Knee Arthritis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Knee arthritis

Content:

• What is knee arthritis?
• Knee arthritis symptoms
• Stages of development of arthritis
• Arthritis causes
• How to treat arthritis

What is knee arthritis?

Any inflammatory process has a great potential danger. The worst threat is sepsis. It is generally accepted that inflammation arises only in soft tissues. This is a very erroneous opinion, since more and more often it affects the joints of the bones - the joints.

Knee arthritis is inflammation of the intra- and periarticular areas of one or both knees. Another name for pathology is drive or gonarthrosis (from the Greek gony - "knee").

The statistics on the incidence of arthritis of the knee joint is as follows: about half (35 to 52%) of people suffering from joint diseases suffer from knee arthritis. More than 30% in children. Moreover, in 23% of all cases, the cause is osteoarthritis. The majority of knee arthritis patients are women over 30. Although this is not always true for secondary pathologies. For example, gonorrheal arthritis is common in men.

A high percentage of the likelihood of developing knee arthritis is caused by high stress on the knees. Each of them can support half the weight of a human body, and because of the very limited range of motion in the knees, this load only increases. The feet are more mobile and complex for this.

Diagnosis of pathology is carried out using radiography, or rather, arthrography. With pseudogout, polarizing microscopy of synovial fluid obtained through puncture is additionally required. The microflora of punctate is used to test the effect of various drugs on infectious pathogens.

In rare cases, additional diagnostic tests are prescribed:

• magnetic resonance imaging;
• biopsy of the synovium and cartilage;
• thermography;
• tomography;
• arthropneumogram;
• tests of the Wright reaction and the Burne test;
• computed tomography - visualization of sequestered bone tissue. Sequestration - a dead area of bone tissue;
• Magnetic resonance imaging;
• ultrasound and radionuclide research.

All synovial tissues of the joint gradually become inflamed. The cruciate ligaments undergo gross changes. The cartilaginous cover is destroyed. Spongy tissue is exposed, in which osteomyelitis or osteitis develops ("inflammation of the bone"). The changes that occur are determined using an X-ray.

Pathological abnormalities over time cover more and more organs:

• bones;
• tendons;
• bursa;
• ligaments;
• cartilage;
• muscles;
• circulatory and lymphatic systems (lymphadenitis);
• various internal organs.

The consequences of gonitis can affect the functioning of many organs:

• other joints - gonarthrosis, capsulitis, spondylitis (inflammation of the spine), bursitis, empyema, flexion contracture in a bent position, osteochondritis - an inflammatory process in bone and cartilage tissue;
• eyes - keratitis, keratoconjunctivitis, uveitis;
• lungs - alveolitis, pneumonitis, interstitial fibrosis;
• heart - pericarditis, rheumatism, myocarditis;
• blood vessels - systemic vasculitis, septic shock, provoking multiple organ failure syndrome, Raynaud's syndrome, capillaritis;
• gastrointestinal tract - enterocolitis;
• kidneys - glomerulonephritis, amyloidosis.

The type of knee arthritis depends on the cause. For example, purulent or septic inflammation is provoked by pathogens that enter the joint cavity from the primary foci of infection with blood or lymph. If both knees are affected, then they speak of Clutton's joints.

There is no unified classification of arthritis of the knee joint for reasons of occurrence:

• infectious;
• reactive after suffering intestinal or urogenital infections;
• juvenile rheumatoid, in which the immune system destroys the cells of its own body, and rashes appear on the skin - rheumatic nodules at the knee and on the hand;
• allergic (more often in the form of polyarthritis);
• rheumatic (usually oligoarthritis);
• psoriatic;
• gouty;
• streptococcal;
• staphylococcal;
• tuberculous;
• gonorrheal;
• infectious and allergic;
• immunoallergic;
• post-traumatic;
• exchange;
• post-vaccination.

The given classification is very contradictory. The disease can be acute or chronic. Some doctors also call the subacute form of the disease.

Depending on the localization of knee arthritis, there are two types:

• capsular or synovial affects the synovium, usually occurs in an acute form, more often develops in children;
• bone or dry affects the bone-cartilaginous ends of the joint.

The more the disease progresses, the more it covers the area. Capsular knee arthritis (otherwise synovitis - synovitis genu) becomes bone arthritis and vice versa. Synovitis can be accompanied by the formation of rice bodies in the effusion. This increases the pain syndrome.

By the nature of the effusion, synovial arthritis is divided into:

• serous;
• serous-purulent;
• purulent.

