What are the most informative diagnostic methods for diseases of the knee joint?

The doctor studies the patient's medical history. Then, asks for his complaints. Only after this he conducts an examination and, if necessary, prescribes x-rays, blood and synovial fluid tests.

During the examination, the doctor pays attention to: swelling, redness and temperature of the joint; sensitivity of the knee; range of passive and active movement; stability of the joint; crepitus during movement; pain when the bulk of the body weight is on the knee; problems with gait; any signs of damage to muscles, tendons, ligaments; symmetry of the disease and how many joints are affected by the disease (a sign of rheumatoid arthritis )

TREATMENT

There is no cure for arthritis. But, there are a number of procedures that help relieve pain. No surgery

Lifestyle changes: Reducing the load that worsens the condition. For example, climbing stairs. Switching from one sport to another, in which the intense load is less. For example, replace jogging with swimming or cycling. Losing weight helps reduce the load on the knee joint. As a result, pain is reduced and the functioning of the joint improves.

These tips can help reduce stress on the knee joint and slow the progression of arthritis.

MRI or CT of the knee joint - which is better?

In answering this question, it is best to trust the judgment of the attending physician. He will be able, based on diagnostic purposes, medical history, primary diagnosis, to select the most effective diagnostic method. If you find it difficult to choose between magnetic and computed tomography on your own, we will be happy to offer you a consultation with an experienced orthopedist. He will be able to make a primary diagnosis and, if further examination is necessary, give a referral for the necessary type of diagnosis

Author: Usenko Nikita Sergeevich

Orthopedist-traumatologist with 8 years of experience

ALTERNATIVE TREATMENTS

The benefits of alternative therapies have not been proven. But you can try. You need to find a qualified practitioner and inform your doctor of the decision. Alternative methods can help relieve pain. These include acupuncture and magnetic therapy.

Acupuncture is acupuncture. The procedure uses thin needles to stimulate certain areas of the body, which can relieve pain or restore sensitivity if a certain area of ​​the body is numb. There are even several scientific studies on the effectiveness of acupuncture. The evidence collected suggests that this technique helps relieve arthritis pain. It is used in many parts of the world. Before starting the procedure, the patient should find out about the qualifications of the specialist, familiarize himself with his certificates and inquire about the sterility of the instruments.

Magnetic therapy is a painless procedure. The inflamed joint, which is located in the electromagnetic field, is exposed to a pulse signal. But it is worth remembering that the benefits of magnetic therapy have not yet been proven.

What is hardware diagnostics?

The era of hardware diagnostics began with the discovery of X-rays at the end of the 19th century. This is how an X-ray machine appeared in the arsenal of doctors. A little later, fluorography and mammography appeared on its basis. In the early 30s of the 20th century, the diagnostic capabilities of ultrasound were discovered, and medical centers began to perform ultrasound diagnostics of various internal organs and evaluate fetal development during pregnancy. In the 70s of the 20th century, the first attempts were made to use the power of magnetic resonance for diagnostic purposes. Since the 80s of the last century, medical institutions in Russia began to be equipped with magnetic resonance imaging scanners. Medicine never stands still, and with the development of X-ray technology, an improved version of radiography appeared, which was called computed tomography. It was widely used in clinical practice in the 80s of the 20th century. First-generation computed tomographs have been replaced by spiral and multispiral tomographs - MSCT. Now most medical institutions in St. Petersburg are equipped with them.

• MRI
• Ultrasound

MRI tomograph:

Siemens Magnetom C

Type:

Open (expert class)

What's included in the price:

Diagnostics, interpretation of images, written report from a radiologist, recording of tomograms on CD + free consultation with a neurologist or orthopedist after an MRI of the spine or joint

Ultrasound machine

HITACHI HI VISION Avius

Class:

Expert (installation year 2019)

What's included in the price:

Diagnostics, interpretation of images, written diagnostic report

A comprehensive examination includes tests aimed at determining circulating autoantibodies and various biochemical markers of the acute phase of inflammation. Joint pain can be a sign of arthritis, including rheumatoid arthritis, arthrosis, osteoarthritis, gout, chondrocalcinosis, ankylosing spondylitis and other diseases. Allows you to identify a possible cause, as well as differentiate various forms of arthritis.

What tests are included in this complex:

· Clinical blood test (with leukocyte formula);

· Erythrocyte sedimentation rate (ESR);

· Fibrinogen;

· Antistreptolysin O;

· Uric acid in serum;

· C-reactive protein, quantitative (method with normal sensitivity);

· Rheumatoid factor (RF);

· Antinuclear factor on HEp-2 cells;

· Antibodies to extractable nuclear antigen (ENA screen).

What biomaterial can be used for research?

Deoxygenated blood.

