Arthropathies are a very large group of diseases that share a common symptom of loss of joint function. Arthropathy may occur in the course of autoimmune, metabolic, neoplastic diseases, genetic defects, trauma or even as a complication of an infection. Absence or inadequate treatment of arthropathy leads to joint dysfunction, which interferes with daily activities, and in the long run may even cause permanent disability.

Arthropathyoccurs when the normal cells in a joint are destroyed or replaced by other cells that do not have the same function.

Inflammation or the presence of abnormal substances in the joint contributes to adverse changes in the tissues that build it.

Autoimmune diseases, infections and proliferative diseases are just some of the groups in which we can distinguish disease entities that cause damage to the musculoskeletal system. Due to their huge number, we decided to discuss only selected pathologies. Nevertheless, in the differential diagnosis one should remember about all possible causes of arthropathy, which is why we have also included the less common ones in the following.

Arthropathy: causes

  • autoimmune diseases

rheumatoid arthritis
juvenile idiopathic arthritis
psoriatic arthritis
Crohn's disease
ulcerative colitis
ankylosingitis spine joints

  • viral infections

rubella virus
parvovirus B19
hepatitis B and hepatitis C
HIV
mumps virus
HTLV virus, Sindbis virus, EBV virus

  • bacterial infections

reactive arthritis
trichomoniasis
tuberculosis
borreliosis
syphilis
rheumatic fever after streptococcal pharyngitis
brucellosis, Whipple's disease

  • metabolic diseases

diabetes
Lesch-Nyhan syndrome
chondrocalcinosis
gout
hemochoromatosis

  • degenerative diseases

coksartroza
gonarthrosis
Bouchard nodules and Heberden nodules

  • proliferative diseases

synovial sarcoma
hypertrophic osteoarthritis
synovial chondrosarcoma

  • blood diseases

haemophilic arthropathy
arthropathy in Von Willebrand syndrome

Arthropathies in the course of autoimmune diseases

Rheumatoid arthritisis an autoimmune disease characterized by chronic inflammation of the joint's synovium. It most often affects the small joints of the arms and legs, causing them pain, excessive heat and swelling. These are markers of ongoing inflammation, which can be seen with imaging tests such as ultrasound and magnetic resonance imaging.

For unknown reasons, cells of the immune system accumulate in the joint capsule. As a result of their action, pathological tissues are produced in the place of normal tissues, which do not have the same properties and lead to joint dysfunction.

Some patients, especially those who do not respond to treatment, develop symptoms resulting from an attack of other organs. Damage to the structures of the heart and pericardium as well as atherosclerosis are the most serious consequences of rheumatoid arthritis, as they can result in life-threatening conditions such as stroke or heart attack.

Treatment of rheumatoid arthritis consists of elements of pharmacotherapy and rehabilitation, which inhibit pathological changes and increase the patient's quality of life. The gold standard in the treatment of this disease is the immunosuppressive drug - methotrexate, which reduces the activity of the immune system.

For several years, biological therapies have been a chance for patients who are refractory to treatment with standard drugs. They work by blocking the factors involved in inflammatory processes in the body.

Still, remember that both treatments are associated with a large number of side effects, such as reduced immunity to fight germs, hair loss, or mouth ulcers.
Juvenile idiopathic arthritis (JIA)is the most common inflammatory arthritis of the developmental age. The criteria for its diagnosis are:

  • age under 16
  • inflammation of a joint or joints for 6 months
  • exclusion of all possible causes of joint inflammation

It is an autoimmune disease with a pathomechanism similar to that of RA. It can exist in three subtypes distinguished by initial symptoms. The most common is the one with 1-4 asymmetric joints at the onset of the disease.

The second version, called polyarticular, is recognized when more than 5 joints are involved.

The heaviest figure - generalized- is characterized not only by pathologies in the joints, but also by fever and salmon rash. It is correlated with damage to internal organs.

All three subtypes are also characterized by possible changes in the choroid, so it is important that people diagnosed with JIA are under the supervision of an ophthalmologist.

Treatment of juvenile idiopathic arthritis is based on the administration of immunosuppressants, mainly glucocorticoids or methotrexate, and the care of a rehabilitation clinic.
Psoriatic arthritisis a disease in which inflammation in the joints coexists with pathological changes on the skin. Skin lesions may precede the symptoms of arthropathy, appear simultaneously or appear long after the first symptoms of the locomotor system.

