Coxitis is inflammation of the hip joint. Diagnosis, causes and treatment

The hip joint (HJ) is the largest joint in the musculoskeletal system. It bears the main force load when a person makes physical efforts, moves or lifts weights. When problems associated with the hip joint arise, a person’s quality of life greatly deteriorates, unpleasant pain appears, and in some cases this can cause loss of ability to work. If you seek medical help late and do not start therapeutic actions in a timely manner, the condition may worsen. In this case, the acute hip disease transforms into a chronic pathology. This is fraught with partial or complete loss of motor activity in the damaged anatomical organ.

General information about the disease

Arthritis of the hip joint (coxitis) is a polyetiological disease in the development of which many factors take part. There are several clinical forms of the disease, during which there are both similar and different symptoms. ICD-10 code M00 – M99.

The hip joint (HJ) is formed by the acetabulum of the pelvic bone and the head of the femur. The spherical shape makes it mobile; a ligament fits from the head of the femur to the acetabulum, holding the articular parts in a normal position. Externally, the hip joint is also strengthened by ligaments and a thick layer of soft tissue. This is the leading supporting joint, located deep in the tissues, so it is not so easy to identify a slow inflammatory process with mild symptoms in it.

Arthritis of the hip joint develops at any age, since the disease can have different origins. The most relevant clinical forms are lesions in childhood and adolescence, as well as tuberculous arthritis.

Alternative Treatments

In addition to traditional and well-known Chinese medicine, too many new drugs, means to combat coxarthrosis and alternative tactics have appeared. As experts say, the meaning of new unconventional technologies that the Internet is replete with is sometimes there, but very often it is a waste of money and time

If you have 2nd or 3rd degree coxarthrosis, then this is your joint.

There is no need to expect a cure after using “miracle” medicines; they cannot in any way affect the deformed parts of the joint. In principle, one can rely on a symptomatic result, but only at the initial stage of development of coxarthrosis. In the later stages, when the clinical symptoms are persistent and pronounced, which is explained by the high degree of destruction, their benefit is practically zero.

Plasmolifting - will PRP therapy cure arthrosis?

Its essence is the introduction into the cavity of the hip joint of plasma saturated with platelets, which is isolated from the patient’s own blood. The procedure promises activation of restoration processes in the lesion area and regeneration of hyaline cartilage due to the “switching on” of the self-renewal mechanism in the cartilaginous structures.

In the first two stages, it is possible, but not guaranteed, that the cartilaginous covers, devoid of nerve endings and the circulatory system, will improve to a normal state. But the procedure will not cure advanced pathogenesis! There is only a tiny fraction of the chance that remission will be achieved. It is worth considering that many scientists have already agreed that such autohemotherapy can cause the development of cancerous tumors, since it stimulates the production of stem cells in large quantities, the effect of which on the body has not been fully studied.

On the left is the smooth head of a healthy hip joint, and on the right is grade 3 coxarthrosis. Imagine how difficult it is to rotate in the acetabulum.

Causes

The etiology of arthritis of the hip joint is very different. A special group of diseases consists of lesions of various origins in childhood and adolescence. They are united under the common name “juvenile idiopathic arthritis” (JIA), where the term “idiopittic” means unspecified origin. This includes both truly unspecified arthritis and rheumatoid, psoriatic and other arthritis in children under 16 years of age. Very often at this age the disease occurs with the development of hip arthritis.

Another reason for the development of hip arthritis is a specific infection - tuberculosis, gonorrhea, syphilis, brucellosis. Infectious hip arthritis in adults most often develops with gonorrhea, in children and adolescents - with tuberculosis.

Nonspecific infection (mostly coccal) can also cause arthritis of the hip joint. The inflammatory process usually develops against the background of open injuries during wounds, surgical interventions and intra-articular manipulations. The process often becomes purulent and requires surgical treatment.

In rheumatoid arthritis, coxitis rarely develops, but it is often one of the symptoms of ankylosing spondylitis, an autoimmune disease that affects the spine and large joints.

Quite often, the cause of the development of hip arthritis is chronic intestinal diseases and some other diseases of the internal organs. Reactive hip arthritis is quite rare.

Read more about which joints are affected by reactive arthritis here.

Very often, patients with coxitis have a hereditary burden - close relatives suffering from similar diseases. Triggering factors for the onset of the disease are: past infections, hypothermia, stress, heavy physical activity, bad habits.

Symptoms of hip arthritis

Arthritis of the hip joint can be acute or chronic. The main manifestations of the disease will be different. It is worth knowing these manifestations in order to consult a doctor in a timely manner.

Joint pain and inability to stand on your leg are some of the first symptoms of hip arthritis

First signs

Symptoms of arthritis of the hip joint in the acute course of the disease: high body temperature, chills, malaise, joint pain, inability to stand on the leg due to pain. The symptoms are characteristic, so the diagnosis is usually not in doubt.