By the presence of pathogens in the articular cavity, gonarthritis is divided into two types:

• septic;
• aseptic, when the joint fluid is sterile.

Preventive measures for arthritis of the knee joint are standard - it is a healthy lifestyle, as well as compliance with sanitary rules and regulations, safety during work. Particular care should be taken by those whose professional activity is associated with a long stay on their feet, as well as constant vibration.

The variety of clinical forms of gonarthritis is due to the extensive volume, the magnitude of the load and the complexity of the knee joint arrangement. The features of the course of the disease depend on age, constitution, reactions of the body and human tissues to various influences.

Knee arthritis symptoms

The following symptoms of the knee joint are distinguished:

• stiffness, stiffness of the knee joints due to severe swelling and accumulation of effusion when going up / down stairs, squatting, driving a car and any movements that involve the affected knee in any way, i.e. the volume of passive and active mobility is greatly reduced;
• pain in the anterior part of the knee, aggravated in positions with the greatest tension of the tendon (is "mechanical" in nature);
• heaviness in the leg;
• massive swelling of soft tissues - dropsy;
• accumulation of exudate in the articular cavity;
• stretching of the capsule and ligaments;
• hypertrophy of the synovial membrane with fungal form;
• redness and local increase in skin temperature within 5-7 cm;
• spindle-shaped view of a sore leg;
• proliferation of villi with infiltration, swelling and fibrous degeneration;
• a symptom of a ballot of the patella (ballot cup) - when the leg is straightened, it seems to plunge into the area of accumulation of exudate, when bent, it "pops up" again;
• Bonnet position of the joint (forced half-bent at a right angle due to muscle tension);
• fever, hectic nature of body temperature;
• chills;
• sweating;
• an increase in regional lymph nodes;
• general malaise, feeling of weakness;
• drowsiness;
• weakness, lethargy;
• decreased appetite;
• periarticular phlegmon in advanced cases (death is very likely);
• atrophy of adjacent muscles, for example, the quadriceps muscle of the thigh - a symptom of Aleksandrov;
• osteoporosis;
• bone destruction of the condyles, patella and tibia, serration, appearance of irregularly shaped focal patterns at the articular ends;
• rheumatic carditis;
• rheumatic chorea;
• rheumatic dense, painless sedentary nodules in the subcutaneous tissue, fascia, aponeuroses and bursa;
• abscesses - abscesses;
• fistulas;
• necrosis of soft tissues and cartilage;
• fibrosis due to connective tissue degeneration of the bursa;
• thickening and thickening of the periarticular tissues;
• filling the joint with scar tissue;
• erosion of articular surfaces;
• ankylosis due to soldering of the articular surfaces with connective tissue.

The listed pathological signs are blurred or pronounced. They are usually divided into local and extra-articular. The manifestation of the entire symptom complex is not necessary at once. It all depends on the type of disease and associated pathologies.

The patella or patella is a small bony “shield” that covers the top of the knee. It is linked to the thigh muscle and enhances its action. The patella is only part of the powerful stabilizing framework of the knee joint. It begins to bulge forward with excessive accumulation of effusion in the cavity of the diseased joint. In this case, the knees acquire a spherical shape. Condyles - semicircular protrusions of the thigh and lower leg.

The symptoms of knee arthritis are very similar to the symptoms of many bone diseases, as well as tumor-like neoplasms:

• fibrous osteodystrophy;
• giant cell osteoclastoma;
• sarcoma;
• pigmented villonodular synovitis;
• synovioma.

Laboratory and instrumental signs of knee arthritis include:

• an increase in ESR - erythrocyte sedimentation rate (or ROE - erythrocyte sedimentation reaction), the number of leukocytes (mainly polymorphonuclear cells), eosinophils and platelets in the general blood test;
• identification of C-reactive protein and seromucoids in a biochemical blood test;
• detection of HLA-27 antigen, β-2 and gamma globulins in blood serum;
• a sharp increase in the number of plasma cells in the synovial membrane;
• cartilage degeneration, narrowing of the joint space, gummy process in bones, erosion and nodes in bone tissue, osteophytes (injuring the synovial membrane), subchondral sclerosis (sclerotic rim around the tuberculous focus and sequestration inside it) on X-rays.

Stages of knee arthritis

There are 3 stages of the development of the disease:

1. First stage, initial. Pre-arthritic phase. It usually takes about 6 hours. The disease proceeds in a purely hyperemic form. The only symptom here is painful syndrome, i.e. arthralgia.

