Inflammation in the joints, characterized by a constant, intensifying course with repeated aggravations of the pathological process, is called a long-term disease. Constant disease of the knee joint leads to stiff movements, local pain, and swelling. Gradually, chronic arthritis causes knee deformity, dislocations, and contractures.
To diagnose the disease, the patient is sent for a full course of studies. It is worth taking certain tests that will help the doctor make the correct diagnosis and prescribe treatment. In case of exacerbation of the disease of the knee joint, medications are prescribed; it is worth giving the affected area of the knee rest. During the weakening of the disease, it is worth carrying out restorative procedures - massage, special exercises, physical therapy, exercise therapy.
When the inflammatory process in the knee persists for three or more months, the disease of the knee joint becomes a long-term form. Any type of polyarthritis can develop into this form, which is divided depending on the conditions and causes into types: reactive, psoriatic, rheumatoid, infectious, gouty. Chronic arthritis, depending on the clinical course of the disease, is divided into two types.
Acute articular inflammatory or primary permanent process are the main causes of the patient’s disease. This diagnosis is made for an adult or a child.
Most often, the causes of chronic disease of the knee joint are traumatic, allergic, and infectious manifestations. With hypothermia or excessive physical activity, inflammation occurs in the knees.
The inflammation process originates in the synovial membrane of the knee. Inflammatory acute exudate accumulates in the joint cavity, after which the inflammatory processes spread to other parts - cartilage, capsules, bone structures. With this diagnosis, the ligaments and tendons of the knee joint undergo changes.
Because there are so many types of knee disease, there are signs that indicate chronic arthritis. With a long-term inflammatory process, an increase in the villi of the synovial membrane and a proliferation of the layer of synovial cells are noticed. The tissues are saturated with lymphoid, plasmacytic substance. Over time, the synovial membrane enlarges with the formation of scars. With constant inflammation of the knee joint, young tissue develops at the edges of the cartilage covering the articular surfaces. Gradually, the tissue covers the cartilage, which leads to its destruction.
Chronic reactive arthritis is accompanied by the occurrence of osteochondral erosions. Over time, young connective tissue is replaced by fibrous tissue, which gradually ossifies. This process of bone tissue formation causes the occurrence of ankylosis. As inflammation spreads through the joints, they become deformed.
There are two clinical forms of permanent arthritis:
The disease is characterized by symptoms: arthralgia, deformation of affected areas. Up to 4 joints may be deformed.
Juvenile rheumatoid arthritis causes fever, itchy rash, hepatosplenomegaly, and lymphadenopathy.
Rheumatoid, like reactive, arthritis leads to deforming changes and immobility of diseased areas. Rheumatoid arthritis affects 3 or more joints of the body. This type of knee joint disease is characterized by typical symptoms: symmetrical damage, the affected areas are constrained in movement in the morning. Patients complain of sudden weight loss, increased sweating, and fatigue. With a long course of the disease, deformation and impaired mobility of the damaged parts occur.
The chronic form leads to frequent, prolonged attacks and less acute gouty manifestations. Sometimes patients experience signs of mono- or polyarthritis that last for several weeks. The disease affects the joints: knee, wrist, ankle, hand joints.
After gout is diagnosed, severe deformation of the affected parts and persistent restriction in movement occur. With chronic exacerbation, tophi are formed, which are whitish-yellow nodules where tissue urates accumulate. More often, nodules are located in the area of the affected joint. Long-term exacerbation of chronic gouty arthritis causes disruption of the kidneys. Over time, the disease can lead to loss of the ability to work and move actively.
Psoriatic arthritis occurs in every third person during the acute stage of the disease. During a disease of the knee joint with skin manifestations of psoriasis, rashes, peeling, itching, and a feeling of tightness of the skin appear. More often, joint damage appears before skin problems appear.
Knee disease is characterized by symptoms: asymmetry, inflammation of the interphalangeal joints. The reactive inflammatory process does not cause pain, hyperemia, and is manifested by tumors in the area of the affected knee, restriction of movement of the foot and hand.