The signs of chronic hip arthritis are difficult to notice. It begins unnoticed with slight pain when moving, morning stiffness, which quickly passes. Sometimes pain appears when the leg is in a certain position, for example, when straightening. Special attention should be paid to such vague symptoms.

Obvious symptoms

In acute hip arthritis, this is increasing joint pain and fever that lasts more than 5 days. This usually indicates the development of a suppurative process.

But more often, hip arthritis develops gradually and the obvious symptoms are a slow increase in stiffness and pain. Since the patient begins to spare his leg, he develops muscle atrophy, the diseased leg becomes thinner than the healthy one, and gait and posture are disturbed. It will be easier to bend your leg at the hip than to straighten it.

Dangerous symptoms

If these symptoms appear, you should immediately consult a doctor:

• pain accompanied by high fever after injury, surgery or manipulation of the hip joint;
• the appearance of joint pain 1 to 4 weeks after the infection;
• pain in the hip joint is accompanied by morning stiffness of movement.

Coxitis syndrome

A child’s bones tend to grow very quickly, which is why in some cases the baby may experience unpleasant, sometimes even painful sensations in one or another area of ​​the musculoskeletal system.

Discomfort and pain may also occur in the hip joint area.

In this case, the child feels pain, which intensifies when walking or moving . However, the appearance of painful sensations is not associated with any inflammatory processes.

Why is hip arthritis dangerous?

The hip joint is the largest joint in the body. It is the support of the human body. However, arthritis of the hip joint often goes unnoticed and leads to disability. The stages of the inflammatory process transform into one another and along with them the function of the hip joint is gradually lost. Therefore, during examination and diagnosis, the stage of the disease, possible complications and the tendency to relapse are identified.

Stages of hip arthritis

According to the degree of activity of the inflammatory process and its progression, there are 3 stages of arthritis of the hip joint:

1. Initial
   – inflammation of the synovial membrane, increased content of inflammatory exudate. At this stage, the restriction of movement is insignificant and occurs mainly due to pain and muscle spasm. On ultrasound, you can see an increased volume of exudate in the joint capsule.
2. Expanded
   . The degree of inflammation activity is high, and the first signs of a destructive process in the hip joint also appear. An X-ray can show narrowing of the joint space and bone loss (osteoporosis), and an MRI can show erosive damage to the cartilage tissue covering the articular surface. The pain is constant, movements are limited, mainly when extending the leg and turning it inward (rotation).
3. Advanced
   - formation of immobility (ankylosis). The bone tissue of the joint grows and fusion occurs into a single conglomerate. Often this fusion occurs in an incorrect position, which seriously limits movement. Complete disability occurs.

Possible complications

Arthritis of the hip joint can be complicated by:

• abscesses and fistulas (breakthrough of purulent exudate to the surface of the body) - with purulent and tuberculous hip arthritis;
• complete immobility of the joint;
• dislocations and subluxations of the hip joint;
• deformation of the entire skeleton against the background of pronounced changes in the hip joint.

To prevent this from happening, you should consult a specialist at the first signs of hip arthritis.

What to do if the disease relapses

Healthy and arthritic hip joint

Some clinical forms of this pathology occur in waves, with exacerbations and remissions. Exacerbations are rarely pronounced, but are still accompanied by pain. To eliminate pain before consulting a doctor, you can take the following measures:

• take any sedative (calming) agent - tincture of valerian or motherwort, Corvalol, etc.;
• take a tablet of medication from the group of NSAIDs (non-steroidal anti-inflammatory drugs) - Diclofenac, Nise, Indomethacin, etc.;
• apply ointment, gel or cream with NSAIDs to the skin over the sore spot (Voltaren, Pentalgin);
• call a doctor at home;
• lie down and take the least painful position.

Transient and reactive types

In the reactive course of the disease, symptoms develop rapidly, affecting not only the joint tissue, but also nearby tissues.

It is necessary to take therapeutic measures immediately .

For treatment, the child is prescribed broad- and narrow-spectrum antibiotics, anti-inflammatory and painkillers. Duration of treatment is about 2 months.

It is believed that the main cause of the transient form of pathology is trauma . However, this has not yet been precisely established. Treatment is carried out in a hospital setting so that the doctor has the opportunity to conduct a full examination of the patient’s body.

During treatment, special attention is paid to such therapeutic methods as sanatorium treatment and rehabilitation measures aimed at restoring the functionality of the joint.

The most common clinical forms of coxitis

Depending on the cause of occurrence, hip arthritis can have a different course. Symptoms of the disease may also vary slightly.

Any form of arthritis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

Acute purulent coxitis

The hip joint is protected from external influences by a thick layer of soft tissue, so infection enters it mainly during injuries and surgical procedures. Much less often, it enters with blood from other infectious and inflammatory foci, for example, with sinusitis, otitis, tonsillitis, etc.

A sign of purulent arthritis is a sharp rise in body temperature, chills, malaise combined with severe joint pain. Such a patient requires emergency surgical care. If it is not provided, the purulent process can spread to the surrounding soft tissues with the formation of abscesses and phlegmons or with blood flow throughout the body (sepsis).