It is a disease entity that is often misdiagnosed as rheumatoid arthritis due to the lack of a temporal correlation of skin and joint changes. The most common are the interphalangeal joints: proximal and distal.

Treatment of psoriatic arthritis is based on pharmacotherapy typical of rheumatoid diseases, as well as constant supervision of a dermatologist whose task is to control skin changes.

Arthropathies in inflammatory bowel diseases

Arthropathy in inflammatory bowel diseases is the result of an inflammatory process that affects the entire body. Inflammatory bowel diseases include Crohn's disease and ulcerative colitis.

For unknown reasons, these disease entities have a dangerous inflammation in the small or large intestine. Cytokines such as TNF-alpha, IL-1B, Il-6, secreted by lymphocytes in the gut wall, activate cells at distant sites in the body. Then we are dealing with parenteral symptoms, among which we distinguish damage to the eyes, tendons, skin and joints.

Both diseases can cause seronegative spondyloarthritis, i.e. inflammation of the spine, sacroiliac joints and extremities, but laboratory tests for rheumatoid factor are negative.

According to statistical data, as many as 40-50% of patients have one extraintestinal manifestation, and in 25% at least two.

An important fact is that 30-46% of patients with inflammatory bowel diseases have symptoms of joint damage. The symptoms of the locomotor system do not have to be correlated in time with the symptoms of the intestine.

Often a common feature for inflammatory bowel diseases and inflammatory diseasesthe current arthropathy is the presence of the HLA-DRB10103 antigen in the blood.

In the case of comorbid arthropathies in patients with inflammatory bowel diseases, three subtypes are distinguished:

  • Type 1 arthropathyis characterized by acute and asymmetric inflammation of the large joints that is accompanied by an increase in intestinal symptoms. Inflammation lasts up to 10 weeks and is usually self-limiting. In addition to the symptoms of the musculoskeletal system, there are also erythema nodosum and iritis.
  • Type 2 arthropathymanifests as a symmetrical attack of many small joints, which can last for years. There was no correlation between the intensity of pain in the joints and the intestinal activity of the disease.
  • Type 3 arthropathyis associated with the involvement of the axial spine and sacroiliac joints. The incidence is as high as 10%, but its course is usually asymptomatic or mildly symptomatic.
    It is correlated with inflammatory changes in the terminal ileum. This type of arthropathy is more common in Crohn's disease and, due to the location of the deformity, it is the most dangerous of them all.
    Ankylosing spondylitis due to inflammatory bowel diseases, unlike the idiopathic form, occurs regardless of age and gender. A few patients experience chest pain caused by enthesitis in the sternocostal and costo-vertebral joints.

Treatment for inflammatory bowel arthropathies is based on the administration of coxib, sulfasalazine or the biological drug infliximab.

There is also a possibility of colon resection in the case of ulcerative colitis. This procedure leads to the remission of peripheral arthropathy, but the axial joints are unfortunately still affected by the disease.

Arthropathies in metabolic diseases

Gout , which occurs in 1-2% of people, is caused by the deposition of sodium urate crystals in the tissues. The excess amount of uric acid in the blood, called hyperuricemia, occurs when uric acid levels exceed the limits of 7 mg / dL in blood for men or 5.5 mg / dL in blood for women.

This situation arises in three cases - overproduction, impaired excretion, or a combination of both. We deal with such abnormalities, among others, in renal failure, hypothyroidism, metabolic syndromes or even with an incorrect diet.

Crystals of uric acid especiallyThey like the articular cavity and it is there that they willingly accumulate, activating inflammation in it. The prolonged reaction of the body leads to joint dysfunction and arthropathy.

Gout affects the characteristic joints and depending on which of them is involved, it takes its name. Gout is the inflammation of the big toe, chiragra - inflammation within the joints of the hand, and gonagra is a specific term for inflammation of the knee joint in the course of gout.

The characteristic redness, swelling, pain and warmth of the mentioned joints is a suggestion to consider this disease entity in the diagnosis.

A person with an acute or chronic gout attack should see a rheumatologist. In the event of a sudden attack, colchicine and anti-inflammatory drugs are used, and in the case of longer treatment, the use of allopurinol is the gold standard. Weight management through exercise and a reduced-meat diet is also essential.

Chondrocalcinosismost often affects the elderly. It is due, like gout, to the deposition of crystals in the tissues. The substance that accumulates excessively in the body is calcium pyrophosphate this time. Its presence in the articular cartilage leads to inflammation and arthropathy.

