Symptoms of ankle arthritis and how to cure it

Arthritis of the ankle

is an acute or chronic inflammatory process in the ankle area, which leads to metabolic disorders in the joint structures. This condition is accompanied by pain and stiffness when moving. But its main danger is that if left untreated, the disease causes degradation of cartilage and even bone tissue and spreads to ligaments, tendons and muscles. In advanced cases, ankle arthritis leads to disability and loss of ability to work.

Arthritis of the ankle joints is debilitating with constant pain and can lead to complete disability.

Since the ankle joint is one of the most loaded joints in the human body,

when it is damaged, a person instinctively transfers his body weight to the other leg. This starts a “domino effect” - soon other joints of the lower extremities and spine begin to fail. Can this condition be prevented and how can ankle arthritis be treated if it has already been diagnosed?

Causes of ankle arthritis

A number of reasons can provoke inflammation and destruction of cartilage tissue, from injury to infection that has entered the synovial bursa. Therefore, from the point of view of etiology, the disease is usually divided into primary (associated with direct damage to the joint) or secondary (associated with extra-articular disease) arthritis of the ankle.

There are 4 groups of causes of ankle arthritis:

• inflammatory (septic, tuberculosis, ankylosing spondylitis), dystrophic (deforming osteoarthritis, metabolic and endocrine diseases, pathologies associated with working conditions),
• traumatic (closed injuries or prolonged and regular vibration exposure)
• others (related to intoxication, diseases of the cardiovascular, nervous and other systems).

Most often, ankle arthritis occurs due to:

• metabolic disorders (diabetes mellitus, gout);
• autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, psoriasis);
• degenerative-dystrophic pathologies (arthrosis of the knee, ankle, metatarsophalangeal joints);
• systemic infectious diseases (mycoplasmosis, chlamydia, influenza, dysentery, salmonellosis and other intestinal and respiratory infections);
• lower extremity injuries.

Factors that predispose to ankle arthritis also include:

• excess weight;
• advanced age;
• sedentary lifestyle;
• allergy;
• smoking;
• alcohol abuse;
• chronic stress;
• unbalanced diet;
• diseases of the spine associated with deterioration of the conduction of nerve impulses;
• increased professional or sports stress on the joint;
• unfavorable microclimatic or unsanitary living or working conditions.

If the disease has not progressed far, the signs of ankle arthritis may completely go away when the negative impact is eliminated - for example, losing weight, giving up bad habits, normalizing your diet and diet.

Otherwise, under the influence of the factors mentioned above, massive cell death occurs throughout the body. Due to the fact that metabolism in the joints is slow due to the lack of blood vessels in the cartilage, the breakdown products of dead cells do not have time to be eliminated. This leads to the accumulation of enzymes in the joints, which “eat away” the cartilage lining. This is why ankle arthritis should not be left to chance - even a short exacerbation is fraught with irreversible consequences!

Causes of the appearance and development of the disease

The most common cause of osteoporosis is a calcium metabolism disorder due to some other disease. The second is disruptions in the process of bone regeneration, that is, in the activity of those cells that are responsible for the renewal of bone tissue.

Factors that increase the risk of “acquiring” such a disease can be divided into two groups: those that depend on the person and those that are independent.

Ankle arthritis: symptoms of the disease

It is easy to confuse the signs of ankle arthritis with other musculoskeletal conditions that cause ankle pain (such as Achilles tendonitis). symptoms of ankle arthritis should be the reason to consult a doctor

• pain when moving the joint, lightly pressing or even touching the skin above the ankle (skin hypersensitivity);
• rapid fatigue of the legs;
• crunching when moving in a joint;
• erythema (redness on the skin due to the fact that the tissues are filled with blood);
• swelling of the joint and feet caused by synovitis;
• local increase in temperature and redness of the skin over the sore joint;
• stiffness when moving;
• frequent spasms and cramps in the lower leg and foot;
• in the later stages - noticeable curvature of the leg or the formation of bumps.

The main distinguishing symptom of ankle arthritis is sharp or aching pain,

which does not leave the patient during rest. Many patients complain of increased pain after the leg has been immobilized for a long time (for example, after a night's sleep). In the morning, as a rule, swelling and other symptoms of the disease increase - with ankle arthritis, patients need an average of 40-60 minutes of movement to restore ankle mobility.