Juvenile idiopathic arthritis (JIA)

Juvenile idiopathic arthritis occurs mainly in children under 16 years of age

This is a large group of diseases that includes all hip arthritis in children and adolescents under the age of 16. It is not always possible to determine the origin (etiology) of this disease. The disease is dangerous because it can quickly lead to complete destruction of the hip joint and early disability.

The disease arises and proceeds unnoticed with a gradual increase in pain and loss of normal function. Quite quickly, the affected leg loses volume and begins to look thinner in appearance. Bone growth also lags behind, one limb becomes shorter than the other. It is difficult for the child to straighten the leg and especially turn the knee inward. Identifying JIA at an early stage and carrying out adequate therapy prescribed by a rheumatologist allows you to avoid disability.

Tuberculous coxitis

Tuberculous arthritis of the hip joint is a severe progressive disease. The source of infection first forms in the bone tissue and only after some time breaks into the joint cavity. Tuberculous arthritis of the hip joint occurs in three stages:

• Prearthritic
  - the tuberculous focus is located inside the joint-forming bones, most often in the area of ​​the acetabulum of the pelvic bone. It proceeds unnoticed in the form of minor pain and periodically developing lameness. At this stage, coxitis is rarely detected.
• Arthritic
  associated with the breakthrough of a tuberculosis focus into the joint cavity:
  beginning - the pain intensifies, the tissues swell, the skin turns red; impaired movement due to muscle spasms; low-grade fever, weakness, lack of appetite;
• height – inflammation progresses, cartilage is destroyed; the pain is very strong, inflammation increases, gait is disturbed, it is difficult to stand on the leg, it moves with difficulty; intoxication increases;
• subsidence of the process - inflammation gradually subsides, connective tissue grows in the articular cavity.
• Postarthritis
  - inflammation goes away, but its consequences remain in the form of shortening of the limb, muscle atrophy and incorrect placement of the limb, as a result of which the configuration of the whole body can change. Ankylosis is most often connective tissue, but bone ankylosis also occurs. Disability.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

Coxitis in chronic inflammatory bowel lesions

Arthritis of the hip joint often begins against the background of chronic ulcerative colitis and Crohn's disease (a pathological process affecting all layers of the intestinal wall). The disease begins suddenly, accompanied by severe inflammation and joint pain. It lasts for several months, then the process subsides without causing any changes in the joint. Relapses of the disease are also possible.

Treatment according to Bubnovsky

Nationally recognized doctor Sergei Bubnovsky is known as the creator of a unique technique belonging to kinesitherapy. Its main task is to restore lost ability to work and relieve pain in sore joints. Without medications or surgeries, the honored doctor helps you expand your range of physical activity and say goodbye to unbearable pain. Recovery occurs through a specially designed set of physical exercises.

Mr. Bubnovsky.

As the doctor notes, the bones cannot hurt, it is the muscles that hurt, which, when sick, stop working normally, weaken and atrophy. It is impossible not to emphasize that the classes successfully train, increase endurance and increase the range of movements not only in the problematic segment of the musculoskeletal system, but also in other parts of the musculoskeletal system. Moreover, they help strengthen the body as a whole.

BUT, if it is not the bones that hurt, but the muscles that atrophy during the disease, then the question arises - why do they atrophy if nothing hurts? And that’s why they atrophy because the pain is so strong that the person begins to limp and unload the limb. And when there is no load, the leg “dries out.” That's all the explanation. He got sick, he limped, his leg atrophied, and then the other one got sick. If gymnastics helped, then more than a million operations a year would not be performed in the world.

The expected therapeutic effect is as follows:

• restoration of mobility;
• improvement of blood circulation in the periarticular tissues;
• saturation of muscle, cartilage and bone structures with nutrients;
• elimination of pain syndrome.

But there is also a positive side to the work of a respected doctor, if he treats it as a way of preparing for surgery in the form of increasing the muscle strength of the legs.

The popular treatment according to the Bubnovsky method, unlike the Evdokimenko method, does not involve the use of drugs from the pharmacy. According to the country's leading rehabilitation specialist, it is enough to apply cold compresses to the sore area and systematically perform the exercises he suggests. By regularly training at home, the muscle complex will return to normal, and the pain will completely subside, while the quality of life will significantly increase.

Diagnostics

To identify symptoms of hip arthritis and its treatment, special questionnaires have been developed for patients, clinical tests for specialists, and various laboratory and instrumental studies. It is not easy to detect this disease at an early stage, but it is most treatable when it starts. Algorithm for examining a patient with suspected coxitis:

• Laboratory methods:
  general, biochemical, immunological blood tests
  - the degree of activity of the inflammatory process and the presence of autoimmune processes are revealed;
• examination of intra-articular fluid under a microscope and by inoculating on nutrient media
  - the nature of the inflammatory process, infection and its sensitivity to antibiotics are revealed.
• Instrumental methods:
  Ultrasound
  - you can detect a large volume of exudate and an increase in the synovium;
• radiography of the hip joint
  - bone changes in the joint;
• MRI or CT
  – changes in articular and periarticular tissues;
• arthroscopy
  – examination of the inner surface of the joint cavity; if necessary, exudate or a piece of tissue is taken for examination;
• aspiration biopsy of the joint
  - sampling of exudate for examination using a puncture method (if arthroscopy is not possible).

