Rheumatology: diseases — симптомы, диагностика и лечение

Osteoarthritis of the knee joint is the gradual destruction of articular cartilage, due to which the bones begin to rub against each other. This is the most common cause of knee pain in people over 45 years of age. Modern medicine cannot restore already lost cartilage, and this should be understood immediately - so as not to spend years on products that promise to “grow cartilage.” But it is quite possible to slow down the destruction, remove pain and maintain mobility, and in severe cases, endoprosthetics returns a person to normal life.

Osteoarthritis, which is more often called arthrosis in everyday life, is the most common joint disease. It primarily affects the knees, hips, hands and spine, and becomes more common with age. There are several strong misconceptions about it, and they interfere with treatment more than the disease itself. First: “this is salt deposition” - a beautiful idea, but incorrect; No salts are deposited in the joint with arthrosis. Second: “the joint is worn out, which means it must be taken care of” - in fact, rest with osteoarthritis is harmful, the muscles weaken, the joint loses support, and the pain intensifies. Third: “the main thing is to find a good chondroprotector” - the evidence base for these drugs is weak, and the most effective intervention for arthrosis of the knee joint remains weight loss and regular exercise, that is, exactly what is not sold in the pharmacy.

Gout is a disease in which the level of uric acid in the blood rises, and its crystals are deposited in the joints, causing attacks of severe inflammation. The classic debut is recognizable almost unmistakably: at night, unbearable pain suddenly arises in the joint of the big toe, it turns red, swells, and it is impossible to touch even with a blanket. Gout is often considered a “disease of nutrition” that can be controlled by diet alone. This is a misconception: diet reduces uric acid levels only slightly, and true gout requires medications taken continuously.

Arthritis is an inflammation of the joint, which primarily affects the synovial membrane lining it from the inside. Unlike arthrosis, where wear and tear of the cartilage is in the foreground, with arthritis there are signs of active inflammation: swelling, redness, local fever and characteristic morning stiffness, which goes away after warming up. Arthritis is not one diagnosis, but a collective name: it covers rheumatoid arthritis, gout, reactive and psoriatic arthritis, joint infections and many other conditions. Correctly determining the form is fundamentally important, because treatment for them differs radically, and delay in some types leads to joint destruction.

Raynaud's phenomenon is a paroxysmal spasm of the small arteries of the fingers in response to cold or excitement. The classic attack goes through three stages: the fingers turn sharply white, then become cyanotic, and when warmed up, they turn red, and tingling or pain appears. If such a reaction occurs on its own, without another disease, it is called Raynaud's disease - it is mild and does not damage tissue. If the spasm is secondary and associated with a rheumatic disease, medication or vibration, it is Raynaud's syndrome, which requires searching for the cause and observation, because it can lead to trophic ulcers.

Knee pain is one of the most common complaints when visiting an orthopedist. The knee joint bears the weight of the body, works like a hinge and is supported by ligaments, menisci and muscles, therefore it is vulnerable to injury, overload, and age-related changes in the cartilage. In young people, pain is more often associated with sports, damage to the menisci and ligaments, or overload of the patella; After forty, osteoarthritis comes to the fore. A separate group of causes are inflammatory and metabolic diseases: gout, rheumatoid and reactive arthritis. Understanding the cause is important because the approaches to treatment for these conditions are fundamentally different.

Arthralgia is joint pain without obligatory signs of inflammation, such as swelling, redness and increased local temperature. This is not a diagnosis, but a symptom, which can be behind very different things: overload and microtrauma, incipient osteoarthritis, viral infection, autoimmune disease, gout, problems with surrounding tendons and ligaments, or even referred pain from the spine. Details help to figure it out: how many joints hurt, is it symmetrical, is there morning stiffness and how long does it last, what intensifies the pain - stress or rest. It is based on these signs that the doctor chooses the direction of the examination.

The hip joint bears the main load when walking, so pain in it quickly changes the way of life: it becomes difficult to put on socks, get up from a chair, or walk the usual distance. It is important to understand that “hip pain” can come from the joint itself, from the surrounding tendons, or even from the lower back. True joint pain is most often felt in the groin and can radiate to the knee, pain on the side of the thigh is usually associated with the tendons and trochanteric bursa, and pain in the buttock with a shooting in the leg is associated with the spine. Both examination and treatment depend on where exactly it hurts.

Bursitis is an inflammation of the bursa, a small sac of fluid that cushions friction between bone, tendon and skin. These bags are located at the elbow, knee, shoulder, hip and heel. With constant pressure, bruise, gout or infection, the bursa fills with fluid and a soft, painful swelling appears over the joint. Movement in the joint itself is usually preserved, but becomes unpleasant. Most bursitis goes away within a few weeks after the load is removed, but it is important to distinguish regular inflammation from purulent inflammation in time: it requires an urgent opening and antibiotics. Recurrent bursitis requires a search for the cause, not just pain relief.

Hemorrhagic vasculitis, or Henoch-Schönlein purpura, is an inflammation of the smallest vessels, in which immune complexes with immunoglobulin A are deposited in their walls. Children of preschool and primary school age are most often affected, usually one to three weeks after a respiratory infection. Typical manifestations are a symmetrical rash on the legs and buttocks that does not fade with pressure, joint pain, cramping abdominal pain and kidney damage. In most children, the disease goes away within a few weeks, but the condition of the kidneys should be monitored for several more months after recovery.