Symptoms of ankle arthritis can easily be confused with other diseases, so consult your doctor for the most accurate diagnosis.

Quite often, arthritis of the ankle joint comes “like a bolt from the blue” - a person goes to bed healthy, and the next morning the leg is already swollen and painful. This is especially true for the infectious form of arthritis. Inflammation in the joint associated with metabolic and autoimmune diseases may coincide in time with exacerbations of the underlying disease.

Systemic manifestations are also characteristic of arthritis of the ankle joint - body temperature rises, weakness, fever with chills, increased sweating, lethargy, loss of appetite, and loss of body weight appear.

If 3 or more signs of ankle arthritis mentioned above appear, a diagnostic examination by an orthopedist or rheumatologist is required. During the interview, the doctor determines the presence of trauma, allergies, metabolic pathologies in the anamnesis, and clarifies the patient’s type of activity. The range of motion in the joint is checked. Laboratory tests are required for differential diagnosis - as a rule, analyzes of ESR and leukocytes, uric acid and rheumatic factor are needed. If there are clear symptoms of ankle arthritis, the specialist may limit itself to radiography.

Stages of ankle arthritis

With ankle arthritis, mobility in the joint is impaired, stagnation of synovial fluid begins, starvation and destruction of cartilage tissue. The degree of development of pathological changes and signs of arthritis of the ankle joint allows doctors to distinguish three stages of the disease.

Stage 1 arthritis of the ankle joint

Acute arthritis begins suddenly, with redness, severe swelling and sharp pain. Among the first symptoms of chronic ankle arthritis is mild pain when moving, which patients attribute to fatigue after a day of work. Over time, the discomfort does not go away, but only increases.

Although in the chronic course of the disease patients rarely seek help at this stage, it is at this stage that treatment of ankle arthritis gives the best results.

Stage 2 ankle arthritis

Pain syndrome annoys the patient almost constantly. Sometimes the pain is paroxysmal, sometimes subsiding, sometimes increasing, but never goes away completely. Sleep disturbances appear. The ankles become hot and swell (especially noticeable when the patient tries to put on shoes). Symptoms of ankle arthritis also appear on the skin - redness, hotness, and acute sensitivity. Limited mobility (inability to turn the foot), weather sensitivity and spasms force most patients to consult a doctor to find out how to treat ankle arthritis.

Stage 3: ankle arthritis

The position of the foot becomes noticeably deformed. Movement in the joint is almost completely limited, even with treatment for ankle arthritis. The patient has difficulty walking and needs assistive devices (cane, crutches, walker). Disability sets in.

Degrees of osteoporosis of joints

How to treat ankle arthritis

Treatment of ankle arthritis is carried out step by step and comprehensively, taking into account the stage and individual dynamics of the disease. First of all, patients are selected with medications and vitamin supplements, and physiotherapy is prescribed to relieve inflammation, relieve pain and improve metabolic processes. At the same time, diet therapy is used (especially effective for gouty arthritis) and a complex of exercise therapy for arthritis of the ankle joint. After acute symptoms are relieved and remission occurs, the patient is placed under the care of a rehabilitation physician, who prescribes massage, manual therapy, and wearing support orthoses and bandages.

In advanced cases, when conservative treatment of ankle arthritis does not bring results, surgical procedures may be required - endoprosthetics, arthroplasty and other reconstructive operations.

All measures for treating ankle arthritis are mutually reinforcing and should not be used individually.

Physiotherapeutic treatment of ankle arthritis

Physiotherapeutic treatment of arthritis of the ankle joints (usually carried out in sessions - from 8 to 24) is included in therapy when the inflammation subsides. It helps eliminate residual congestion, improve mobility in the joint, ensure lasting remission and quickly return the patient to normal life without symptoms of ankle arthritis.

Physiotherapy is one of the effective ways to combat pain associated with ankle arthritis.

A number of procedures (magnetic therapy, medicinal electrophoresis) are allowed at the peak of the disease. They enhance the effect of systemic and local drugs.

For the treatment of ankle arthritis, the following is used:

• laser therapy;
• ultra-high frequency therapy (UHF);
• amplipulse;
• phonophoresis with hydrocortisone ointment;
• UV therapy;
• massotherapy;
• cryotherapy;
• diadynamic therapy;
• balneotherapy and mud therapy.

Any independent warming of a sore joint in the acute stage is strictly prohibited!

