Of the variety of joint damage, the most common doctors consider reactive arthritis of the knee joint. Both adults and children may need treatment for this disease, although more often they are affected by young men aged 20-35.
The development of reactive arthritis is caused by various bacteria, primarily chlamydia and gonococcus. However, in addition to the urogenital etiology of the disease, there is also enterobacterial, in which the appearance of arthritis is provoked by various intestinal infections, and then the pathology affects both men and women equally. Some doctors place in a separate group of patients in whom reactive arthritis is provoked by respiratory diseases. However, infectious bronchitis, tracheitis, pneumonia are usually provoked by chlamydia and mycoplasmas. Such cases are much less common than arthritis of urogenital or intestinal origin. Therefore, not all doctors agree with the selection of the third group.
Reactive arthritis of the knee joint develops due to the presence of bacteria in the body, but the pathogens are not the causative agents of the disease, but the immune complexes present in the bloodstream. The real cause of the onset of the disease is a violation and weakening of the immune system. According to the latest data, the risk of developing this type of arthritis strongly depends on heredity: in carriers of the HLA-B27 gene it is 50 times higher than in all other people.
Reactive arthritis of the knee joint can develop in parallel with the course of the infectious disease that caused it. However, more often it manifests itself 3-4 weeks after the disease. Arthritis is manifested by the following symptoms:
- local rise in temperature (region of the joint affected by the disease);
- swelling of the affected joints; in some cases, swelling quickly spreads even to nearby tissues;
- pain syndrome. It is observed in the active phase of existence, amplified by the movements of the affected limb, calming down at rest. The patient also experiences pain when feeling the knee;
- constrained limited mobility. Often reactive arthritis of the knee joint is accompanied by progressive lameness;
- inflammation of the eyes. It is noted in approximately seventy percent of patients with a similar diagnosis. Most often manifested by conjunctivitis, although there are more complicated cases from the point of view of an ophthalmologist – keratitis or ulceration of the cornea;
- skin lesions – from urticaria to psoriasis rashes. Mucous membranes may be affected; most often, patients are diagnosed with stomatitis.
Among the additional symptoms, we note a decrease in working capacity and rapid fatigue of patients. Many patients at an early stage of reactive arthritis lose weight dramatically, unnaturally quickly losing weight. In patients with systemic diseases of the heart or kidneys, exacerbations are observed. In some cases, tachycardia is provoked by arthritis in people who have not previously been registered with a cardiologist.
With urogenital infection, reactive arthritis of the knee joint is almost always accompanied by symptoms of the genitourinary system. In men, they are expressed by burning, problems with urination (soreness, difficulty, outflow from the channel of the mucous masses, frequent ineffective urges), urethritis. The inflammatory process in the prostate may begin; less often, inflammation also captures testicles – the development of orchitis begins.
In women, reactive arthritis of the knee joint is manifested by vaginitis and / or inflammation of any pelvic organs. Patients feel constant discomfort in the genitals, accompanied by bloody discharge. If a woman continues to lead an intimate life without barrier protection, the probability of an ectopic pregnancy with the subsequent development of infertility is high.
Symptoms of the disease can also include fever with chills and a serious increase in overall body temperature. True, this manifestation of the onset of the disease is most characteristic of children.
The disease can affect not only the knee joints: arthritis also affects the ankle or metatarsophalangeal joint, often pathology affects the spinal column.
If there is a suspicion of reactive arthritis of the knee, the examination by a doctor should be performed in a comprehensive and diverse manner:
- blood test: general, biochemical, analysis of antigens and antibodies, other options;
- urinalysis: usually quite common;
- fecal analysis – is carried out to detect possible pathogenic flora;
- analysis of smears taken from the genitals. Since reactive arthritis of the knee joint with the vast majority of episodes is caused by sexually transmitted diseases, the study of the biomaterial taken is carried out primarily: it allows you to quickly identify the causative agents of the corresponding infection;
- sigmoidoscopy and fibrocolonoscopy (examination of the rectum and colon).
- analysis of immune enzymes;
- tomography – computed or magnetic resonance;
Radiography indications for the disease are uninformative, but a patient with a suspicion of this diagnosis is still referred to the image: it allows you to identify additional pathologies in the joint. Arthroscopy or joint puncture are rarely done.
