Rheumatoid and infectious arthritis: what are the differences from arthrosis

The terms arthrosis and arthritis are often confused and are also called arthrosis-arthritis. But these terms have fundamentally different meanings and different diseases. What unites them is the root (artron) - meaning joint. Arthritis is an inflammatory disease of the joint(s) and the inflammatory process, one way or another, affects other organs and systems of the whole body due to autoimmune (for example, rheumatological diseases such as rheumatoid arthritis, SLE) or other disorders. With metabolic disorders (for example, gout or diabetes), the joints are affected and, in such cases, the term arthropathy is used. The term arthralgia is used to refer to joint pain of various origins. Arthrosis or osteoarthrosis refers to degenerative changes in joints that occur over the age of 45-50 years due to natural wear and tear. Thus, the fundamental difference between arthritis and arthrosis is that arthritis is an inflammatory disease, while arthrosis is degenerative changes in cartilage due to involutional changes in the body and natural wear and tear of the cartilage tissue of the joints.

Arthritis . The term is often used to describe a group of more than 100 diseases.

These diseases can affect joints, muscles, tendons and ligaments, as well as the skin and some internal organs.

Osteoarthritis is a normal degenerative condition associated with aging. It mainly affects cartilage tissue, which becomes thinner, thickens and loses functionality. Changes in cartilage can lead to pain, decreased mobility, and decreased muscle strength.

Arthritis

About 350 million people worldwide have arthritis. For example, in the United States it is noted that almost 22 percent of the population (40 million, including 250 thousand children) have some form of arthritis and often other terms are used to refer to the inflammatory process in the joints, such as arthralgia, arthropathy or arthrosis .

Data

• Arthritis is inflammation of one or more joints.
• Symptoms of arthritis include pain and limited joint function.
• Arthritis can affect both men and women, adults and children.
• Arthritis is treated by a rheumatologist.
• Early diagnosis can help prevent permanent damage and disability.

The disease is often accompanied by joint pain (arthralgia). There are many different reasons for the development of inflammation in the joints. These may be trauma (osteoarthritis), metabolic disorders (for example, gout or pseudogout), hereditary factors, direct and indirect effects of infections (bacterial or viral), disorders of the immune system with an autoimmune component (for example, rheumatoid arthritis and systemic lupus erythematosus) . Common to all types of arthritis are that both joints and tendons, muscles, ligaments, cartilage are affected, and internal organs are often affected. With some types of arthritis, especially of autoimmune origin, internal organs (heart, lungs, kidneys) are affected and the patient may have general symptoms, such as fever, chronic fatigue, weight loss, and swollen lymph nodes.

Symptoms

Symptoms of arthritis include pain and limited mobility in the joints. Joint inflammation is characterized by stiffness, swelling, redness and a local increase in temperature in the joint area. There may also be pain in the joint area. With many types of arthritis, symptoms occur in other organs that are not directly related to the joints. Thus, patients with arthritis may have symptoms such as fever, swollen lymph nodes, weight loss, and symptoms of dysfunction of organs such as the lungs, heart, or kidneys.

Diagnostics

The first step in diagnosing arthritis is to consult a rheumatologist. The doctor analyzes the history of the disease, symptoms, examines the joints, determines the presence of inflammation in the joint area, the presence of deformity, and also checks for the presence of somatic problems that may cause the development of joint inflammation. Various methods are used to diagnose arthritis, such as laboratory tests, radiography, and ultrasound. In some cases, diagnosing the type of arthritis requires multiple visits to a rheumatologist, who is a specialist who deals directly with arthritis. Timely diagnosis allows you to prescribe adequate treatment and avoid serious complications, both from the joints and often from internal organs.

It should be noted that both before and especially after a diagnosis of arthritis, maintaining contact with a doctor is of great importance, as it allows you to monitor both changes in the course of the disease and the possibility of adjusting treatment and safe use of medication (some drugs have a number of side effects ).

