that the patient will not be able to stay on his feet for a long time and play sports as before. Also, people suffering from arthrosis of the ankle joints, unfortunately, cannot take an active part, both in everyday and professional life.Due to the limited mobility of the ankle, as well as the content of the ankle joint at rest, pain begins to be given to the foot or to the lower leg.
Examination of the axis of the lower extremities and the axis of the ankle joint
Deformation of the hind foot, that is, the heel.
Planovalgus deformity of the foot:
This is an inward curvature of an initially straight axis starting from the lower leg to the foot, after which the height of the arches of the foot itself decreases, and the heels and toes deviate outward.The middle longitudinal inner arch of the foot practically disappears.
In order to prescribe the correct treatment, during the clinical examination, the doctor conducts a thorough examination of the axis of the lower extremities.
To establish an accurate diagnosis, our specialists offering foot treatment will pay special attention to deformities in the ankle joint, as well as pronation of the calcaneus, i.e. eversion of the foot inward or outward. In addition, the condition of the arch of the foot is examined.
Plovalgus deformity is accompanied by eversion of the calcaneus (valgus position of the hindfoot).Thus, congenital or acquired deformities after trauma can contribute to the occurrence of arthrosis of the ankle joint. Therefore, the doctor will definitely ask you about the past accidents, injuries, or about the presence.
pain in the foot. And only when the specialist receives all the necessary information, he will be able to prescribe you targeted treatment.
The x-ray shows the joint space, as well as problems with the axis of the lower extremities and deformities
To diagnose arthrosis in the ankle joint, an X-ray is performed under the load of the leg.Disease assessment based on no-load imaging of the lower extremities, inaccurate. The necessary X-ray images show the position of the axes relative to each other, as well as the distribution of cartilage damage in the ankle joint. In addition, these images allow conclusions to be drawn regarding the causes of arthrosis.
X-ray of the axis of the lower extremities and ankle
In order to assess the role of deformities of the hindfoot, it is necessary to take an X-ray image of Zaltsman, on the basis of which the structure of the calcaneus is judged and a decision is made on the need for simultaneous correction of the limb from the back.
Fig. 14 Deformation of the ankle fork leads to excessive movement of the ankle. Arrows show the missing correspondence between the tibia and fibula after rupture of the syndesmosis. © Dr. Thomas schneider
Then an X-ray of the foot is taken under stress, which allows assessing the degree of development of existing arthrosis of the adjacent joints. In this case, the position of the longitudinal arch of the foot also plays an important role: Flattening of the arch of the foot with flat feet or the opposite change with a hollow foot affects the health of the upper ankle joint.
Images of the entire leg to assess the state of the axis of the lower extremities and its effect on the ankle joint are necessary both before displacement osteotomy and before arthroplasty
What helps a doctor recognize arthrosis on a radiograph?
Fig. 15: Deformation of the ankle fork increases the distance between the tibia and fibula. The arrows indicate the missing articular surface correspondence. Untimely treatment of this deformity can lead to arthrosis in the ankle joint.© Dr. Thomas schneider
Computed tomography is an excellent addition to the diagnosis of concomitant arthrosis.
The SPECT examination helps the doctor to conclude about the process of bone metaplasia after stress distribution.
Signs of progressive arthrosis of the ankle joint on the radiograph
The joint gap gradually disappears, and the bones adjacent to the joint become more and more dense, until a bony protrusion (osteophyte) is formed under the influence of a strong load on the extreme region of the bone.An increase in pressure in the bone can lead to its disintegration – the so-called bone cyst (bone cyst) – a disease during which a cavity is formed in the bone, which occurs due to its necrosis (osteonecrosis). The last sign indicating arthrosis in the ankle joint is deformation of the articular surfaces, due to a change in the load line in the joint.
On the upper ankle joint, “flattening” of the talus is quite often observed, as well as repeated cases of bone slipping.
The above changes may entail certain restrictions, which in the future may have a negative impact on adjacent joints.
Conservative treatment is aimed not only at reducing pain syndrome
Treatment of ankle arthrosis: General principles
- Treatment by improving metabolism promotes the regeneration of articular cartilage.
- Treatment by improving proprioception (feeling the position of parts of your own body relative to each other) helps to prevent eversion and leg injuries.
- Muscle strengthening treatment improves joint stability.
