INFECTIOUS AND ALLERGIC POLYARTHRITIS (polyarthritis infectiosoallergica; late lat. infectio infection; grech, alios of another, other + ergon action; polyarthritis) — the recurrent high-quality synovitis connected generally with a focal streptococcal infection and which is characterized by full reversibility of process.
Still S. P. Botkin spoke about expediency of allocation of a recurrent form of the acute damage of joints which is not followed by neither their permanent deformations, nor formation of heart diseases (1884).
In 1939 N. D. Strazhesko described the so-called focal rheumatism close to acute rheumatism, but not striking cardiovascular system. From 50th the described disease appears in literature as subacute joint rheumatism of adults [Ravol, Vinyon, Bertye (P. R a vault, G. Vignon, L. Berthier), 1950], anginous polyarthritis [F. Kost, Burel (M. of Bourel), 1956], secondary rheumatism or antistreptolizinovy type of polyarthritis [H. Tichy, 1960]. In English literature the similar disease is called benign polyarthritis. A. I. Nesterov (1962) suggested to call this form infectious and allergic polyarthritis.
In 1971. And. - and. the item as independent nozol, unit was carried to group of inflammatory arthritises. However it is frequent And. - and. the item can be only an initial symptom of rheumatism or a pseudorheumatism, making respectively 5 — 13 these % nozol, forms.
Etiology and pathogeny
Etiol, factors And. - and. items can be different microorganisms, however the leading role belongs to a streptococcal infection.
As the proof of participation of a streptococcal infection in development And. - and. items are provided the facts of communication of the beginning of a disease with earlier postponed quinsy or with an aggravation hron, tonsillitis, sinusitis, etc., and also permanent increase in antistreptococcal antibodies. It is supposed that the streptococcal infection with predisposition can lead to development of allergic reaction in a look synovitis (see).
The attention to adverse heredity is paid: in families of nearly 2/3 patients And. - and. the item rheumatism, bronchial asthma and other diseases of the allergic nature takes place.
Morfol. the picture is characterized by the expressed hypostasis of a synovial membrane, expansion of kapillyarnovenozny network, however without the expressed developments of stagnation and without transuding of plasma proteins. Productive capillarites can be observed. Macrophagic cellular reaction is recovered, but considerable lymphoid plazmotsitarnoy infiltration is not observed. Changes are limited to reaction of a microvascular bed. At a number of patients in the period of an aggravation of process changes in joint bags and circumarticular fabrics can be observed. Synovial fluid has light yellow color, low cellular structure, high viscosity, gives a good mutsinovy clot, i.e. practically almost does not differ from norm.
And. - and. items preferential are ill women. The beginning of a disease almost at all patients is the share of age up to 40 years, and at 3/4 of them — up to 30 years.
First symptoms And. - and. items most often arise in 7 — 14 days after an aggravation of the center of a streptococcal infection, however shortening of this interval to 5 — 7 days or development of arthritis is quite often noted during a streptococcal infection. The disease usually begins sharply, less often subacutely. There are joint pains which are often amplifying at the movement, their swelling. Involvement in process of several joints, both large, and small, quite often happens at the same time. In the expressed cases in joints also temperature increase of skin, its reddening can be observed. The movements of joints are limited because of a pain syndrome, is more rare owing to exudative changes in joints.
Changes in joints pass completely through 4 — 6 weeks from an initiation of treatment, and their function is completely recovered. In some cases later a nek-swarm time (from 2 months to several years) palindromias, sometimes very frequent which also come to an end full a wedge, recovery without the residual phenomena from joints are observed. Heart and other internals remain intact.
Laboratory indicators of peripheral blood (acceleration of ROE, a leukocytosis), and also immunol, and biochemical, tests (ASL-O, of ASG, DFA, seromucoids, protein fractions of blood) considerably deviate norm only at acute option of a disease. Under the influence of treatment they during 1 — 2 week are normalized. During remission all reactions to existence of inflammatory process are negative.