2. Second stage, early arthritis. The arthritic phase is the height of the disease.

   The signs of the second stage can appear cyclically:

   • cartilage tissue begins to harden;
   • the bone grows pathologically;
   • the synovial membrane becomes inflamed;
   • abscesses are formed;
   • the joint capsule thickens.

3. Stage three, advanced arthritis. The post-arthritic phase is the remission of the disease.

   Signs of the third stage:

   • cartilage is becoming increasingly thinner and almost completely destroyed;
   • in their place, due to progressive zonal osteogenesis, bone growths are formed;
   • cavities with foreign matter appear in the bones;
   • the joint is destroyed;
   • scarring of tissues occurs;
   • the leg takes a vicious position and shortens / lengthens;
   • the person becomes disabled.

   At the last stage, arthritis takes on a chronic form. Relapses and exacerbations of the disease are possible. The pain syndrome can intensify with a sharp change in the weather. This property of the body is called meteosensitivity.

The knee joint is the largest in the human body and has more synovial fluid than others. When pathogens enter it, the inflammatory process proceeds violently, therefore it is so important to stop the disease at the first stage. Otherwise, unpleasant consequences cannot be avoided.

On the subject: Knee gonarthrosis: degrees, types, methods of treatment

Knee arthritis causes

There are many reasons for the development of arthritis of the knee joint, including:

• mechanical overload from friction in the front section and prolonged kneeling (“housewife’s knee”);
• incorrect bone position, which means uneven distribution of the load on the joint;
• rubella vaccination - post-vaccination arthritis;
• prolonged hypothermia or frostbite of the legs;
• trauma, for example, bruise, fracture, crack, rupture of the articular meniscus or damage to the ligaments - post-traumatic gonarthrosis;
• allergy (drug and serum sickness) - allergic arthritis, for example, with urticaria or Quincke's edema;
• Reiter's disease - a syndrome of arthritis, urethritis and conjunctivitis (mainly in young men);
• brucellosis;
• Behcet's disease;
• arthritis of other joints, for example, purulent or parasitic;
• helminthic and protozoal invasions;
• tuberculosis - tuberculous arthritis;
• croupous pneumonia;
• acute strepto-, pneumo- or staphylococcal infection - infectious or septic arthritis;
• fungus;
• gonorrhea;
• chlamydia;
• syphilis;
• Lyme disease;
• lupus erythematosus;
• psoriasis (very rare) - psoriatic arthritis;
• hepatitis;
• pyrophosphate arthropathy with calcification;
• gout - metabolic disease with deposition of uric acid salts in the joints - metabolic or gouty arthritis;
• ankylosing spondylitis is a hereditary disease of the musculoskeletal system;
• capillarotoxicosis;
• erythema nodosum;
• collagenosis (extremely rare);
• sarcoidosis;
• leukemia;
• hemophilia;
• scurvy;
• osteomyelitis;
• angina;
• scarlet fever;
• otitis;
• pharyngitis;
• dermatomyositis.

It is sometimes difficult to identify the cause of arthritis. the inflammatory process progresses gradually and until the onset of pain syndrome, characteristic symptoms may be absent. The most severe form of arthritis of the knee joint is acute phlegmonous with purulent fusion of the surrounding soft tissues, breakthrough of pus into the tissues of the thigh and lower leg.

Types of infectious agents:

• bacteria;
• viruses;
• parasites;
• pathogenic fungi.

Bacteria:

• staphylococci;
• gonococci;
• streptococci;
• Haemophilus influenzae - Haemophilius influencae;
• gram-negative bacteria such as Pseudomonas or Salmonella - Salmonella.

Staphylococcus species:

• Staphylococcus aureus;
• epidermal staphylococcus - Staphylococcus epidermidis.

Streptococcus species:

• β-hemolytic group A streptococcus - Streptococcus pyogenes - is activated in gram-positive flora;
• streptococci of other groups.

Viruses:

• HIV - Human Immunodeficiency Virus;
• rubella;
• mumps;
• hepatitis B;
• parvoviruses.

Parasites are the causative agents of the following diseases:

• opisthorchiasis;
• strongyloidosis - Cochin's diarrhea;
• dracunculiasis - Rishta disease;
• hookworm infection - miners' rash, earthen scabies, or Egyptian chlorosis;
• schistosomiasis;
• echinococcosis of the liver;
• filariasis, including wuchereriasis, brugiosis, and onchocerciasis;
• loiasis causing a Calabar tumor.