- Treatment by straightening the axes of the lower extremities helps to reduce the loads that have a negative effect on the articular cartilage.
- Treatment by correcting deformities of the hindfoot prevents unilateral wear of the cartilage layer.
- Treatment of pain and inflammation treatment improves the course of inflammation damaging cartilage in active arthrosis in the ankle joint
First of all, our specialists try to carry out treatment without surgery.The treatment that will be offered to the patient depends on the stage of arthrosis, and its goal is to stop or suspend the course of the disease.
In order to understand the principles by which conservative treatment operates, it is necessary to pay attention to the above causes of the onset of the disease. We carry out conservative treatment not only to pretend that we are doing something. To a greater extent, our foot treatment specialists try to influence the mechanisms of arthrosis occurrence.Thus, each conservative treatment makes sense in the general concept of the treatment of the disease.
When discussing the treatment of ankle arthrosis, we do not recommend making a distinction between conservative and surgical treatment. Conservative treatment and surgical treatment work according to the same principle: Improvement of congruence and stability in the ankle joint in order to slow down or completely stop arthrosis.
Example exercise on the Balance Board balance trainer:
Purpose of exercise: Improving coordination and self-preservation functions in the ankle
Starting position: Stand hip-width apart.
Exercise: Balance your weight on the machine.
Fig. 17: Ankle training with the Balance-Board. You can familiarize yourself with other exercise concepts by visiting our website on the Internet.
Please note that we recommend independent exercises to restore joint stability and eliminate pain at home only after a thorough examination by a specialist, as well as after diagnostics and recommendations of our physiotherapists.We must make sure 100% that this ankle treatment is appropriate for your individual case.
A specially designed exercise plan will be given to you by one of our experienced physiotherapists. © 2014 Dr. Thomas Schneider,
Conservative treatment of ankle arthrosis
- Orthopedic shoes
- Chondroprotective treatment for the preservation of articular cartilage.
- Special orthosis designed to relieve injured joints in varus or hallux valgus.
- A set of exercises for muscle recovery.
- Therapeutic gymnastics
Also, in our clinic, drug treatment is carried out using anti-inflammatory drugs, the so-called antirheumatic drugs or non-steroidal antirheumatic drugs (NSAR).Painkillers and anti-inflammatory drugs should not be taken constantly or in the morning. We recommend taking these medications when the pain is just beginning.
In addition to this, we offer physiotherapy treatment, as well as the use of special orthopedic devices (eg orthopedic insoles, half insoles, foot and toe correctors).
In addition, we try to slow down the process of degeneration of cartilage tissue by injecting special preparations for the restoration of articular cartilage.First of all, this treatment is recommended in the early stages of arthrosis of the ankle joint: To achieve optimal results, this procedure is performed using ultrasound equipment.
If conservative treatment has not brought the desired results, we offer surgical treatment. However, in most cases, conservative treatment of arthrosis in the ankle joint is successful.
For more serious ankle problems, our trained orthopedic surgeons will immediately plan surgical treatment.However, even after a successful operation, the patient may need long-term conservative treatment, as well as physiotherapy.
Physiotherapy and Rehabilitation
After ligament injury, 20% of patients experience chronic instability in the ankle joint. First of all, this condition can harm athletes, since the tendency to injury in this case increases. Ankle ligament instability puts you at risk of re-stretching from injury.Low congruence of the articular surfaces, which is the cause of injuries and arthrosis of the ankle joints, can also lead to degeneration of the ankle joint. Occasionally, special training to maintain protective reflexes can help prevent further sprains. In addition to “balance board” (see above), modern treatment offers a variety of exercises that promote muscle recovery, self-awareness and long-term stabilization.Please note that special exercises to stabilize the ankle joints must be performed after surgical reconstruction of the ligaments.
Orthopedic products for the treatment of arthrosis of the ankle joint
Orthopedic shoes and orthopedic insoles create conditions for the correct load on the joint. Deformations can be corrected by increasing the height of the outer or inner edge of the shoe. Thus, ergonomic footwear helps to reduce joint pain and stops the development of the disease.
In addition, with the help of a special ankle orthosis (derotation boot), the foot is fixed in a predetermined position (correction of internal or external rotation). First of all, at the initial stage of the disease, orthopedic products help reduce pain and improve joint mobility.
