Arthritis (arthritis) non-infectious

Arthritis (arthritis) non-infectious (synonym: infect arthritis, rheumatoid arthritis is a chronic, progressive inflammatory disease of the joints, leading patients often to full disability. Affects people aged 20-50 years. Although women are 2 to 4 times more often than men.
Etiology and pathogenesis is unclear. Considered infectious and allergic disease. Suggest that the starting point for the development of the disease is the focus of chronic streptococcal infection (defeat of the tonsils, middle ear infections, teeth and so on). The continuous impact of focal infection causes immunological transformation of the body and the development of allergies. The latter causes the occurrence of arthritis and its persistent course.
The disease is sometimes preceded by a flu, quinsy, hypothermia. Start often subacute - low grade fever, pain and swelling in many joints. Typical symmetry of defeat and the involvement of small joints of the hands and feet. After the first attack full backward development of pathological changes in the joints do not usually observed. A tendency to frequent recurrence of involvement in the process of new joints. The disease leads to the development of resistant strains, and violation of the functions of the joint down to complete immobility due to the formation of intra-articular fibrous or bone growths (fibrous or bone the ankylosis). In the thickness of the soft tissues, usually on the forearm near the elbow, can detect rheumatoid nodules - dense, painless connective tissue formation. Developing quickly atrophy of muscles near the affected joints, flexion contractures, subluxations. In the study of blood noted a significant acceleration ROHE, in the acute period, leukocytosis, in the long process - hypochromic anemia and leucopenia. Relatively specific for this disease is the presence in the blood of special protein - macroglobulin, called rheumatoid factor.
When the joint-visceral forms of non-infectious arthritis, except joints are affected and internal organs: heart (myocardial dystrophy, rarely mitral valve), light (chronic interstitial pneumonia), kidney (focal jade, amyloidosis). Could experience damage to eyes (irit, iridotsyklit). A special variation of the joint-visceral form is the so-called septic form. It is characterized by malignant with high fever, chills and drenching sweat, expressed General exhaustion, atrophy of muscles, rapid development of ankylosis (see) and contractures (see), the increase in the spleen, liver, lymph nodes, vasculitis.
To infectious nonspecific polyarthritis also include Bechterew's disease (see Spondylitis, Reiter syndrome (arthritis, urethritis, conjunctivitis), still's (arthritis, enlargement of the spleen, lymph nodes, leukopenia) and Sjogren's syndrome (arthritis, mucous membranes).
The diagnosis is made on the basis of the nature of the disease (long-term, often relapsing with the development of resistant articular changes), accelerated ROHE, availability revmatoidnykh knots, radiographic changes (osteoporosis, narrowing of joint cracks, edge defects of bones).
From rheumatism is irreversibility of articular changes. Other infectious arthritis (brucellosis, gonorrheal, tuberculosis etc) are excluded by the lack of communication with specific infection.
Treatment. Rehabilitation of chronic foci of infection (removal of tonsils, carious teeth, the use of antibiotics and other). Desencibilizirutuyu therapy: acetylsalicylic acid (up to 3 g daily), amidopyrine, analgin (up to 2 g per day), phenylbutazone (0.15 g 3 times a day). When pronounced inflammatory changes in the joints, the joint-visceral and "septic" form used hormonal preparations are under constant supervision of a physician: prednisolone (10-20 mg / day), triamcinolone (8-16 mg per day). While improving the cancellation of hormonal therapy should be carried out gradually [1/4 pill (1-2) every 5 days], in order to avoid a worsening of the disease. To change the immunological reactivity and achieve long-term remission appoint hingamin (Raskin, delagil, chloroquine) 0.25 g 1 a day after dinner. Treatment with these drugs is carried out in the course of a year or more. The effect occurs very slowly. Locally on the joints in the acute period used quartz (erythemal dose); improving and reducing ROHE - paraffin, mud applications, hydrogen sulfide, radon baths. Mandatory component of the treatment is a massage of muscles (but not joints!), therapeutic exercise. To avoid the development of contractures and vicious provisions of the joints even in the acute period of the disease it is necessary to periodically change the position of the patient with cushions, pillows. It is impossible to allow the patient to accept fixed non-physical poses. You should continue regularly (2-3 times a day) to conduct therapeutic gymnastics, despite the pain and stiffness in the joints. Training start with simple exercises, which alternated with relaxation of muscles, and then pass to the exercises with a gradually increasing resistance. Classes are often carried out in sitting and lying down, at a slow pace, with pauses for rest. In patients with chronic disease (expressed functional disorders of the joints) it is important to systematically train movements necessary for self-service (washing, combing, the use of kitchenware, appliances, walking on the stairs, and so on), teach possible simple work that will allow them to engage in socially useful work.