Nonspecific Infectious Polyarthritis
(Internal Disease - Collagen)
Etiology and pathogenesis are not sufficiently clear. It is assumed that this common infectious-allergic disease associated with the presence in the body the focus of chronic infection (chronic tonsillitis, otitis, cholecystitis, etc.). Continuous flow in the blood of toxins from the infection focus leads to a change in immunological reactivity and the development of allergy. In the process of disorganization of connective tissue (mainly tissue of the joints), released a number of substances purchased properties autoantigens, against which antibodies are formed and the whole process takes autoimmune in nature, manifested by persistent, progressive course. In the blood of patients with infectious arthritis, there is a special macro globulin (rheumatoid factor), reinforcing agglutination, quite specific for this disease.
Symptoms and flow. The clinic is characterized by an unusually persistent and progressive chronic polyarthritis with a pronounced tendency to exacerbations. Are affected primarily the small joints of hands and feet (mostly middle interphalangeal), then the knees, wrist and all the other joints. Disease is often preceded by angina, influenza, cooling. The disease onset may be acute, the type of acute rheumatoid arthritis, but more often the disease begins and flows with subacute subfebrile temperature and low inflammation in the joints in the form of swelling, flushing and increased skin temperature, effusion into the cavity of the joint, pain on palpation of joints and movements . Later in the joints gradually develop proliferative effects, tissue of the joints are sealed, there are resistant strains due to the development of contractures, bursitis and subluxations of the joints. Function of the joints progressively worse until the complete ankylosis. At the same time near the affected joints develop pronounced muscle atrophy, trophic skin changes (thinning of the dryness), and nails. Under the skin of the forearm near the elbow sometimes form characteristic dense, painless education about the size of a pea (rheumatoid nodules).
On chest radiographs in the first (early) stages of osteoporosis epiphyses of bones found in the second - narrowing of the gap and the glenoid articular surfaces Uzury single in the third - Multiple Uzury, sometimes destroying the heads of bone subluxation, and the fourth (terminal) stage - the bone ankylosis. The edges of articular surfaces can be observed small Exostoses - the phenomenon of secondary osteoarthritis. In addition to joint damage, with Infectious arthritis may extraarticular lesions, most often in the form of Adenopathy, a small increase in the liver and spleen. There may also be observed pleurisy (pericarditis, peritonitis), generalized vasculitis (petechial rash, ecchymosis, bleeding), lung (focal or chronic interstitial pneumonia), heart (myocardial dystrophy, cardio with prolonged sluggish flow, sometimes with the formation of heart disease - lack mitral valve), the nervous system (from functional disorders to severe polyneuritis). Most importantly, renal damage type or focal nephritis, or, more often, the development of amyloidosis with renal failure and uremia, which is one of the causes of death in these patients.
The most difficult proceeds articular-visceral form with septic flow, which is based on generalized vasculitis. However, except for arthritis and multiple lesions of internal organs, there is a fever hectic type, a stunning chill and pouring sweat. The disease in this form of rapidly progressive and can result in the death of the patient within 1-2 years.
Combined form, when the disease takes place against a background of primary osteoarthritis, the most favorable. Characterized by small inflammation, slow progression and not sharp restriction of the joints. Infectious arthritis can also develop in patients with rheumatic diseases.
One of the clinical variants of the flow Infectious arthritis with the localization process in the small joints of the spine is Bechterew’s disease (ankylosing spondylitis, spondyloarthritis). Ill usually young men, and the process begins with the defeat of the sacroiliac joints and then spreads to the spine, hip and shoulder joints. Peripheral joints, which develop inflammation typical Infectious arthritis with outcome in ankylosis, are affected less frequently (in 20 - 25% of cases). Bechterew’s disease is manifested clinically severe pain and restriction of movements in the spine, the development of kyphosis, reduced lumbar lordosis, sciatica secondary phenomenon due to compression of nerve roots and, finally, complete immobility of the spine, and sometimes the large joints.
At first radiograph revealed changes in the sacroiliac joint, narrowing, and then the complete closure of the articular gap, more symmetrical ossification of longitudinal ligament of the spine and signs of ankylosis in the vertebral-rib joints. When ossification of ligaments and vertebral bodies, spinal fusion takes the form of a bamboo stick.
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