To determine the form of the disease, the patient will have to visit a therapist and consult other doctors: pediatrician, rheumatologist, dermatologist. To make a diagnosis, it is worth undergoing a full examination, including: radiography, arthrography, CT, MRI, ultrasound. They can take a puncture from the affected area.
With an X-ray examination, the doctor can detect osteoporosis, erosion of the joint surface, cysts, periostitis, and narrowing of the gaps between the joints. To get a complete picture of the disease, the patient undergoes tests: blood, CBC, ELISA. It is worth submitting synovial fluid for analysis. Rheumatoid arthritis is diagnosed in a patient whose blood contains rheumatoid factor.
Treatment of chronic arthritis is possible for certain types of its manifestations. It is better to carry out treatment aimed at eliminating the cause of the disease when certain types of arthritis are diagnosed: infectious, gouty. Other forms of arthritis can be treated during flare-ups with medications that fight inflammation. The doctor prescribes the patient intra-articular injection of synthetic drugs, which are hormones of the second phase of stress. To relieve pain, the patient is advised to immobilize the painful part during an exacerbation. You can use special orthopedic devices - walkers, canes.
During remission, the patient must perform special exercises to develop the knee. You can go for exercise therapy or massage. Operations are advised to be carried out only in certain cases.
Reactive chronic arthritis occurs after an infectious disease. For treatment, two directions are used: antibacterial therapy, therapy for joint syndrome. Symptoms are the same as most types of arthritis: stiffness, pain, swelling, deformity. Reactive chronic arthritis is not completely cured; during remission, symptoms can be alleviated.
The long-term disease cannot be fully cured. It is impossible to cure the disease completely. With properly selected treatment and constant monitoring by a rheumatologist, this will allow long intervals between exacerbations to be achieved. In this case, a person will live a full life and will be able to work at home and at work. With frequent exacerbations, disability occurs earlier. The patient's physical activity decreases, he will not be able to care for himself or realize himself.
To live a full life, patients with this diagnosis must follow the instructions of their doctors. Symptoms indicating the onset of arthritis are the first signal to visit a doctor.
Chronic arthritis is an inflammatory disease of the joints, characterized by a long, progressive course with periodic exacerbations of the activity of the pathological process. Regardless of location, chronic arthritis is characterized by local pain, stiffness during movements, swelling of tissues and over time leads to joint deformation, contractures, and subluxations. Diagnosis of various forms of chronic arthritis includes a comprehensive x-ray, ultrasound, tomographic examination, and laboratory tests. The basis of therapy for exacerbation of chronic arthritis is temporary immobilization of the joint, the prescription of non-steroidal and steroidal anti-inflammatory drugs, and basic agents. During periods of remission, restorative treatment (PTL, exercise therapy, massage) is indicated.
Chronic arthritis is a form of arthritis in which signs of inflammatory joint damage persist for more than 3 months. Inflammatory diseases of the joints of various etiologies can occur according to the type of chronic arthritis: rheumatoid arthritis, gouty arthritis, infectious arthritis (gonorrheal, tuberculous, fungal), psoriatic arthritis, etc. Due to the peculiarities of the clinical course, juvenile chronic arthritis and chronic arthritis are identified as independent nosological forms TMJ. The variety of variants of chronic arthritis determines interest in the disease from rheumatology, pediatrics, dentistry and other disciplines. Chronic arthritis can occur as a result of acute joint inflammation or as a primary chronic process. Both adults and children are susceptible to various forms of chronic arthritis.
The group of diseases united by the concept of “chronic arthritis” is heterogeneous, so their etiology is also complex and diverse. The course of infectious arthritis can be supported by an infection that persists in the body: nonspecific (tonsillitis, sinusitis, pyelonephritis, viral hepatitis C, etc.) or specific (tuberculosis, gonorrhea, syphilis). Arthritis in gout is caused by infiltration of articular tissues with urates, followed by an inflammatory reaction.