Treatment

Treatment for arthritis depends on the specific type of arthritis. As a rule, an integrated approach is used, including both medicinal treatment methods (NSAID painkillers to influence the immune system) and non-drug treatment methods (physiotherapy, exercise therapy).

For most forms of arthritis, diet plays little or no role in treatment, but omega-3 fatty acids found in fish have been shown to have a beneficial role. At the same time, with some types of arthritis (for example, gout), eating a number of foods high in purines (red meat, shellfish) or foods such as beer can trigger an exacerbation of the disease. With the same disease as celiac disease, taking foods containing gluten (wheat, barley, rye) can lead to increased joint pain.

The prognosis for patients with arthritis depends on the severity of the inflammatory processes, the presence of complications, and the presence of concomitant lesions of internal organs. For example, rheumatoid arthritis often leads to damage to the lungs, kidneys, eyes, etc. Chronic joint inflammation can lead to permanent joint damage and loss of joint function, making joint movement difficult or impossible.

Since most forms of arthritis are genetically determined, there are no real methods of prevention. But it is possible to prevent arthritis associated with injury or arthritis caused by infection (for example, septic arthritis, reactive arthritis, Whipple's disease).

What is a heel spur and how is it treated?

Contrary to existing belief, a heel spur is not a cause, but a consequence of the disease. The human foot is a brilliant, almost perfect creation of nature. The structure of the foot resembles an arch and therefore its small bones in mass and thickness can withstand enormous loads.

Like human feet, arched bridges are constructed, assembled from thin elements and at the same time supporting the colossal mass of trains and cars.

The arched shape of the arch of the foot is supported on the plantar side by a powerful ligament - the plantar aponeurosis. The posterior end of the plantar aponeurosis is attached to the heel bone, and the 6 anterior ones diverging in a bundle are attached to the toes. In this way, it connects the forefoot and back of the foot and keeps the foot from spreading out.

Shifting the center of gravity of the body forward (stooping, excess weight, weakness of the leg muscles), especially in combination with walking, running or jumping, leads to repeated micro-tears of aponeurosis fibers from the heel bone, and healing of damaged fibers occurs by turning the damaged part of the aponeurosis into bone.

This is how the heel spur visible on x-rays appears. Pain when putting weight on the foot occurs mainly due to the appearance of new tears in the aponeurosis, and not due to the pressure of the spur on the tissues of the foot.

Relieving a patient of pain due to a heel spur is a completely doable task. Principles of treatment practiced in our center: 1. Return the center of gravity of the body to physiological limits. Usually this task is quite doable. Here we successfully use 6 methods of manual therapy and 4 methods of therapeutic exercises. 2. Support the arch of the foot from the plantar side and relieve the plantar aponeurosis. For this we use soft orthopedic insoles. The insoles fit into regular shoes. They can be used periodically or continuously. 3. Engage the calf muscles that support the arch of the foot. Often these muscles are not fully activated due to the fact that the nerve roots compressed in the lumbar spine do not fully conduct nerve impulses from the brain to these muscles (pain and/or heaviness in the lower back + heel spur). In this case, gymnastics and manual therapy again come to the rescue. 4. Relieve inflammation and stimulate healing at the site of damage to the plantar aponeurosis. To do this, we use medications with anti-inflammatory and healing effects. For severe and prolonged pain, we inject these drugs directly into the area of ​​injury. The injection is performed with a very thin needle and is provided with local anesthesia.

Arthrosis

Compared to arthritis, this disease is not an inflammatory joint disease. However, damage to the articular cartilage occurs. The cause may be both involutional changes and injuries or wear of cartilage tissue due to excessive loads. Osteoarthritis can manifest as swelling and pain. Also, in some cases, the disease can lead to changes in other organs and systems. It can lead to both a decrease in range of motion and range of motion. Most often, arthrosis affects the hip joints, knee joints, and spinal joints. Osteoarthritis, an infrequently used term to describe degenerative joint diseases. To understand, it is important to first understand the anatomy of the joint. The ends of the bones that form the joint have a smooth surface called the subchondral bone. Behind this is articular cartilage, which is a strong but elastic connective tissue that protects bones, facilitates movement between surfaces, and also acts as a shock absorber. It is this cartilage that forms the articular surface, and not the bones themselves. The joint has synovial membranes that secrete synovial fluid into the joint space, which lubricates the joint surfaces and acts as a shock absorber. The outer joint capsule provides strength to the joint.