Massage in the treatment of ankle arthritis

Massage for ankle arthritis helps restore nutrition to cartilage tissue, support muscles and ligaments weakened during the disease, eliminate stiffness and prolong remission even in chronic cases. The procedure is performed on both legs, involving the thighs, shins, ankles, and arches of the feet.

Please note: massage techniques are used strictly after the removal of “acute” symptoms. Massage in the presence of even slight residual inflammation can cause arthritis to recur.

Self-massage without the knowledge of a specialist for arthritis of the ankle joint is extremely undesirable.

Exercise therapy for ankle arthritis

Exercises for ankle arthritis should begin 2-4 weeks later, i.e., after the acute period of the disease has passed. If an exercise causes severe pain, you should postpone performing it until the ligaments are stronger. Particular care should be taken in case of traumatic arthritis of the ankle joint - exercises are contraindicated in the presence of fresh fractures, sprains and other injuries.

The course of exercise therapy for ankle arthritis is at least 2-3 months, if there is a risk of relapse - up to 2-3 years. It is important to perform a set of exercises for ankle arthritis every day (1 time), without skipping.

We recommend the following simple exercises for ankle arthritis, which are suitable for patients of any age and with any level of physical fitness:

1. Starting position - sitting on a chair straight, hands holding the seat. Without lifting your heels from the floor, spread your feet as wide as possible to the sides and up, and then bring them together into a standing position.
2. Starting position - sitting on a chair, feet on the floor approximately shoulder-width apart. Slowly and smoothly move your feet inward and upward until your big toes touch.
3. Starting position - behind the chair, hands on the back. Rise up on your toes until you feel tension at the top point, without putting any emphasis on your hands (they hold on to the chair for safety).
4. The starting position is the same. Focusing on your heel, lift your toes as high as you can, as if pulling them towards you.
5. Starting position: standing, legs not wide apart. Gently rise up on your toes, bringing your heels together.
6. The starting position is the same. Rise up on your toes, spreading your heels.
7. Starting position - legs spread wide apart, the healthy leg is in front (toe forward), the painful leg is behind (toe slightly to the side). With your palms resting on the knee of your healthy leg, do a shallow squat on your healthy leg (the affected leg does not bend). The feet should be completely on the floor without lifting off. Repeat the same, placing the affected leg forward.

The following exercises for ankle arthritis can be performed in the morning while lying in bed - this will help you warm up and reduce pain when doing household chores.

1. Starting position: lying on your back. Perform circular movements with your toes with maximum amplitude clockwise and counterclockwise.
2. Starting position: lying on your back. Bring your toes in and out with maximum amplitude, swinging them left and right.
3. The starting position is the same. Stretch the toe of your left foot forward, away from you. Right - back to yourself. Smoothly change legs.
4. The starting position is the same. Curl your toes, tensing your muscles, and bring your feet together. Then pull your toes toward you and spread your feet.

These exercises for ankle arthritis are performed 6-8 times. Avoid sudden movements.

Please note that in the early days, exercise for ankle arthritis may cause moderate pain, and the pain in the joint may even worsen. But after 2-4 weeks, the discomfort will completely disappear, and the range of movements will increase.

Reactive arthritis in children - diagnosis and treatment

One of the pressing problems of modern pediatrics is the diagnosis and treatment of inflammatory joint diseases. The most common rheumatic disease of childhood is reactive arthritis (ReA), which occurs in 86.9 per 100,000 children [1].

The term “ reactive arthritis ” was introduced into the literature in the early 70s of the twentieth century. Finnish scientists K. Aho and R. Ahvonen to designate arthritis that developed after a yersinia infection. At the same time, the “reactive”, sterile nature of arthritis was emphasized. As diagnostic methods improved, the concept of “sterility” of synovitis in ReA became relative. The discovery of circulating bacterial antigens and microbial DNA and RNA fragments in the serum and synovial fluid of patients with ReA gave impetus to the formation of fundamentally new views on ReA [2, 3, 4, 5]. Until recently, ReA meant any inflammatory disease of the joints associated with a current or past infection.