Surgical treatment of the ankle joint
Fig. 19: Calcaneus valgus (X-valgus of the foot, toes and heel turned outward) is a typical deformity of the ankle resulting in arthrosis.© ortoped-klinik.com
As well as conservative treatment, surgical treatment is aimed at improving stability in the ankle joint and treating the causes of arthrosis of the ankle joint.
High-quality treatment of arthrosis of the ankle joint in our clinic is the use of all the most modern technologies and surgical techniques that help to improve the centering of the mechanical axis of the joints with the help of muscles and tendons. We have already talked about the fact that arthrosis of the ankle joints is formed as a result of curvature of the axis of the lower extremities or other deformities of the ankle joint.
Surgical methods aimed at restoring the axis of the ankle joint or eliminating the asymmetry of the talus in the ankle fork help to restore the joints or stop the development of arthrosis.
Fig. 19: Ankle prosthesis (x-ray)
Arthroscopic joint clearing of the ankle: Removing loose bodies from the joint
- Arthroscopic release of joints from free articular bodies (articular mouse) between the articular surfaces.
- Abrasive arthroplasty: Removal of destroyed surfaces of articular cartilage and its roughness.
- Retrograde drilling or microfracture technique for damage to the talus cartilage.
- Articular cartilage transplant in the ankle joint: Transplantation of autologous cartilage cells that are grown outside the joints.
- Correction of the tibia or heel axis (Corrective Osteotomy): The bone structures to be corrected are artificially broken by the orthopedic surgeon, and then they are fixed at the desired angle and position.Thus, deformations are eliminated.
- Ligament reconstruction: The stability of the external ligaments is important for the functionality of the joints.
- Ankle Replacement Surgery: A surgical treatment that helps to restore the original gait and the normal sequence of movements in the joint.
- Ankle immobilization (arthrodesis): In this operation, the orthopedic surgeon removes the articular surfaces, matches the treated surfaces of the tibia and talus, and then fixes them.
Today, ankle arthroplasty is a more effective method of treating arthrosis than the previously used method of immobilizing joints (arthrodesis).
Ankle arthroscopy: Surgical treatment of arthrosis
Arthroscopic treatment of arthrosis is …
- Ligament restoration.
- Ligament plasty and refixation.
- Articular cartilage transplantation.
- Treatment of articular cartilage.
- Removal of free articular bodies (articular mouse – detached cartilage fragments)
- Removal of bone spurs.
- Treatment of inflammation of the synovial membrane of the joints (synovitis).
- Treatment of infringement of the bone or soft tissue structure between the articular surfaces (treatment of impingement syndrome).
One of the most effective methods of treating arthrosis of the ankle joints is arthroscopic minimally invasive treatment, which has wide diagnostic capabilities.During the “keyhole operation”, the surgeon makes only a small incision near the ankle, approx. 1 cm, into which a microcamera (endoscope) and surgical instruments are inserted.
Using this method, our specialists can assess the condition of joints, ligaments, bones and articular cartilage: The camera transmits an image of what is happening on a large monitor, on which the orthopedic surgeon can fully see the patient’s joint.
Wound healing after this intervention occurs very quickly, the likelihood of scar formation is minimal.This method allows for a gentle and effective treatment of ankle arthrosis and provides patients with such advantages as, for example, a relatively short rehabilitation period.
Fig. 21: LEFT: Deviation of the talus (talus) disrupts the fixation of the articular components of the ankle. The bulk of the weight falls on the edge of the talus. Due to chronic reboot, arthrosis is formed. RIGHT: Condition after osteotomy (surgical transection of the bone to correct deformities) of the tibia.Normalization of the load on the articular surfaces, restoration of mobility and reduction of the progression of joint degeneration. Depending on the initial situation, the development of arthrosis of the ankle joint stops or is delayed for many years. © www.ortoped-klinik.com
Accompanying interventions are intended for the preservation and replacement of joints
Joint preservation or replacement?
The third generation durable endoprostheses were invented in the 90s.Many years have passed, and modern specialists who offer the treatment of arthrosis of the ankle joint have learned a lot of useful information about what contributes to the long-term preservation of the installed endoprosthesis.
Orthopedic surgeons constantly improved their knowledge and before the operation of ankle joint prosthetics performed the so-called accompanying operations, helping to eliminate any inaccuracies. Then it became known that patients who were previously recommended an operation to immobilize the joints (arthrodesis) can undergo joint-preserving ankle surgery.With the help of accompanying interventions, our specialists can help patients with arthrosis restore their natural mobility for many years.
