Arthrosis of the joints, cerebral form of rheumatism, chorea

Arthrosis of the joints is a chronic disease. This is an ailment that is characterized by the gradual destruction of the cartilage of the joint. As a result, deformation of bone tissue occurs. Most often, arthrosis affects the knee and hip joints.

Types of Arthrosis of the Joints

Symptoms of arthrosis. The most striking sign of the presence of arthrosis is considered to be pain that occurs during exertion or during movement. Due to the subsequent development of the disease and the change of its stages, pain can also be felt when the patient is at rest. Due to the destruction of the layer of cartilage, the bones begin to rub against each other, which causes crunching and clicks when performing even small loads. If arthrosis remains undetected for a long time and continues to progress, then the joint begins to deform. As a result, the patient’s inflammatory process may aggravate, which will lead to numbness of the fingertips and a decrease in their sensitivity.

The causes of arthrosis. Risk groups for the disease

As already mentioned, the main root of the development of arthrosis is the deformation of the cartilage layer between the joint, bone and tissue. This can occur due to the following factors:

  • Various minor injuries to the joints due to falls, etc.
  • Repeated fractures.
  • Too much joint load.
  • Genetic predisposition.
  • Often wearing high-heeled shoes, or uncomfortable shoes.

The causes of arthrosis

The risk group for arthrosis includes people who are overweight; suffering from varicose veins; piano musicians; people professionally involved in sports; IT employees, office workers.

Therapy and prevention of arthrosis

First you need to determine the stage of the disease. Treatment will be prescribed in accordance with it. Therapy of arthrosis begins with the elimination of pain. Together with an anesthetic, anti-inflammatory drugs are also prescribed. In some cases, medical treatment is insufficient, therefore, a course of physiotherapy is also prescribed. This course includes massage, which will eliminate painful sensations, as well as restore the mobility of the affected joint. They also plan a course of physiotherapy exercises. With its help, the patient’s condition is strengthened, and muscles are also developed.

When performing physical exercises, the correct patient upset is also established and a gait is formed. During the period of remission, doctors use treatment in sanatoriums. There are cases when all the methods mentioned above either cannot bring the result, or it is too late to apply them. Then surgery is used. It may include the installation of a joint prosthesis. As for the prevention of the disease, it includes the following points: balanced nutrition; weight control; wearing comfortable shoes; avoidance of injuries and fractures; monitoring of loads in the presence of genetic addiction.

Diagnosis of arthrosis

Arthrosis in a patient can be detected during examination and conversation with him, as well as using auxiliary studies. This is arthroscopy, CT and MRI, ultrasound, x-ray. For the first stages, an X-ray and a harmless method, an ultrasound method, are often used. The latter method allows you to choose the exact method of treatment of the disease. CT and MRI allow a broader examination of the joint. Arthroscopy is used if you need to establish the causes of the disease.

Arthrosis is perceived by many as a disease that is not serious. However, this is not at all true. It can aggravate the condition of the patient and provoke many unnecessary problems, such as inflammation of the tissues surrounding the joint; limitation of mobility; joint shape change. Therefore, if some symptoms of the disease are observed, you should definitely consult a doctor.

Cerebral rheumatism

Cerebral rheumatism is usually observed in children and young people and is associated primarily with damage to the vessels of the brain. Increased vascular permeability causes damage to the cortex and, especially, subcortical nodes, mainly the striatum. Microscopically in these areas, inflammatory and degenerative changes in the form of peritoneal vascular space infiltration and spot hemorrhages, degenerative changes in nerve cells, sometimes capillary thrombosis, but without specific granulomas, can be detected. Ashof-Talalayev granulomas are usually found in the heart muscle.

Cerebral rheumatism

In mild cases, patients complain of dizziness, flushing of the head. In severe cases, there may be symptoms of meningo-encephalitis, infectious chorea in adults, minor chorea in children, and even rheumatic psychosis. All these diseases usually occur several years after the onset of rheumatism with the corresponding lesions of the joints or heart, and only chorea minor appears simultaneously; often it is preceded by a sore throat, diseases of the ear or paranasal nasal cavities.

The main symptom of minor chorea is involuntary muscle contractions, more often - the upper half of the body, and then the entire muscle; muscle twitches and uncoordinated rapid movements of the limbs (hyperkinesis) occur; involuntary adduction and abduction of the arms, flexion and extension of the fingers, raising and lowering of the shoulders, called St. Witt's dance, are observed.

All these movements impede walking, speech, and interfere with food; during sleep, cramps stop. Chorea can also be unilateral (hemichorea), as a result of unilateral damage to the striatal region. In addition, patients have irritability, affective instability, rapid change of mood; in rare cases, psychosis occurs with hallucinations and delusions. Examination of the heart in some cases reveals the presence of endomyocarditis. There may be joint pain.