Currently, ReA includes inflammatory non-purulent diseases of the joints that develop as a result of immune disorders, after an intestinal or urogenital infection. In the vast majority of cases, ReA is associated with acute or persistent intestinal infection caused by enterobacteria (Yersinia enterocolitica, Yersinia pseudotuberculosis, Salmonella enteritidis, Salmonella typhimurium, Shigella flexneri, Shigella sonnei, Shigella Newcastle, Campylobacter jejuni), and with acute or persistent urogenital infection caused by oh Chlamydia trachomatis. Respiratory tract infections associated with Mycoplasma pneumoniae, and especially Chlamydophila pneumonia, can also cause the development of ReA. There is also evidence of an association between ReA and intestinal infections caused by Clostridium difficile and some parasitic infections.

ReA, associated with intestinal infection and infection caused by Chlamydia trachomatis, develops predominantly in genetically predisposed individuals (HLA-B27 carriers) and belongs to the group of seronegative spondyloarthritis [2, 3, 6]. Antibodies to a number of microorganisms have been found to cross-react with HLA-B27. This is explained by the phenomenon of molecular mimicry, according to which the cell wall proteins of a number of intestinal bacteria and chlamydia are structurally similar to certain parts of the HLA-B27 molecule. It is assumed that cross-reacting antibodies can have a damaging effect on the body's own cells, which most express HLA-B27 molecules. However, it is believed that such cross-reaction may interfere with the implementation of an adequate immune response, contributing to the persistence and chronicity of the infection. There is evidence that carriers of HLA-B27, after an intestinal and urogenital infection, develop ReA 50 times more often than in individuals who do not have this histocompatibility antigen.

The diagnosis of ReA is made in accordance with the following diagnostic criteria adopted at the III International Meeting on ReA in Berlin in 1996 [7].

• Peripheral arthritis:
  – Asymmetrical.

  – Oligoarthritis (affects up to 4 joints).

  – Predominant damage to the joints of the legs.

• Infectious manifestations:
  - Diarrhea.

  - Urethritis.

  – Time of onset: 2–4 weeks before arthritis develops.

• Laboratory confirmation of infection:
  – Not necessary, but recommended if there are clinical signs of infection.

  – Mandatory, in the absence of obvious clinical manifestations of infection.

• Exclusion criteria - established cause of mono- or oligoarthritis:
  – Spondyloarthritis.

  – Septic arthritis.

  – Crystalline arthritis.

  – Lyme disease.

  – Streptococcal arthritis.

However, in real practice, the term ReA is mistakenly used by rheumatologists much more widely and includes arthritis after a viral infection, post-vaccination arthritis, post-streptococcal arthritis and some others.

Currently, one of the most common causes of ReA development is chlamydial infection.

In the structure of ReA, chlamydial arthritis accounts for up to 80% [8, 9, 10]. This is due to the chlamydia pandemic in the world, the characteristics of the transmission routes of chlamydial infection, the development cycle of chlamydia and the response to therapy. Susceptibility to chlamydia is universal; there are many ways of transmission of infection, including contact and household routes (in relation to Chlamydia pneumonia). The trigger role of intestinal infection in the development of ReA also remains relevant.

The classic manifestation of ReA is Reiter's disease or urethro-oculo-synovial syndrome, first described by Benjamin Brody and then by Hans Reiter, under whose name the syndrome entered medicine. Reiter's disease is currently considered a special form of ReA and is characterized by a classic triad of clinical symptoms: urethritis, conjunctivitis, arthritis. In the presence of keratoderma, they speak of tetralogy of Reiter's disease. Reiter's syndrome most often begins with symptoms of damage to the urogenital tract 2-4 weeks after an infection or suspected infection with chlamydia or intestinal bacteria. In Reiter's syndrome, trigger infectious factors are most often Chlamydia trachomatis, Shigella flexneri 2a, or a combination thereof.