The decisive factor for both preservation and replacement of joints is the correction of associated injuries, which are most often the cause of the formation of arthrosis of the ankle joint.
Such injuries (deformities, ligament injuries or ankle fork correction) can be treated without complications during arthroplasty: Surgical corrections of this kind can prevent premature weakening of the endoprosthesis.
After the accompanying surgical interventions, unstable and deformed joints can still be cured with arthroplasty.
Treatment of the negative effects of foot deformities on the upper ankle joint prosthesis requires high professionalism and long-term experience of the attending physician.
In case of foot deformity (planovalgus deformity), we perform surgical treatment aimed at correcting the tarsal bones (osteotomy).
During the osteotomy, the surgeon forms the longitudinal arch of the foot with pin fixation and a plaster cast bandage. When pronating the calcaneus, a transverse osteotomy of the tarsal bones is performed at the level where the sphenoid bones are located. The longitudinal arch of the foot is formed by the formation of a wedge-shaped regenerate with the base outward and upward.
Surgical preservation of joints or endoprosthetics?
Before deciding which treatment is most appropriate for a patient, the doctor takes into account the following factors.
- Complexity of the ankle deformity.
- Patient weight.
- Degree of activity.
- Frequency of physical activity.
Correction of concomitant changes in the ankle joint has a positive effect on arthrosis. The potential of joint preservation surgeries along with modern possibilities of osteosynthesis (bone grafting) and articular cartilage treatment (cartilage transplantation in the ankle joint) is significantly increasing.
As a rule, the treatment of concomitant diseases helps patients to do without endoprosthetics or arthrodesis. The desire to avoid or delay joint replacement surgery can have a positive impact on the patient’s health.
Stabilization of ligaments or plastic ligament reduces the likelihood of arthrosis
Preservation of the ankle joint implies …
- elimination of interfering factors (free articular bodies, inflammation of the synovial membrane of the joints)
- stabilization and regeneration of damaged cartilaginous surfaces.
- stabilization and plastic ligaments.
- Restoration of the natural position of the axis of the lower extremities by osteotomy of the calcaneus or talus.
In addition to the stability of the ligaments and tendons, congruence is an important aspect – the exact position of the talus and ankle fork. If the talus is one of the bones of the tarsus that forms the lower part of the ankle joints; insufficiently compacted, there is a possibility of rebooting to some departments of these components.There is no load on other parts of the ankle joint. In overloaded areas, long-term damage to the articular cartilage is observed, and arthrosis develops in the area of mechanically overloaded surfaces.
Our clinic offers treatment of ankle arthrosis at the highest level! Please contact our specialists.
→ More about modern ankle prosthesis surgery
90,000 TYPES OF DISEASES | orto.lv
All diseases of arthritis or rheumatic diseases are divided into four large groups:
The natural aging process of a person can affect joints and their health, causing wear, pain and inflammation at the ends of the bones. At risk are people with overweight, joint injuries, heredity and age.
Osteoarthritis is the most common form of degenerative arthritis.
The role of the human immune system is to provide protection to all systems of the body, for example, to destroy the infectious agent.In the case of an autoimmune disease, the body loses tolerance to its tissues. The body perceives its tissues as foreign and tries to fight them by producing antibodies. Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis are the most common causes of inflammatory arthritis.
There are two types of infectious arthritis:
- the infection affects the joint itself;
- Reactive arthritis is when an infection affects other systems in the body, but one or more joints become inflamed in response to it.Reactive arthritis is caused by microorganisms, bacteria and fungi such as tuberculosis, salmonellosis, Lyme disease, dysentery, sexually transmitted diseases, hepatitis C.
Crystalline arthropathy (arthritis resulting from metabolic disorders)
Gout is one of the most common diseases of this group of arthritis. Gout differs from other forms of arthritis – it occurs as a result of improper metabolic processes when uric acid accumulates in the blood, which in the form of needle-shaped crystals settles in tissues and joints.The presence of salt crystals irritates tissues, causing severe, sudden pain and swelling. The disease most commonly affects the big toes, base of the fingers, and knee joints.
People can often have more than one arthritis condition at the same time, so treatment should be comprehensive, consistent and reasonable .
