What is polyarthritis: causes, diagnosis, treatment

What is polyarthritis

Polyarthritis of the joints can act as an independent disease (infectious nonspecific rheumatoid polyarthritis), as well as be a consequence of other pathologies (gout, rheumatism, etc.). Inflammation often occurs simultaneously in different parts of the body. The disease disrupts the function of the tendon-ligamentous apparatus, destroys cartilage tissue and underlying bone.

Nerve endings and blood vessels are involved in the process, which leads to the development of pain, swelling, which disrupts microcirculation, causing trophism and gas exchange of joint tissues to suffer. The result of pathological processes with long-term polyarthritis is deformation of the joint structures.

Classification of polyarthritis

For the typology of the disease, it is customary to use several criteria. Depending on the duration of the flow, there are:

1. Acute polyarthritis. It is characterized by a rapid onset, rapid progression, and a vivid clinical picture.
2. Chronic polyarthritis. Occurs due to lack of treatment (or inadequate therapy) of the acute form. It is characterized by a recurrent nature, an erased clinical picture, and a sluggish course.

Another classification is based on the location of inflammation. The following types of pathology are distinguished:

• polyarthritis of the hands;
• wrists;
• brachial;
• vertebrate;
• temporomandibular;
• hip;
• knee;
• ankle;
• toes.

Depending on the etiological sign:

Rheumatoid arthritis: symptoms, diagnosis and treatment

Joint pain, feeling of “stiffness” in the morning. What is this? Are you overtired at work? “Re-exercise” at the gym? Got a cold?

The manifestations listed above may indicate an illness, the cause of which remains not fully understood to this day.

Rheumatoid arthritis. We are talking about it with Candidate of Medical Sciences, rheumatologist at the Expert Voronezh Clinic, Inna Alekseevna Strelnikova.

— Inna Alekseevna, what is rheumatoid arthritis and for what reasons does this disease occur?

This is an immunoinflammatory rheumatic disease of unknown etiology. It is characterized by chronic erosive arthritis and systemic damage to internal organs.

The causes of rheumatoid arthritis are currently completely unknown to medicine. According to world statistics, it affects on average about 1% of the population.

— Is rheumatoid arthritis coded in ICD-10?

Yes. It is reflected under code M05 (seropositive rheumatoid arthritis) and M06 (other rheumatoid arthritis).

— What happens to the body with rheumatoid arthritis?

The development of this disease is based on inflammation of an immune nature, mainly affecting joint tissue.

In the initial stages, the patient complains of pain and swelling in the joints, and morning stiffness for more than 30 minutes. The small joints of the hands and feet are most often affected.

This pathology is also characterized by extra-articular manifestations. These include vasculitis of the skin and other organs, neuropathies, pleurisy, Sjogren's syndrome, rheumatoid nodules.

With rheumatoid arthritis, so-called constitutional signs are sometimes observed: general weakness, loss of body weight, increased body temperature. But these signs may not exist.

— Does this disease creep up unnoticed or do rheumatoid arthritis have warning signs?

There are not always warning signs. The disease can begin immediately with classic manifestations. However, nonspecific complaints of joint pain can often be noted throughout the year. The pain changes its localization (i.e., now in one or another joint), or is noted simultaneously in several, symmetrically or asymmetrically. There may also be swelling of the joints (optional). At this stage, a diagnosis of “undifferentiated arthritis” is made.

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As an independent manifestation, without articular signs, the erythrocyte sedimentation rate (ESR) may increase and the content of C-reactive protein may increase (laboratory signs of inflammation). The constitutional manifestations that I spoke about may also be noted here.

— Which joints are most often affected by rheumatoid arthritis?

Certain small joints of the hands and feet (metacarpophalangeal and metatarsophalangeal, proximal interphalangeal joints of the hands and feet). Large joints are much less frequently affected: hip, knee, wrist, shoulder.

— What is included in the diagnostic standard for rheumatoid arthritis?

Complaints and a detailed medical history are collected, a thorough examination and an objective examination of the patient are carried out.

Laboratory tests are required. These include a complete blood count, a complete urinalysis, a blood test for C-reactive protein, rheumatoid factor, and antibodies to cyclic citrullinated peptide (ACCP).

X-rays of the joints of the hands and/or feet, as well as any other joints that have obvious manifestations, are also performed.

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According to indications, radiography or computed tomography of the chest organs, electrocardiography and other studies may be performed.