Clinical picture

Reiter's syndrome, associated with intestinal infections, begins acutely, with an increase in body temperature to febrile levels, a disturbance in the general condition, and intoxication. The classic symptoms of the triad - conjunctivitis (keratoconjunctivitis), urethritis (cervicitis) - most often precede the development of arthritis. Conjunctivitis is observed in 30–60% of patients and is acute (photophobia, blepharospasm), clinical signs of scleritis (“cat's eye symptom”), keratoconjunctivitis may occur, and in some patients, corneal ulcers form. 12–37% of patients develop uveitis [11]. Urethritis can occur acutely, subacutely; asymptomatic urethritis is often noted, manifested only by sterile pyuria. Articular syndrome in Reiter's disease of shigellosis and yersinia etiology is also characterized by an acute onset [12]. Asymmetric oligoarthritis is characteristic, less often - a polyarticular variant of arthritis. Arthritis occurs with a pronounced pain reaction, joint defiguration (mainly due to exudation into the joint cavity and periarticular swelling of soft tissues), increased local temperature, and hyperemia of the skin over the joint. Often there is severe hyperesthesia of the skin over the affected joint, painful contracture, the patient cannot lean on the leg due to pain. Reiter's disease mainly affects the knee, ankle, and first toe joints, and less commonly, the sacroiliac joint and lumbar spine. The wrist and elbow joints may be involved. Characterized by asymmetrical damage to small joints and periarticular tissues of the hands and feet with severe swelling of the fingers, pain, hyperemia of the skin and the formation of the so-called “sausage-shaped deformity”, which is noted in 5–10% of children. In approximately 50% of patients, asymmetric oligoarthritis is combined with the development of enthesitis and enthesopathies (pain and tenderness on palpation at the sites of attachment of tendons to bones). Most often, enthesopathies are determined along the spinous processes of the vertebrae, the iliac crests, in the places of projection of the sacroiliac joints, in the places of attachment of the Achilles tendon to the tubercle of the calcaneus, as well as in the place of attachment of the plantar aponeurosis to the tubercle of the calcaneus. Patients with ReA experience pain in the heel area (talalgia); pain, stiffness, limited mobility in the cervical and lumbar spine and sacroiliac joints. These clinical symptoms are characteristic of adolescent boys with the presence of HLA-B27. These children have a high risk of developing juvenile spondyloarthritis.

Reiter's disease, associated with chlamydial infection, is characterized by a less severe clinical picture [8, 10]. Damage to the urogenital tract is characterized by blurred clinical picture. Boys may develop balanitis, infected synechiae, and phimosis. In girls, damage to the urogenital tract may be limited to vulvitis, vulvovaginitis, leukocyturia and/or microhematuria, as well as clinical cystitis. Damage to the urogenital tract may precede the development of articular syndrome by several months.

Eye damage is characterized by the development of conjunctivitis: often catarrhal, unexpressed, short-lived, but prone to recurrence. One third of patients may develop acute iridocyclitis, which can lead to blindness. Eye damage may also precede the development of articular syndrome by several months or years.

Exudative arthritis (mono- or oligoarthritis) in Reiter's disease of chlamydial etiology can occur without pain, stiffness, or severe dysfunction, but with a large amount of synovial fluid and continuously relapsing. In this case, joint damage is characterized by a long-term absence of destructive changes, despite recurrent synovitis.

Often ReA occurs without distinct extra-articular manifestations related to the symptom complex of Reiter's syndrome (conjunctivitis, urethritis, keratoderma). In such cases, the leading one is articular syndrome, which is also characterized by predominant damage to the joints of the lower extremities, of an asymmetrical nature. Despite the absence of extra-articular manifestations, these children also have a high risk of developing juvenile spondyloarthritis. The presence of a characteristic articular syndrome, accompanied by severe exudation and associated with a previous intestinal or urogenital infection or with the presence of serological markers of an intestinal or urogenital infection, makes it possible to classify the disease as reactive arthritis with a high degree of probability.

Diagnosis of ReA

Diagnosis of ReA is based on clinical and anamnestic data, including the presence of a characteristic articular syndrome associated with an infectious process. Due to the fact that the infection preceding the development of ReA is not always pronounced, data from additional laboratory tests become especially important in the diagnostic process. To make an accurate diagnosis, it is necessary to isolate the pathogen that caused the infection and/or detect high titers of antibodies to it in the blood serum. To identify trigger infections, various microbiological, immunological and molecular biological methods are used. Etiological diagnosis includes the following.

1. Immunological method.
   1.1. Detection of chlamydia antigen in epithelial cells obtained as a result of scrapings from the urethra and conjunctiva, as well as in synovial fluid (direct immunofluorescence analysis, etc.).

   1.2. Detection of antibodies to chlamydia antigens in blood serum and synovial fluid (complement fixation reaction, direct and indirect immunofluorescence):

   • acute phase of chlamydia or exacerbation of a chronic process - the presence of immunoglobulin (Ig) M during the first 5 days, IgA - within 10 days, IgG - after 2-3 weeks;

   reinfection or reactivation of a primary chlamydial infection - an increase in the level of IgG, determined by IgA, there may be single IgM;

2. chronic course of chlamydia - the presence of constant titers of IgG and IgA;
3. asymptomatic course of chlamydia, persistence of the pathogen - low IgA titers;
4. previous chlamydial infection - low IgG titer.