So, the main types of bacterial infectious arthritis, depending on the etiology - the causes of its occurrence:

• gonococcal;
• tuberculous primary bone or primary synovial form;
• brucellosis;
• borreliosis or Lyme (with Lyme disease);
• yersiniosis;
• dysenteric;
• salmonella.

For reasons of arthritis of the knee joint, they are divided into two types:

1. Primary (independent disease);
2. Secondary (concomitant to another pathology).

Risk factors or predisposing causes are:

• prematurity;
• excess weight;
• heredity;
• chronic foci of infection;
• surgical interventions;
• gonorrhea - a venereal disease that affects the urinary tract;
• furunculosis, accompanied by the appearance of boils;
• peritonsillar abscess behind the tonsils;
• angina - inflammation of the mucous membrane of the throat;
• scarlet fever (mainly in childhood);
• inflammation of the middle ear;
• pneumonia - pneumonia;
• infective endocarditis - inflammation of the endocardium - the inner lining of the heart;
• immunodeficiency states;
• recurrent septicemia;
• joint prostheses;
• diabetes mellitus - an endocrine disease due to insulin deficiency;
• sickle cell anemia - anemia;
• chronic tonsillitis - inflammation of the tonsils;
• caries - destruction of dental tissue;
• tumor;
• hypogammaglobulinemia - protein deficiency;
• alcohol addiction;
• drug use;
• congenital defects of the musculoskeletal system;
• weak muscular frame of the knee joint;
• extreme sports.

The symptoms of the disease are strikingly different depending on the causes of its occurrence. So, if it is prolonged mechanical friction, then arthritis usually proceeds without fever. With severe arthritis of the knee joints, you can completely lose the ability to move.

On the subject: Knee pad for arthrosis of the knee joint

How is knee arthritis treated?

The complex of therapeutic measures includes:

• removal of inflammation (NSAIDs - non-steroidal anti-inflammatory drugs);
• anesthesia;
• restoration of metabolic processes (taking chondroprotectors, vitamins and immunostimulants);
• strengthening of immunity;
• normalization of joint tissue nutrition;
• getting rid of excess weight (auriculotherapy, diet, herbal medicine to improve metabolic processes and breakdown of fatty deposits, to reduce stress on the knees);
• restoration of normal motor activity, support ability of the lower extremities, restoration of the full range of motion;
• preventive measures to prevent relapse of the disease.

Not only medications, but also support aids such as a cane or crutches can help relieve pain. Orthopedic devices are also used, such as knee pads, splints and special shoes. The leg is also immobilized with a simple plaster cast, a coxite bandage or a splint made from a plaster cast.

In case of a secondary disease, the primary measures are aimed at eliminating the underlying disease. The treatment is carried out in a comprehensive manner.

Non-steroidal anti-inflammatory drugs:

• Ibuprofen. Pros: safe, fewer side effects than other drugs; rarely causes agranulocytosis in the blood. Cons: antipyretic and analgesic effect is less than that of Paracetamol; can provoke the appearance of edema, hypertension, aspirin asthma, stomach ulcers, liver and kidney damage;
• Naproxen. Pros: has few side effects; highly effective. Cons: greater risk of cardiovascular complications than Ibuprofen;
• Aspirin or Acetylsalicylic acid. Pros: good antipyretic ability; prevents thrombosis (antiaggregatory or "anti-adhesion" drug in case of inflammation). Cons: does not help with pain; can cause Reye's syndrome, which affects the liver and brain;
• Paracetamol. Pros: the only remedy, without the risk of puffiness and hypertension; less often destroys the gastric mucosa; better than others relieves pain and fever. Cons: with age, the effect of the drug weakens; quickly wears out the liver, because it is activated in it;
• Almiral, Ortofen or Diclofenac. Pros: quickly relieves arthritic pain. Cons: significantly increases the likelihood of stroke; strongly plants the kidneys; negatively affects the gastrointestinal tract;
• Olfen is a drug based on sodium diclofenac;
• Nimesulide. Pros: effective remedy; well tolerated; the total number of complications from the stomach and intestines is lower than that of analogues. Cons: no precise data on the cardiovascular safety of the drug;
• Revmoxicam or Meloxicam. Pros: gives a significant improvement; easy to carry. Cons: cardiovascular safety is not well understood; high relative risk of bleeding.