A full examination can only be carried out in a clinic.

Treatment of hip arthritis

Treatment measures can be conservative or surgical. The main goal of treating hip arthritis is to relieve pain and suppress the progression of the disease. The patient is prescribed individually selected complex treatment.

Drug therapy

Treatment of hip arthritis begins with drug therapy. All medications are selected individually for each patient:

Crunching in joints - when to worry

Intra-articular injections of hyaluronic acid

Non-drug methods

These treatments for hip arthritis include:

• Immobilization is carried out mainly for tuberculous coxitis and ankylosing spondylitis at the stage of acute inflammatory process. A large coxite plaster cast is applied, covering the affected leg, pelvic girdle and torso to the nipples. When the process subsides, the bandage is replaced with crutches and the load on the leg is gradually increased by incorporating therapeutic exercises.
• Massage – performed after acute inflammation subsides, helps improve blood circulation, activate metabolism and restore joint function.
• Therapeutic exercise (physical therapy) - for some types of hip arthritis, especially in childhood and adolescence, exercise therapy is prescribed as early as possible - this prevents the development of ankylosis. The load should be constant and gradually increasing. Monitoring by a doctor is required.
• Physiotherapeutic procedures - different types of procedures can be prescribed at any stage. At the acute stage, this is electrophoresis with anti-inflammatory and painkillers; when the process subsides, UHF, paraffin, laser and magnetic therapy.
• Reflexology is an effect on points on the human body reflexively associated with the hip joint.
• Sanatorium-resort treatment is carried out in a state of remission, no earlier than six months after the last exacerbation. Resorts shown:
  with sodium chloride waters and mud - Anapa, Pyatigorsk, Evpatoria;
• with hydrogen sulfide waters - Sochi-Matsesta;
• with radon waters - Belokurikha, Tskhaltubo.

Traditional methods of treatment

Traditional medicine can be used as an auxiliary therapy for hip arthritis only as directed and under the supervision of a physician. For swelling and joint pain, the following folk remedies are suitable:

• decoction of bay tree leaves; 20 g of crushed raw materials pour 500 ml of hot water, boil over low heat for 5 minutes, cool, strain and take 150 ml three times a day before meals; has anti-inflammatory and analgesic effects; course – 3 days with a week break, then repeat everything;
• ointment for joint pain; mix the yolk of a chicken egg, 20 ml each of apple cider vinegar and turpentine; store in the refrigerator and use as a pain reliever, applying to the skin over the sore spot at night.

Read more about the most effective methods of treating arthritis in this article.

Surgical methods of treatment

In severe cases of arthritis of the hip joint, endoprosthetics is performed

Surgical assistance is required for purulent hip arthritis. Punctures are performed, pus is removed from the joint cavity, then it is washed with an aseptic solution. When abscesses and phlegmons appear, they are opened and the pus is removed. In case of significant destruction of the hip joint, especially in cases of trauma, resection of the most affected bone areas is performed.

In case of complete loss of joint function, the operation of choice is endoprosthetics - replacement of the destroyed joint with an artificial implant.

Reactive arthritis in children

About the article

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Regular issues of "RMZh" No. 5 dated March 18, 2006 p. 381

Category: General articles

Authors: Tvorogova T.M. , Korovina N.A. , Gavryushova L.P.

For quotation:

Tvorogova T.M., Korovina N.A., Gavryushova L.P. Reactive arthritis in children. RMJ. 2006;5:381.

Inflammatory joint diseases are one of the pressing problems of modern pediatric rheumatology. Among them, for many years, the leading role belonged to juvenile rheumatoid arthritis (JRA). However, in recent years there has been a tendency towards an increase in reactive arthritis (ReA) in children. The frequency of ReA in the structure of rheumatic diseases in various countries of the world ranges from 8 to 41% [1].

