Arthritis of the knee joint
- What is knee arthritis?
- What causes arthritis?
- Symptoms of knee arthritis
- Surveys. To what specialist to apply?
- Diagnosis of knee arthritis
- Treatment of arthritis of the knee joint
- Recommendations for patients with arthrosis of the knee joint
Pain in the knee joint may be "natural" (it is also called functional), and, more often, it can be a manifestation of some kind of disease. The so-called functional pain by origin is akin to the one that arises in muscles after being overloaded by physical work at the dacha or in the gym, passes quickly enough. However, if there are signs of inflammation, or arthritis, the knee joint is a signal for urgent consultation with a doctor.
What is knee arthritis?
The knee joint consists of bones, intra-articular structures (for example, meniscus, articular cartilage), a ligamentous device holding this structure in a certain position, and an internal lining of the joint (synovial membrane). Inside the joint, there is normally a small amount of fluid that plays the role of lubricant and "nutrient solution."
Classic signs of inflammation are blunt, burgeoning pains, enlargement of the joint in the volume and smoothing of its contours (swelling), redness of the skin above the joint surface (optional), increased temperature in the knee region, inability to fully support the leg, or increase pain when trying to bend or unbend his leg in the knee.
What causes arthritis?
Specialists in the treatment of diseases of the musculoskeletal system have to deal with such causes of arthritis:
- "inflammatory", or autoimmune, rheumatological disease ( rheumatoid arthritis , spondylitis, psoriatic arthritis , gout , systemic lupus erythematosus and some others). In these cases, the inflammation inside the joint is caused by a "breakage" in the immune system, in which the body's own defense cells begin to attack their own cells of the joint internal lining.
- osteoarthritis in case of its exacerbation . Osteoarthritis is a disease of the musculoskeletal system, which is not very well called "degenerative". It arises in people of physical labor, those who often and often walk, especially on the stairs, as well as among athletes (often regardless of the sport - weightlifter weightlifters suffer as often as athletes, runners). "Victims" of osteoarthritis become with equal frequency of men and women. Even the development of this disease is facilitated by the unplanned flat feet, wearing uncomfortable shoes, including high heels, in a word - any inadequate load on the legs in general and the knee joint in particular. "Natural" load - the body weight of a person exceeding the norm, in itself is a rather serious risk factor for the development of osteoarthritis, the first sign of which can be inflammation of the knee joint.
- Post - traumatic events (if there was a blunt joint injury, stretching or rupture of ligaments or intra-articular structures, which is often the case, for example, when falling from mountain skis).
- stands alone Baker's cyst - intra-articular fluid formation, periodically filled with synovial (joint) fluid. Such a "bag" can bring a lot of trouble if it grows to large sizes (sometimes up to several tens of centimeters), or to get bogged down.
Infection . Several dozen microorganisms and viruses capable of causing inflammation of the knee joint have been described. This chlamydia, and ureaplasma, and streptococci, and the herpes virus, and hepatitis virus ... If you can identify the pathogen and choose the appropriate drug, arthritis disappears completely.
inflammation against a common disease. Unfortunately, such severe conditions for the body as cancer, HIV infection, tuberculosis , sarcoidosis and some others can occur with the phenomena of arthritis. There are such diseases are not so often, and are usually accompanied by weight loss, loss of appetite, weakness, shortness of breath with physical exertion, pallor, torrential sweat. Experienced therapist, summarizing all the data obtained, without any difficulties, will reveal the true "culprit" of arthritis, and, with successful treatment, pain in the joints disappear just as they did.
Why the joint swells, increases in volume and hurts?
The main reason is the accumulation of a large amount of fluid inside the knee joint. "Sticking", "stupid", "pressing" nature of pain is explained in this case by purely mechanical causes. The liquid presses from inside the joint walls, and, without finding an outlet, causes painful sensations. In addition, the fluid that forms in the knee joint during inflammation contains a large number of irritating intraarticular structures of substances. These substances additionally cause the production of a liquid - and a vicious circle is obtained. The third cause of inflammation and pain is the settling of the crystals of uric acid (in the so-called "sand" people) in the joint. These crystals represent the tiniest needles that cause microdamages to the intra-articular structures, the synovial (articular) membrane, contributing to the development of arthritis.
Symptoms of knee arthritis
What worries the patient when it comes to the knee joint? As a rule - dull raspiruyuschaya pain, the inability to bend or unbend the leg, less often - "wedging" the joint. Often disturbed by crunching or snapping when flexing or unbending the leg in one knee joint or both. It is very important to clearly articulate - when it hurts, at what time of day, and at what load.
What do you hear? Talk with the patient.
