Connective tissue dysplasia. Connective tissue dysplasia Neoarthrosis as a consequence

Joint hypermobility is a congenital pathology characterized by increased joint flexibility - the range of motion exceeds normal physiological indicators. Large joints are often affected - knees, ankles, elbows or shoulders. The ICD 10 code is M35.7 (hypermobile syndrome).

Etiology

A genetic predisposition manifests itself in poorly developed connective tissue, which leads to overstretching. Prolonged physical activity, trauma, or past arthritis, accompanied by a large accumulation of fluid in the joint cavity, can lead to the development of pathology.

Risk factors for developing joint hypermobility syndrome:

• Hereditary diseases (Marfan and Ehlers Danlos syndrome, osteogenesis);
• Professions that require prolonged physical activity (musicians, loaders, dancers);
• Decreased tone of the muscular system (develops due to lack of physical activity or a stroke);
• Gender of the person (women are more often affected by the disease).

Interesting!

Due to impaired collagen elasticity, not only joints, but also organs suffer - these are the eyes, skin, blood vessels (their dysfunction develops).

In children, the cause of the development of joint hypermobility is associated with metabolic disorders and vitamin deficiency. In older people, this disease is practically not detected.

Clinical manifestations of pathology

According to the clinical picture, joint hypermobility syndrome is divided into two types: articular and extra-articular. Patients with the syndrome are characterized by periodic trauma (sprains or dislocations).

Articular manifestations of pathology:

• Arthralgia and myalgia (palpation does not reveal muscle changes, but there is pain radiating to the knee or ankle);
• Articular or periarticular pathology (synovitis in the acute stage);
• Painful sensations in the back;
• Flat feet complicated by tenosynovitis.

Extra-articular symptoms of hypermobility:

• The skin is easily stretched (striae appear) and is easily injured;
• Mitral valve prolapse;
• The appearance of signs of varicose veins (spider veins are visible on the legs and thighs, the legs swell in the evening, and there is a feeling of heaviness in the limbs);
• Umbilical or inguinal hernia;
• Abnormal position of teeth or improper formation of teeth;
• Prolapse of internal organs (kidneys, uterus or stomach).

Joint hypermobility in children occurs with the following features:

• In the first months of a baby’s life, determining pathology is difficult: most children normally have hypertonicity of the muscular system;
• In young children, hypermobility occurs equally, regardless of gender, but in adolescence, the pathology most often develops in girls.
• As the child gets older, the connective tissue matures, so signs of hypermobility decrease.

Playing sports (dancing, gymnastics) leads to aggravation of the disease, although children with high plasticity achieve success in classes faster.

Diagnostics

Joint hypermobility syndrome in children is detected during an initial examination by a pediatrician - a medical history is taken, then diagnostic tests are performed for the extensibility of connective tissue:

• The patient is asked to reach the inner side of the forearm with the thumb;
• Touch your palms to the floor (legs remain straight, heels do not come off the floor);
• Straighten and bend your knees and arms (with hypermobility of the joints, the limbs bend at an angle in the opposite direction).

Additional diagnostic methods are prescribed to differentiate from connective tissue diseases:

• Radiography;
• Laboratory blood test;
• CT scan.

If necessary, the patient is referred for consultation to other specialists: an ophthalmologist, rheumatologist or cardiologist.

Treatment

When treating joint hypermobility, symptomatic therapy is used, aimed at eliminating the patient's complaints - pain, discomfort in the joints. If internal organs are damaged, medical or surgical treatment is performed.

Dr. Komarovsky argues that it is necessary to avoid heavy physical activity, limit professional sports and joint mobility using a fixing bandage. In case of prolonged pain syndrome, the use of orthoses (knee pads) is acceptable. If flat feet are detected, special orthopedic insoles are selected.

Exercise therapy is effective for the syndrome (exercises strengthen the muscular system, preventing overstretching of connective tissue and ligaments).

A set of exercises for hypermobility of the knee joints:

• Lying on your stomach, place your arms along your body, palms down. Without leaning on your hands, you need to slowly bend your body, bringing your shoulder blades together as much as possible. Fix the body in this position for 20 seconds, slowly return to the starting position. Exercise allows you to strengthen your back muscles. Repeat 10-15 times;
• To strengthen the lumbar muscles and buttocks, you need to lie on your stomach, bring your legs together, and extend your arms along your body. Slowly raise your legs 20 -30 cm from the floor until you feel tension in the gluteal muscles, stay in this position for 30 seconds, return to the starting position, repeating the exercise 5-10 times;
• The following exercise improves blood circulation in the pelvis and strengthens the muscles of the thighs and buttocks: lying on your back, bend your knees, placing them shoulder-width apart, and extend your arms along your body. Leaning on your feet and shoulders, you need to slowly lift your pelvis from the floor and fix your body in this position for 30 seconds. return to the starting position, relax as much as possible. Repeat the exercise 10-12 times;
• Lying on your back, knees slightly bent, feet together. As you inhale, you need to slowly lift your body, keeping your back straight. Place your hands along your hips, gaze directed upward. It is necessary to stay in this position for 30 seconds, then slowly return to the starting position and relax;
• It is necessary to bend your knees and lean against the wall; from the outside it should seem as if the person is sitting on a chair. Fix the body in this position for the maximum possible time (at least 40 seconds). At the end of the exercise, straighten up and relax;
• Lying on your stomach, bend your leg at the knee, clasping your foot with your palms and relaxing your thigh muscles as much as possible. Slowly press your heel to your buttock and fix the body in this position for 60 seconds, then relax and repeat the exercise with the other limb.