In Russia, among rheumatic diseases, ReA in children under 14 years of age is 56%, in adolescents 37% [2]. The data presented indicate the importance of ReA in childhood and dictate the need for a differentiated diagnostic and therapeutic approach to various variants of this joint pathology in children. Reactive arthritis is an aseptic (non-purulent) joint disease that develops in response to an extra-articular infection in which the causative agent cannot be isolated from the joint. The term “reactive arthritis” was proposed by Finnish researchers Ahvonen et al. in 1969, who first described arthritis that developed after yersinia infection. Subsequently, “reactive arthritis” completely replaced the one proposed by A.I. Nesterov in 1959 coined the term “infectious-allergic arthritis”. Previously, it was believed that ReA was “sterile”, since neither the living causative agent nor its antigens could be isolated from the joint cavity. Subsequently, as methodological techniques improved, individual microbial antigens and even microorganisms themselves capable of reproduction were isolated from joint tissues and synovial fluid [2]. During our long-term observations of children with ReA, we were repeatedly able to isolate chlamydial DNA from the synovial fluid, and in one case, E. coli. In this regard, there are indications in the literature that the term “reactive arthritis” should be used with caution [2,3,4]. However, it is still widespread both in the literature and in international classifications of rheumatic diseases. In the working classification of rheumatic diseases of 1985, three groups of ReA were distinguished: • post-enterocolitic • urogenital • after nasopharyngeal infection At the IV International Workshop on Reactive Arthritis (Berlin, 1999), an agreement was reached on the definition of reactive arthritis. It is recommended to call inflammatory (non-purulent) joint diseases that develop shortly (usually no later than 4 weeks) after an acute intestinal or urogenital infection as reactive arthritis. The etiological factors of postenterocolitic ReA should be considered Yersinia, Salmonella, Shigella, Helicobacter; urogenic - chlamydia, ureaplasma. Other forms of arthritis - post-streptococcal, post-viral, Lyme arthritis, according to the conclusion of the experts of the International Meeting, should be combined with the term “arthritis associated with infection”, and this group should not include septic, purulent arthritis. However, a number of issues require further study. In particular, the list of microbial agents that initiate ReA remains incomplete. Possibly, mycoplasma, clostridia and other infectious agents have a trigger effect [4]. Based on the above, it follows that the infectious agent is the leading one in the development of ReA. The immune response is manifested by the production of antibodies circulating in the blood and synovial fluid. A long-lasting elevated level of antibodies indicates the presence of an infectious agent, on the one hand, and the persistence of microbial antigens in tissues and synovial fluid, on the other. In addition, numerous literature data indicate the importance of genetic predisposition [2,4,5,6,7]. The authors note a close relationship between ReA and one of the antigens of the major histocompatibility complex – HLA-B27. Moreover, the association of HLA-B27 with urogenic arthritis is observed in 80-90% of cases, with postenterocolitic arthritis - in 56%. At the same time, the role of HLA-B27 in the development of ReA has not been fully studied. There are only a few hypotheses: – HLA-B27, being a receptor for microbes, promotes their spread in the body, including in the joint cavity; – HLA-B27, participating in cellular immune reactions, is able to present microbial cells to cytotoxic T lymphocytes. In this case, an inadequate immune response and persistence of the microbe are possible. – in recent years there have been many supporters of the theory of microbial mimicry, when there are similar proteins (antigenic determinants) in a microbe and HLA-B27. In this case, the immune response is directed both against the infectious agent and the tissue’s own cells, having a damaging effect on them. Cross-reacting antibodies weaken the immune response against the infectious agent, which prevents complete elimination and contributes to its persistence [1,8]. A common clinical feature of ReA is a previous infection. By the time arthritis develops, clinical signs of infection usually subside. A mild, asymptomatic course of urogenital infections is possible. In some cases, arthritis develops simultaneously with diarrhea, urinary tract infection, and eye damage (conjunctivitis, iritis, iridocyclitis). At the onset of articular syndrome, low-grade fever, weakness, and loss of appetite are often noted. Clinical features of ReA include: • acute nature of the articular syndrome • asymmetry of the articular syndrome • oligo- or monoarthritis of medium and large joints of the lower extremities • the possibility of a torpid course of the articular syndrome Diagnostic criteria adopted at the International Meeting of Rheumatologists (1995) help in making a diagnosis ( Table 1). Postenterocolitic ReA is characterized by an acute onset with a typical localization - in the joints of the lower extremities. However, sometimes the wrist joints may be involved in the process. In this case, general reactions are expressed in the form of fever (380-390), leukocytosis, acceleration of ESR to 40-45 mm/hour. For this variant of ReA, a torpid course of the articular syndrome is typical, averaging 3-5 months. In some cases, transformation into JRA is possible. Urogenic ReA is characterized by a torpid course combined with high laboratory activity. One of the variants of ReA is Reiter's syndrome (according to ICD-10 M02.3 - Reiter's disease). The disease develops in temporary connection with intestinal or urogenital infections. Currently, Reiter's syndrome is considered to be a consequence of chlamydial infection. At the same time, Chlamydia pneumoniae is detected in 90% of children, and Chlamydia