Most common types of arthritis or rheumatic diseases
Rheumatoid arthritis is an autoimmune disease whose causes are not fully understood.In the case of rheumatoid arthritis in the body, antibodies are produced against the synovial membrane of the joints, destroying the structure of the joints, causing irreversible damage to the cartilage and joint, as well as bone erosion.
In addition to damage to the joints, patients with rheumatoid arthritis may develop subcutaneous nodules, enlargement of lymph nodes, and damage to the heart (myocarditis, endocarditis). Inflammation of the blood vessels (vasculitis), endocrine system abnormalities, eye damage (iritis or iridocyclitis), and damage to other organs may also occur.
Reactive arthritis is a consequence of another disease. Reactive arthritis is caused by microorganisms, bacteria and fungi, for example, pathogens of tuberculosis, salmonellosis, Lyme disease, dysentery, sexually transmitted diseases, hepatitis C, as well as inflammatory processes in the body – in the urinary tract or intestines. The disease usually affects the knee joints, ankles, and feet. The inflammation can also affect the eyes and mouth and cause skin rashes.By timely starting treatment of the underlying disease, joints can be protected from the development of chronic arthritis.
Approximately 10-30% of people with psoriasis develop psoriatic arthritis, which causes joint inflammation. In some cases, psoriatic arthritis develops first, and only later does psoriasis appear. Psoriatic arthritis can affect any joints in the body, including the finger and spine.
A chronic autoimmune joint disease that causes inflammation in the spine.Inflammation and degenerative changes in the spine are common, causing stiffness. Inflammation is characterized by a progressive course with periods of remission (rest) and exacerbation, which ultimately can cause the formation of severe ankylosis or adhesions. The causes of the disease are still not exactly clear, but heredity is of great importance.
A common condition with chronic pain. Fibromyalgia is musculoskeletal aching pain with nearly 20 distinct points of pain.The causes of pain are not fully understood. Fibromyalgia is 9 times more common in women than in men.
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis is a chronic disease characterized by persistent joint inflammation. Typical signs of joint inflammation are pain, swelling, and limitation of movement. “Idiopathic” means that the cause of the disease is not clear, and “juvenile” in this case means that symptoms appear before the age of 16.
As a result of the disease, the synovial membrane, which covers the joint and is usually very thin, becomes much thicker and inflammation cells enter it, and the amount of joint fluid increases.This causes swelling, pain, and limitation of movement. A characteristic sign of joint inflammation is its stiffness after a long rest, so it is especially pronounced in the morning (morning stiffness). Juvenile idiopathic arthritis has several forms, depending on the symptoms.
In the case of osteoarthritis, the inflammation involves the joint capsule, the surfaces of the joint bones and the articular ligaments. As a result of the inflammatory process, the cartilage layer of the joint is worn out.It is the most common chronic joint disease in the world, affecting about 150 million people. All types of arthritis cause joint inflammation. Osteoarthritis affects many people as they age, but young people are also at risk of the disease.
Gout is a metabolic disease associated with the accumulation of uric acid salts in the body in the form of small crystals. They are deposited mainly in joints, cartilage, kidney tissues, in the subcutaneous layer and other places.This process can proceed without any noticeable external signs. Symptoms of joint pain, tenderness, redness, and swelling may appear suddenly. They can be caused by infection, joint injury, surgery, excessive alcohol consumption, or eating foods rich in purines (a chemical) (brain, liver, sardines, anchovies, beans, etc.). Gout most commonly affects the big toe, less often the heel, foot, hand, or elbow joint.
Polymyalgia rheumatica is a chronic, episodic inflammatory disease of large arteries – one of the most common forms of arthritis in people over 70 years of age.Manifested by pain in the hip and shoulder joints, morning stiffness. Patients may have nonspecific complaints of fever, weight loss, and weakness. There is usually muscle pain in both the shoulder and hip joints. Sleep is disturbed due to pain.
Systemic lupus erythematosus
Systemic lupus erythematosus is a chronic disease of the immune system when the body’s defenses mistakenly begin to attack the cells and tissues of its own body due to too many antibodies in the blood (an autoimmune disease), which causes inflammation and damage to joints, muscles, kidneys and other organs.Patients are characterized by a red butterfly-shaped rash on the face.
Scleroderma or systemic sclerosis is a general disease of the connective tissue, which is characterized by thickening of the skin and fibrosis (fibrosis), as well as specific damage to internal organs, mainly the heart, lungs, kidneys and the digestive tract.