Cartilage is elastic connective tissue. Cartilage cells (chondroblasts) produce and secrete a large number of different substances, such as collagen, into the extracellular matrix. It is this matrix that is responsible for the properties of cartilage, namely its strength and flexibility. Sometimes chondroblasts remain inside the matrix and are called chondrocytes. Cartilage is constantly subject to wear and damage. Cartilage cells constantly replenish the cartilage matrix and thus maintain the integrity of the cartilage.

With age, the ability to regenerate any tissue decreases, but does not stop completely. Even in young people, the body's ability to repair tissue is limited by time. If there is constant and excessive wear and tear on the articular cartilage beyond the time required for repair, then the cartilage will weaken. This is the reason why the disease is more common in older people and more often in those who lead an active lifestyle. There are other factors that complicate regenerative processes, such as inflammatory mediators, which affect normal cartilage regeneration when there is even slight inflammation. Likewise, if there are some medical diseases (such as diabetes) that slow down or stop the activity of cartilage cells, the cartilage gradually wears out. When the cartilage weakens, cartilage ruptures occur, and fragments can float in the joint cavity. Bone tissue is also affected by arthrosis and a condition called osteoarthritis occurs.

Symptoms

Symptoms develop very slowly. In the early stages of cartilage erosion, there may be no symptoms. In addition, arthrosis is a degenerative disease, not an inflammatory condition, and therefore may not manifest itself for a long time. Once symptoms begin, the condition gradually worsens, also over a long period of time. The leading symptom of arthrosis is pain.

The pain is usually isolated to the affected joint. The pain usually worsens during and after movement in the affected joint. In milder cases, pain does not appear during movement, but only some time after exercise. There may also be pain on palpation in the joint area. But pain with arthrosis is usually not accompanied by swelling, as is the case with inflammatory phenomena in the joint (for example, with rheumatoid arthritis).

Joint stiffness is another common symptom. This is most noticeable when waking up in the morning and after a long period of rest. Movement can reduce stiffness, but excessive movement will eventually lead to pain. Joint stiffness tends to get worse over time as the disease progresses. Even when joint stiffness decreases, normal range of motion is not restored. Over time, this leads to a significant decrease in motor activity. The joint may also experience a crunching sound when moving, especially as the disease progresses. Normally, the articular cartilage at the ends of bones rubs against each other, but due to the smooth surface and good lubrication by synovial fluid, this friction does not lead to the appearance of sounds. With arthrosis, the cartilage surface is not so smooth and this leads to the appearance of sounds when moving in the joint (crunching, grinding). Firming – large joints, such as the knees, become firmer to the touch. Bone growths that occur with arthrosis (osteophytes) form over time and can be felt under the skin in the form

Diagnostics

As a rule, diagnosis does not present any particular difficulties and is based on a combination of examination data and instrumental data (radiography, CT, MRI, ultrasound of joints). But given that arthritis also causes changes in cartilage tissue, a careful differential diagnosis of degenerative changes in joints with the consequences of a long-term inflammatory process is necessary. Therefore, laboratory diagnostics are also necessary when diagnosing arthrosis.

Treatment

The disease is more often observed in older people and therefore treatment is most often symptomatic. The key to conservative treatment is to reduce symptoms of pain and improve joint functionality. Drug treatment (for example, NSAIDs) should be prescribed taking into account the concomitant somatic pathology present in older people. A good effect is achieved by intra-articular injection of synovial fluid endoprostheses (Fermatron, Ostenil, etc.), which reduces friction in the joint, improves joint function and reduces pain. Intra-articular administration of long-acting steroids (for example, diprospan) is also possible. Recently, prolotherapy has begun to be used, which consists of introducing substances into tissues that improve the regeneration of connective tissue.