trachomatis is detected in only 10% [10]. The clinical picture is characterized by the presence of urethro-oculo-synovial syndrome. In children, damage to the urogenital tract is manifested by leukocyturia, dysuria, symptoms of vulvitis or vulvovaginitis in girls, balanitis or balanoposthitis in boys. Under our observation, among the patients with Reiter's syndrome, there were three boys aged 12-14 years, in whom balanitis occurred with bright confluent erosions with scalloped edges. Eye damage in the form of conjunctivitis is short-lived and ephemeral, but it may recur. Literary data indicate the possibility of developing iridocyclitis and uveitis [3,5,11]. Articular syndrome in the form of acute asymmetric arthritis occurs with the accumulation of a large amount of synovial fluid (up to 50-70 ml in the knee joints), involving large and small joints of the lower extremities. Damage to the first toe with the formation of a “sausage-shaped” deformity is quite common. The “staircase symptom” is characteristic, in which there is a gradual involvement of the joints from bottom to top. Periarticular lesions in the form of bursitis, tendovaginitis, enthesitis and enthesopathies are typical. The classic triad of symptoms may be joined by skin lesions in the form of keratoderma of the palms and feet, psoriasis-like plaques on the skin of the face, trunk, and limbs. With a prolonged course, onychodystrophy develops (change in nail color, fragility, roughness, tuberosity), which is often regarded as a mycotic lesion. The duration of Reiter's syndrome in an acute course is 2-3 months; in a prolonged course, transformation into JRA is possible. Reactive arthritis is classified as a seronegative spondyloarthropathy. This is explained by the identical clinical symptoms of ReA and the onset of spondyloarthropathy. The latter manifest in childhood and adolescence with reactive asymmetric oligoarthritis of the lower extremities, which is combined with enthesitis. Damage to the hip joints deserves special attention. In 1/3 of children and adolescents, arthritis of the hip joints is the first symptom of spondyloarthropathy. At the onset, other joints are affected only in 10-15% of patients [4,12,15]. Damage to the sacroiliac joints significantly increases the likelihood of spondyloarthropathies. Specific clinical signs that have occurred in the past or are detected at the time of observation allow one to suspect the onset of spondyloarthropathy in children with clinical signs of ReA. These include: • pain in the gluteal muscles (constant or intermittent); • pain in the sacrum or morning stiffness in the lumbar region; • pain in the heel, sole or other enthesopathy; • the presence of a “sausage-shaped” finger on a hand or foot; • diarrhea, dysuria a month before the onset of arthritis. Timely specific nosological diagnosis of spondyloarthropathy in children is possible only through dynamic observation, laboratory and radiation diagnostics. Examination of children with ReA includes: 1. Family history with an emphasis on diseases of the musculoskeletal system, metabolic disorders. 2. Epidemiological history. 3. Clinical blood test. 4. General urine analysis. 5. Biochemical blood test (CRP, protein fractions, fibrinogen, uric acid, kidney and liver function indicators). 6. To identify the infectious agent: – microbiological examination of feces, synovial fluid, scrapings from the conjunctiva, external genitalia; – immunological methods to detect antibodies to antigens of enterobacteria and intracellular pathogens in synovial fluid and blood serum; – study in urine, in the epithelium of the urogenital tract, synovial fluid of DNA and RNA of chlamydia, ureaplasma using polymerase chain reaction; – seeding of synovial fluid, genital secretions onto cellular structures (the cultural method is the “gold standard” for clarifying the trigger role of chlamydia in joint pathology). 7. X-ray examination of joints, spine, sacroiliac joints (according to indications). 8. Electrocardiography (according to indications). When carrying out a differential diagnosis, the following are excluded: – acute rheumatic fever; – infectious arthritis (septic); – other diseases from the category of spondyloarthropathy (juvenile spondyloarthritis, onset of ankylosing spondylitis, etc.); – seronegative JRA; – metabolic arthritis; – synovitis against the background of joint hypermobility syndrome; – other inflammatory diseases of the joints. The goal of treatment for ReA in children is to eliminate the causative factor - the infectious agent, as well as cure or achieve stable clinical and laboratory remission of the articular syndrome. All children with ReA receive drug therapy taking into account age, individual effectiveness, the appropriate trigger agent, as well as the severity and nature of the articular syndrome. 1. Antibacterial therapy is prescribed when an infection is detected. This applies primarily to chlamydial, myco- and uroplasma infections, as well as Helicobacter pylori. The drugs of choice are new generation macrolides that accumulate intracellularly in inflamed tissues (Table 2). It should be noted that with increasing duration of one course of antibacterial therapy, the effectiveness of treatment does not increase [10]. If articular syndrome persists, it is possible to prescribe a second course of antibiotics using one of the above drugs. In this case, the interval between the first and second courses should be at least 5-7 days. It must be remembered that penicillin drugs are not indicated for chlamydial infection due to their transformation into L-forms, which are insensitive to antibiotics. In addition, immunocompetent cells (phagocytes, T-cells) practically do not react to L-forms, which contributes to the persistence of the pathogen and the chronicity of the articular syndrome. According to our observations, a combination of antibacterial therapy with one of the immunocorrective drugs - lycopid, which stimulates the functional activity of phagocytes and increases the synthesis of specific antibodies, is justified. For children aged 1.5 to 15 years, licopid was prescribed at a dose of 1 mg/day. The duration of the course was no more than 15 days. The start of therapy with licopid preceded the prescription of a macrolide (5 days - licopid, then 10 days - macrolide + licopid). In the case of chronic articular syndrome, immunocorrective therapy requires great caution, since the development of an immunoaggressive stage of the inflammatory process cannot be excluded. In postenterocolitic ReA, antibacterial therapy is usually ineffective [16]. 