The etiology of such severe inflammatory diseases of the joints as rheumatoid arthritis, ankylosing spondylitis, etc. is less studied. The participation of infectious agents in the origin of these types of arthritis remains unproven, but generally recognized pathogenetic factors are changes in general and tissue reactivity, the development of allergies and immune complex reactions. Chronic arthritis can accompany the course of various diseases, for example, psoriasis, systemic lupus erythematosus, Reiter's syndrome, sarcoidosis, Behçet's disease, relapsing polychondritis and a number of others.
Factors contributing to the development of primary chronic arthritis are a sedentary lifestyle, hypothermia, hyperinsolation, prolonged stress on the same joint, endocrine changes (puberty, pregnancy, menopause, etc.), diseases (thyroid disease, diabetes mellitus), vaccination, etc.
This term refers to various forms of arthritis lasting more than 12 weeks that occur in children. Juvenile chronic arthritis occurs with a frequency of 0.3-0.4 cases per 1 thousand children. Peaks of incidence occur at ages 2-6 years and puberty; girls get sick approximately 3 times more often. In some children, there is a connection between juvenile chronic arthritis and previous acute respiratory viral infections, trauma, vaccinations (DPT, etc.), and administration of medications (gammaglobulin). Close relatives of young patients often suffer from rheumatoid arthritis and collagenosis.
Clinical signs of juvenile chronic arthritis consist of arthralgias, changes in configuration and dysfunction of the affected joints. With monoarticular or oligoarticular juvenile chronic arthritis, 1 to 4 joints are affected (usually ankles, knees, individual fingers). Oligomonoarthritis often occurs with symptoms of chronic uveitis, leading to blindness.
With the polyarticular variant of chronic arthritis, more than 4 joints are involved in the inflammatory process - usually small joints of the hands, joints of the legs, sometimes the cervical spine, the temporomandibular joint. Involvement of the joints of the lower extremities leads to difficulties in movement; upper limbs - to problems with performing everyday activities and writing; TMJ – to underdevelopment of the lower jaw (“bird jaw”). The disease tends to progress with the formation of persistent deformities and contractures, atrophy of the periarticular muscles; Possible delay in physical development, shortening of limbs.
Systemic juvenile rheumatoid arthritis is characterized by fever, the presence of a spotty, itchy rash, lymphadenopathy, and hepatosplenomegaly. Articular syndrome is accompanied by arthralgia and synovitis. This form is often complicated by pleurisy, myocarditis, pericarditis, and pulmonitis.
Rheumatoid arthritis occurs as a chronic polyarthritis, leading to the development of deformities and ankylosis of the joints. Typical signs of rheumatoid arthritis are the involvement of 3 or more small joints of the hands and feet in the pathological process, symmetry of the lesion, morning stiffness in the affected joints, which gradually disappears during the day. Variable fever, weight loss, sweating, and fatigue are noted. Extra-articular manifestations of rheumatoid arthritis include subcutaneous nodules, exudative pleurisy, vasculitis, and peripheral neuropathy. A long, chronic course of rheumatoid arthritis leads to characteristic deformities (ulnar deviation of the hands, S-shaped deformation of the fingers), pronounced functional disorders - stiffness or complete immobility of the joints.
The course of the chronic form of arthritis is characterized by the occurrence of frequent, longer, but less acute gout attacks. Periodically, the so-called gouty status may occur - prolonged attacks of mono- or polyarthritis lasting up to several weeks. The first metatarsophalangeal joint, joints of the hand, knee, ankle, wrist, etc. are affected.
3-5 years after the manifestation of gout, severe joint deformities, contractures, and persistent limitations in movement develop. A typical manifestation of chronic gouty arthritis is the formation of tophi - tissue accumulations of urate in the form of whitish-yellow nodules. Tophi can be localized on the inner surface of the ears, in the area of the joints, and less often on the sclera and cornea. With a long course of gout, damage to internal organs develops, mainly to the kidneys (urolithiasis, urate nephropathy, renal failure). Chronic gouty arthritis leads to the development of secondary osteoarthritis, fibrous or bone ankylosis and can cause loss of ability to work and motor activity of patients.