During classes, adults should not make sudden movements to the maximum possible amplitude in order to avoid injury. Good physical activity is provided by visiting the pool: swimming allows you to work out all muscle groups without stress on the musculoskeletal system. Physiotherapeutic procedures are used as additional treatment methods: ozokerite or paraffin applications, electrophoresis.

The clinical picture of HMS is diverse and includes both articular and extra-articular manifestations, which are generally reflected in the mentioned Brighton criteria for HMS syndrome.
A careful history taking is a significant aid in diagnosis. A characteristic fact in the patient’s life history is his special sensitivity to physical stress and a tendency to frequent injuries (sprains, subluxations of joints in the past), which suggests a failure of the connective tissue. The excess range of motion in the joints detected by the Beighton method complements the actual clinical forms of manifestation of VHMS.
Articular manifestations.
Arthralgia and myalgia. The sensations may be painful, but are not accompanied by visible or palpable changes in the joints or muscles. The most common localization is the knee, ankle, and small joints of the hands. In children, severe pain in the hip joint has been described, responding to massage. The severity of pain is often influenced by the emotional state, weather, and the phase of the menstrual cycle.
Acute post-traumatic articular or periarticular pathology, accompanied by synovitis, tenosynovitis or bursitis.
Periarticular lesions (tendinitis, epicondylitis, other enthesopathies, bursitis, tunnel syndromes) occur more often in patients with VHMS than in the general population. They occur in response to an unusual (unusual) load or minimal trauma.
Chronic mono- or polyarticular pain, in some cases accompanied by moderate synovitis provoked by physical activity. This manifestation of VHMS most often leads to diagnostic errors.
Repeated dislocations and subluxations of joints. Typical localizations are the shoulder, patello-femolar, metacarpophalangeal joints. Sprained ligaments in the ankle joint.
Development of early (premature) osteoarthritis. This can be either true nodular polyosteoarthrosis or secondary damage to large joints (knees, hips) that occurs against the background of concomitant orthopedic anomalies (flat feet, unrecognized hip dysplasia).
Back pain. Thoracalgia and lumbodynia are common in the population, especially in women over 30 years of age, so it is difficult to make an unambiguous conclusion about the connection of these pains with joint hypermobility. However, spondylolisthesis is significantly associated with GMS.
Symptomatic longitudinal, transverse or combined flatfoot and its complications: medial tenosynovitis in the ankle joint, valgus deformity and secondary arthrosis of the ankle joint (longitudinal flatfoot), posterior talar bursitis, thalalgia, corns, hammertoe deformity, Hallux valgus (transverse flatfoot) ).
Extra-articular manifestations. These signs are natural, since the main structural protein collagen, which is primarily involved in the described pathology, is also present in other supporting tissues (fascia, dermis, vascular wall).
Excessive extensibility of the skin, its fragility and vulnerability. Striae not associated with pregnancy.
Varicose veins that begin in youth.
Mitral valve prolapse (before the introduction of echocardiography into widespread practice in the 70-80s, many patients with HMS syndrome were observed by a rheumatologist with a diagnosis of “rheumatism, minimal degree of activity” due to complaints of joint pain and heart murmurs associated with prolapse valves).
Hernias of various localizations (umbilical, inguinal, white line of the abdomen, postoperative).
Prolapse of internal organs - stomach, kidneys, uterus, rectum.
Thus, when examining a patient with suspected VHMS, and this is every young and middle-aged patient with non-inflammatory joint syndrome, it is necessary to pay attention to possible additional signs of systemic connective tissue dysplasia. Knowledge of the phenotypic manifestations of Marfan syndrome and osteogenesis imperfecta allows us to exclude these hereditary diseases. If obvious skin and vascular signs are detected (skin hyperelasticity and spontaneous formation of bruises without signs of coagulopathy), it is legitimate to talk about Ehlers-Danlos syndrome. The question of differential diagnosis of benign HMS syndrome and the “mildest”, hypermobile type of Ehlers-Danlos syndrome remains open. This cannot be done using the Brighton criteria, which the authors specifically mention; in both cases there is moderate involvement of the skin and blood vessels. There is no known biochemical marker for either syndrome. The question remains open and will, apparently, be resolved only with the discovery of a specific biochemical or genetic marker for the described conditions.
Considering the widespread prevalence of constitutional HMS in the population, especially among young people, it would be erroneous to explain all joint problems in this category of people only by hypermobility. The presence of HMS does not at all exclude the possibility of them developing any other rheumatic disease, to which they are susceptible with the same probability as persons with a normal range of motion in the joints.
Thus, the diagnosis of HMS syndrome becomes justified when other rheumatic diseases are excluded, and the existing symptoms correspond to the clinical signs of the syndrome, logically supplemented by the identification of excessive joint mobility and/or other markers of generalized connective tissue involvement.

The functioning of the musculoskeletal system directly depends on the condition of the connective structures that are located next to the joints: capsules, ligaments and tendons. They are particularly strong and provide a person with normal movement, but at the same time they have flexibility and elasticity. It is these qualities of structures that help maintain the integrity of tissues when stretched under load. Joint hypermobility syndrome in children is a condition in which the range of motion in a joint is exceeded compared to physiological settings.

Reasons for the occurrence of the violation

Joint hypermobility syndrome (in ICD 10 - code M35.7) most often appears in those people who have strong extensibility of the ligamentous tendon fibers, transmitted from their parents. As a result of an inherited disorder, proteoglycan, collagen, glycoprotein and the enzymes that ensure their metabolism change significantly. Disturbances in the synthesis, maturation and breakdown of connective tissue components lead to severe extensibility of the joints.

