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Arthralgia
Last reviewed: 19.11.2021
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Arthralgia is a syndrome accompanied by pain and impaired function of the joint or group of joints.
Arthralgia is observed not only in diseases of the joint apparatus (arthritis, arthrosis, periarticular tissue diseases), but also in other pathological processes: infectious and allergic processes, blood diseases, nervous and endocrine systems, etc. Arthralgia can be caused by organic (inflammatory, dystrophic, degenerative) changes in the joint and surrounding soft tissues or functional neuro-vascular disorders.
Arthralgia with exudative arthritis
In exudative inflammatory processes in the joints, defined by the general concept of "arthritis", "synovitis", arthralgia is associated with a violation of tissue metabolism and accumulation in the synovial membrane and periarticular. Tissues of products, irritating nerve endings. The reasons for their development are many, mainly these are repeated traumas, transitional inflammations from neighboring tissues, but can be caused by diseases of other organs and systems, in this case we are talking about a reactive synovitis, for example, endocrine and metabolic disorders. A special place is occupied by the humeropathy periarthritis.
Arthralgia with them is of a permanent nature. Pain aching, depending on the type of inflammation, can be severe, especially with dry arthritis. The shape of the joint changes due to the effusion and swelling of the surrounding tissues, the skin fold is thickened (Alexandrov's symptom). When swelling in the knee, there is a symptom of ballotation of the patella - with pressure it springs and floats as it were; Baker's symptom is the protrusion (one or more) of the joint bag into soft tissue, palpatory resembles a cyst that can be found in the popliteal fossa above or below the popliteal fold, more often between the two calf muscles. The temperature of the skin above them is increased due to irritation of the nerve endings. Movement is limited due to painful contracture. Exudate for arthritis can be serous, serous-fibrinous, serous-hemorrhagic, purulent, putrefactive. The nature of the exudate is determined by joint puncture and laboratory examination of the punctate.
[12], [13], [14], [15], [16], [17], [18], [19], [20], [21]
Arthralgia with purulent arthritis
Purulent arthritis is accompanied by the same clinical picture, but their severity is significant. The formation of purulent arthritis goes against a background of developing intoxication syndrome. Arthralgia is permanent. Pains are sharp, pulling character. Joint in forced, semi-bent state to increase the volume of movements. The patient spares him from the load, pressing him to the trunk or other limb (a symptom of reduction), or supports by hands. It is sharply increased in volume and due to effusion and due to edema of surrounding tissues. The skin above it is hot to the touch, hyperemic. Palpation and attempts at movements are very painful. When a large accumulation of exudate reveals a symptom of fluctuations, and when gonarthritis is determined by the symptom of balloting the patella. When puncturing the joint, either explicit pus or neutrophilic transudate is obtained. In the presence of purulent exudate, it is necessary to be wary of osteomyelitis of the bones that make up the joint, especially if there is an intoxication syndrome, as exogenous invasion of purulent microflora can occur only with penetrating wounds or with an abscess detected during examination.
[22], [23], [24], [25], [26], [27], [28]
Arthralgia for allergic arthritis
A special place is occupied by infectious-allergic polyarthritis (in the form of monoarthritis these processes practically do not occur). They can be caused by a nonspecific infection, more often in association with viruses, with the formation of rheumatism, chronic sexual infection (gonorrhea, chlamydia, trichomoniasis) with the development of Reiter's disease, tuberculosis, syphilis, etc., in which immuno-dependent autoantigens are formed.
The involvement of the joints in the process is explained by the fact that it is in the synovial membranes that the maximum number of immunocompetent lymphoid cells forming the pathological immune complexes of the antigen-antibody is formed, which is characteristic of auto-allergic reactions. The provoking factors in the formation or exacerbation of polyarthritis are an exacerbation in the main focus of a chronic infection of any localization, more often of the ENT organs or activation (provocation) of the reaction in case of a viral infection, hypothermia and catarrhal diseases, etc.
The pathogenesis of the formation of these polyarthrites has not yet been fully studied, since it is complex and diverse. The synovial membrane in the functional plan is the most active of all serous leaves, both in exudation and in resorption. It is richly vascularized and innervated, which causes a rapid response to various direct and indirect effects, vascularization is provided not so much by the blood as by the lymphatic vessels, and the synovial fluid is lymphoid. Innervation is mostly a vegetative part, which is clinically manifested by the symmetry of joint damage, the violation of trophic muscles, bones, cartilage plates, increased perspiration, etc.
With systemic infectious-allergic polyarthritis, arthralgia is constant, spontaneous, of different intensities, sharply increased when the weather changes, with prolonged rest, especially at night and in the morning, causing stiffness, while the patient has to change position, move more to reduce pain. Often arthralgia is combined with myalgia and neuralgia. In addition to damage to the synovial membrane and cartilage, ligaments can be involved in the process, causing their reactive inflammation - ligament, more often on the brush, accompanied by arthralgia. There may be a "dry" Sjogren's syndrome: polyarthritis, polymyositis, dry mucous and skin, up to seborrheic dermatitis; Felty's syndrome: a combination of rheumatoid polyarthritis with neutropenia and splenomegaly, which also belong to rheumatoid diseases and can be combined among themselves in 50% of cases. Bujo's disease - accompanied by the development of recurrent volatile exudative rheumatoid arthritis and rheumatic heart disease with high fever, arthralgia develops or worsens after streptococcal angina, the lungs, kidneys, meninges can be affected.