Articular syndrome associated with psoriasis develops in about a third of patients, mainly in severe forms of the disease. Skin manifestations of psoriasis include rashes (psoriatic plaques) localized on the scalp and in the area of the extensor surfaces of large joints, peeling, itching, and a feeling of tightness of the skin. In most cases, skin lesions precede arthritis, sometimes they occur simultaneously, or articular syndrome occurs before skin manifestations.
Asymmetry and dactylitis involving the distal interphalangeal joints are typical for joint damage. With chronic dactylitis, pain and hyperemia are usually absent, but there is thickening of the fingers, the formation of flexion contractures and limited mobility of the hands and feet. Quite often, patients with chronic psoriatic arthritis develop spondylitis, sacroiliitis, and enthesopathies.
General practitioners, pediatricians, dermatologists, rheumatologists, etc. can participate in recognizing various forms of chronic arthritis. The presence of arthritis is confirmed by anamnesis, objective examination and the results of instrumental studies (ultrasound of the joint, radiography, arthrography, CT of the joint, MRI). Puncture of the affected joint, diagnostic arthroscopy, and biopsy of the synovial membrane are informative.
The most typical radiological signs of chronic arthritis include periarticular osteoporosis, narrowing of interarticular spaces, erosion of articular surfaces, periarticular cysts, and periostitis. To determine the clinical variant of chronic arthritis, laboratory tests play a primary role: CBC, immunological and biochemical blood tests, ELISA, and examination of synovial fluid. Thus, the main marker of rheumatoid arthritis is the detection of RF in the serum of patients; juvenile oligomonoarthritis - identification of antinuclear factor, etc.
Etiotropic therapy is possible only for certain forms of chronic arthritis (infectious, gouty). In other cases, during exacerbation of the inflammatory process, non-steroidal (NSAIDs) and steroidal anti-inflammatory drugs are prescribed, which can be used systemically and locally. Intra-articular administration of glucocorticosteroids is possible. For rheumatoid and psoriatic arthritis, basic anti-inflammatory therapy is carried out. At the height of exacerbation, short-term immobilization of the joint is indicated, followed by the use of orthopedic devices to facilitate movement (walkers, canes, etc.).
In order to increase overall joint mobility, regular exercise therapy and massage are necessary. To reduce residual inflammatory reactions, prevent the development of fibrosis, maintain and prolong the remission of chronic arthritis, courses of physiotherapy, balneotherapy, and spa treatment are recommended. Surgical treatment of chronic arthritis may be required in the case of destructive joint lesions and severe functional impairment. In this case, joint replacement, arthroplasty, arthroscopic synovectomy, etc. can be performed.
Chronic arthritis cannot be cured completely, however, properly selected therapy and regular monitoring by a rheumatologist can achieve long-term remission and a satisfactory quality of life, both domestically and professionally. Frequent relapses of chronic arthritis, as well as systemic manifestations of the disease, aggravate the prognosis: in these cases, disability occurs early, limiting physical activity, self-care and self-realization.
Large cysts in the subchondral zone of the bone or in its deeper layers, sometimes compaction of soft tissues.
Large cysts near the joint and small erosions on the articular surfaces, constant compaction of the periarticular soft tissues, sometimes with calcifications.
Large lesions, but less than 1/3 of the articular surface; osteolysis of the epiphysis, significant compaction of soft tissues with lime deposits.
Examples of diagnosis formulation:
1. Primary gout, acute gouty arthritis of the 1st metatarsophalangeal joint of the right foot in the acute phase, FNS – I.
Chronic gout, severe course, chronic gouty arthritis with predominant damage to the joints of the feet, secondary osteoarthritis, auricular tophi, FNS II.
Complications: urolithiasis (8x9 mm calculus of the ureteropelvic segment on the left, left-sided hydronephrosis), chronic secondary bilateral pyelonephritis with predominant damage to the left kidney in the stage of latent inflammation, CKD stage III, symptomatic arterial hypertension, CHF I.
SYSTEMIC SCLERODERMA (SSc)
Systemic scleroderma is an autoimmune connective tissue disease, the main clinical signs of which are caused by widespread microcirculation disorders, fibrosis of the skin and internal organs.