All the described processes can affect the body of a pregnant woman from the outside. In most cases, such changes occur in the early stages, when the embryo is just beginning to develop and its organs and systems are being formed. The following negative factors affect the connective tissue of the fetus:

• pollution coming from the environment;
• poor nutrition (lack of vitamins, microelements and nutrients);
• infectious lesions of women;
• severe stress, anxiety and stress on the nervous system.

Acquired form

From all this it follows that hypermobility syndrome is a congenital disease. But it is important to distinguish it from other hereditary diseases, in which some changes occur in the structure of the connective tissue (Marfan or Ehlers-Danlos syndrome). It is also important to remember about natural flexibility, which is not a pathological form. Many people do not even realize that they have such a difference, since childhood they consider it quite ordinary.

An acquired form of joint mobility is in most cases diagnosed in dancers or track and field athletes, but it occurs as a result of training and is local in nature, spreading mainly to the lower part of the limb. Difficulty with joint mobility is an uncommon condition but is difficult to identify diagnostically.

Features of the development of the disorder in children

Previously, joint hypermobility was attributed to a peculiar structural feature of the musculoskeletal system. Parents always tried to take a very flexible child to a special section at an early age. It was believed that this skeletal structure ensures the rapid achievement of good athletic results. Now hypermobility of joints in a child is considered a form of deviation.

When actively involved in sports, the joints of children and adults with this disorder experience severe loads that significantly exceed those allowed. In people with normal joints, such a load leads to various injuries - sprains or dislocations. After proper treatment, many athletes quickly resume training. With hypermobility, everything happens differently. Even a harmless injury can greatly change the structure of cartilage, bone tissue, tendons and ligaments, and can also lead to osteoarthritis.

Prohibited sports

A sick child is prohibited from engaging in the following sports:

• gymnastics and acrobatics;
• running, biathlon;
• hockey, football;
• long jump;
• sambo and karate.

Treating specialists recommend that parents of especially flexible children do not send them to sports institutions right away. Such a child must undergo a full examination in the hospital. If he is found to have hypermobility of the joints, then he will have to give up all sports that are dangerous for him.

Clinical picture of the syndrome

Joint hypermobility is classified as a systemic non-inflammatory lesion of the musculoskeletal system. This condition has so many symptoms that it may seem that the patient is suffering from a completely different disease. Such patients are often misdiagnosed.

Special diagnostic measures in a medical institution help to specify the boundaries of hypermobility and distinguish this lesion from other diseases with similar symptoms. When determining the main symptoms of the disease, it is important to consider the articular and extra-articular forms of manifestation of the disease.

Articular manifestation

The first signs of damage in this case appear for the first time in childhood or adolescence, when the child is actively involved in sports and various physical activities. Most often, they are not considered as a consequence of pathological changes in the structure of tissues and are quite common; for this reason, the disease is detected quite late.

At the first stage of development of joint hypermobility syndrome in adults and children, quiet clicking or crunching sounds are observed in the joints; such sounds occur arbitrarily or when physical activity changes. Over time, the sounds may go away on their own. But other, more severe signs are added to the symptoms, which help to accurately identify joint hypermobility syndrome in children and adults:

• pain (myalgia or arthralgia);
• recurrent dislocations and subluxations;
• scoliosis;
• flat feet of varying degrees.

Joint pain occurs after playing sports or at the end of the day. In most cases, it spreads to the legs (hip hypermobility syndrome in children), in addition the shoulders, elbows and lower back may be affected. Constant myofascial pain may occur in the shoulder girdle. At an early age, a child with this syndrome gets tired too quickly and asks to be held back.

Dangerous complications

Overuse causes damage to joints and nearby tissues. People susceptible to hypermobility are at risk of developing the following conditions:

• ligament ruptures and various sprains;
• bursitis and tenosynovitis;
• post-traumatic arthritis;
• tunnel syndromes.

Against the background of general weakness, the patient may feel instability in the joints, which appears when the stabilizing role of the capsule and ligamentous apparatus decreases. Most often this occurs in the ankles and knees, which are heavily stressed every day. In the future, hypermobility syndrome can lead to degenerative joint diseases, for example, osteoarthritis.

Joint mobility assessment

When assessing joint movement, the specialist first determines their volume. If it is higher than normal values, then we can safely say that the patient has hypermobility. The assessment primarily relies on the following clinical tests:

• the thumb is retracted towards the forearm;
• the elbow or knee joint is extended (angle no more than 10 degrees);
• the patient should touch the floor with his hands without bending his knees;
• the metacarpophalangeal joints are extended (the angle should not exceed 90 degrees);
• The thigh is moved to the side (angle about 30 degrees).

This helps to accurately establish high joint flexibility, which is important in identifying disorders in ligaments, tendons and capsules. It is important to remember that the sooner such signs are identified, the less dangerous the consequences for the human musculoskeletal system will be.

The joint signs of joint hypermobility syndrome in children from birth are a good example of connective dysplasia. But they are not the only ones that make up the general symptoms of the disease.

Extra-articular signs

Since hypermobility has a systemic form, it is characterized by extra-articular manifestations. Connective tissue is important for human organs and systems, so dysplasia can negatively affect all functions and even lead to significant disturbances in the overall structure. In most cases, pathological disorders extend to the skeletal system. In addition to joint disorders, the doctor may notice some external features: high palate, delayed development of the upper or lower jaw, curvature of the chest, excess length of the fingers or toes.

There are other signs of hypermobility:

• strong stretchability of the skin, increased chance of injury and damage;
• mitral valve prolapse;
• varicose veins in the legs;
• prolapse of the kidneys, intestines, uterus, stomach;
• different forms of hernia (inguinal, umbilical hernia);
• strabismus, epicanthus.