The very history of the appearance of pain in the knee joints can already push the doctor to the idea of a diagnosis.
- First, the doctor will exclude the post-traumatic nature of inflammation.
- Secondly, he will ask questions about the presence of "inflammatory" diseases in relatives. It is known that diseases such as rheumatoid arthritis, spondyloarthritis (simultaneous damage to the joints of the limbs and the skeleton of the spine), and some others can be inherited.
- Thirdly, it will clarify the condition of other joints. It often happens that the leading complaint of the patient at the reception is pain in the knees, and when questioning it will be found out that it is difficult to bend or unbend fingers in the mornings, or pains in the lower back are disturbed at night, or it becomes difficult to wear out because of the swelling of the ankle joints. The so-called "multiple" joint damage is a hallmark of some inflammatory rheumatological diseases, as well as polyarthritis in certain "common" diseases, for example, oncological diseases.
- Fourth, it is very important to clarify the general condition, the patient's well-being. It usually does not suffer from post-traumatic arthritis and osteoarthritis.
What is visible during the examination?
When examined, the presence of skin defects - bruises, scratches, pricks - will strengthen the doctor's opinion that before him is a patient with post-traumatic arthritis. It happens that the trauma only "starts" the autoimmune process, but it happens much less often. The doctor records the presence of signs of inflammation (we dwelled in detail at the beginning of the article), signs of arthrosis. The latter are determined by the presence or absence of soreness by pressing certain "painful" points and probes with "passive" movements.
Surveys. To what specialist to apply?
- Surgeon-orthopedist . Most often, with diseases of the musculoskeletal system, patients turn to surgeons or traumatologists. Or to traumatologists-orthopedists, if they are available in a polyclinic. This is where the first diagnostic search takes place, and the first diagnostic errors. Orthopedists are rarely well-trained in the field of rheumatology, their task is to diagnose and treat post-traumatic joint changes.
- Therapist . This is the doctor to whom the patient addresses, if in addition to pain in the knee joint there are so-called "general" complaints: fever, weakness, weight loss, morning stiffness in the body or individual joints. The therapist is that person who can (and should) suspect the presence of an "inflammatory" rheumatological disease and prescribe at least a blood test. Further along the chain, the patient is usually sent to the rheumatologist.
- Rheumatologist . The best option for the patient. Narrow profile specialization allows rheumatologists, at the stage of examination and questioning, to get as close as possible to the cause of the problem, to prescribe the necessary additional examination and to choose the right treatment as early as possible. Often it is precisely the time prescribed medications determine the patient's prognosis for work capacity, physical activity, and sometimes for life.
- Infectionist . Solves a fairly narrow range of problems, but is necessary when it comes to arthritis associated with infection. To be sure that the causative agent is removed from the body forever and arthritis does not recur, regular monitoring is needed, which is performed by the infectious disease specialist.
Diagnosis of knee arthritis
To clarify the diagnosis, in addition to laboratory methods, so-called instrumental tools are widely used. Well, when we have at our disposal a whole arsenal of diagnostic procedures, you can choose the most informative, most appropriate to the clinical situation.
- Radiography . The cheapest, but not enough informative method. Will allow to evaluate the structure of the bone: there is no gross destruction of bone, excessive growth of bone (this is called "proliferation" and it looks like the formation of build-ups or thorns). In some cases, the gap between the large bones will be narrowed, in other cases - widened. All these are indirect indications by which an experienced radiologist can presume, for example, the presence of osteoarthritis.
- Ultrasound (ultrasound) . This method of research is highly respected by surgeons, because, unlike radiography, ultrasound can understand what happens to soft joint structures - ligaments, tendons, meniscuses - suffering, especially in trauma. Using this method, it is possible to identify articular "bags" filled with fluid (Baker's cyst), because of which the joint can "jam". On many devices now it is possible to see deposits of crystals of uric acid, which in most cases confirms the diagnosis of gout.
- MRI (magnetic resonance imaging) . An expensive, informative method that serves to identify a small amount of fluid, initial signs of bone tissue destruction, meniscus tears, in general, those changes that neither X-ray nor ultrasound are visible.
- Arthroscopy . The only method that allows "live" to see the joint from the inside. Through special punctures, a video camera is inserted into the joint on a flexible conductor, allowing the doctor to estimate the situation as accurately as possible. Cons of this procedure - the need for anesthesia, rehabilitation period of several days, possible complications (including joint suppuration).
- Laboratory methods . With the help of a blood test, you can determine whether the occurrence of arthritis is a sign of an autoimmune disease, or is it a manifestation of inflammation especially in the joint area that does not extend to the entire body. The second situation is much more comforting for both the doctor and the patient.