1.3. Detection of antibodies to intestinal bacteria in blood serum (using direct hemagglutination reaction and complement fixation reaction).

5. Morphological method - identification of the morphological structures of the pathogen (staining of preparations, immunofluorescent analysis).
6. Cultural method - isolation of chlamydia (cell culture, chicken embryos, laboratory animals).
7. Molecular biological - detection of pathogen DNA (polymerase chain reaction, etc.). The method is used to detect pathogen DNA in blood and synovial fluid [5].
8. Bacteriological examination of stool.
9. Bacteriological examination of urine.

The most conclusive evidence is the isolation of trigger microorganisms using classical microbiological methods (stool culture, transfer of scrapings from the urethral epithelium and/or conjunctiva to cell culture). More often it is possible to isolate chlamydia from the urogenital tract, much less often - enterobacteria from feces.

Difficulties in diagnosing ReA are often due to the erased subclinical course of the primary infectious process. Arthritis develops more often with mild forms of intestinal or urogenital infections, and by the time arthritis develops, the signs of the trigger infection in most cases disappear. In addition, in conditions of an impaired immune response, the development of chronic persistent forms of infection is possible. Therefore, at the onset of articular syndrome, it is necessary first of all to exclude hidden intestinal and chlamydial infections. In addition, the diagnosis of ReA is complicated by the combination of previous infectious processes of different localizations. It has also been established that damage to the intestines and urinary tract can be either primary in relation to ReA or develop simultaneously with it and even later, which often makes it difficult to determine cause-and-effect relationships.

Differential diagnosis of ReA from other types of juvenile arthritis is often difficult. The most common pathology requiring differential diagnosis with ReA is infectious arthritis, infection-related diseases accompanied by arthritis, as well as orthopedic pathology and various forms of juvenile idiopathic arthritis.

Viral arthritis. It is currently known that about 30 viruses can cause the development of acute arthritis. These include: rubella viruses, parvovirus, adenovirus, hepatitis B virus, herpes viruses of various types, mumps virus, enteroviruses, Coxsackie viruses, etc. Diagnosis is based on the connection with a viral infection or vaccination. The clinical picture is more often represented by arthralgia than arthritis. Clinical symptoms are observed within 1–2 weeks and disappear without residual effects.

Diagnostic criteria for poststreptococcal arthritis include:

• the appearance of arthritis against or 1–2 weeks after a nasopharyngeal infection (streptococcal etiology);
• simultaneous involvement of predominantly medium and large joints in the process;
• possible torpidity of the articular syndrome to the action of non-steroidal anti-inflammatory drugs (NSAIDs), subtle changes in laboratory parameters;
• the presence of elevated titers of post-streptococcal antibodies;
• identification of chronic foci of infection in the nasopharynx (chronic tonsillitis, pharyngitis, sinusitis).

Tick-borne borreliosis (Lyme disease). Diagnosis of borreliosis is based on medical history: the patient’s stay in an endemic area, a history of a tick bite, as well as a characteristic clinical picture. The diagnosis is confirmed by serological methods that detect antibodies to Borrelia burgdorferi.

The diagnosis of septic arthritis is made on the basis of the clinical picture of the infectious process, determination of the nature of the synovial fluid, the results of culture of the synovial fluid for flora with determination of sensitivity to antibiotics, as well as radiological data (in the case of osteomyelitis).

The clinical picture of tuberculous arthritis is represented by general symptoms of tuberculosis infection: intoxication, low-grade fever, autonomic disorders and local symptoms - joint pain, mainly at night, arthritis. To confirm the diagnosis, X-ray data, analysis of synovial fluid, and biopsy of the synovial membrane are necessary.

The greatest difficulty is in the differential diagnosis of ReA with juvenile rheumatoid arthritis (JRA), a variant of “little” girls, since the clinical picture shows similar symptoms: oligoarthritis, mainly of the lower extremities, eye damage in the form of conjunctivitis, uveitis. The diagnosis of JRA is made based on the progressive course of arthritis, the presence of immunological changes (positive antinuclear factor), characteristic immunogenetic markers (HLA-A2, -DR5, -DR8), and the appearance of radiological changes characteristic of JRA in the joints.