Often people suffering from hypermobility complain of fatigue, general weakness of the body, anxiety, aggression, headaches, and problems sleeping.

Treatment of the disease

After establishing an accurate diagnosis, the doctor remains to choose an effective treatment method. The choice of treatment for joint hypermobility in children and adults will depend on the cause of its occurrence, the main symptoms and severity of pain.

At the same time, it is very important that the patient understands that such a lesion cannot lead to disability, and that with properly selected treatment, all negative symptoms will quickly go away.

To improve his condition, the patient must exclude from his daily life any stress that leads to pain or any discomfort in the joints.

For high intensity pain in individual joints, specialized elastic braces are used, which are also called orthoses (you can purchase elbow pads or knee pads).

In case of particularly severe pain, it is allowed to use medications. In most cases, analgesics (analgin, Dexalgin and Ketanov) are taken to eliminate pain. For many patients, doctors prescribe special ointments with a warming effect and ointments containing non-steroidal anti-inflammatory components.

Physiotherapeutic procedures will bring no less benefit: laser therapy, paraffin treatment, therapeutic mud.

Special exercises and gymnastics are considered the main ones in the treatment of hypermobility syndrome. When they are performed, joints, ligaments and muscles receive the necessary stability and strength.

Exercise therapy for joint hypermobility in children helps the joints to fully flex and straighten. Therapeutic exercise also helps to tense all muscles well. With joint hypermobility, exercises can be strength and static, they are performed at a slow pace and without special weights. Stretching exercises are strictly prohibited, as they only worsen the condition of the joints.

Accurate diagnosis

The doctor can make a diagnosis by examining the patient’s appearance and listening to his main complaints. The child may talk about frequent injuries, the appearance of bruises on the body after minor external influences.

To distinguish hypermobility syndrome from osteoarthritis, arthritis, coxarthrosis, special instrumental diagnostics must be carried out:

• radiography;
• magnetic resonance or computed tomography.

It is necessary to proceed to treatment only if there is a joint disorder caused by hypermobility of the limbs. In other situations, a child or adult is recommended to strengthen muscles and ligamentous tendons: do therapeutic exercises, swim or just walk.

Relief of condition

The following orthopedic products help to significantly relieve pressure on joints:

• elastic bandages;
• posture correctors;
• inserts between fingers.

The results obtained after the research will help to accurately understand the severity of damage to the tendon-ligamentous apparatus, as well as the number of complications obtained.

Joint pain and arthritis accompany many diseases, follow them, or may precede the typical picture of an acute inflammatory process. Arthralgia with signs of local inflammation is characteristic of more than 200 diseases. It can be the leading symptom or one of the accompanying manifestations.

Arthritis (from the Latin artr - joint, itis - inflammation) - inflammatory lesions of the joints, differing in origin, localization, manifestations, but having common features of local inflammation and damage to the inner lining of the joint.

Among all rheumatological manifestations in childhood, reactive arthritis is the most common. In older age groups, it develops in young people under 40 years of age. In most manifestations it is associated with acute intestinal infection caused by enterobacteria and acute urogenital chlamydial infection. Respiratory mycoplasma and chlamydial infections (Mycoplasma pneumoniae et Chlamydia pneumonia) can also provoke the development of reactive arthritis.

Reactive arthritis (ReA) is an acute inflammation of the joints of a non-purulent nature, symptoms develop no later than 1 month after an acute intestinal or genitourinary infection, associated with the histocompatibility antigen HLA-B27. May be due to the development of mediated immunological inflammation after vaccination, influenza, tuberculosis and other infections.

Thus, the true cause of the disease is not infectious inflammation provoked by a pathogen, but the damaging effect of immune complexes, provoking typical joint damage with intra-articular fluid accumulation.

Classification in ICD-10

All of them belong to the class of infectious arthropathy: in ICD-10 code M 00-M 03.

Code M 02 in ICD-10 – reactive arthropathy

Code M 02.0 in ICD-10 – arthropathy accompanying intestinal shunt

Code M 02.1 in ICD-10 – post-dysenteric arthropathy

Code M 02.2 in ICD-10 – post-immunization arthropathy

Code M 02.3 in ICD-10 - Reiter's disease

Code M 02.8 in ICD-10 – other reactive arthropathy

Code M 02.9 in ICD-10 – reactive arthropathy, unspecified

Classification of reactive arthritis (Table 1)

Most common location of joint lesions (Table 2)

Symptoms

1. Symptoms of general intoxication: an increase in temperature from low-grade to high fever, general weakness is expressed, and a decrease in appetite and weight is noted.
2. Symptoms of joint damage: asymmetrical reactive arthritis; Characterized by damage to both large and small joints of the legs - ankle, knee and joints of the feet, especially the big toes. Less commonly affected are the joints of the upper limbs: shoulder, sternoclavicular or temporomandibular, sacroiliac. No more than six joints are affected at the same time.
3. The development of inflammation in the areas of attachment of joints and ligaments to bones (entheses). Tenosynovitis most often develops in the toes or hands, and in the heel area.
4. Damage to the mucous membranes: symptoms of conjunctivitis with damage to the eyes, urethritis and annular balanitis, cervicitis in women with damage to the genitourinary system, painful erosions on the oral mucosa.
5. Signs of keratoderma: foci of hyperkeratosis of the plantar part of the feet or hands.
6. Signs of nail damage (usually toes).
7. Combined lesions of other organs:

• aortitis (inflammation of the aortic wall);
• myocarditis;
• mitral valve insufficiency;
• myositis – damage to skeletal muscles;
• polyneuritis - the appearance of symptoms of damage to the peripheral nervous system;
• enlarged lymph nodes (for example, the inguinal group in urogenital pathology).

