Violation of the mobility of the joints is most often expressed in its limitation, that is, the impossibility of performing movements in full. The most common cause is a painful limitation of mobility caused by muscular tension. It is usually easily diagnosed due to the clear connection between the pain syndrome and the amount of movement in the affected joint. Restricted mobility can also be associated with structural changes in the joint itself (adhesions, adhesions, wrinkling of the ligament-ligament apparatus) or surrounding tissues (skin, muscles), in these cases they speak of joint contracture. Complete immobility of the joint – ankylosis, usually associated with fibrous adhesions or filling the joint cavity with bone tissue.
In terms of methodology, it is very important to maximally objectify those changes in the joints that the doctor finds. This is important not only in terms of follow-up of the patient, assessment of the effectiveness of therapy, but also a precise understanding by other colleagues of what the doctor had in mind when describing changes in the articular apparatus. Currently, in rheumatology there are a number of objective quantitative indicators, which, if they are not universally recognized, are in any case known and understood by doctors.
1. Pain index – it is detected during active and passive movements of the joints and is assessed as follows: 0 points – no pain, 1 point – minor pain when moving, 2 points – moderate pain, which is why movements are limited, 3
points – very severe pain, due to which movement in the joint is sharply limited or impossible.
2. The inflammatory index is determined by the method of examining and palpation of the joint and is assessed as follows: 0 points – there is no exudation in the joint, 1 point – slight exudation, 2 points – exudation is moderate, 3 points – exudation is pronounced.
3. The articular index is estimated by the method of palpation – 0 points — the joint is insensitive, 1 point – weak soreness, 2 points – moderate soreness, 3 points – sharp soreness.
4. Joint score refers to the number of actively inflamed joints and is usually calculated by the inflammatory index. It is accepted that the metacarpophalangeal and proximal interphalangeal joints of the hands, the tarsus joints and the metatarsophalangeal joints of the feet are considered for a given limb as a single joint and are evaluated by one assessment (according to the most affected combination). The temporomandibular, sternoclavicular and clavicular-acromial joints for each pair are also evaluated by one assessment. A very important, objective assessment of the affected joints is the measurement of the circumference. This method can not be used for all joints and moreover one must be very careful to ensure that the measuring tape is always applied in one and the same . same place. Finally, a very reliable characteristic is the measurement of the range of motion in a joint, which is carried out by a goniometer. In practice, it is possible to limit the assessment of the implementation of those movements, which are shown in Figures No 5, 6, 7.
Arthral lesions in UXA have a number of clinical features, and the first of these is undoubtedly the persistence of arthritis. It is this symptom that is the basis for the classification of joint lesions to the disease, since only the presence of arthritis for three months suggests YUHA. Another feature is the absence of exudative changes in the affected joint (s). The pain appears only when moving in the joint. Except in rare cases with pronounced exudative phenomena in periarticular tissues.
yah, palpation of the joint is also painless. The presence of morning stiffness of varying degrees of severity and duration (from tens of minutes to several hours) can be considered very characteristic. Often, the diurnal rhythm of arthralgia, which is most pronounced in morning hours, can also be noted. These features can serve to a significant extent for diagnosis.
The most common mono-, oligoarthritic variant of the onset of UHA, which occurs in half of the patients. Almost two thirds of them fall ill at the age of 2-4 years. A subacute beginning without distinct common manifestations can be considered sufficiently typical. A common pattern is that the more joints are simultaneously involved in the pathological process and the larger the joints, the brighter and more active the initial period. The first symptoms that parents notice are impaired function. affected joints, less often – changes in their configuration. Practically in all children, with detailed questioning, it is possible to identify the presence of morning stiffness, and in younger children, parents themselves often notice that the child has a worse affected joint in the morning, and by the middle of the day and in the evening the movements recover almost completely. In these forms of lesions, the large joints of the lower limbs most often suffer, of which the knee joint is in the first place, and the right knee joint is affected almost 3 times more often than the left one. The second place in frequency is occupied by the ankle joints. The remaining joints (hip, wrist, small joints of the hands and feet) are involved less often.
An objective examination revealed a change in the configuration and an increase in the volume of the joints due to periarticular tissues, in half of the patients – an increase in the local temperature. In almost all cases, there are painful contractions, as a rule, of moderate degree. When injuring the knee joints, the maximum extension is usually limited, less often – maximum flexion, with injuries of the ankle and wrist – maximum flexion and extension, hip joints – abduction and rotational movements.
Laboratory activity clearly correlates with the severity of the disease (manifestation of general intoxication, temperature reaction, and to a lesser extent, local changes on the part of the joint). In the acute onset, there is an increase in ESR, the appearance of C-reactive protein in the blood, dysproteinemia with an increase in a2 and γ-globulins. In the subacute and latent course of the disease, the laboratory indicators of activity either do not change, or their moderate changes are detected, mainly as a result of dynamic observation.