Juvenile spondyloarthritis. This disease is a possible outcome of the chronic course of ReA in predisposed individuals (HLA-B27 carriers). The joint syndrome, as with ReA, is represented by asymmetric mono- or oligoarthritis with predominant damage to the joints of the legs. The cardinal signs that make it possible to make a diagnosis of juvenile spondyloarthritis are radiological data indicating the presence of sacroiliitis (unilateral or bilateral).

Treatment

There are three types of therapy: etiotropic, pathogenetic, symptomatic.

Etiotropic treatment of ReA associated with chlamydial infection. Since chlamydia are intracellular parasites, the choice of antibacterial drugs is limited only to those that can accumulate intracellularly. These drugs include macrolides, tetracyclines and fluoroquinolones. However, tetracyclines and fluoroquinolones are quite toxic, their use is limited in pediatric practice. In this regard, macrolides are used to treat chlamydial arthritis in children. Azithromycin - for children, on the first day of administration, the dose of the drug is 10 mg/kg, and in the next 5-7 days - 5 mg/kg in one dose. The best effect is achieved when using the antibiotic for 7–10 days. Roxithromycin - for children, the daily dose is 5-8 mg/kg body weight. Josamycin (vilprafen) daily dose of the drug is 30–50 mg/kg body weight, divided into three doses. Clarithromycin is used in children over 6 months - 15 mg/kg/day in 2 doses, spiramycin - in children weighing more than 20 kg at the rate of 1.5 million IU/10 kg body weight per day. The frequency of administration is 2–3 times.

In adolescents, tetracyclines and fluoroquinolones may be used.

For ReA associated with intestinal infection, there are no clear recommendations for antibiotic therapy. The presence of antibodies to intestinal bacteria and especially bacteriological confirmation of intestinal infection is the basis for prescribing antibiotics. Aminoglycosides are used - amikacin IM or IV - up to 15 mg/kg/day in one or two injections, 7 days, gentamicin IM or IV 5-7 mg/kg/day in two injections, 7 days , fluoroquinolone drugs (for children over 12 years of age).

Pathogenetic therapy. Monotherapy with antibiotics has insufficient effect in case of protracted and chronic course of ReA and inadequate immune response. It is advisable to use various immunomodulatory agents (tactivin, lycopid, polyoxidonium) in combination with antibiotics for the treatment of chronic chlamydial arthritis.

According to the results of long-term controlled studies, the most effective regimen was using lycopid [8, 10, 13].

The scheme of combination therapy with lycopid and antibiotics in patients with chronic ReA associated with chlamydial infection is as follows.

• Likopid is used in the form of sublingual tablets. For children under 5 years of age, it is advisable to prescribe licopid 1 mg 3 times a day, for children over 5 years old - licopid 2 mg 3 times a day. The course of treatment is 24 days.
• On the 7th day of taking licopid, an antibiotic is prescribed. It is possible to use any antibiotic that has antichlamydial activity. Since it is necessary to block 2-3 life cycles of chlamydia, the course of antibiotic treatment should be at least 7-10 days.
• After completing the course of antibacterial therapy, children continue to receive licopid for up to 24 days.

The use of immunomodulators is contraindicated in cases of ReA transformation into spondyloarthritis and high immunological activity.

Symptomatic therapy. NSAIDs are used to treat articular syndrome in ReA. Diclofenac orally 2–3 mg/kg/day in 2–3 divided doses or naproxen orally 15–20 mg/kg/day in 2 divided doses or ibuprofen orally 35–40 mg/kg in 2–4 divided doses or nimesulide orally 5 mg/kg in 2–3 doses or meloxicam orally 0.3–0.5 mg/kg in 1 dose.

Glucocorticosteroids, as the most powerful anti-inflammatory drugs, are used during exacerbation of articular syndrome. Their use is limited primarily to the intra-articular route of administration. If necessary, you can use a short course of methylprednisolone pulse therapy, which involves rapid (over 30–60 minutes) intravenous administration of large doses of methylprednisolone (5–15 mg/kg for 3 days).

In case of severe and torpid course of the disease, the appearance of signs of spondyloarthritis, high clinical and laboratory, including immunological, activity, the use of immunosuppressive drugs is possible. The most commonly used is sulfasalazine (at a dose of 30–40 mg/kg per day), less commonly methotrexate (at a dose of 10 mg/m2 per week).