Additional methods for diagnosing arthritis

1. Instrumental:

• radiography of the joint;
• spiral computed tomography or magnetic resonance imaging;
• osteoscintigraphy;
• NMR spectroscopy;
• Ultrasound of the joint;
• arthroscopy.

1. Laboratory:

• general clinical;
• biochemical research;
• immunological;
• immunoelectrophoresis;
• examination of synovial fluid.

We have systematized information about what changes in the results of laboratory and instrumental examinations can be expected in Table 3.

Differential diagnosis of reactive arthritis

Differential diagnosis of ReA is given in Table 4.

Differential diagnosis of joint damage in reactive arthritis with other articular pathologies based on examination data is given in Table 5.

Disease

Features of joint damage

Laboratory indicators

X-ray features

There are three approaches to the treatment of reactive arthritis:

• drug treatment;
• functional treatment;
• treatment with folk remedies.

In the first case, the following therapeutic agents are distinguished:

1. When the source of infection is identified and the cause of arthritis is established, treatment with antibiotics is carried out, taking into account sensitivity to the relevant microorganisms.
2. NSAIDs are used to reduce signs of inflammation, pain, and hyperthermia.
3. GCS is prescribed systemically in case of severe systemic manifestations. More often, GCS treatment is carried out in the form of intra-articular injections.
4. The basic drug for the transition of arthritis to a chronic form is sulfasalazine for a long time (several months).
5. Systemic enzyme therapy - treatment with Wobenzym.

Treatment with folk remedies involves both the use of decoctions and infusions of herbs with anti-inflammatory and antibacterial effects, and the local use of compresses from comfrey, horseradish, and black radish.

Medications (Table 6)

Post-immunization reactive arthritis (after vaccination) develops more often in children, so it is necessary to adjust the dose of the drug per kilogram of the child’s weight.

Similar symptoms may appear in arthritis of various etiologies. Only an experienced doctor can conduct a thorough diagnosis to determine the cause of arthritis and prescribe the correct treatment. It must be taken into account that each drug has side effects and may be contraindicated in a particular case for a given patient. Even treatment with folk remedies should be carried out under the supervision of a doctor; it is usually impossible to completely get rid of this disease, however, with adequate therapy, long-term remission occurs. The prognosis for arthritis after an intestinal infection is more favorable than for Reiter's syndrome, articular syndrome due to ulcerative colitis and Crohn's disease.

Sources:

1. Attending doctor. E.S. Zholobova, E.G. Chistyakova. Reactive arthritis in children - diagnosis and treatment;
2. V.A. Molochkov Moscow Regional Research Clinical Institute named after. M.F.Vladimirsky, Moscow. Reiter's disease. Consilium Medicum. 2004; 03;
3. V.M. Chepoy. Diagnosis and treatment of joint diseases. Moscow. "Medicine".

Gonarthrosis of the knee joint, ICD-10 code: M15-M19 Arthrosis

Deforming osteoarthritis, abbreviated as DOA, refers to chronic joint diseases. It leads to the gradual destruction of articular (hyaline) cartilage and further degenerative-dystrophic transformation of the joint itself.

ICD-10 code: M15-M19 Arthrosis. These include lesions caused by non-rheumatic diseases and affecting mainly peripheral joints (extremities).

• Spread of the disease
• Development of DOA
• Symptoms
• Diagnostics

Arthrosis of the knee joint in the international classification of diseases is called gonarthrosis and has the code M17.

In practice, there are other names for this disease, which are synonyms according to the ICD10 code: arthrosis deformans, osteoarthrosis, osteoarthritis.

Spread of the disease

Osteoarthritis is considered the most common disease of the human musculoskeletal system. More than 1/5 of the population of our planet faces this disease. It has been noted that women suffer from this disease much more often than men, but with age this difference smooths out. After the age of 70, more than 70% of the population suffers from this disease.

The most “vulnerable” joint for DOA is the hip. According to statistics, it accounts for 42% of cases of the disease. Second and third places were shared by the knee (34% of cases) and shoulder joints (11%). For reference: there are more than 360 joints in the human body. However, the remaining 357 account for only 13% of all diseases.

A joint is the articulation of at least two bones. Such a joint is called simple. The knee joint, a complex joint with two axes of motion, articulates three bones. The joint itself is covered with an articular capsule and forms an articular cavity. It has two shells: outer and inner. Functionally, the outer shell protects the articular cavity and serves as an attachment point for ligaments. The inner lining, also called synovial, produces a special fluid that serves as a kind of lubricant for rubbing bone surfaces.

A joint is formed by the articular surfaces of its constituent bones (epiphyses). These endings have hyaline (articular) cartilage on their surface, which performs a dual function: reducing friction and shock absorption. The knee joint is characterized by the presence of additional cartilage (menisci), which perform the functions of stabilization and attenuation of impact impacts.

Development of DOA

The development of arthrosis begins with damage to the tissues of the articular cartilage (ICD-10 code: 24.1). The process occurs unnoticed and is usually diagnosed with significant destructive changes in the articular cartilage.

Etiology

The main factors contributing to the development of arthrosis: increased physical load on the articular cartilage, as well as its loss of functional resistance to normal loads. This leads to its pathological changes (transformation and destruction).

