Diseases of the synovial joint: treatment
Connective tissue - endothelial and underlying loose, lining articular capsule from the inside - is a synovial membrane that forms in the lateral flanks, in the upper turn and in the anterior part of the fold and nap. When arthroscopy is performed, puffiness, color and vascular pattern, as well as all pathological inclusions in the thickness of the synovium and on the surface, are estimated, the sizes, shape, structure of synovial folds and villi are evaluated. All this is of great importance in the diagnosis of joint diseases. The synovium can be inflamed. Synovitis is the most common manifestation of chronic diseases. Chronic synovitis within the envelope speaks of primary inflammation in arthritis and secondary inflammation of arthrosis, deforming joint.
According to the most recent information, the key link in the development of chronic arthritis is an autoimmune process, when an unknown pathogenic factor is recognized with the help of an antigen-presenting cell. Secondary synovitis of deforming arthrosis is due to the accumulation of cartilage decay products - fragments of molecules of collagen and proteoglycans, membranes of chondrocytes and the like. In a normal state, no cell of the immune system with these antigens is in contact, and therefore they can be recognized as an absolutely alien material. This is what leads to a strict immune response, and therefore is accompanied by a chronic inflammation, from which the synovial membrane suffers. Especially often there are similar changes in the knee joint. There are a lot of systemic diseases of the synovial membrane, and for them there is a certain classification.
1. Diseases with articular syndrome - a lesion of connective tissue with rheumatoid arthritis, when mostly small joints are affected. This type of erosive-destructive polyarthritis, while the etiology is not too clear, and autoimmune pathogenesis is complex.
2. Infectious arthritis, which is associated with the presence of infections, including hidden ones. For example, the synovial membrane of the joint is affected by infections such as mycoplasma, chlamydia, bacteroides, ureplazm and many others. This includes septic( bacterial) arthritis.
3. Diseases from metabolic disorders, such as gout, ochronosis( it is a consequence of the disease of congenital - alkaponuria), pyrophosphate arthropathy.
4. The synovial membrane of the joint is susceptible to neoplasms - tumors and tumor-like diseases. This is a vinzonodular synovitis, synovial chondromatosis, synovium and hemangioma, synovial ganglion.
5. The defeat of the synovial membrane of the joint for degenerative-dystrophic type and deforming arthrosis are considered very widespread diseases. For example, many people suffer from degenerative-dystrophic joint damage after forty-five years, and the degree of this lesion may be different.
About the disease
Synovitis is a common disease that even military medicine of the United States, which has recently excited Russia by the tender for the collection of RNA and the synovial membrane of Russians, is concerned about it. This is explained by the fact that in the world there is a persistent search for solutions in the fight against joint diseases. The fact is that the inflammatory process is accompanied by the accumulation of effusion( fluid) in the cavity of the joint, and knee joints suffer most often, although the defeat can be overtaken by the ankle, elbow, wrist, and any other joint. Diseases of the synovium develop, as a rule, only in one of them, rarely a few joints are affected. Develop synovitis from infection, after trauma, from allergies and certain blood diseases, with metabolic disorders and endocrine diseases. The joint increases in volume, the synovial membrane thickens, pain appears, the person feels malaise and weakness. If a purulent infection joins, the pain becomes much stronger, general intoxication may occur.
After the detection of symptoms, after the examination and investigation of the synovial fluid, a diagnosis is established. This, for example, inflammation of the synovial membrane of the joint. Treatment is prescribed: puncture, immobilization, if necessary - surgery or drainage. Given the course of the disease, you can identify acute synovitis and chronic. Acute is always accompanied by edema, fullness and thickening of the synovial membrane. The joint cavity fills the effusion - a translucent liquid with fibrin flakes. Chronic synovitis shows the development of fibrous changes in the capsule of the joint. When the villi proliferate, fibrinous overlays appear that hang directly into the joint cavity. Soon the overlays are separated and transformed into "rice corpuscles" floating freely in the fluid of the joint cavity and additionally injuring the shell. By the types of inflammation of the synovial membrane and the nature of the effusion, one can distinguish between serous synovitis or hemorrhagic, purulent or serous-fibrinous.
If pathogenic microorganisms get into the joint cavity, an infectious synovitis occurs. The causative agent can penetrate into the envelope with penetrating wounds of the joint - from the external environment, as well as from the tissues surrounding the synoidal membrane, if there are purulent wounds or abscesses near the joint. Even from distant foci, the infection can easily penetrate into the area of the joint cavity, causing inflammation of the human synovial membranes, as the blood vessels and lymphatic vessels are everywhere. Infectious nonspecific synovitis is caused by staphylococci, pneumococci, streptococci and similar pathogens. Infectious specific synovitis causes pathogens of specific infections: with syphilis - pale treponema, with tuberculosis - tubercle bacillus and the like.