In most children, ReA ends in complete recovery. In some patients, episodes of ReA recur and subsequently signs of spondyloarthritis appear, especially in HLA-B27 positive patients. Prevention measures include timely detection of chlamydial infection in a child and his family members, adequate treatment of urogenital infection.

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12. Cassidi JT, Petty RE Textbook of Pediatric Rheumatology. Toronto, W. B. Saunders Company. 2002. 819 rub.
13. Alekseeva E. I., Zholobova E. S., Chistyakova E. G., Valieva S. I. Principles of treatment of reactive arthritis associated with chlamydial infection in children // Issues of modern pediatrics. 2004. T. 3. No. 4. P. 28–34.

E. S. Zholobova , Doctor of Medical Sciences, Professor E. G. Chistyakova , Candidate of Medical Sciences, Associate Professor D. V. Dagbaeva MMA named after. I. M. Sechenova, Moscow

Drug treatment for ankle arthritis

Treatment of ankle arthritis with medications is carried out in several directions:

• relieving inflammation;
• elimination of pain;
• restoration of the cartilage lining of the joint;
• removal of decay products from the joint and periarticular tissues;
• improvement of tissue nutrition (stimulation of blood circulation).

In case of secondary ankle disease, treatment of the underlying pathology is also necessary - for example, taking antibiotics, cytostatics, antihistamines and basic drugs for the treatment of rheumatoid arthritis. The drugs are taken orally, externally, or as intra-articular injections for ankle arthritis.

Drug treatment for arthritis can quickly relieve pain and partially restore the cartilage tissue of the joint.

Attention: conventional analgesics for the treatment of ankle arthritis are used no longer than 3 days before visiting a doctor, as they mask complications!

Consequences and complications of osteoporosis of the joints

A complication of this disease is fractures even with low load, the most dangerous of which is a fracture of the femoral neck. To exclude such complications, you need to wear protectors for damaged joints, avoid strong physical exertion and those impacts that can lead to injuries (jumping, running, etc.).

Important! If you are taking medications that cause dizziness, talk to your doctor about stopping them or adjusting the dose. When you feel dizzy, there is a risk of falling and getting a fracture.

Anti-inflammatory drugs for ankle arthritis

Anti-inflammatory drugs for the treatment of ankle arthritis are steroidal (hormonal) and non-steroidal. First of all, non-steroidal drugs (NSAIDs) are used, which are designed to relieve the symptoms of ankle arthritis, but do not affect the condition of the cartilage tissue. These include: artradol, ibuprofen, diclofenac, ketoprofen, meloxicam, nimesulide, indomethacin, celecoxib, lornoxicam.

If NSAIDs fail to relieve pain, the doctor prescribes a short course of GCs (glucocorticoids) - most often in the form of injections for ankle arthritis. You should take the course no more than 2 times a year, strictly following the doctor’s recommendations, since uncontrolled use of GCs negatively affects the immune system, the endocrine system, and can worsen the condition of the joints.

Most often used in the treatment of ankle arthritis: hydrocortisone, prednisolone, methylprednisolone, diprospan.

Chondroprotectors for ankle arthritis

Drug treatment of ankle arthritis with NSAIDs and GCs is symptomatic. But for joint regeneration, nutrients are needed - glucosamine and chondroitin, which are part of synovial cartilage and joint fluid. They provide sufficient viscosity of synovial lubrication, increase the elasticity and shock-absorbing characteristics of cartilage.

The most effective in the treatment of ankle arthritis are: artracam, artravir, chondroitin complex, dona, structum, protecon, arthra, alflutop, movex active, teraflex.

Antispasmodics and muscle relaxants for ankle arthritis

With arthritis of the ankle joint, disturbances in muscle tone and spasms are common, which disrupt metabolic processes and provoke an exacerbation of pain.

To eliminate them, use: drotaverine, tolperisone, tizanidine, mydocalm, baclosan.

Warming agents for ankle arthritis

Warming agents in the treatment of ankle arthritis are represented by ointments, creams, gels, compresses and balms for external use. They have a local irritating effect, help relieve pain and inflammation, and improve tissue trophism.

In any pharmacy you can buy: diclofenac, voltaren, fastum gel, finalgon, nicoflex, viprosal B, capsaicin, indomethacin ointment.