Research method

· Flow cytometry: Clinical blood test (with leukocyte formula);

· Capillary photometry method: ESR;

· Clotting method (detection of side light scattering, determination of percentage by end point): Fibrinogen;

· Immunoturbidimetry: Antistreptolysin O, C-reactive protein, Rheumatoid factor;

· Enzymatic colorimetric method: Uric acid;

· Indirect immunofluorescence reaction: Antinuclear factor on HEp-2 cells;

· Enzyme immunoassay: Antibodies to extractable nuclear antigen (ENA screen).

How to properly prepare for research?

• During the day before the test, do not drink alcohol or take medications (as agreed with your doctor);
• Do not eat for 12 hours before the test;
• Avoid physical and emotional stress for 24 hours before the test;
• Do not smoke 3 hours before the test

General information about the study

Joint pain can be a sign of arthritis, including rheumatoid arthritis, arthrosis, osteoarthritis, gout, chondrocalcinosis, ankylosing spondylitis and other diseases.

Inflammation of the joints can also be caused by infectious or systemic diseases: influenza, scarlet fever, tuberculosis, gonorrhea, chlamydia, as well as a chronic focus of infection caused by staphylococci or streptococci. The basis of many joint diseases is the inflammatory process, which causes mobility impairments in the musculoskeletal system.

Inflammation is a biochemical protective reaction of the body in response to tissue damage; it can be both acute and chronic. For example, in rheumatoid arthritis, the process of systemic chronic inflammation is accompanied by an increase in erythrocyte sedimentation rate (ESR) and the concentration of acute-phase proteins such as fibrinogen and C-reactive protein. Fibrinogen is one of the factors known as “rheumatic tests”. The level of fibrinogen increases sharply in the blood when there is inflammation or tissue damage.

Antistreptolysin-O is one of the laboratory markers of rheumatism; it is used for the differential diagnosis of rheumatism and rheumatoid arthritis (in the case of RA, the level of antistreptolysin-O is much lower). An increase in this indicator indicates sensitization of the body to streptococcal antigens.

Elevated uric acid levels are one of the signs of gout, rheumatism, arthritis and other disorders. If the rate of synthesis of uric acid exceeds the rate of its elimination from the body, the process of purine metabolism is disrupted. The retention of this substance in the body affects the activity of the kidneys, renal failure develops, leading to inflammation of the joints, in which uric acid crystals are deposited in the joint (synovial) fluid.

Rheumatoid factor (RF) is one of the standard criteria for rheumatoid arthritis established by the American Association of Rheumatology (AAR). It is detected in 75-80% of patients with rheumatoid arthritis, but is not specific for rheumatoid arthritis, but indicates the presence of suspicious autoimmune activity. It is also found in Sjögren's syndrome, scleroderma, dermatomyositis, hyperglobulinemia, and B-cell lymphoproliferative diseases. About 30% of patients with systemic lupus erythematosus (SLE) who do not have signs of rheumatoid arthritis are RF-positive. The sensitivity of RF for rheumatoid arthritis is only 60-70%, and the specificity is 78%.

Rheumatoid factor is an antibody against immunoglobulin G (IgG) fragments. More often (up to 90% of cases) these antibodies belong to class M immunoglobulins (IgM); IgG, IgA, and IgE are rare. Despite its low specificity, the presence of RF is considered an important prognostic sign for the outcome of rheumatoid arthritis.

Antinuclear antibodies (another name is antinuclear factor) are a heterogeneous group of antibodies that react with various components of the cell nucleus. A healthy person with normal immunity should not have antinuclear antibodies in the blood or their level should not exceed the established reference values. The loss of a number of readily soluble components from the nucleus of HEp-2 cells (standardized cells used in the analysis) or their redistribution into the cytoplasm may be the reason for the detection of low titers of antinuclear factor in the HEp-2 cell line.

It is advisable to use, together with the determination of antinuclear factor, the determination of the specificity of antinuclear antibodies, which avoids false negative results in systemic rheumatic diseases. The definition of “specificity of antinuclear antibodies” refers to the determination of autoantibodies to specific antigens, for which the determination of extractable nuclear antigen (ENA screen) is used. ENA is a readily soluble component of the cell nucleus. This test includes the antigens RNP-70, RNP/Sm, SS-A, SS-B, Scl-70, centromeric protein B and Jo-1, and a number of them are produced recombinantly.

Due to its high sensitivity of 95-98%, the combined use of two tests allows for both early diagnosis of systemic diseases and clarification of the diagnosis of systemic diseases in the case of an unclear clinical picture.

The specificity of ENA screening is somewhat inferior to the specificity of testing for antibodies of the ENA group using the immunoblot method. This fact is of particular importance in the case of examination of persons suspected of having systemic lupus erythematosus, as well as mixed connective tissue disease. Taking this into account, if the result of ENA screening is positive, an additional confirmatory study is performed - immunoblot.