In chronic arthritis and polyarthritis, periarthritis forms in 26% of cases, when tendons and serosa are involved in the process, periodic arthralgia arises without an inflammatory reaction.
[29], [30], [31], [32], [33], [34], [35], [36], [37]
Functional arthralgia
It is observed in vegeto-vascular dystonia, "psychogenic rheumatism", neurasthenia, etc., characterized by pains that are caused by transient vascular disturbances of blood supply to the joint and increased receptor excitability. They are distinguished by polymorphism of pain sensations, absence of local changes, ineffectiveness from taking analgesics, but high effect from sedatives.
Arthralgia in degenerative diseases
In dystrophic and degenerative diseases, defined by the general concept of "arthrosis", arthralgia is caused by mechanical irritations of the synovial membrane with osteophytes, their fragments, fragments of necrotic cartilage and cartilaginous hernias. Arthralgia with them is moderate, mainly under static and mechanical stress, significantly reduced at rest. They develop very slowly, without a pronounced impairment of function, only in far-reaching cases. Deformation due to growth and thickening of bone tissue (marginal, osteophytes) are most pronounced in the area of interphalangeal articulations of the hands (hiberden's nodules) and hip joints (state of flexion, adduction and external rotation of the thigh). During movements and palpation, it is most pronounced in the knee, a characteristic coarse crunch is determined due to calcareous deposits, fibrosing of the capsule. Muscles around, as a rule, are hypotrophic or atrophic. More often 1-2 symmetrical joints suffer, mainly large, with a sick functional load. If an effusion forms during the exacerbation, the process is defined as arthrosoarthritis, and if there is a lesion of the bone tissue - like osteoarthritis.
Structural changes in tissues are detected radiographically (preferably with the use of electroradiography, densitometry, pneumoarthrography) or with the help of magnetic resonance imaging. In this case, identify the characteristic signs - epiphyseal osteoporosis, narrowing of the joint gap, the surface of the bones, ankylosis and fibrosis. With arthrosis - deformation of the epiphyses and cartilaginous plates, the presence of articular hernia or articular mouse, thickening, calcification and sclerosing of the synovial membrane.
How is arthralgia diagnosed?
Laboratory blood indices relatively indicate the development of inflammation by the presence of leukocytosis, the growth of ESR, neutrophilia, with allergies - eosinophilia. Brighter changes with purulent arthritis. Serological reactions and studies, which combine the so-called rheumatestes: the DFA reaction, the seromucoid, the growth of the globulins, the C-reactive protein, the latex test, the Valera-Rose Bordet-Zhang reaction, and much more, give great information. In the presence of an infectious-allergic polyarthritis in men it is necessary to investigate prostate juice for - detection of chronic gonorrhea (better after a provocation) or chlamydia (antigenic reaction is also carried out on it). A laboratory study of exudate reveals the presence of an inflammatory reaction in the form of blood elements and the presence of crystals. For suppuration is characterized by a high content of neutrophils, for tuberculosis - lymphocytes, for allergies - eosinophils. For arthrosis, the change in laboratory parameters is not typical.
If the puncture reveals blood, it is about hemarthrosis. Hemarthrosis - bleeding into the cavity, develops mainly with injuries. The knees, which carry the maximum physical load and have an increased vascularization, are often affected. Others give hemarthrosis rarely and do not have such a clinic.
Arthralgia of the knees, especially in young men, should cause particular caution, since they contain the vascularized Goffa fatty bodies, which can be traumatized and sclerosed with the development of hemarthritis (Hoff's disease) or hemarthrosis. In acute knee injury, often meniscus is damaged, the clinic for their ruptures is covered by hemarthrosis, and subsequently is detected by the meniscitis or persistent synovitis.
Inspection should be done in comparison with the opposite joint. In cases of hemarthrosis, there is an increase in volume; when palpated, it is painful, hot to the touch due to irritation of the parapatellar nerve; the patella is mobile and springs (a symptom of ballotation of the patella); at large volumes, fluctuation can be determined. At a puncture receive a blood.
To confirm the diagnosis of arthralgia, radiography is performed - to exclude or confirm damage to the bones; puncture - to determine the nature of effusion, removal of blood and flushing of the joint with 2% solution of novocaine. Very rarely, and only in specialized departments, conduct arthroscopy.
In addition to the main synovial bag that forms the joint cavity, there is an isolated bag of bursa in the surrounding tissues, its inflammation is called "bursitis". More often bursitis develops in the region of the elbow, knee, ankle. The main reasons for their development are repeated traumas, but there may be also reactive inflammations. Suppuration is rare, in most cases there is a serous and serous-fibrinous effusion. It can be acute and chronic. When forming bursitis under the skin, an elastic, soft, fluctuating formation is revealed, oval, round or oblong. Arthralgia, edema and hyperemia are noted only with suppuration. In other cases, the skin is thinned and degenerated. With a chronic form in the cavity of the bag, specific fibrinous corpuscles, "rice grains," are palpable.