The signs of a common, or as they say rheumatologists, systemic inflammation, include:
- increased ESR (sedimentation rate of erythrocytes)
- inflammatory changes in the body will "confirm" the increase in the level of leukocytes and lymphocytes (these indicators will be increased with infectious (reactive) arthritis).
The biochemical blood test will be useful, first of all, for determining the level of uric acid in the blood (this is, first of all, a sign of gout), and also to determine possible contraindications to the prescription of medicines (increase of hepatic enzymes).
Immunological analyzes are the most expensive, but also the most informative studies. Without going into details, let's just say that one immunological analysis can be enough to make a diagnosis.
And what if all the test results are negative, there is no inflammation, but the phenomenon of arthritis is pain, is there a swelling?
Treatment of arthritis of the knee joint
The main thing that worries a patient with knee arthritis is how to relieve pain. For the first time faced with such a problem, they begin to take uncontrolled tablets of non-steroidal anti-inflammatory drugs, or, worse, intramuscularly administer them. These drugs are randomly sold in the pharmacy chain, like vitamins or cosmetics! But after all each drug except indications (pain, inflammation), there are also their contraindications. The pharmacists usually do not know about this, or do not consider it necessary to remind.
For example, that non-steroidal anti-inflammatory drugs can not be taken with gastritis and ulcers of the stomach and intestines, as well as hemorrhoids and coronary heart disease.
- Nonsteroidal anti-inflammatory drugs are preparations from which the treatment of knee arthritis usually begins.
- "Local" treatment - a variety of gels, creams and ointments containing the same non-steroidal agents - can be used freely if there is no skin reaction to the drug (redness, itching, flaking). In case of intolerance to the gel or ointment, it should be discarded, and in the future, after normalizing the skin condition, to resume local treatment with another remedy.
Treatment of autoimmune diseases is performed only by a rheumatologist under strict control.
Special drugs are used that suppress the "raging" immune cells exactly where it is needed.
- Preparations from the group of chondroprotectors require patient patience, perseverance in achieving the intended goal and a clear understanding of the meaning of treatment: slow (otherwise it will not work) and a gradual improvement in the structure, and hence the function of the articular cartilage.
- Physiotherapy treatment. Used for osteoarthritis, post-traumatic arthritis, gouty arthritis. These are procedures, so beloved by the "spawners", based on the influence of magnetic, ultrasonic waves, weak laser radiation, local cold application. In autoimmune diseases, it can cause an even greater exacerbation.
- Fixation, or joint orthosis. The purpose of this treatment is to give the sore joint a rest, to unload it. Bandages, orthoses, elastic bandaging are used.
- Intraarticular and periarticular injection of steroids is a rapid achievement of anti-inflammatory effect. This method of treatment should not be confused with the favorite surgeon's "blockade" when a solution of novocaine for pain relief is injected into certain points around the joint (this procedure is performed, for example, during the match, when there is no opportunity to rest the injured leg). Steroid, or glucocorticosteroid drugs should not be administered more than once every 3 months, in addition, they can cause quite serious side effects.
- Hyaluronic acid preparations. They are prescribed for osteoarthritis and represent a "prosthesis" of the synovial fluid. In the classical course of osteoarthrosis, synovial fluid in the knee joints is small, it is viscous and does not perform its role of cushioning and feeding the cartilage sufficiently. The introduction of these drugs directly into the joint with a syringe allows you to achieve a long anesthetic and, most importantly, improving the very structure of the joint, the effect.
Recommendations for patients with arthrosis of the knee joint
1. Nutrition. In case of locomotor system, any special diet, except for gout, is not required. If gout is detected, this imposes certain limitations on the patient: it is necessary to exclude red meat (beef, veal, mutton), tomatoes, smoked foods, spices, fresh leaf greens, and alcohol.
2. Treatment of the underlying disease, the manifestation of which was arthritis of the knee joint. It is worth attune to a long enough, perhaps, for several months or even years, treatment with repeated courses. But an easy step is worth it, is not it?
3. Fighting overweight is the cornerstone for most patients with osteoarthritis. It must be remembered that the joints of a person are "calculated" by nature to a certain weight, and not to the one that we like.
4. Physical therapy, swimming, cycling. Sufficient physical activity is vital for those who are faced with the problem of osteoarthritis.
5. When walking, it is strongly advised not to make ascents and descents on the stairs, this strengthens the "wear" of the knee joints.
6. It is worth stint and get good quality, if possible orthopedic shoes or order orthopedic insoles for an individual cast. Like physical education, classes in the pool or taking prescribed medicines is a financial investment in one's own organism, which will reciprocate in response to care!
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