2. Non-steroidal anti-inflammatory drugs (NSAIDs). This class of pharmacological agents is a necessary component of the treatment of ReA. NSAIDs quickly reduce pain and reduce the intensity of the inflammatory process by suppressing the activity of the enzyme cyclooxygenase (COX), which is involved in the synthesis of prostaglandins. In the last decade, the understanding of the points of application of NSAIDs in the regulation of prostaglandin synthesis has expanded significantly. Two isoforms of COX have been discovered: COX-1 and COX-2, which play different roles in this regulation. It is COX-2 that takes part in the synthesis of pro-inflammatory prostaglandins, which enhance the processes of inflammation and cell proliferation. The activity of COX-1 determines the production of prostaglandins, which are responsible for normal physiological cellular reactions not associated with inflammation [13]. NSAIDs, acting on both isoforms of COX, reduce the activity of the inflammatory process and at the same time can lead to undesirable reactions from various organs and systems. Currently, NSAIDs that can selectively inhibit COX-2 (meloxicam, nimesulide) have been developed and are widely used. The main NSAIDs used in the treatment of ReA in children are shown in Table 3. From the data in this table it follows that NSAID therapy has age restrictions. The drugs of choice for children under 5 years of age are paracetamol and ibuprofen. However, the minimum effective therapeutic dose of ibuprofen is lower than paracetamol, which significantly reduces the risk of possible adverse reactions. Ibuprofen blocks COX both in the central nervous system and at the site of inflammation, which causes a distinct anti-inflammatory effect. The analgesic effect of the drug is also double (central and peripheral), and therefore it is more pronounced than that of paracetamol [14]. The drug does not form toxic metabolites, is well tolerated and can even be prescribed to infants. 3. Local therapy for ReA includes intra-articular administration of glucocorticosteroids (GC) and local use of NSAIDs in the form of ointments, creams, and gels. Intra-articular administration of HA has a distinct anti-inflammatory and analgesic effect. In combination with the above therapy, as a rule, 1-3 injections are sufficient to relieve articular syndrome. The use of ointment forms of NSAIDs, especially in children of the first years of life, is safer and allows you to reduce the dose of orally taken drugs. Gels are preferred, since the alcohol solution present in their composition contributes to the fastest transcutaneous effect. In this case, NSAIDs suppress the production of inflammatory mediators directly in the tissues surrounding the joint. 4. If ReA is torpid or the process is chronic, sulfasalazine is indicated in a daily dose of 20-30 mg/kg, but not more than 1.5-2 g per day. The initial dose is 125-250 mg per day, the dose is increased to the calculated dose gradually, once every 5-7 days. The clinical effect occurs after 5-6 weeks of treatment. The duration of the course is individual, but not less than 2 months. Thus, when carrying out complex therapy for ReA in children, one should take into account the biological characteristics of the infectious agent, evaluate the nature of its interaction with the macroorganism, and synchronize treatment with the activity and nature of the course, severity, and dynamics of the inflammatory process in the joints. References 1. Cassidy. JT, Petty RE Textbook of Pediatric Rheumatology. Noronto, W. B. Saunders Company 2001; 819. 2. Alekseeva E.I., Zholobova E.S. Reactive arthritis in children. Questions of modern pediatrics, 2003, vol. 2, No. 1, p. 51-56. 3. Guide to internal medicine. Rheumatic diseases, ed. V.A. Naso-nova, N.V. Bunchuk, M. 1997, p. 305-335. 4. Agababova E. R. Some unclear and unresolved issues of seronegative spondyloarthropathies. Scientific and practical rheumatology, 2001, No. 4, p. 10-17. 5. Agababova E. R. Reactive arthritis and Reiter’s syndrome. Rheumatology, 1997, chapter 11, p. 324-331. 6. Alieva D.M., Akbarov S.V. Clinical variants of reactive arthritis in children. Scientific and practical rheumatology, 2001, No. 4, p. 74-79. 7. Zholobova E.S., Chistyakova E.G., Isaeva K.S. Hereditary and infectious factors in the development of juvenile chronic arthritis. Abstracts of the All-Russian Congress “Pediatric Cardiology 2002”, M. 2002; 227. 8. Ikeda V., Yu DT The pathogenesis of HLA B27 arthritis: the role of HLA B27 in bacterial defense. Am J Ved Sci 1998; 316:257. 9. Kingsly G., Sieper J. Third International Workshop on Reactive Arthritis: an overview. Ann Rheum Dis 1996; 55: 564-570. 10. Chistyakova E.G. Chronic joint diseases in children (juvenile rheumatoid arthritis, Reiter's disease, juvenile chronic arthritis) associated with chlamydial infection. features of the clinic and course. Author's abstract. diss. ... Ph.D. Med. Sciences, M. 1998. 11. Molochkov V.A. Reuters Consilium Medicum 2004, v. 6, No. 3, p. 200-202. 12. Drezenko A.A. The possibilities of local therapy for spondylitis. RMG, 2005, t. 13, No. 24, p. 1632-1636. 13. Nasonov E.L. Non -steroidal anti -inflammatory prepes. RMG, 1999, No. 8, p. 392-396. 14. Autret E., et al. Evaluation of Ibuprofen Versus Aspirin and Paracetamol on Efficacy and Comfort in Children with Father. EUR J Clin 1997; 51: 367-71. 15. Agababova E. R. Modern areas of research with spondyl arthropes. Act speech. The first All -Russian Congress of Rheumatologists. Saratov, 2003. 16. Rheumatology. Clinical recommendations, ed. E.L. Nasonova, M., 2005, p. 86-90.