the Diagnosis presents serious difficulties and is established taking into account a wedge, pictures and datas of laboratory. Roentgenograms of joints without patol, changes, sometimes it is possible to find expansion of joint cracks because of a considerable exudate in a joint. An ECG and FKG without visible changes. And. - and. the item should be differentiated first of all with rheumatic polyarthritis (see. Rheumatism ) and initial stages pseudorheumatism (see). Simultaneous damage of several joints against the background of an infection or after it, lack of «volatility», a little bigger persistence during, the relative duration of a joint syndrome, an intaktnost of heart, smaller effect of salicylates and simultaneous disappearance of changes from joints distinguish And. - and. the item from rheumatic. Important differential and diagnostic criterion is absence at And. - and. the item of signs of a carditis and development of heart diseases even after several postponed attacks. Unlike a pseudorheumatism, And. - and. the item has a high-quality current, despite a frequent recurrence, always comes to an end with a complete recovery of outward and function of the affected joints. At And. - and. the item does not happen rentgenol. the changes so characteristic of a pseudorheumatism though at early stages of a pseudorheumatism they can be also absent. In such cases only dynamic observation allows to establish the diagnosis correctly. The test for a rhematoid factor at patients And. - and. the item always happens negative (see. Rhematoid factor ).
Certain difficulties can arise at differentiation And. - and. the item with allergic arthritises at various infections and with specific arthritises. However in these cases signs of a basic disease are found.
Treatment of the acute period of a disease consists in impact on the centers hron, infections and elimination of a sensitization of an organism. Apply antibiotics from group of penicillin to fight against focal infection and erythromycin; with intolerance of antibiotics it is possible to use streptocides.
Antimicrobic therapy is carried out under cover of the desensibilizing means. Therapy by salicylates is pathogenetic. It is recommended acetilsalicylic to - that, in the presence at the patient of hypersensitivity to it — pyrazolon derivatives. In certain cases at acute option of a course of a disease the intensive course of treatment is conducted by Prednisolonum. Use of quinolinic drugs for the purpose of prevention of development of a pseudorheumatism is recommended also long, till 1 year.
Full sanitation of the centers of an infection is necessary for prevention of the repeated attacks.
From the very beginning of a disease it is recommended sparing to lay down. gymnastics and physical therapy — Ural federal district the affected joints. After elimination of exudative changes in joints thermal procedures — a diathermy, an inductothermy and paraffin are recommended; it is shown a dignity. - hens. treatment in resorts with hydrosulphuric, radonic or salty bathtubs.
And. - and. the item is completely curable.
Prevention includes dispensary observation for the patients who transferred And. - and. the item, within 2 — 3 years after the last exacerbation of a disease, sanitation of the centers hron, infections; during the autumn and spring periods — performing antirecurrent treatment by Bicillinum and pangamaty calcium on 100 mg a day for 20 — 40 days.
Infectious and allergic polyarthritis at children's age
Infectious and allergic polyarthritis at children's age makes 6,1% of all diseases of joints at children. Meets more often at children of school age. The beginning of a disease in most cases happens acute. Arthritis develops against the background of or soon after quinsy or an acute respiratory disease. In patol, process also average are most often involved small, large joints are more rare. Patol, process usually develops in one or two joints, is more rare in three. The swelling of the affected joint often happens clear, pains quite often weak and most often do not lead to noticeable dysfunction of the affected joints. At most of patients body temperature is increased. Signs of a carditis are absent. Under the influence of treatment positive dynamics a wedge, symptoms of a disease is noted.
The principles of treatment, the forecast and prevention same, as well as at adults.
Bibliography: Dolgopolova A. V., Melikhov N. I. and Kuzmina N. N. Clinical displays of infektsionnoallergichesky polyarthritis at children's age, Vopr, revm., No. 1, page 35, 1970; Isakovi.I.izabolotnykhi. Infectious and allergic polyarthritis, L., 1973, bibliogr.; The M e l and x about in and N. I. and Kuzmin H. H. About infektsionnoallergichesky polyarthritis at children's age, in book: Rheumatism at children, under the editorship of A. V. Dolgopolova, century 2, page 148, M., 1970; Nesterov A. I. About special clinical option of infectious and allergic polyarthritis, Vopr, revm., No. 3, page 3, 1965; Nesterov A. I. and Astapenko M. G. About classification of diseases of joints, in the same place, No. 3, page 47, 1971; Arthritis and allied conditions, ed. by J. L. Hollander, p. 218, Philadelphia, 1974; In about at 1 e J. A. a. B u with h a n a n W.W. Clinical rheumatology, Oxford — Philadelphia, 1971; Jaffe H. L. Metabolic, degenerative, and inflammatory diseases of bones and joints, Philadelphia, 1972; TichyH. u. Seifert H. Neue Ergeb-nisse serologischer Untersuchungen in der Rheumatologie, B., 1963.
A. A. Matulis, G. P. Kurtinite, Ya. P. Yushenayte.