Physiotherapy can quite effectively reduce pain and reduce inflammation.

Exercise therapy. Dosed physical activity allows you to maintain the functionality of the joints, but the loads must be selected carefully, since excess loads lead to increased pain.

Surgery. In case of severe arthrosis of large joints (for example, coxarthrosis or gonarthrosis) and significant dysfunction of the joint and persistent pain, endoprosthetics is recommended.

How do we help our patients?

We strive to provide maximum help and support to our patients: 1. We use any treatment methods that can help our patients return to normal life and work. 2. We strive to save time and money for our patients, and at the same time provide high quality treatment. With your consent, you will be prescribed and performed any diagnostic or therapeutic procedure, expensive or cheap, necessary for a successful result. 3. We teach our patients, whenever possible, to independently maintain their health through exercise, proper nutrition and other preventive measures.

We are convinced that it is a mistake to isolate yourself in any one method of medication, manual therapy or physical therapy. Therefore, our doctors use modern medications, physiotherapy, 6 methods of manual therapy and various types of therapeutic exercises, combining them in the interests of their patients. The doctors of our center have been trained by leading world experts - professors Robert Wood, Johannes Vossgreen, Paul Rennie, L.F. Vasilyeva and others; have certificates from European medical associations and participate in international medical congresses.

We pay great attention to motor rehabilitation and restoration of patients' ability to work. Control of posture and movement has a very complex organization and is provided by the central nervous system, therefore, during the treatment process, we not only restore the mobility of the vertebrae and joints, but also, using special techniques, “show” the central nervous system deviations in its work and retrain it.

Is it possible to solve the problem radically? What are the forecasts?

Osteoarthrosis (coxarthrosis, gonarthrosis, osteoarthrosis of other joints)

It is almost always possible to improve the patient’s condition - completely relieve pain or reduce it to an acceptable limit, increase joint mobility. Of course, if the joint is not destroyed and does not require surgical treatment. However, without supportive treatment, arthrosis can progress. To maintain the achieved treatment results for a long time, the following measures will be required:

1. Gymnastics. Usually it is enough to do it 2-3 times a week for 15 minutes. Maintains mobility and proper biomechanics of joints, which protects them from further mechanical damage.
2. Periodic preventive treatment (chondroprotectors, physiotherapy, manual therapy, massage). The frequency of preventive treatment is from 1 time every 2 years to 2-3 times a year, depending on the severity of arthrosis and the age of the patient.
3. Follow the exercise regimen and balanced diet recommended by your doctor.

Inflammatory joint diseases (arthritis, polyarthritis, spondyloarthritis, ankylosing spondylitis, etc.)

It is almost always possible to extinguish the activity of joint inflammation, by greater or lesser measures, within a period of several days to 2-3 months. Pain goes away, mobility of joints and spine is restored. The most important task in these diseases is to avoid relapse of inflammatory activity. It would be honest for us to say that these diseases require long-term treatment, periodic medical monitoring and systematic prevention. And yet, inflammatory joint diseases recede with punctual implementation of the following measures:

1. Regular laboratory (2-4 times a year) and x-ray (1-2 times a year) monitoring of inflammation activity for many years. Allows you to notice in time a tendency towards an increase in the activity of inflammation of the joints or, conversely, a state of improvement when anti-inflammatory treatment can be canceled.
2. Timely anti-inflammatory treatment based on the results of tests and radiography. Almost the only reliable way to maintain your ability to work. In addition to safe modern non-steroidal drugs, we use basic therapy with sulfasalazine.
3. Gymnastics. Usually it is enough to do it 2-3 times a week for 15 minutes. Maintains mobility and proper biomechanics of joints, which protects them from mechanical damage and limited mobility.
4. Periodic preventive treatment (chondroprotectors, physiotherapy, classes with a rehabilitation specialist, massage). The frequency of preventive treatment is 1-2 times a year.
5. Follow the exercise regimen and balanced diet recommended by your doctor.