Factors contributing to the development of the disease determine the main prerequisites for its occurrence. Thus, loss of resistance can be caused by the following circumstances:

• Hereditary predisposition;
• Endocrine and metabolic disorders;
• Age-related changes (especially after 50 years of age);
• Diseases of the musculoskeletal system with a different etiology.

Increased stress on articular cartilage occurs as a result of:

• Chronic microtraumatization. This may be due to professional activities, sports activities or household reasons;
• Overweight, obesity;
• Joint injuries of various origins.

Pathogenesis of articular cartilage

Destruction of articular cartilage is caused by long-term microtraumas of articulated bone surfaces or simultaneous trauma. In addition, some developmental disorders, for example, dysplasia, contribute to changes in the geometry of articulated bone surfaces and their compatibility. As a result, articular cartilage loses its elasticity and integrity and ceases to perform its functions of shock absorption and friction reduction.

This leads to the formation of cords from the connective tissue, designed to compensate for changes in the kinematics of the joint. The consequence is an increase in the amount of synovial fluid in the joint cavity, which also changes its composition. The thinning and destruction of articular cartilage leads to the fact that the bone endings begin to grow under the influence of loads in order to distribute them more evenly. Osteochondral osteophytes are formed (ICD-10 code: M25.7 Osteophyte). Further changes affect the surrounding muscle tissue, which atrophies and leads to deterioration of blood circulation and an increase in pathological changes in the joints.

Symptoms

The main symptoms of the development of DOA include:

Painful sensations

Joint pain is the main reason for a visit to a specialist. Initially, it appears irregularly, mainly during movement (running, walking), hypothermia, or prolonged uncomfortable body position. Then the pain becomes non-disappearing and its intensity increases.

Difficulty moving

At an early stage, gonarthrosis is characterized by a feeling of “stiffness” that appears after a long period of rest (sleep, rest). The knee joint becomes less mobile, its sensitivity decreases and pain of varying intensity is felt. All these manifestations decrease or completely disappear with movement.

Another characteristic symptom is creaking, clicking and other extraneous sounds that occur during prolonged walking or a sudden change in body position. In the future, these sounds become a constant accompaniment when moving.

Loose joint

Often arthrosis of the knee joint leads to its pathologically hypertrophied mobility. According to ICD 10 code: M25.2, this is defined as a “loose joint.” This manifests itself in linear or horizontal mobility that is unusual for it. A decrease in the sensitivity of the end parts of the limbs was noted.

The main functions of the knee joint are movement (motor function) and maintaining body position (support function). Arthrosis leads to functional impairment. This can be expressed both in limited amplitude of its movement and in excessive mobility, “looseness” of the joint. The latter is a consequence of damage to the capsular-ligamentous apparatus or hypertrophied muscle development.

With the development of the disease, the motor function of the diarthrosis joint degrades, and passive contractures begin to appear, characterized by limited passive movements in the joint (ICD code 10: M25.6 Stiffness in the joint).

Musculoskeletal dysfunction

The degenerative-dystrophic changes that occur over time develop into dysfunction (motor and support) of the entire lower limb. This manifests itself in lameness and stiffness of movement, unstable functioning of the musculoskeletal system. Irreversible processes of limb deformation begin, which ultimately leads to loss of ability to work and disability.

Other symptoms

These non-main types of symptoms include:

1. Change in the size of the limb, its deformation;
2. Joint swelling;
3. Excessive presence of joint fluid (to the touch);
4. Visible changes in the skin of the extremities: increased pigmentation, characteristic capillary network, etc.

Diagnostics

The problem with diagnosing arthrosis is that the appearance of the main symptoms with which the patient comes to a specialist already indicates certain serious changes in the joint. In some cases, these changes are pathological.

Preliminary diagnosis is made on the basis of a detailed medical history of the patient, taking into account his age, gender, profession, lifestyle, presence of injuries and heredity.

A visual examination allows you to see those characteristic symptoms of arthrosis that were discussed: swelling, increased local skin temperature. Palpation allows you to determine pain and the presence of excess joint fluid. It is possible to determine the amplitude of movement of the affected area and understand the degree of limitation of motor function. In some cases, characteristic deformities of the limbs are noticeable. This occurs with a long course of the disease.

Instrumental examination methods

The main methods of instrumental diagnosis of DOA include:

1. Radiography;
2. Magnetic resonance and computed tomography (MRI/CT);
3. Scintigraphy (injection of radioactive isotopes to obtain a two-dimensional image of the joint);
4. Arthroscopy (microsurgical examination of the joint cavity).

In 90% of cases, radiography is sufficient to diagnose arthrosis. In cases that are difficult or unclear for diagnosis, other instrumental diagnostic methods are in demand.

The main signs that allow diagnosing DOA using radiography:

• Pathological growths in the form of osteochondral osteophytes;
• Moderate and significant narrowing of the joint space;
• Hardening of bone tissue, which is classified as subchondral sclerosis.

In some cases, radiography can reveal a number of additional signs of arthrosis: articular cysts, joint erosions, dislocations.

Causes and types of knee arthritis, symptoms and treatment

• Types and forms of the disease
• Symptoms
• Treatment methods
• Prevention

Arthritis is a pathology of the joints, which is based on an inflammatory process. Often the disease is chronic and can bother a person for years. Arthritis of the knee joint (gonarthritis, gonitis) is a widespread problem in the world, especially many cases are registered in civilized countries: in Europe, in the USA and here in Russia. The disease often leads to disability, so if you have already been diagnosed with this, treatment should be comprehensive, and you need to start acting as soon as possible.