— What is the difference between rheumatism, rheumatoid arthritis and polyarthritis?

The concept of “rheumatism” is no longer used in modern medicine. Instead, the designations “acute rheumatic fever” and “rheumatic heart disease” have been adopted.

Acute rheumatic fever occurs more often in young people, often females (from 7 to 25 years). It begins with a sore throat (acute period). After 2-3 weeks, pain in the joints, pain in the heart, and possibly annular erythema and chorea appear.

Acute rheumatic fever can occur without or with the formation of heart disease. In the latter case they talk about rheumatic heart disease. If the defect does not form, rheumatic fever usually goes away; recurrences are extremely rare. Today this pathology is less common.

As for polyarthritis, just by the name we can conclude that we are talking about inflammatory damage to several joints. Polyarthritis can be rheumatoid, psoriatic, etc. Those. This is not an independent diagnosis, but rather a syndrome.

Who gets rheumatoid arthritis more often: men or women?

Among women. The onset of the disease is most often from 40 to 55 years (less often at younger and later ages). The ratio to men in frequency is 3:1.

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— Can this diagnosis occur in children?

Yes. It is formulated as "juvenile rheumatoid arthritis."

— Who is at risk for developing rheumatoid arthritis?

These are individuals who, in the complete absence of symptoms of the disease, have an increased level of rheumatoid factor, ACFP, in their blood. This picture can be observed for several years. The disease itself may not develop.

Otherwise, identifying a risk group is problematic. Heredity and predisposition factors have not been fully studied.

Hypothermia or previous infection may be a provoking factor (not a risk factor).

— What specialty do doctors treat patients with rheumatoid arthritis?

Mainly rheumatologists.

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In remote areas where there are no such specialists, patients can be treated by internists and general practitioners, but with periodic consultations with rheumatologists. However, it is still better for such patients to be treated by a rheumatologist.

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Please note: consultations are not available in all cities

If necessary, orthopedists, neurologists, etc. are involved in treatment.

— Can this disease be cured once and for all, or is this serious diagnosis a death sentence?

Rheumatoid arthritis is not a death sentence. There is an answer to the question whether it is curable or not. With proper treatment, low disease activity or complete remission can be achieved for a certain period of time. Treatment is lifelong.

— Are rheumatoid arthritis and hormonal treatment synonymous or is therapy possible without the use of hormonal drugs?

Treatment without hormonal drugs is possible. Ideally, it is not used at all, or such agents are used locally (in particular, intra-articular injection).

In other cases, such drugs can be prescribed systemically (for example, in the form of tablets) - at the onset of the disease, with pronounced inflammatory activity. They are subsequently cancelled. In some cases, small dosages of hormones are used continuously.

— What are the consequences of rheumatoid arthritis?

In the absence of proper treatment and significant activity of the inflammatory process, early disability, joint deformities, and increased risk of infectious diseases occur. When internal organs are involved in the process (cardiovascular, pulmonary pathology, etc.) - a decrease in life expectancy.

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— Does rheumatoid arthritis impose restrictions on the patient’s lifestyle? What can and cannot be done with this disease?

When the activity of the process is low or in remission, regular light physical activity, cycling, and swimming are possible. It is recommended to eat rationally and observe a work and rest schedule. In the absence of joint deformation, there are no special restrictions.

Hypothermia and infectious diseases should be avoided. Excessive physical activity is undesirable: rheumatoid arthritis and high-performance sports are, in my opinion, incompatible things. This can lead to worsening of rheumatoid arthritis.

Avoid being overweight and stop smoking. If the process is active in any way, you should not visit saunas and steam baths.

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— Tell us about the prevention of rheumatoid arthritis. How not to provoke an exacerbation of the disease?

Since the cause of the disease is not understood, there is no primary prevention.

Prevention of relapses of rheumatoid arthritis includes constant compliance with the rheumatologist’s treatment recommendations; to give up smoking; avoiding hypothermia, infections, excessive physical exertion; maintaining normal body weight.

For reference:

Strelnikova Inna Alekseevna

Graduate of the Faculty of Medicine of the Voronezh State Medical Academy in 2007.

In 2008, she completed a clinical internship in the specialty “Therapy”.

From 2008 to 2011, she completed full-time postgraduate studies in the specialty “Internal Medicine”. Has an academic degree of Candidate of Medical Sciences.

In 2009, she completed her primary specialization in rheumatology.