Periarthritis, bursitis, tendinitis

Treatment takes about 1-3 months. It is always possible to relieve pain and increase joint mobility; pain decreases already in the first week of treatment. In cases of advanced periarthritis (6 months or more without proper treatment), joint mobility is often limited by 10-20%. For 1-2 years, preventive treatment is highly desirable (chondroprotectors, physiotherapy, classes with a rehabilitation specialist, massage). The frequency of preventive treatment is 1-2 times a year.

Heel spur

Treatment takes from 1-2 weeks to 3 months; pain decreases already in the first week of treatment. In the future, it is very important to maintain correct foot biomechanics: wear soft orthopedic insoles, maintain a healthy spine (gymnastics, manual therapy, massage, swimming).

What is useful and what is harmful for joint diseases?

Physical activity mode

Useful: exercises - “taffy”, increasing the elasticity and strength of muscles, measured walking, swimming, training on exercise machines (only with an instructor and without axial load on the joints and spine).

Harmful: running, jumping, tennis, jerking exercises, exercises “through pain”, lifting weights, standing for long periods of time.

Nutrition

Healthy: fresh vegetables, fruits, grain fiber (bran, whole grain).

Harmful: fat of animal origin, flour, smoked, spicy; for gout, limit the consumption of foods containing purines - meat, fish, beans and peas, dairy products, tomatoes.

Are injections effective: injection injections are different

Intra-joint injections today aim not only to reduce inflammation and alleviate the patient’s condition. Modern drugs are many times more effective than chondroprotectors in restoring articular cartilage by renewing synovial fluid. Today intra-articular injections of the following drugs are practiced:

• Glucocorticoids.

They allow you to quickly eliminate pain and relieve inflammation, but do not improve the condition of the cartilage. They can be used only in the acute period, with synovitis, when other methods are contraindicated. The drugs are hormones, so their frequent administration stops the regeneration of cartilage, and with excess weight, hypertension, peptic ulcers and other diseases, side effects often occur.

• Hyaluronic acid.

Such preparations are also called “liquid prostheses”. Once inside the joint, they act as natural synovial fluid, lubricate the surfaces, and stimulate the restoration of cartilage. Products based on hyaluronic acid can cause allergies. Their validity period is only a few months, since immune cells in the human body contribute to the rapid breakdown and elimination of the drug.

• Synthetic synovial fluid substitutes, such as Noltrex

Noltrex is an artificial endoprosthesis that also replaces synovial fluid and restores its normal viscosity. Unlike natural-based drugs, it contains no components that would be broken down by phagocytes. That is why the medicine remains at the injection site for a long time and provides a long-lasting effect - up to one and a half to two years.

Synthetic Noltrex is absolutely safe and hypoallergenic

When should you resort to surgical treatment?

When the joint is unable to support and move (destroyed), we refer our patients for surgical treatment. Conservative treatment in such cases is an unjustified waste of the patient’s money and precious time. The fact is that an incompetent joint “relieves” the load when moving and relying on healthy joints and the spine. This is the path to arthrosis of other joints and herniated intervertebral discs.

Full or partial joint replacement is possible. Joint replacement surgeries have been performed for a long time; surgical and postoperative rehabilitation techniques have been developed and adapted for older people with age-related concomitant diseases.

Diagnostics

Taking into account the multiplicity of causes that provoke the development of arthritis, some forms were especially actively studied by doctors in order to develop an optimal diagnostic algorithm.

Juvenile arthritis (hereinafter referred to as JA) is one of the most disabling rheumatic diseases of childhood.