The temperature is normal or slightly elevated. In a blood test - moderate anemia, a small neutrophilic leukocytosis, which can be replaced by leukopenia with relative lymphocytosis, monocytosis and eosinophilia, ROE is slightly accelerated. Urine - without abnormalities. Duration of disease on average 2-3 months; mild form of small chorea disappears within a few weeks, severe can last up to 6-8 months and even a year; as with articular rheumatism, relapses can occur, especially in the presence of infectious foci in the body.

The diagnosis of the disease is difficult. It is necessary to consider the onset - more often after a sore throat or other infectious disease, the presence of rheumatic heart disease or joints, which is relatively rare. As a differential diagnosis, one should remember about hysterical twitching and chorea tic, which can resemble muscle twitching in small chorea, but which by an effort of will can be temporarily suppressed, which almost does not happen in true chorea. The prognosis for chorea is quite favorable. With timely treatment, patients recover; with chorea in pregnant women, the prediction is more serious; in 2-4% of cases, after chorea, endocarditis develops, followed by heart disease. Prevention of chorea and, in general, rheumatic lesions of the central nervous system coincides with the general prevention of rheumatism, especially in childhood.

Treatment is basically similar to treatment for articular and cardiac forms, but, in view of the significant damage to the central nervous system, has a number of features. In addition to salicylates, pyrazolone derivatives, hormone therapy, etc., sodium bromide treatment is indicated according to 3, 0-4, 0 g per day, especially in combination with chloral hydrate; You can also prescribe enemas from chloral hydrate according to 2, 0 g per 50 ml of distilled water.

Huntington Chorea

The clinical picture of Huntington's chorea consists, on the one hand, of movement disorders, and on the other, of various mental changes that require psychiatric treatment and often lead to the need for a stay in a psychiatric hospital.

The hereditary nature is reliably established; inheritance is dominant, the vicious gene is localized in the short arm of the 4 chromosome. The penetrance is complete, i.e., the probability of the disease (potential) in the children of patients is 50%.

Cerebral atrophy primarily affects the caudate body (respectively, an enlargement of the anterior horns of the lateral ventricles is observed on a CT scan), as well as putamen and pallidum (the shell and pale ball of the lenticular nucleus), and later other parts of the brain. Histologically determined degeneration of nerve cells, especially the neostriatum with an increase in the nuclei of astrocytes and the growth of connective tissue.

Against the background of a decrease in muscle tone, constant motor anxiety arises, up to the grotesquely expressed movements of the limbs that arise bizarrely and proceed atypically; the muscles of the face and body may be involved, speech unarticulated, blurry and incomprehensible. There is also a hypotonic-hyperkinetic extrapyramidal syndrome, and already externally the patient looks sick and exhausted.

Mental symptoms often occur earlier than neurological and initially correspond to organic personality changes. The progression of the disease leads to a psycho-organic decline in activity and to dementia. Less common are psychoses with depressive and paranoid-hallucinatory symptoms.

The disease often begins between 40 and 50 years, very rarely - in childhood. Initially, there is agitation and disinhibition of drives, mood disorders and unrestrained. The disease progresses uncontrollably. The patient is becoming increasingly demented, helpless and in need of care. The disease eventually leads to death.

In the initial stages of Huntington's chorea is easily visible. If hyperkinesis is poorly expressed, then they are regarded as awkwardness or psychogenic motor disturbances and are incorrectly evaluated primarily because they are intensified by emotional stress. Mental characteristics are initially regarded as “psychopathies” or “mild schizophrenia,” including in examinations of punishable acts. But a thorough family history ultimately indicates the correct diagnosis. Molecular genetic studies also make possible individual preclinical, even antenatal, diagnosis.

In differential diagnosis, attention is paid to hyperkinetic syndromes in other forms of chorea (small chorea, pregnant chorea, hyperkinetic syndrome in atherosclerosis and metabolic disorders), as well as late hyperkinesis (late dyskinesias) after prolonged treatment with antipsychotics. There is no causal therapy. Hyperkinesis can be suppressed with antipsychotics. Otherwise, advice is given regarding mental and somatic disorders and late-stage care.

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Dmitriy Yarovoy

Yarovoy Dmitry Mikhailovich Orthopedic and traumatologist with more than 10 years of experience. During medical practice, he conducted more than 800 successful operations.

He specializes in the treatment of musculoskeletal pathologies, has professional skills in orthopedics, pharmacy and traumatology. It provides emergency care for injuries, diagnoses and helps with diseases of the musculoskeletal system, such as: arthritis, arthrosis, osteochondrosis.

He practices conservative and surgical treatment of bone and limb fractures. It provides medical assistance for damage to the menisci or cruciate ligaments.

Obzoroff

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