The list of specialists whose examination is necessary for pathology is also quite long: the patient needs a consultation from a rheumatologist who will accurately establish the nature of the pathology (many symptoms of the reactive and rheumatoid varieties coincide). After determining the type of pathogen, a visit to a venereologist, gastroenterologist, otolaryngologist or urologist will be required to prescribe a course of treatment for the infection. If the pathology of the knee joint provoked inflammation of the eyes, an ophthalmologist will need to be examined, who will determine the degree and nature of the lesion, and will recommend the right course of treatment. You may also need a dermatologist examination if the underlying disease is manifested by skin rashes.
Under any circumstances, the patient is advised to consult a cardiologist, since heart ailments are a frequent complication of reactive arthritis.
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The primary task of the doctor is to destroy the infection that caused reactive arthritis of the knee joint. The treatment consists in taking antibiotics, and due to the fact that harmful microorganisms have an intracellular location, the course of drugs will be long. Initially, tetracycline group medicines are selected; if they are ineffective, drugs are selected from macrolides, aminoglycosides or other groups.
Since antibacterial drugs kill not only pathogens, but also bacteria necessary for the normal functioning of the internal organs, it is recommended to take probiotics at the same time as they restore the normal flora of the intestines and stomach.
Since the pathology is due to a malfunction in the immune system, the patient may be assigned its corrections (immunomodulators) or drugs that suppress an excessive response from the body’s defenses (immunosuppressors).
As with arthritis of any other nature, this type of disease is characterized by extensive inflammatory lesions. To stop the process and stop the inflammation, anti-inflammatory drugs of a non-steroidal nature are prescribed. Depending on the severity of the disease, medications can be taken orally or injected into the affected joint. In difficult cases, when these medications do not cope with their task, hormonal glucocorticosteroids, most often prednisolone, are prescribed to the patient.
If hormone therapy is also ineffective, a specialist doctor may prescribe a course of inhibitors of tumor necrosis factor. With the help of such drugs, you can even cope with the most resistant forms of the disease to other influences.
In parallel, therapy is carried out aimed at eliminating the negative reaction from other organs: the heart, kidneys, skin and eyes.
In some cases, reactive arthritis of the knee joint causes an inflammatory effusion – an accumulation of joint fluid inside the joint cavity. In this case, measures are taken to remove it: an evacuation drainage is installed, which drains the liquid out. In this case, there is a need for additional acceleration of the removal of inflammatory processes. The course of treatment includes external exposure to applications of ointments and creams with dimexide.
After the initial stabilization of the patient’s condition, medical methods are supplemented by physiotherapy. The most common and effective procedures:
- drug electrophoresis;
- paraffin therapy;
- mud treatment;
- sinusoidal modulating current therapy.
The acceleration of recovery, maintaining joint mobility is facilitated by a set of exercises in therapeutic gymnastics.
Reacted arthritis of the knee, diagnosed in a timely manner, can be cured in about eighty percent of patients; a third of these patients after six months of therapy completely get rid of the disease. A similar proportion of patients is forced to be constantly observed by a doctor, since patients suffer from relapses (although without the progression of the disease and complications). In the remaining 15%, the pathology takes a chronic form with a tendency to worsen.
Of all patients, only 5% suffer from a severe form of arthritis, leading to deformities with destruction of the joints.
After the end of the main treatment, the patient must observe a number of preventive rules:
- regularly, in accordance with the schedule drawn up by the doctor, undergo a medical examination, take prescribed tests;
- comply with the diet developed by doctors: affected joints need a diet with a special diet;
- keep track of your fitness. At least daily to do a gymnastic complex proposed by a specialist and aimed at maintaining maximum mobility of the patient articulation;
- carefully observe the rules of personal hygiene, avoid sexual intercourse with random people, so as not to be at risk of infection with urogenital diseases. With intimate contacts, the patient is obliged to use barrier means of protection;
- under the supervision of a physician, strengthen immunity in ways approved by him.
If a lesion is detected by various infections of the gastrointestinal tract or genitourinary system, in addition to examinations, a person who has undergone reactive arthritis of the knee joint should also apply for an examination of the limb. Even if he did not have a previous relapse of the disease, a new infection can provoke an exacerbation or transfer the disease to a chronic phase.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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