Systemic scleroderma is the most important representative of the scleroderma group of diseases, which also include limited (focal) scleroderma, diffuse eosinophilic fasciitis, Buschke's scleroderma, multifocal fibrosis, induced forms of scleroderma and pseudoscleroderma syndromes.
(scleroderma group of diseases)
Systemic scleroderma (systemic sclerosis):
— crossover (overlap) + dermatomyositis (DM) + rheumatoid arthritis (RA), etc.;
2. Limited scleroderma:
- focal (plaque and generalized);
- linear (such as “saber strike”, hemiform).
3. Diffuse eosinophilic fasciitis.
4. Scleroderma Buschke.
5. Multifocal fibrosis (localized systemic sclerosis).
6. Induced scleroderma:
— chemical, medicinal (silicon dust, vinyl chloride, organic solvents, bleomycin, etc.);
— vibration (associated with vibration disease);
— immunological (“adjuvant disease”, chronic transplant rejection);
- paraneoplastic, or tumor-associated.
- hereditary (porphyria, phenylketonuria, progeria, amyloidosis, Werner and Rothmund syndromes, scleromyxedema, etc.).
— Generalized skin lesions of the extremities, face and torso during the year; Raynaud's syndrome appears simultaneously with or after skin lesions.
— Early development of visceral pathology (interstitial lung lesions, gastrointestinal tract lesions, myocardium, kidneys).
— Significant reduction of capillaries of the nail bed with the formation of avascular areas (according to capillaroscopy of the nail bed).
— Detection of antibodies (AT) to topoisomerase-1 (Scl-70).
- Long period of isolated Raynaud's phenomenon.
- Skin involvement is limited to the face and hands/feet.
- Late development of pulmonary hypertension, gastrointestinal lesions, telangiectasia, calcinosis (CREST syndrome: an abbreviation for Calcinosis, Raynaudphenomenon, Esophageal dismotility, Sclerodactyly, Telangiectasia).
— Detection of anticentromere antibodies.
— Dilation of the capillaries of the nail bed without pronounced avascular
Scleroderma without scleroderma:
- No skin thickening.
— Signs of pulmonary fibrosis, acute scleroderma kidney, lesion
— Detection of antinuclear antibodies (Scl-70, ASA, nucleolar).
Crossover forms (overlap syndromes) are characterized by a combination of clinical signs of SSc and one or more systemic connective tissue diseases.
— The onset of the disease is before 16 years of age.
— Skin lesions are often focal or linear (hemiform)
- Tendency to form contractures. Possible developmental abnormalities
— Moderate visceral pathology (detected mainly when
The so-called prescleroderma is distinguished; it includes patients with isolated Raynaud's phenomenon in combination with capillaroscopic changes or immunological disorders characteristic of SSc.
Gouty arthritis, “the disease of the aristocrats,” as it was called about a century ago. The disease is directly related to metabolic disorders and the deposition of uric acid salts in the joints. Gout in its pure form is rare, although this word is usually used to describe arthrosis of the big toe in women in old age. This is only partly correct, real (true) gout is the lot of the male population; it is very rare among the fair sex.
Symptoms and causes of gouty arthritisGout affects two systems in the body - the urinary and musculoskeletal systems. The joints suffer the most - they are the ones that start to bother you first. It is noteworthy that at the initial stage of the disease, symptoms of gouty arthritis in the form of pain can occur irregularly and appear once every 2-3 months. In women, symptoms are usually milder and attacks are less painful. As a rule, the joints of the big toes, ankles, knees and elbows are affected.
Less commonly affected are the interphalangeal and wrist joints of the fingers. The affected area swells, the skin over it becomes purple in color. After the first attack of gouty arthritis, symptoms may disappear within 3-4 days. However, gout will continue to destroy body tissue. Over time, the pain will begin to intensify, and the intervals between attacks will decrease.
Specific accumulations of salt crystals under the skin (tophi) may also occur. They look like whitish nodules and are located in the area of the ears or joints. As the disease progresses, the accumulation of urate in the kidneys increases. This leads to the development of urolithiasis and kidney failure. If this issue is not addressed in time, the disease will develop into acute gouty arthritis, which is much more difficult to cure.
