The knee joint, like the hip joint, is the largest and most significant functional anatomical junction. The same joint is also the most vulnerable. The impact of various negative external and internal factors often leads to the fact that in the knee joint often develops a local inflammatory process - arthritis of the knee joint.
The second name for arthritis of the knee joint is gonarthritis( other Greek gonocoel, arthra joint, it - inflammation), or, simply, drives. In clinical practice, several dozen types of knee arthritis are isolated. All of them differ from each other for reasons, mechanism of development( pathogenesis) and clinical picture. By the mechanism of development, arthritis of the knee is divided into primary, when inflammation is caused by the disease of the joint itself, and secondary, when the negative changes in the joint go as a complication of other diseases. Although this classification is very conventional. It should be noted that any external influence or pathological shift in the body can lead to the development of arthritis of the knee joint.
Knee arthritis can be the result of the following diseases:
Symptoms of knee arthrosis
- Injuries. Bruises, crushing, tearing of the knee capsule and hemorrhages in the cavity of the knee joint necessarily lead to inflammation - posttraumatic arthritis develops.
- Infections. Here the mechanism can be different. Infections can penetrate into the joint from an open wound with trauma, be carried by a blood stream from the septic, tuberculosis foci, their genitourinary tract with gonorrhea.
- Reactive mechanisms. The reactive gonarthritis can also be called infectious to some extent. After all, it develops after the transferred urino-genital and intestinal infections. True, the microbes themselves are not found in the joint. Apparently, the basis of this arthritis is played by pathological perverse immune reactions, as in rheumatic diseases.
- Rheumatic diseases. As a rule, these are rheumatism and rheumatoid arthritis, the most common causes of gonarthritis. These diseases are characterized by a diffuse lesion of connective tissue in all anatomical structures, including in the knee joint. It should be noted that rheumatism often affects large joints, incl.and knees, while rheumatoid arthritis is characterized by a predominant lesion of small joints. Although rheumatoid arthritis of the knee joint is also a common phenomenon in patients suffering from this disease.
- Tumors. Tumor process in the knee is always accompanied by inflammation. Moreover, knee tumors can be both primary and metastatic, when atypical cells are entered into the knee with a current of blood and lymph from other foci.
- Gout. Inflammation of the joint capsule is due to the local accumulation of uric acid crystals.
- Psoriasis. The mechanisms of development of gonarthritis in this disease are not fully understood.
As can be seen from all of the above, the causes of arthritis of the knee joint are manifold. And for each of these reasons, there is a mechanism for the development of the disease.
To know how arthritis of the knee occurs, the anatomical structure of the knee joint needs to be clarified a little. This joint is formed by three bones - the femoral, tibial, and patella. Joint bony surfaces are covered with cartilage, additionally stabilized by ligaments and menisci.
All these structures are enclosed in an articular fibrous capsule. Inside the capsule is covered with a synovial membrane that secretes the synovial fluid. Normally, the amount of synovial fluid serving as a lubricant and nutrient medium for articular cartilage is small - no more than 2 ml. Under the influence of the above negative factors, the synovial membrane becomes inflamed, and the amount of the joint fluid increases several fold.
This is the essence of gonarthrosis. The inflammatory fluid itself is called exudate. Sometimes the exudate can be with an admixture of blood( with trauma) or pus. Purulent arthritis is the result of infected lesions or sepsis.
The main symptoms of knee arthritis:
- Pain. The nature of the pain can be different - sharp, aching, searing. The reasons for which the knee hurts, too, are different - this is the mechanical factor in injuries, and the expansion of the capsule with accumulated exudate, and the direct exposure of microbial toxins to the sensitive nerve receptors of articular cartilage.
- Swelling of the soft tissues of the joint. Local inflammatory reactions cause the permeability of the blood capillaries to increase. As a result, the liquid part of the blood, plasma, partially exits into the surrounding tissue, there is swelling.
- Redness of the skin - the mechanism is the same. Under the influence of the inflammatory process, the dermal capillaries expand in the projection of the knee joint, redness occurs.
- Local temperature increase - the mechanism is the same.
- Violation of the configuration of the joint. In part, this is manifested by an increase in the volume of the knee due to accumulated exudate. In the late stages of gonarthritis, irreversible structural changes occur in the knee joint - arthrosis of the knee or gonarthrosis is formed.