From 2015 to the present, he has been working as a rheumatologist at Clinic Expert Voronezh LLC. In Voronezh he receives at the address: Voronezh, st. Pushkinskaya, house No. 11.

Etiology

Polyarthritis is a multifactorial disease. In some cases, pathology begins against the background of an existing infection or chronic disease. Main reasons:

• previously suffered bacterial, fungal, viral infections;
• disturbance of mineral metabolism;
• psoriasis;
• joint injuries;
• unfavorable heredity;
• rheumatological pathologies;
• chronic diseases of the ENT organs and the genitourinary system;
• allergy;
• STI.

Risk factors include age over 55 years, unhealthy lifestyle (alcohol, drugs, smoking), hypothermia, excess weight, weakened immunity, etc.

Symptoms

Polyarthritis manifests itself as simultaneous or sequential damage to a group of joints. For each form of the disease there are general and specific signs.

The clinical picture of the disease, depending on the etiology, is accompanied by local symptoms:

• pain in the affected area;
• decreased performance, fatigue, weakness;
• swelling over the joints;
• hyperemia of the skin;
• local hyperthermia;
• morning stiffness;
• crunching when moving;
• decreased motor ability of the joint;
• joint deformation.

More often, the disease starts with damage to small joints (fingers). As the pathology progresses, large joints become involved in the process. Polyarthritis is distinguished by the degree of activity: 0 – remission; I – low; II – average; III – high. Determined by the duration of morning stiffness, pain assessment, ESR and CRP (C-reactive protein) levels.

Main symptoms

The characteristic symptoms of polyarthritis are determined not by the reasons for its appearance, but by the form of the disease. The inflammatory process develops inside the joint capsule and spreads to nearby tissues. The localization of inflammation may vary depending on the type of polyarthritis. For example, a symptom characteristic of rheumatic arthritis is symmetrical inflammation of the joints of the phalanges of the fingers; with reactive polyarthritis, the joints of the legs are more often affected, and with gouty – the feet.

The main symptoms of acute polyarthritis include:

• severe pain in several joints;
• limitation of joint mobility;
• the appearance of swelling;
• hyperemia (redness) of the skin and hyperthermia (increase in temperature) in the joint area;
• increase in body temperature.

In the chronic course of the disease, articular cartilage is gradually destroyed, bone tissue grows, and joints become immobilized, which leads to disability.

The subacute and chronic forms of polyarthritis are characterized by dulling of pain, a progressive decrease in the range of motion and thickening of the joints. With advanced chronic polyarthritis of the joints, in the photographs of patients you can see severe thickening of the knuckles and curvature of the fingers.

Diagnostics

The diagnosis is established after collecting anamnesis, examination, laboratory and instrumental research methods, such as:

• radiography;
• Ultrasound scanning of joints;
• arthroscopy;
• puncture of joints to obtain synovial fluid for research;
• MRI, CT;
• bacteriological examination of synovial fluid with determination of sensitivity to antibiotics;
• general clinical blood tests (with leukocyte count, ESR), urine;
• detection of C-reactive protein;
• IgM, IgA and IgG antibodies;
• ELISA, PCR for infections;
• biochemical analysis (total protein, uric acid, creatinine);
• OAM;
• Rehberg and Zimnitsky's test.

The therapy program is drawn up in accordance with the data obtained from the diagnostic examination.

Treatment

The disease is treated by a rheumatologist. The basic principles of correction are aimed at eliminating the cause, stopping inflammation and pathological symptoms. In the acute form of the pathology, the patient is hospitalized in a hospital.

When diagnosed with polyarthritis, the following drugs are prescribed:

1. NSAIDs (Meloxicam, Etoricoxib, Diclofenac). They have a pronounced anti-inflammatory and analgesic effect.
2. Glucocorticoids (“Prednisolone”, “Hydrocortisone”). Eliminate pain, increase range of motion in the joint.
3. Immunosuppressants (Methotrexate, Leflunomide). Used for autoimmune processes.
4. Antibiotics (Levofloxacin, Clarithromycin, Amoxicillin, etc.). Antibacterial agents are prescribed for confirmed infectious nature of polyarthritis. The drug group is selected after determining the sensitivity of the microorganism. Broad-spectrum antibiotics are used most often: fluoroquinolones, macrolides, penicillins, tetracyclines.
5. N-anticholinergics (“Mydocalm”, “Baclofen”). Eliminate muscle spasms and reduce pain.
6. Vasodilators (Pentoxifylline). Improves microcirculation in tissues and relieves swelling.
7. Local medications (ointments, creams, gels): “Alorom”, “Dolgit”.
8. Biostimulants (“Plasmol”).
9. Chondroprotectors (“Alflutop”, “Structum”). Helps prevent degenerative changes in joints.
10. Homeopathic remedies (“Homvio-Revman”, “Intsena”, herb erva woolly, etc.).