Lincomycin, an antibiotic, antimicrobial drug, is often used in the treatment of infectious gonitis. Pros: copes well with pathogens, mycoplasma, bacteroids. Cons: May cause nausea, vomiting, diarrhea, stomatitis and other complications.

Ointments for arthritis of the knee joint:

• Finalgon;
• Apizartron;
• Histalgon.

Corticosteroids - steroid hormones - are injected directly into the joint cavity:

• Hydrocortisone suspension;
• Kenalog;
• Trasilol or Aprotinin;
• Diprospan.

Immunostimulants for gonarthritis:

• Levamisole or Decaris. Pros: enhances immunity, scar ulcers. Cons: provokes a headache, disrupts sleep;
• Taktivin in solution;
• Methyluracil. Pros: accelerates wound healing; generally well tolerated. Cons: possible allergic skin reactions, dizziness.

Chondroprotectors are taken for long courses even after the end of the main treatment. They significantly accelerate cell regeneration. If arthritis is provoked by an infectious agent, then antibiotic therapy (etiotropic) is performed. Additionally, immunostimulants and anti-toxic agents are administered.

Forms of medications prescribed for arthritis of the knee joint:

• tablets (for example, Diclofenac);
• solutions for intramuscular and intraarticular injection (eg, corticosteroids);
• gels (for example, Diklak);
• cream;
• ointments (for example, Bishofit, Nikoflex, Menovazin);
• solutions for lotions (for example, Dimexide).

These medications have many side effects, overload the gastrointestinal tract, therefore, at the same time as taking them, it is necessary to follow a diet and prescribe drugs that support the digestive process.

Find out more: List of modern drugs and drugs for joints

If an abscess occurs, it must be punctured. Otherwise, a fistula will form. In the absence of sequesters, fistulas are amenable to iodoform filling according to Mosetig-Moorhof. Quartzing accelerates the healing process.

To correct the resulting deformities of the knees, i.e. O- and X-shaped legs, use orthopedic correction methods. In case of contracture, gonitis require constant stretching of the limb or light one-stage redress with plaster fixation. Neglected cases are amenable to straightening with the Ermolaevsky apparatus or are corrected by supracondylar osteotomy.

Correction of bone deformities is possible only by surgery. Types of surgical interventions when driving:

• replantation of the synovial membrane of the joint;
• cartilage transplantation;
• arthroscopy - removal of bone processes and other manipulations through a micro-incision;
• endoprosthetics - replacement of joint components with implants;
• arthrodesis - complete immobilization of the joint;
• arthrolysis or Wolff's operation - excision of fibrous adhesions;
• synovectomy - removal of the affected synovium;
• flushing the joint;
• alignment of the menisci (these are lunar cartilaginous formations, additional shock absorbers of the legs);
• arthroplasty - partial or complete prosthetic joint replacement;
• osteotomy - removal of a piece of bone to relieve pressure on a joint
• intra-articular necrectomy;
• plastic resection - removal of a joint or part thereof - a closed or open knee with fascial interposition;
• wide bilateral parapatellar arthrotomy.

In severe cases, resection, wedge-shaped osteotomy, or arthroplasty are performed a second time. Resections and nearthrosis should not be done until the age of 17. If the growth zones of the bones of the lower extremities are damaged, the child will forever remain lame.

Some therapies are only used if pain and inflammation are relieved. Among them are the methods of Tibetan medicine:

• physiotherapy;
• massage and self-massage to relax the muscular frame of the knee and increase blood circulation;
• pharmacopuncture - the introduction of drugs in minimal doses into biologically active points of the back;
• acupuncture or acupuncture;
• auriculotherapy - insertion of needles into biologically active points of the ears;
• medical and physical training complex;
• health resort improvement.

The following physiotherapy procedures are prescribed:

• phonophoresis with hydrocortisone;
• paraffin applications;
• magnet;
• quartzing;
• laser;
• UHF;
• radon or hydrogen sulfide baths.

You can't !:

• self-medicate;
• endure pain or constantly relieve it with analgesics and do not seek help from specialists;
• with the secondary, drive to treat only it, ignoring the disease-root cause.

Large joints of the bones of the lower extremities are in danger of an inflammatory process, often only because of the negligence of the person himself. Work without observing the simplest sanitary rules and regulations, without sparing yourself, can only have a negative effect on health. Without timely suppressing chronic infectious foci in the body, a person condemns himself to long-term treatment and the occurrence of various complications.

Just 1 simple exercise heals the knees - Dr. Evdokimenko:

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.