If gout is suspected, it is necessary to perform a biochemical blood test, as well as an x-ray of the hands and feet. The diagnosis is confirmed if there are characteristic joint lesions, as well as an increased level of uric acid in the blood. Blood tests should be performed during and between acute attacks of the disease.
Treatment of elbow bursitis with dimexide link here
The reasons contributing to the development of gout have not been fully studied. But it has been precisely determined that in most cases the development of gouty arthritis is influenced by heredity, and men are more susceptible to developing the disease.
Representatives of the fair sex more often encounter the first manifestations of gout only during menopause (after 60 years), while men - already at the age of 40 years.
An important factor in the occurrence of gouty arthritis is nutrition.
In the case of poor nutrition, namely alcohol abuse, frequent consumption of strong coffee or tea, excess meat products and sweets, the risk of developing the disease increases several times.
That is why many experts call gout “the disease of aristocrats.”
In some cases, an attack of gout can develop in patients who have a hereditary predisposition to this disease when they are faced with severe injuries, burns and surgical interventions - in this case, the onset of the disease is in no way associated with the patient’s age or gender .
It is also possible to develop gout in patients who have to undergo chemotherapy treatment for malignant neoplasms - in this case, the cause of metabolic disorders is massive cell breakdown.
With gout, small nodules form under the skin. Large joints are mainly affected: elbows, ankles and knees. Small joints are much less likely to be involved.
The affected joints become painful to the touch. The skin over them swells and becomes red. The temperature rises. The slightest touch in this area causes severe pain. The mobility of the joint is limited to such an extent that in some cases the patient cannot move independently.
The acute period can last from several days to several days. Then all symptoms subside and remission occurs. At this stage, diagnosing the disease will be very difficult. The remission period can last for years.
Over time, after each acute period, new joints are involved in the inflammatory process, and a more severe course appears. If left untreated, gouty arthritis can become chronic. In this case, complications may arise from many organs and systems. For example, kidney damage. These include urolithiasis, kidney failure, etc.
Treatment of gout can be divided into 2 stages:
During an acute attack of gouty arthritis, it is necessary to provide functional rest to the affected joint. Fasting is contraindicated; you must adhere to diet No. 6, drink 2.5 liters of alkaline liquid per day.
To eliminate the symptoms of inflammation and pain, the doctor will prescribe one or more medications from the following:
Under no circumstances should you take these medications without a doctor's prescription. These are serious medications that have many contraindications and side effects. Therefore, self-medication can only make things worse for yourself.
Physiotherapeutic treatment is also widely used: ultraviolet irradiation of the joint, electrophoresis, applications with dimexide.
Basic anti-relapse therapy includes:
Diagnosis of gouty arthritis is carried out by studying the clinical picture of the disease, laboratory tests to identify the provoking factor, and radiographic studies. When puncturing the affected joint, this type of arthritis can be diagnosed by the presence of monosodium urate crystals in the intra-articular fluid.
Acute gouty arthritis is an acute, fleeting inflammation caused both by direct effects of uric acid crystals and indirectly by activation of neutrophils and synovial fluid cells. Phagocytosis of crystals by leukocytes with destruction of lysosomes and release of lysosomal products, as well as chemotactic substances, activation of complement, and the kallikrein system contribute to the rapid development of an acute inflammatory process.
As a rule, one of the joints is affected, mainly the lower extremities, with almost obligatory (and in half of the cases debuting) damage to the joint of the 1st toe. Severe pain, the impossibility of the slightest movement in the affected joint, even the touch of a sheet, severe hyperemia and swelling that occurs acutely (within several hours, usually in the morning) are typical signs of acute gouty arthritis.
Factors that provoke the occurrence of a joint attack in gout are alcohol, excess animal protein in food and consumption of other foods rich in purines, dehydration (hot climate, sauna), hypothermia, trauma. The most significant are hypothermia of the joints and their physical overload, including static, for example, walking in tight shoes.