In addition to drug therapy, other methods are used for pathology: physiotherapy (laser, electrophoresis, magnetic therapy, UHF, etc.), massage, acupuncture. During the period of remission, it is recommended to perform physical therapy exercises.

Publications in the media

Polymyalgia rheumatica (rhizomelic pseudoarthritis) is a clinical syndrome of unknown etiology, characterized by pain and stiffness of the muscles of the proximal shoulder and pelvic girdle, fever, weight loss, anemia, and a significant increase in ESR; occurs in older people. In 15% of cases, polymyalgia rheumatica is accompanied by giant cell arteritis.

Etiology unknown. Increased titers of antibodies to adenovirus and RSV are detected. Statistical data. Incidence: about 50 per 100,000 population. The predominant age is over 60 years. The predominant gender is female (3:1). Among the patients, immigrants from the Caucasus predominate. Clinical picture • Constitutional symptoms: non-hectic fever, weakness, loss of appetite, weight loss, depression • Soreness and stiffness of the muscles of the shoulder and pelvic girdle, as well as cervical muscles. The pain intensifies with movement and subsides with rest. On palpation - muscle tension. Muscle strength is not changed • Limited mobility in the shoulder and pelvic girdle, correlating with disease activity. With a long course - muscle atrophy, capsulitis of the shoulder joint • Symmetrical polyarthritis with damage to large and small joints (including scapuloclavicular and sternoclavicular). Arthritis often occurs against the background of a full-blown clinical picture and less often at the onset of the disease • Carpal tunnel syndrome: swelling of the hands, pain and decreased sensitivity in the I–III fingers and the radial side of the IV finger (15%) • Symptoms of giant cell arteritis (15%). Laboratory data • Increased ESR • Anemia - normochromic normocytic • Thrombocytosis • Increased concentration of CRP in the blood serum • Normal level of CPK • RF is not detected • Moderate changes in liver function tests. Instrumental data • Muscle biopsy is not informative • There are no indications for temporal artery biopsy unless symptoms are detected to suggest giant cell arteritis • Synovial membrane biopsy - moderate nonspecific synovitis • X-ray examination of joints: very rarely - narrowing of the joint space, erosion. MRI can detect subacromial, subdeltoid bursitis and subclinical synovitis of the shoulder joint; however, MRI is not necessary for diagnosis.

Differential diagnosis • Rheumatoid arthritis: erosive and destructive changes in the joints, presence of RF in the blood • Fibromyalgia: normal ESR • Depression: no increase in ESR • Polymyositis: increased CPK levels, characteristic changes in muscle biopsy • Hypothyroidism: increased CPK levels, changes in thyroid function glands • Osteoarthritis: X-ray changes in the joints are characteristic, an increase in ESR is not typical • Malignant neoplasm - it is necessary to consider the possibility of polymyalgia rheumatica as a paraneoplastic syndrome. Diagnostic Criteria • Over 50 years of age at onset • Bilateral tenderness and stiffness for at least 1 month and affecting 2 of 3 areas •• neck or trunk •• shoulders •• hips • ESR greater than 40 mm/h • Rapid response to prescription of GC (prednisolone 15 mg or less).

TREATMENT General tactics . The basis of treatment is GCs, which have a positive effect on the clinical symptoms and inflammatory activity of the disease. However, GCs do not prevent the development of giant cell arteritis in polymyalgia rheumatica. Mode . Some of the frequently repeated painful movements can be prevented (for example, increasing the height of a chair from which the patient has difficulty rising or using a long-handled comb). There is no need to limit activity. Diet. Adequate consumption of calcium-containing products against the background of GC (see Osteoporosis). Drug treatment • Prednisolone •• Initial dose of 10–20 mg/day in several doses until the ESR normalizes •• After achieving a clinical effect, the dose of prednisolone is reduced gradually: first by 1–2.5 mg/day every 3–4 weeks, and after achieving doses 10 mg 1 mg/week •• During the dose reduction process, it is necessary to carefully monitor the dynamics of symptoms: monitor ESR every 4 weeks for the first 2 months, then every 8-12 weeks for 12 months after completion of treatment • NSAIDs are usually less effective, however, their use is possible during the period of gradual withdrawal of GCs.