The symptoms and course of the disease resemble gout, hence this pathology was formerly called pseudogout. Treatment of chondrocalcinosis involves the administration of intra-articular glucocorticosteroids and the use of colchicine and non-steroidal anti-inflammatory drugs.

Post-infection arthropathies

Infectious arthropathies occur when infection with a microorganism occurs within a joint or is the result of the systemic presence of a pathogen.

As a result ofparvovirus B19 infectionmay lead to serious complications in the form of arthropathy. Adults in the second stage of infection, in which there are no virus antigens in the blood and respiratory secretions, are primarily at risk of joint damage.

It begins approximately 17-18 days after infection and is characterized by a rapid build-up of specific anti-B19 antibodies in the body. The antibodies form immune complexes that can precipitate and accumulate in the skin, forming rash erythematosus, or in joints, causing symptoms of arthropathy. Symptoms of joint damage disappear within 14 days.

1-15% of patients struggling with infectionrubellamay experience arthropathy in the small joints of the hands and knees. Joint pain and swelling appear in the rash period and are more common in women. Inflammation and related dysfunctions of the musculoskeletal systemlasts for about 10 days.

Reactive arthritis , formerly known as Reiter's syndrome, is the body's response to bacteria or their toxins in the joints. About a month after a bacterial infection of the intestines or urethra, 1-4% of patients may develop arthropathy.

Treatment consists in removing pathogenic bacteria from the body, as well as administering systemic or intra-articular anti-inflammatory drugs. If these methods are ineffective, rheumatoid medications such as methotrexate or sulfasalazine are recommended.

Rheumatic feveris a dangerous disease that is a complication after infectionStreptococcus pyogenes . Streptococcus and human antigens are so close that immune cells attack not only bacterial cells but also normal host cells.

About 3 weeks after streptococcal pharyngitis, the first flare of rheumatic fever occurs. In the body, the antibodies attack the endocardial and heart muscle cells and the joints.

In 90% of cases, the inflammation is migrating, which means that pain and swelling affect the joint and then disappear. A particularly dangerous complication are changes in the heart, including permanent valve dysfunction.

Other causes of arthropathy

Hemophilic arthropathyis a secondary joint injury caused by bleeding into the joint. In patients with haemophilia A, low activity of the tissue factor in the synovium and negligible thrombogenesis predispose to intra-articular bleeding. Iron ions in the blood stimulate angiogenesis in the joints and activate the free radical system.

Both mechanisms damage chondrocytes and lead to synovial hyperplasia, which manifests itself initially with inflammation and then destruction of the joint.

Treatment of haemophilic arthropathy is based on administering to the patient a concentrate of deficient coagulation factors and, depending on the stage of arthropathy, isotope synovectomy, stiffening or even arthroplasty.

Arthropathies - how to prevent them and how to treat them?

The basis of defense against arthropathies is proper diagnosis, which allows to identify the cause of joint damage. Depending on it, a specialist doctor uses specific pharmacotherapy based on drugs modifying the course of a given disease as well as painkillers and anti-inflammatory drugs.

It is important to also remember about a daily he althy lifestyle, based on physical activity and a properly balanced diet. Regular movement and exercise as recommended byphysiotherapist, allow you to increase the production of synovial fluid in the joint cavity. This reduces friction between the moving bones, reducing pain and improving range of motion in the joint.

Omega-3 fatty acids contained in fatty fish, fruits and vegetables are the basic components of the diet that reduce inflammation in the body. Physiotherapy units also allow the treatment of arthropathy with the help of physical phenomena.

Lasers, magnetic field, cryotherapy and ultrasounds are treatment methods used in patients with joint dysfunctions. In a situation where the destruction of the joint is already advanced, the joint is stiffened to prevent further damage.

Alloplasty is the last resort for people in whom other treatments turn out to be ineffective. The surgical procedure of replacing a physiological joint with a mechanical one allows many people to regain their former efficiency.
References:
1. Zdzisław Dziubek, Infectious and parasitic diseases, Warsaw, PZWL Medical Publishing, 2012.
2. Bogdan Pruszyński, Radiology. Diagnostic imaging X-ray, CT, ultrasound and MR, Warsaw, PZWL Medical Publishing, 2014
3. Tadeusz Sz. Gaździk, Orthopedics and traumatology. Volume 1-2, Warsaw, PZWL Medical Publishing, 2010
4. Krystyna Księżopolska - Orłowska, Physiotherapy in rheumatology, Warsaw, PZWL Medical Publishing, 2013

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Anatomy