Acute gouty arthritis lasts several days and goes away without a trace even without treatment. After the first attack of gout, approximately 10% of patients experience a long-term remission, but the majority experience 1-3 relapses or monthly (less often weekly) attacks within the first year. An epidemiological study (Framingham study, 1967) revealed a direct relationship between the level of uricemia and the possibility of developing gouty crises. Thus, with a level of uric acid in the blood of 6.0-6.9 mg/dL, gout was recorded in 1.8% of cases, and with a level of 7.0-7.9 mg/dL - in 11.8% of cases.
As uric acid accumulates in the body, the frequency and nature of gout exacerbations may change; Continuously recurring attacks and, in rare cases, unusually severe attacks are possible. In 4 of the patients we observed, the gouty crisis was extremely severe, with the simultaneous development of multiple arthritis, the formation of tophi, their inflammation, ulceration and the release of a thick chalky mass with a large number of uric acid crystals (a pseudophlegmonous form of gouty attack described in the literature). To distinguish gouty arthritis from other acute monoarthritis (pyrophosphate, calcium deposition, septic arthritis, etc.) is possible by puncture of the joint with examination of the synovial fluid using polarizing microscopy.
Symptoms of acute gouty arthritis are the presence of typical monosodium urate crystals inside or outside leukocytes. X-ray examination of the joint affected by inflammation in this disease has no diagnostic value and only in the later stages reveals periarticular deposits, decreased bone density, the presence of bone cavities, Despite the brightness of the clinical symptoms gouty joint attack, the diagnosis of gout is often delayed. Thus, of the 100 patients with gout we observed in recent years, in more than 80%, as evidenced by the anamnesis, the disease was recognized 8 years or more from the onset of attacks of arthritis. At the first visits to the doctor, the diagnosis of “faceless” arthritis prevailed; patients were often referred to a surgeon with traumatic arthritis, to an infectious disease specialist with suspected erysipelas, and very often they were diagnosed with rheumatoid arthritis.
After the first attacks, a patient suffering from gout, which remains unrecognized, subsequently easily copes with articular crises until the disease becomes chronic with deformation of the joints and gouty tophi. In addition to developing chronic joint damage, characteristic kidney damage is noted.
If urates (derivatives of uric acid) begin to accumulate in the joints, gouty arthritis of the foot occurs. The person suffers from unbearable pain, all movements in the joint become simply impossible, and severe swelling appears. Typically, this acute form most often affects men. And the disease usually occurs at an older age.
Gouty arthritis of the foot is characterized by an acute onset of the disease, when pain occurs exclusively in the joint.
Chronic gouty arthritis most often occurs only after a period of intermittent gout and, as a rule, in the joint where several acute articular attacks have previously been observed (rarely, chronic arthritis develops in a joint that was not previously affected, or after the first attack of acute arthritis).
Its localization is varied: most often, inflammatory changes appear in the joints of the feet, then in the joints of the arms, ankles, elbows and knees; less often - in the shoulder, hip, sternocellular joints.
The first symptoms of chronic gouty arthritis are a feeling of joint stiffness that appears after a period of rest, as well as a crunching sound when moving. Later, moderate pain occurs during exercise, stiffness increases and becomes permanent, moderate and then severe deformation of the joint appears, caused first by exudative and then proliferative changes in the articular and periarticular tissues. Secondary osteoarthritis occurs. Osteolysis caused by intraosseous deposition of urate can lead to destruction of the epiphyseal ends of articulating bones, which can clinically manifest itself, for example, in shortening of the fingers. Occasionally, subluxations and dislocations occur. With the formation of fibrous or bone ankylosis, joint mobility is completely lost.
A feature of exacerbations of chronic gouty polyarthritis is a less pronounced pain syndrome, which is noticeably less intense during “joint attacks” of intermittent gout, but occurs more often and lasts for a longer time - up to several months. Although even during the period of chronic gout, typical acute attacks of arthritis may occur in those joints that have never been affected before and do not show signs of a chronic inflammatory process.
Kidney damage is the most unfavorable symptom of this disease; observed in 15-75% of cases (on average with chronic gout in 50-60% of cases).