Types and forms of gonarthritis

The reasons why gonarthritis occurs are not fully understood. Gonarthritis can develop as an independent pathology or be a symptom of other diseases, for example, rheumatism. There are primary and secondary forms of the disease. Primary arthritis is a pathology that occurs independently, “on its own,” while secondary arthritis occurs as a manifestation or complication of other diseases.

The primary form includes the following types of illness:

As a manifestation or complication of other pathologies, knee arthritis is possible:

• For osteoarthritis. Inflammation of the joint cavity occurs against the background of its deforming lesion and destruction of cartilage.
• For rheumatism. Rheumatism is a general disease of the body in which large joints and the heart are most affected.
• For psoriasis (disease of the skin and connective tissue).
• For lupus erythematosus (damage to the immune system).

When the disease is arthritis of the knee joint, the symptoms can be violent, bright and sluggish. Since gonarthritis can be acute (begins suddenly and often proceeds violently) and chronic (the first signs of the initial stage of the disease are invisible, the disease lasts a long time with periodic exacerbations).

Also, inflammation can be unilateral or bilateral (symmetrical), for example, with rheumatism, the process will always be bilateral.

Characteristic symptoms

How to distinguish inflammation of the knee joint from another lesion? Diagnosis is the task of the doctor.

Regardless of the causes of development, the manifestations of different forms of arthritis have common symptoms:

Symptoms of knee arthritis can vary depending on the severity of the disease.

Grade 1 is characterized by minor pain; in the morning there may be a limitation in the mobility of the knee, which goes away after some time.

Stage 2 is characterized by more serious symptoms: the pain becomes more intense, obvious swelling of the knee area, redness and swelling are visible. Difficulties in movement become more pronounced.

Stage 3 gonarthiritis is deforming arthritis, in which severe pain causes persistent muscle spasm, resulting in deformation of the knee.

Treatment methods

Quite a lot has been said about the dangers of self-medication, and for a problem such as arthritis, this is especially true. Therefore, in order to successfully treat the disease, be sure to consult an experienced doctor: after the examination, you will be given an individual treatment plan depending on the type of disease, its stage and all the characteristics of your body. Traditional medicine uses pills, injections, and physical therapy to treat knee arthritis. Each type of pathology requires its own approach, since the mechanism of development, the causes of occurrence, and the symptoms of the disease will be different in each case.

Traditional therapy

Anti-inflammatory drugs, drugs containing hormones and acetylsalicylic acid help treat arthritis.

If the cause of inflammation is an infectious process, then antibiotics are prescribed. If the cause is some general pathology of the body, appropriate therapy is prescribed depending on the disease.

Local medications include ointments, creams and compresses, the purpose of which is to eliminate pain, relieve swelling, improve blood circulation in the knee and warm it.

In severe cases (grade 2–3 of the disease or its acute period), treatment of arthritis of the knee joint with medications that are injected directly into the joint cavity using an injection is indicated. These may be hormonal drugs with an anti-inflammatory effect, chondroprotectors that help restore the normal structure of joint structures, and some other drugs.

During the period of exacerbation of the pathology, it is important to provide rest and warmth to the affected joints; sometimes bed rest is prescribed.

You should follow a diet. Use:

• Fresh vegetables and fruits.
• Fatty fish. It is rich in omega-3 fatty acids, which are beneficial for joint cartilage.
• Seafood containing chondroitin is a natural component that nourishes cartilage. These are squid, shrimp, mussels.

Consumption of salty and spicy foods should be limited.

Massage and manual therapy are also useful for treating knee arthritis.

It is important to understand that the disease can be completely cured only with an integrated approach.

Gymnastics

You can easily perform therapeutic exercises at home. It is important to avoid sudden movements and excessive stress (both directly during classes and in life in general). Gentle stretching exercises help treat the disease very well - they are very useful.

Let's look at a few simple and effective exercises that will help stop knee arthritis and can also serve as a preventative measure.

The number of repetitions of each exercise at the beginning of training should be no more than five; if a smaller number of approaches causes discomfort, do less. In the future, the number of approaches can be increased to ten.

Self-treatment at home

A good addition to traditional methods of treatment are traditional medicine, which can be successfully used at home. To treat arthritis of the knee joint at home, use anti-inflammatory decoctions of medicinal herbs, tinctures, compresses and homemade ointments, which effectively relieve pain, help reduce acute inflammation and prevent complications. A large number of effective recipes are collected in the article “Treatment of arthritis with folk remedies.”

Prevention

Here are the main measures to prevent and prevent complications of the disease, which are aimed at eliminating the main causes of the disease:

• avoid hypothermia of the feet, especially prolonged stay in cold water;
• if your work involves long periods of standing or sitting, take breaks for a short warm-up or walking;
• follow a diet, fight excess weight (if you have it);
• increase immunity and body resistance (healthy lifestyle, hardening, vitamins);
• give up bad habits.

It is, of course, up to the doctor to decide how to treat arthritis of the knee joint in each specific case. But the recovery process largely depends on the patient. If you strictly follow all the doctor’s recommendations and be attentive to your health, the chances of a favorable outcome are high, and it is quite possible to even completely cure the disease. Take care of yourself and be healthy!

Connective tissue performs several functions in the human body. It is not responsible for the functioning of any organs, but at the same time forms their supporting frame and outer coverings.

The organs of the human body are 90% composed of connective tissue. In some cases, a person may develop a special systemic connective tissue disease called dysplasia.

This term refers to a failure in the formation and development of connective tissue in humans. Dysplasia is a systemic disease and can affect groups of organs.

The disease can occur both at the stage of intrauterine development of the child and develop after his birth.

The specificity of connective tissue dysplasia is that it is not limited to just one specific manifestation, but represents a group of diseases. Their peculiarity is the non-inflammatory nature of their occurrence.