With aseptic synovitis of pathogenic microorganisms in the joint cavity is not observed, and the inflammation acquires a reactive character. This happens if there are mechanical injuries - joint injuries, intra-articular fractures, meniscus lesions, when the synovial membrane of the knee joint, ligament ruptures and many more causes. In the same way, aseptic synovitis occurs with irritation of the free joints, as well as structures that were previously damaged - a severed meniscus, damaged cartilage and the like. Other causes of aseptic synovitis may include endocrine diseases, hemophilia and impaired metabolism. When a person with an allergen comes in contact, an allergic synovitis occurs. Treatment of the synovial membrane in this case is assumed after excluding the allergen effect on the patient's body.
In nonspecific acute serous synovitis, the synovial membrane is thickened, the joint is enlarged in volume. Its contours are smoothed out, even a bursting feeling appears. The pain syndrome is not very pronounced, or absent. However, the movements of the joint are limited, with palpation, there is a slight or moderate pain. An ailment is possible, the local and general temperature slightly increases. Palpation reveals fluctuation. The surgeon necessarily conducts the following tests: covers the fingers of both hands with the opposite parts of the joint and gently presses from either side. If the other hand feels a push, then the joint contains a liquid. The synovial membrane of the knee is examined by balloting the patella. When pressed, it is immersed as far as it will go into the bone, then, when the pressure is stopped, it seems to float up. In contrast to purulent acute synovitis, there are no vivid clinical manifestations.
A synovitis acute purulent is always visible, as the patient's condition deteriorates sharply, there are signs of intoxication: a sharp chill, weakness, fever, maybe even nonsense. Pain syndrome is pronounced, the joint with edema in the volume is greatly increased, with hyperemic skin above it. All movements are extremely painful, in some cases joint contracture develops, and regional lymphadenitis is possible( nearby lymph nodes increase).Chronic synovitis may be serous, but the form is most often mixed: vizno-hemorrhagic, serous fibrinous and the like. In these cases, the clinical symptomatology is meager, especially at the earliest stages: aching pains, the joint quickly becomes tired. In chronic and acute aseptic synovitis, effusion can be infected, after which a much more serious infectious synovitis develops. That is why the study of RNA and synovial membrane is so important.
Infectious processes can spread far beyond the joint and its membranes, passing to the fibrous membrane, which leads to the onset of purulent arthritis. The mobility of joints is provided precisely by the state of the synovial membrane and ribonucleic acid, which realizes genetic information about a person. The process extends further: on surrounding soft tissues develop phlegmon or periarthritis. The severest complication of infectious synovitis is panartrite, when the purulent process covers all the structures that participate in the formation of the joint-all bones, ligaments and cartilages. There are cases in which the result of such a purulent process becomes sepsis. If a chronic aseptic synovitis exists in the joint structure for a long time, many unpleasant complications appear.
The joint gradually, but constantly, increases its volume, because the excess fluid fluid synovial joint of the hip joint, knee or shoulder does not have time to suck back. If there is no treatment for such chronic diseases, it is quite possible to develop a dropsy of the joint( hydratrosis).And if the dropsy is in the joint for a long time, the joint becomes loose, the ligaments cease to fulfill their function, because they are weakened. In these cases, not only does the subluxation of the joint occur, but also a full-fledged dislocation.
After the analysis of the clinical signs that are obtained after the studies and diagnostic puncture, a diagnosis is made. In this case, not only the presence of synovitis is confirmed, but the reasons for its appearance should be revealed, and this is a much more difficult task. To clarify the diagnosis of the underlying disease with a chronic and acute synovitis, arthropneumography and arthroscopy are prescribed. Biopsy and cytology may also be required. If there is a suspicion of hemophilia, metabolic disorders or endocrine disorders, appropriate assays should be prescribed. If the allergic nature of the inflammation of the synovial membrane is suspected, allergic tests should be performed. The most informative is the study of fluid obtained using a diagnostic puncture - punctate. In acute aseptic form of synovitis, acquired as a result of trauma, the study will show a large amount of protein, which is evidence of high permeability of blood vessels.
Reducing the total amount of hyaluronic acid reduces the viscosity of the effusion, which characterizes the lack of a normal state of the synovial fluid. Chronic inflammatory processes reveal increased activity of hyaluronidases, chondripterins, lysozyme and other enzymes, in this case disorganization and accelerated destruction of cartilage begins. If pus is found in the synovial fluid, this indicates a purulent synovitis process that must be examined with a bacterioscopic or bacteriological method that will allow the establishment of a specific type of pathogenic microorganism that caused inflammation and then select the most effective antibiotics. A blood test is mandatory, in order to detect an increase in ESR, as well as an increase in the number of leukocytes and stab neutrophils. If sepsis is suspected, additional seeding on the sterility of the blood is needed.