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Approach to treating the disease at the Paramita clinic, Moscow

Patients with suspected hip arthritis are always carefully examined by specialists at our clinic using modern laboratory and instrumental methods, including MRI. During the examination, the main and concomitant diseases are identified and only after that individually selected treatment is prescribed.

Our doctors are trained in all existing methods of treating this disease. The Western techniques they use allow them to act directly on the source of inflammation, while the Eastern ones – on the body as a whole, restoring the proper functioning of all organs and systems, including the hip joint.

This approach to treatment allows you to quickly eliminate the pain syndrome and stimulate the patient’s desire for recovery. Then the main course of treatment is carried out, aimed at suppressing inflammation and progression of the disease. The final stage is the restoration of lost joint function. Treatment allows patients to forget about pain and lead a normal life. More information about treatment methods for hip arthritis can be found on our website.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthritis

Treatment: traditional and orthopedics

To suppress the pathogen, the child takes antibiotics.
Drug therapy not only eliminates the pathogen, but also prevents the progression of the disease. For full treatment it is necessary to go through 2 stages. The first is taking broad-spectrum antibiotics, hormonal therapy, limb fixation and vitamin therapy. The second stage is physical rehabilitation after illness. The set of procedures includes electrophoresis, laser and UHF points. It is also necessary to perform exercises to strengthen muscles, massage, use therapeutic exercises and use special devices (orthoses, bandages).

General clinical recommendations

To avoid relapses of hip arthritis and forget about pain, patients are recommended to:

• lead an active healthy lifestyle;
• Healthy food;
• get rid of excess weight and bad habits - smoking and alcohol abuse;
• do exercise therapy every day; Swimming is especially beneficial;
• avoid heavy physical activity, hypothermia and stress;
• carefully treat all acute and chronic diseases;
• take courses of anti-relapse therapy several times a year as prescribed by a doctor.

How not to get sick

The hip joints should be especially taken care of by persons with a family history and who have relatives with a similar pathology. To do this, you need to avoid any factors that provoke the disease: infections, hypothermia, stress. It is also necessary to move more, engage in feasible sports to strengthen the muscles of the back and lower extremities, and also maintain normal body weight.

What to eat

Meals should be varied and regular. It is worth limiting: spicy seasonings, fried, fatty, smoked foods, alcohol, sweets - all this can provoke inflammatory processes in the joints.

Frequently asked questions about the disease

Which doctor should I contact?

It’s better to start with a therapist, he will advise who to contact. A surgeon treats purulent processes, a rheumatologist - everything else, except for tuberculosis, you need to contact a phthisiatrician.

Can juvenile arthritis be cured without surgery?

With adequate treatment, you can get rid of relapses of the disease and its progression. Modern methods of conservative treatment allow patients to forget about exacerbations forever during maintenance treatment. Surgery is a last resort, but sometimes it is still necessary.

Literature:

1. Yablokova E. A. Clinical features and impaired mineralization of bone tissue in children with inflammatory bowel diseases. Diss. Ph.D. honey. Sci. M., 2006. 185.
2. Dzyuba G.G., Reznik L.B., Erofeev S.A., Stasenko I.V. Modern methods of treating surgical infection of the hip joint // Modern problems of science and education. – 2021. – No. 5.
3. D'Incà R., Podswiadek M., Ferronato A., Punzi L., Salvagnini M., Sturniolo GC Articular manifestation in inflammatory bowel disease patients. A prospective study // Dig Liver Dis. 2009, Mar 9.
4. Rodriguez VE, Costas PJ, Vazquez M., Alvarez G., Perez-Kraft G., Climent C., Nazario CM Prevalence of spondyloarthropathy in Puerto Rican patients with inflammatory bowel disease/Ethn Dis. 2008, Spring; 18(2 Suppl 2):S2–225–9.

Themes

Arthritis, Joints, Pain, Treatment without surgery Date of publication: 12/09/2020 Date of update: 03/12/2021

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