POLYARTHRITIS

From Big Medical Encyclopedia

POLYARTHRITIS (polyarthritis; grech, poly is a lot of + arthron a joint + - itis) — a simultaneous or consecutive inflammation of several joints. Items with damage of 2 — 3 joints call an oligoarthritis.

The item can be observed at many diseases: infectious diseases (gonorrhea, yersinioza, dysentery, erizipeloida, viral hepatitis, rubella, etc.), disturbances of exchange (gout, ochronosis, hemochromatosis), diseases of blood, tumoral processes, rheumatism and close diseases, system vasculites, serum disease, nek-ry hron, diseases of intestines (disease Krone, nonspecific ulcer colitis), etc. In the majority of these cases of P. has acute or subacute character and it is, as a rule, completely reversible. The firm chronic P. which is quite often leading to gradual development of deformations of joints is the basic a wedge, manifestation pseudorheumatism (see), Bekhterev's diseases (see. Bekhtereva disease ), psoriasis polyarthritis (see. Arthritises ), diseases of Reuters (see. Reuters disease ).

In emergence Items major importance have infections, disturbances of immunity and genetic predisposition. So, it is established that the so-called reactive P. developing at a number of intestinal infections (a yersinioza, dysentery, salmonellosis, and also, perhaps, at a brucellosis), is observed by hl. obr. at the persons having certain genetic features of immune system — in the presence of histocompatibility antigens (HLA B27) (see. Immunity transplant, histocompatibility antigens ). This antigen considerably more often than in population, it is found also at Bekhterev's disease, a disease of Reuters and psoriasis polyarthritis. At children's age most often infections (preferential virus), sepsis, rheumatism, allergic reactions to pharmaceuticals, vaccines and serums, and also a juvenile pseudorheumatism are P.'s reasons.

Many links of a pathogeny at various P. are identical. These are processes of formation of cell-bound immune complexes, activation of system of a complement, kinin system, prostaglandins, enzymes of lysosomes, factors of coagulation and a fibrinolysis, phagocytosis and many other provos-palitelny factors. There are left not clear bonds between separate links in specific cases of P., the reasons leading to bystry stopping of an inflammation (even without treatment) and vice versa — to transition of process in hron, a form.

Clinical signs The item — pain, a swelling of joints, temperature increase in the affected joints, sometimes a dermahemia over them and feeling of constraint. Dysfunctions of joints at different diseases externally are in many respects similar.

Are important for early diagnosis attentive assessment of details a wedge, manifestations and the subsequent purposeful additional inspection of the patient. Have essential value: localization of process, symmetry or asymmetry of damage of joints, firmness or a volatility of an inflammation, existence or lack of signs of an inflammation of sacroiliac joints (see. Sacroileitis ), existence of extraarticular manifestations, typical for these or those diseases, which can proceed is hidden or in the erased form; specification of communication of P. with the nature of the previous infections (the epidemiological anamnesis, bakterio-and virologic researches). Some datas of laboratory have Differentsialnodiagnostichesky value: definition rhematoid factor (see), HLA B27, LE cells and antibodies to native DNA, antinuclear factors, uric to - you, antibodies to streptolysin-0, etc., and also a research synovial fluid (see). In some cases P.'s diagnosis is established on the basis of studying of a bioptat of a synovial membrane of a joint.

P.'s features at various diseases — see. Arthritises , Joints , and also relevant articles, e.g. Brucellosis , Infectious and allergic polyarthritis , Rheumatism .

The nature of treatment of P. depends on its nosological accessory. Regardless of P.'s etiology widely use various non-steroidal anti-inflammatory drugs. Corticosteroid drugs are used extremely carefully, especially at chronic Items. In some cases appoint quinolinic derivatives, salts of gold, D-Penicillaminum, immunodepressants, immunostimulators, apply various physiotherapeutic, balneological and operational methods of treatment.

Forecast in many respects depends on character of a course of the basic process which led to emergence of the Item. At a pseudorheumatism, psoriasis P. and other chronic P. damage of joints quite often results in disability.



Bibliography: Nesterov A. I. and Astapenko M. G. About classification of diseases of joints, Vopr, revm., No. 3, page 47, 1971; The Reference book on rheumatology, under the editorship of V. A. Nasonova, M., 1978; Katz W. A. Rheumatic diseases, Philadelphia — Toronto, 1977; R at with k e-waert A. Os et articulations, P., 1971.

See also bibliogr, to St. Arthritises , Bekhtereva disease , Collagenoses , Pseudorheumatism , Joints .


M. M. Brzhezovsky.

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