Clinical blood test

• JA with systemic onset – pronounced leukocytosis (30-50 thousand) with a neutrophilic shift to the left (up to 30% of band leukocytes). ESR increases to 50-80 mm/h, hypochromic anemia, thrombocytosis.
• Juvenile polyarthritis, JRA – hypochromic anemia, neutrophilic leukocytosis (up to 15*109/l), ESR > 40 mm/h.
• Pauciarticular juvenile arthritis - usually laboratory parameters remain normal, but sometimes typical changes characteristic of JA occur.

Immunological and immunogenetic analysis

• JA with systemic onset – the content of CRP, IgM and IgG increases.
• Juvenile polyarthritis - sometimes ANF (antinuclear factor) is positive, RF is negative. Increased levels of CRP, IgM and IgG.
• Pauciarticular juvenile arthritis - 80% of cases are positive for ANF, RF is negative, a high titer of HLA A2 is detected.

X-ray examination of joints

Changes in bone structures are assessed according to Stein-Broker.

1. stage – epiphyseal osteoporosis is observed.
2. stage – osteoporosis is associated with the breakdown of cartilage, narrowing of the joint space, and isolated erosions.
3. stage – DDI of cartilage tissue and bone, osteochondral erosions and subluxations in the joints are formed.
4. stage – similar to III with the inclusion of fibrous or bone ankylosis. Reactive arthritis (hereinafter referred to as ReA)

Patient examination scheme

1. clinical blood test;
2. proteinogram (total protein and protein fractions);
3. CEC titer;
4. immunological markers of RA;
5. immunological markers of SLE – antinuclear factor, antibodies to DNA, LE cells;
6. HLA typing (HLA B-27);
7. diagnosis of intestinal infections and latent genitourinary infections (PCR, RNGA, RIF);
8. X-ray of the affected joints, sacroiliac joints, and spine.

With a long course of ReA, laboratory parameters similar to JA are always found: increased ESR, dysproteinemia, hyperimmunoglobulinemia, high titer of CEC. One of the most important diagnostic signs of ReA is seronegativity for immunological markers of RA and SLE.

Knee structure

The knee is a complex structural element of the musculoskeletal system, which provides flexion and extension movements of the lower limb in this section. The articulation is based on the following bone components:

• Distal part of the femur (internal, external condyle);
• Proximal part of the tibia (also internal, external condyle, tibial plateau);
• The patella is a flat bone, which is surrounded on all sides by connective tissue fibers of the tendon coming from the femoral muscles (easily palpable through the skin on the anterior surface of the joint).

The articular bony surfaces of the femur and tibia are not compatible; for normal sliding, a cartilaginous layer is located between them. The cartilage in the knee takes the form of paired formations - menisci. The menisci have a horseshoe shape (the convexity is directed outward), and they are anatomically distinguished:

• Body (the most massive part);
• Front horns;
• Hind horns.

An important role in the knee is played by the tendon-ligamentous apparatus, which ensures the stability of the articulation in the sagittal and frontal planes. The posterior and anterior cruciate ligaments prevent pathological mobility in the anteroposterior direction. When they rupture, a “drawer” symptom appears, when, with a fixed tibia, the femur can be moved back. To combat the disease, you need to know exactly the symptoms and treatment of knee arthritis.

The medial and lateral collateral ligaments provide immobility of the knee in relation to the outer and inner sides. When the internal or external collateral ligament is torn, a valgus (towards the midline) or varus (away from the midline) deformity of the lower extremity can occur.

Glucosamine

It acts as an amino sugar, which gives a “start” to the biochemical synthesis of glycosylated proteins. It is also a structural component of cartilage tissue. Thanks to glucosamine, the body receives “natural” materials for the development, repair and support of tendons, ligaments and other tissues. With age, the body produces less of this substance, which leads to deterioration of the musculoskeletal system.

Rheumatologists say that taking a glucosamine supplement can reduce pain and the destruction of cartilage tissue. More than 18 studies that served as the basis for the 2005 review clinically supported the substance's effectiveness and beneficial effects on osteoarthritis.

The norm for patients is 700 mg/day. If necessary, the dosage can be increased to 1500 mg.