The syndrome is expressed as:

• damage to tissue structures and substances;
• changes occurring in collagens, complex proteins, fibroblasts, elastic fibrils.

These defects become the main cause of impaired self-regulation in the body at any level, since connective tissue is present in any part of it.

ICD designation

For a long time there was no generally accepted name for this disease in medicine.

With the final confirmation of the systemic nature of the development of dysplasia, a general definition of the disease was officially approved - hypermobility syndrome.

This disease has a code according to ICD-10 - M35.7. According to the International Classification, joint hypermobility is the main symptom of connective tissue diseases. This emphasizes the systemic nature of dysplasia.

In Russian medicine, a group of diseases is called connective tissue dysplasia. This term includes both syndromic and non-syndromic manifestations of the disease.

Reasons for development

The main provoking factor in the development of the disease are various gene mutations to which the child’s body is exposed during the period of intrauterine development. Mutations affect various types of enzymes, protein-carbohydrate complexes.

There may be over 1,000 different variants of genetic changes in proteins that trigger the development of the disease. The disease can be inherited.

The causes of mutations are the following factors:

Mutations can cause the following possible disturbances in protein chains:

• their lengthening;
• truncation;
• development of selective mutations by substitution of amino acids.

Reference. It is assumed that one of the factors causing connective tissue dysplasia in humans is insufficient intake of magnesium into the body during embryonic development.

Symptoms

Manifestations of the disease are different. There are both mild forms and severe ones that require a special approach. Symptoms and treatment of connective tissue dysplasia syndrome highly individual for each patient and in many ways unique.

The following manifestations of the disease are possible:

Symptoms depend on the type of disease. There are differentiated and undifferentiated forms. The signs of the first are:

• aortic aneurysm;
• bone fragility;
• skin atrophy;
• finger deformity (arachnodactyly);
• scoliosis;
• funnel chest deformity;
• increased skin vulnerability (Ehlers-Danlos syndrome);
• Marfan disease in the form of a violation of the shape of the skeleton, pathologies of the organs of vision and the cardiovascular system.

Undifferentiated connective tissue dysplasia syndrome is manifested by symptoms:

• increased skin elasticity;
• excessive joint mobility;
• skeletal abnormalities;
• atypical thinness of the skin;
• various forms of malfunctions in the functioning of myocardial valves and organs of vision.

Attention! People with undifferentiated dysplasia are not classified as sick, but belong to a group of patients prone to exhibiting possible characteristic pathologies.

Diagnostics

The most accurate diagnosis can be made using the following methods:

• endoscope examination;
• skin biopsy;
• X-ray examination of joints, lungs, spine;
• electrophysiological examination (ECG, electroencephalogram);
• blood test for biochemistry;
• Ultrasound of the kidneys and pelvic organs;
• medical genetic examination;
• 24-hour urine test;
• measuring body parts;
• joint mobility test.

The detection of problems in the functioning of several body systems indicates the likely development of connective tissue dysplasia in the patient.

Therapy methods

Therapy for the disease should be comprehensive and individual, depending on the symptoms and damage to specific body systems in the patient. Treatment of the disease includes:

• physiotherapy, performing special exercises;
• taking medications to improve metabolism;
• adherence to diet;
• surgical methods for deformation of the chest and musculoskeletal system.

Non-drug therapy includes:

Drug therapy includes taking the following medications:

• metabolic stabilizers (“Alfacalcidol”);
• stimulators of collagen production (ascorbic acid, magnesium citrate);
• drugs supporting the heart muscle (“Mildronate”, “Lecithin”);
• tissue repair stimulators (“Chondroxide”);
• drugs that normalize amino acid levels (“Glycine”).

Patients need intensive nutrition. It is necessary to consume protein foods, fish, cheeses, and seafood in large quantities. It is important to include meat-based broths, fruits and vegetables in your diet, and also take Omega-class dietary supplements.

Peculiarity! Surgical treatment is carried out only in two cases: when a person is life-threatening with severe vascular pathology and with obvious deformities of the chest.

Features of treatment in children

Connective tissue dysplasia syndrome in children requires a special approach to its treatment. It is important to pay attention to the following methods:

• child's dietary compliance(it should be dense and include various types of meat, legumes, fruits and vegetables, seafood);
• proper organization of lifestyle(refusal of serious sports activities in favor of physiotherapy and light gymnastic exercises);
• competent adaptation of the child to life in society(lesson with a psychologist to prevent the formation of an inferiority complex);
• use of special joint-strengthening splints and casts for young children;
• taking a course of metabolism-stimulating medications(course duration is 60 days, after which there is a break).

In case of serious pathologies associated with the disease, the child requires surgical treatment in the form of surgery. It is carried out in case of serious threats to the life of children with connective tissue dysplasia.

Important! Muscle dysplasia in children, as in adults, due to the genetic factor of its development, cannot be definitively treated. Therapy can only reduce the signs of its manifestation, slow down symptoms or stop the development of the syndrome.

Contraindications

If a person has this disease, the following is not recommended and prohibited:

• engage in hard and harmful work;
• perform exercises to stretch the spine or hang on the horizontal bar;
• expose yourself to stress and psychological overload;
• engage in contact sports and weightlifting.

Conclusion

Connective tissue dysplasia syndrome is a group of diseases of genetic origin. They are characterized by a multiplicity of symptoms, which requires an integrated approach to diagnosis and treatment.

Taking into account the hereditary nature of the development of the disease, it is not amenable to definitive treatment, but the therapy used for it can significantly improve the patient’s quality of life and avoid the progression of pathologies until old age.