Patient needs rest, maximum limitation of movements of the affected joint, especially during exacerbation. External and internal anti-inflammatory drugs are prescribed - "Nimesil", "Voltaren" and the like. If the synovitis is pronounced, injections are given, then they turn into tablet forms of treatment. If there are significant fluid accumulations in the joint, a puncture is indicated, which besides the diagnostic has a therapeutic value. Diagnosis is as follows: differentiates purulent arthritis and hemarthrosis( blood in the joint cavity), cytological examination( especially with crystalline arthritis) of the joint fluid is performed. During puncture, a yellowish liquid is produced in a rather large amount( especially with inflammation of the synovial membrane of the knee joint - more than one hundred milligrams).After removing the fluid with the same needle, anti-inflammatory drugs, kenalog or diprospan, are administered.
If the cause of the disease is established and the amount of fluid in the joint is insignificant, the patient will have to be treated on an outpatient basis. If the inflammation of the synovial membrane has occurred as a result of trauma, the patient is sent to the emergency room. Symptomatic synovitis of the secondary plan should be treated by specialized specialists - endocrinologists, hematologists and so on. If the amount of effusion is high and the disease is acute, this is an indication for hospitalization. Patients with traumatic synovitis are treated in the department of traumatology, with purulent synovitis - in surgery and so on - according to the profile of the underlying disease. Aseptic synovitis with a small amount of effusion suggests a tight bandage on the joint, elevated position and immobilization of the entire limb. Patients are referred to UHF, UV irradiation, electrophoresis with novocaine. A large amount of fluid in the joint involves therapeutic punctures, electrophoresis with hyaluronidase, potassium iodide and phonophoresis with hydrocortisone.
Therapy and surgery
Acute purulent synovitis requires mandatory immobilization when the limb is elevated. If the course of the disease is not severe, pus is removed from the joint cavity by means of a puncture. If a purulent process of medium gravity occurs, continuous and long-term flow-aspirating washing with an antibiotic solution of the entire joint cavity is required. If the disease is severe, the joint cavity is opened and drained. Chronic aseptic synovitis is treated by therapy of the underlying disease, tactically the treatment is established individually, with due consideration of the severity of the disease, absence or presence of secondary changes in the synovium and joint, punctures are performed and rest is provided.
The prescriptions contain anti-inflammatory drugs, glucocorticoids, salicylates, chymotrypsin and cartilage extract. After three or four days the patient is sent to paraffin, ozocerite, magnetotherapy, UHF, phonophoresis or other procedures of the physiotherapy plan. If there is significant infiltration and frequent recurrences, aprotinin is injected into the joint cavity. Chronic synovitis with irreversible changes in the synovium, persistently recurring forms of it require surgical intervention - complete or partial excision of the synovial membrane. The postoperative period is devoted to restorative therapy, which includes immobilization, anti-inflammatory drugs, antibiotics and physiotherapy.
The prognosis is usually favorable for allergic and aseptic synovitis. If the therapy is carried out adequately, all inflammatory phenomena are eliminated almost completely, the effusion disappears in the joint, and the patient can now move in any volume. If the form of the disease is purulent, complications often develop, contractures are formed. There can be a danger even the life of the patient. Chronic aseptic synovitis is often accompanied by stiffness, and in a number of cases, relapses occur, contractures develop after synovectomy. It should be noted that synovitis almost always accompanies any chronic diseases in the joints, and therefore relapses are possible.
To reduce the inflammatory process that occurs in the synovial membrane, a course of anti-inflammatory injections, as well as the introduction of glucocorticosteroids into the damaged joint, if there are no congenital pathologies of the joint( sometimes with pathological changes, diagnostic arthroscopy and appropriate treatment).So the pain is removed, and the joint gradually begins to work better. The main thing is the elimination of the main cause of synovitis, and if then to remove the affected part of the synovial membrane, this necessarily leads to a positive result. The prognosis is not bad for the consequences of surgical intervention.
There are often enough situations of full recovery with restoration of joint mobility. Loss of function occurs only in severe forms of purulent varieties of synovitis, and these cases sometimes lead to the patient's death from infection of blood. This disease should not be treated carelessly. Children usually get sick for a week or two, everything ends without any dangerous consequences. In adults - differently, because most often the origin of the disease is not traumatic. On self-healing, hope is in no case impossible, because there may be sepsis and death.
In order for this disease to pass by, it is always timely to treat all infectious diseases, and exercise is moderate. As soon as you feel discomfort, immediately give joints rest, if discomfort does not stop - go to the doctor. Launched forms lead to the need for prompt intervention, although such incidents of disability are not too frequent.