- Movement disorders. Restriction of the volume of movements is due to pain and arthrosis changes. Chronic arthritis and subsequent gonarthrosis lead to a fixed fusion of the joint surfaces. Complete immobility - ankylosis of the knee develops.
- Ballooning of the patella. Immersion of the patella when pressing on it in the joint cavity, overflowing with exudate.
Spread of edema from the knee joint to nearby areas of the thigh and lower leg.
All these signs are not uniformly expressed in different types of arthritis. Acute arthritis in infections and injuries occurs with more severe symptoms. With chronic arthritis, the clinical picture is worn out. Especially severe rheumatic or infectious arthritis in children.
Along with the above-described changes, extra-articular manifestations appear in the first place in small patients - nausea, vomiting due to inflammatory intoxication, severe fever, confusion.
Gonarthrit in children and adults can be paired and unpaired, it is sometimes accompanied by inflammatory lesions of other large and small joints. Such multiple articular inflammation of 2 or more joints is termed polyarthritis.
Treatment of arthritis of the knee joint should begin with the provision of a protective regime. This mode assumes the maximum exclusion of loads on the diseased joint. Movements of the patient at the time of exacerbation should be minimized. In this case, you should use a cane, crutches or special walkers. The knee itself is immobilized( immobilized) with the help of special removable orthopedic devices - orthoses.
Accumulated exudate must be removed, otherwise further treatment loses all meaning. For this purpose, articular punctures are indicated - injections, in which syringe is used to evacuate the accumulated fluid and pus. The field of this into the joint cavity makes injections with antibiotics( Amicil, Streptomycin) and steroid hormones( Diprospan, Hydrocortisone).These drugs, steroid hormones, have a powerful anti-inflammatory effect.
The knee brace immobilizes the joint and prevents the spread of soft tissue edema.
Further medical treatment of arthritis of the knee joint is performed using non-steroidal anti-inflammatory drugs( NSAIDs).Representatives of this group are Diclofenac, Orthophene, Atstilsalicylic acid, Piroxicam. NSAIDs with knee arthritis should be taken in a complex way - pills and intramuscular injections are needed. And for local use, ointments and gels with Indomethacin, Ibuprofen Voltaren are shown.
Local irritating ointments( Apizartron, Finalgon) do not have high anti-inflammatory activity, but they improve local blood circulation, cause resorption of inflammatory foci, and therefore can be used together with NSAIDs. In the recovery period, general restorative medications( Pentoxil, Tactivine), vitamins, chondroprotectors( chondroitin complex, chondroxide) are prescribed.
After relieving the exacerbation, exercise therapy is performed( LFK).The goal of sports wellness treatment is to strengthen the muscles of the thigh and lower leg, expand the volume of movements in the knee joint. Exercises with gonarthritis should be as gentle as possible. Therefore, they are performed in the supine position on the back with arms and legs extended along the body.
The first stage - sipping, during which all joints, including knees, are straightened. Then alternate stretching of socks on the inspiration and heels on exhalation. Then they proceed to more complex elements, including the "butterfly"( raising the legs in the knees with closed feet), the "bicycle"( the rotation of the legs bent in the knee and hip joints), the "bridge"( lifting the trunk with support to the back of the head and heels).
Treatment of gonarthritis with folk remedies is carried out mainly locally - with the help of flour, homemade ointments and medicinal mixtures. One of these mixtures is 350 ml of vinegar, 50 g of ginger, half a kilogram of melted pork fat, 4 eggs. All this is mixed, infused for 3 days, and superimposed on the joint.
Another effective mixture - a third of st.spoons of juice are rare, 1.5 tablespoons.spoons of honey and 1 tbsp spoon of alcohol. This mixture can be used immediately after its preparation. It should be noted that traditional treatment for most gonarthrites is not self-sufficient, and can only be used as a supplement to pharmaceutical preparations.
When gonarthritis should be observed diet. After all, the proper intake of food is also a kind of treatment. In this regard, all high-calorie foods( flour products, animal fats), as well as salty, spicy dishes, alcoholic beverages, should be excluded. In the diet should be fresh vegetables, low-fat meat, fish and seafood.
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