Complications. Polymyalgia rheumatica has no serious complications; For complications of giant cell arteritis, see Giant cell arteritis. Prognosis • There are no reliable predictors of the development of giant cell arteritis in the setting of polymyalgia rheumatica, so each case of polymyalgia rheumatica should be monitored for the development of signs of vasculitis • In the absence of giant cell arteritis, 50–75% of polymyalgia rheumatica resolves within 3 years. However, the lack of treatment leads to a sharp deterioration in the quality of life of patients.

ICD-10 • M35.3 Polymyalgia rheumatica

Prevention

To maintain healthy joints, you must follow the rules of prevention:

• lead a physically active lifestyle: walking, doing yoga, swimming, etc.;
• avoid injury, hypothermia;
• give up bad habits (smoking, drinking alcohol);
• normalize weight;
• watch your posture;
• timely sanitization of foci of infection in the body;
• prevent vitamin deficiency and mineral deficiency.

In addition, it is necessary to maintain a drinking regime - 1.5–2.5 liters of fluid per day.

Patients are advised to adhere to the following diet:

• minimize the consumption of table salt;
• when preparing dishes, use the methods of boiling or baking in the oven;
• for gout - reduce the amount of protein, eliminate wine, chocolate, etc.;
• spices, spicy, sour foods can aggravate arthritis;
• turmeric relieves inflammation (add 1 tsp per day to any dish daily);
• reduce the consumption of coffee, white bread, fatty meat, mushrooms;
• eat more fruits (except citrus fruits) and vegetables.

It is very important to seek help from a specialist at the first signs of illness.

Frequently asked questions about polyarthritis

What is grade 2 polyarthritis?

This is a progressive inflammation in which thinning of the cartilage tissue is observed. Cartilage atrophy leads to friction between the head and the articular cavity, pain, and swelling. Radiographically, it appears as a narrowing of the joint gap.

How to treat polyarthritis?

Treatment depends on the type and severity of the pathology. Complex conservative therapy is used predominantly. The treatment program is compiled individually for each patient after undergoing a diagnostic examination.

Why is polyarthritis dangerous?

The pathology is dangerous due to complications that may have articular and extra-articular manifestations: contracture, deformation, ankylosis of the joint, damage to other organs and tissues (salt deposition, rheumatoid nodules, scar damage to the lungs, inflammation of the heart sac, etc.). The outcome of the disease can be a significant decrease in the standard of living, even disability.

Stages and manifestations

Symptoms of the development of stage 1 joint disease are practically invisible externally. The patient sometimes experiences pain during physical activity, prolonged compression of an object, or during weather changes. In the morning, the condition is characterized by stiffness of movement. Discomfort and aching sensations appear on the interphalangeal joints.

At stage 2, small nodules form on the fingers. Painful sensations appear that are not associated with physical activity or overexertion. Some patients experience the first symptoms of deformity: protrusion of the fingers to the sides, their thickening.

If polyarthritis of the fingers is not treated, then stage 3 occurs. The fingers become ugly, indicating a severe degree of deformity. Large nodes and sharp osteophytes of bones form. In some situations, they can even break through the skin.

Symptoms of age-related, infectious and metabolic forms of the disease are represented by painful sensations in the joints. Unpleasant signs appear in the following places:

• in the joints that connect the proximal phalanx and the bones of the palm;
• in the joints between the middle and proximal phalanx.

If the patient develops the psoriatic type, then pain occurs in the distal joint. Common manifestations in the form of aching sensations in the fingers are also characteristic of polyarthritis. The pain may radiate to the wrist or hand. It is not uncommon for symptoms to occur during worsening weather or at night.

The following manifestations appear:

1. Inability to perform small tasks such as holding objects and performing other activities that require fine motor skills.
2. Stiffness appears after sleep.
3. The tissues become swollen.
4. The tissue around the inflammation becomes numb and red.
5. After hypothermia, the painful sensations intensify.

The development of polyarthritis leads to the formation of nodules in the joint area. Lack of intervention leads to weakening of muscle tissue and deformation of the fingers. The possibility of developing muscle atrophy cannot be ruled out. In the future, the disease affects blood vessels, nerves and tendons.