Detection of antibodies indicates the presence of an autoimmune disorder, but does not indicate a specific disease because the test is a screening test. The goal of any screening is to identify people at increased risk of a particular disease.

What is the research used for?

• Differential diagnosis of arthritis;
• Diagnosis of systemic autoimmune diseases;
• To diagnose rheumatoid arthritis and Sjögren's syndrome, and to distinguish them from other forms of arthritis and diseases with similar symptoms.

When is the study scheduled?

• For symptoms of an autoimmune disease (prolonged fever, joint pain, fatigue, weight loss, skin changes);
• When identifying changes characteristic of systemic connective tissue diseases (increased ESR, level of C-reactive protein, circulating immune complexes);
• For rheumatoid arthritis (determining the activity of the process, prognosis and control of treatment of the disease);
• If you suspect gout (the main symptom is pain in the joints, most often in the big toe);
• If you have morning stiffness or joint stiffness.

What do the study results mean?

To make a diagnosis, it is important to use a comprehensive examination, which includes laboratory diagnostics, clinical data and modern methods of instrumental examination of joints: CT, MRI, ultrasound.

Clinical blood test (with leukocyte formula)

Reference values: decoding of the general blood test (see detailed description)

The leukocyte formula is usually interpreted depending on the total number of leukocytes. If it deviates from the norm, then focusing on the percentage of cells in the leukocyte formula can lead to erroneous conclusions. In these situations, the assessment is made based on the absolute number of each type of cell (in a liter - 1012 / l - or microliter - 109 / l).

More details about the results: https://www.helix.ru/kb/item/02-005#subj12

Erythrocyte sedimentation rate (ESR)

Reference values:

In arthritis, the inflammatory picture of the blood is clearly expressed with a sharp increase in ESR to 40-80 mm.

More details about the results: https://www.helix.ru/kb/item/02-007#subj12

Fibrinogen

Reference values: 1.8 - 3.5 g/l

More details about the results: https://www.helix.ru/kb/item/03-011#subj12

Antistreptolysin O

Reference values:

More details about the results: https://www.helix.ru/kb/item/06-007#subj12

Serum uric acid

Reference values:

More details about the results: https://www.helix.ru/kb/item/06-033#subj12

C-reactive protein, quantitative (method with normal sensitivity)

Reference values: 0 - 5 mg/l

More details about the results: https://www.helix.ru/kb/item/06-182#subj12

CRP more than 10 mg/l indicates acute inflammation, chronic disease, injury, etc. For viral infections, metastases, sluggish chronic and some systemic rheumatic diseases, the concentration of CRP is 10-30 mg/l; for bacterial infections, exacerbation of some chronic inflammatory diseases (for example, rheumatoid arthritis) and tissue damage (surgery, acute myocardial infarction) - 40-100 mg/l (sometimes 200 mg/l), for severe generalized infections, burns and sepsis - up to 300 mg/l or more.

Rheumatoid factor

Reference values:

More details about the results: https://www.helix.ru/kb/item/13-020#subj12

Antinuclear factor on HEp-2 cells

Reference values: antibody titer not exceeding 1:160 is considered negative

Positive result: antibody titer 1:320 or more

• A negative result in a patient with signs of an autoimmune process does not exclude the presence of an autoimmune disease;
• ANAs are detected in 3-5% of healthy people (10-37% over the age of 65 years);
• If the test for antinuclear antibodies is positive, it is necessary to perform an immunoblot of antinuclear antibodies to clarify the type of autoimmune disease and make a diagnosis.

More details about the results: https://www.helix.ru/kb/item/13-045#subj12

Antibodies to extractable nuclear antigen (ENA screen)

Reference values: negative

When immunosuppressive therapy is prescribed, the test result may be negative.

More details about the results: https://www.helix.ru/kb/item/13-046#subj12

What can influence the result?

• Uremia may result in a false-negative ANA test result;
• Many drugs are associated with the development of drug-induced lupus and the appearance of ANA in the blood;
• Some drugs lower fibrinogen levels: anabolic steroids, phenobarbital, streptokinase, urokinase, and valproic acid;
• False-negative results in the analysis of antistreptolysin O can be observed in nephrotic syndrome, as well as treatment with corticosteroids and some antibiotics; hypercholesterolemia and liver diseases lead to overestimated indicators;
• Stress, intense physical activity, a diet rich in purines, anabolic steroids, niacin, epinephrine, thiazide diuretics, beta blockers, furosemide and some other drugs can lead to falsely elevated uric acid levels;
• The rate of false-positive rheumatoid factor test results increases with patient age.