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Professor Ilan BANK
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Polyarthritis of the joints

 
, medical expert
Last reviewed: 07.06.2024
 
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A disease of the musculoskeletal system in which several joints are affected simultaneously - with degenerative-dystrophic changes in their bone and cartilage structures - is diagnosed as joint polyarthrosis.

Epidemiology

Experts of the American College of Rheumatology estimate the prevalence of polyarthrosis at 5-25% of the population. In at least 42% of cases, this disease is detected in the family history of patients. [1]

Causes of the polyarthritis of the joints

Osteoarthritis or osteoarthritis with simultaneous involvement of more than one joint is a multiple degenerative arthropathy associated with destruction of intra-articular hyaline cartilage and damage (remodeling) to subchondral bone that can occur in virtually any synovial joint.

In the absence of terminological uniformity, polyarthrosis is also referred to as generalized or multi-joint osteoarthritis, Kellgren syndrome or generalized osteoarthritis, multiple deforming/degenerative osteoarthritis, and polyosteoarthritis. [2]

Often it is not possible to find out the main or predisposing causes of pathology, and in such cases idiopathic or primary polyarthrosis is determined - the most common form of this disease. And polyarthrosis in adults over 65 years of age is explained by the "wear and tear" of articular cartilage due to natural aging (although the disease can occur at the age of 40 to 50 years). [3]

Secondary polyarthrosis etiologically may be due to:

  • traumas;
  • long-term overloading of joints with disturbances in their statics and dynamics;
  • joint inflammation (rheumatoid and other types of arthritis);
  • synovial joint chondromatosis;
  • valgus/varus/flat foot deformity;
  • Intervertebral disc degeneration, spinal curvature - scoliosis, traumatic spondylitis, spinal osteochondropathy;
  • joint hypermobility syndrome;
  • autoimmune diseases of connective tissue (systemic lupus erythematosus, scleroderma);
  • congenital abnormalities, including familial dissecting osteochondritis (with detachment of articular cartilage from subchondral bone) or hereditary connective tissue dysplasia, which leads to ligament weakness and chronic instability of joints, as a result of which their degenerative-dystrophic changes may develop.

Risk factors

In addition to traumatic joint injury and advanced age, risk factors for developing polyarthrosis include:

  • female gender (since the pathology is more often observed in women, which may be due to age-related hormonal changes (during menopause);
  • heavy physical work and some sports that put increased strain on the joints;
  • Overweight and obesity (also increasing the mechanical load on all joint structures);
  • Congenital dislocation of bones and dislocations of joints (for example, dislocation of the head of the femur outside the acetabulum - congenital hip dislocation);
  • Muscle dystrophy and loss of muscle tone needed to support joint stability;
  • certain endocrine diseases (hypothyroidism, diabetes mellitus);
  • The presence of polyarthrosis in relatives, i.e. Hereditary predisposition.

Genetic factors in the development of primary generalized osteoarthritis play not the least role in accelerating the process of cartilage degeneration. In particular, these include polymorphisms of the FRZB gene encoding the expressed protein in chondrocytes (cartilage tissue cells); mutations of genes that encode structural proteins of the extracellular matrix of cartilage tissue, and others. [4]

Read - Risk Factors and Causes of Osteoarthritis

Pathogenesis

The individual components of the mechanism of development of multiple degenerative arthropathy remain the subject of research that examines changes in the connective structures of joints and the relationship between cartilage extracellular matrix damage and subchondral bone destruction. [5]

What explains the pathogenesis of this disease read in the publications:

Symptoms of the polyarthritis of the joints

Typical symptoms of polyarthrosis of joints of various localizations are manifested by pain in the joint, its swelling, stiffness (stiffness) and reduced range of motion.

Most often the first signs of degenerative and dystrophic changes in the bone and cartilage structures make themselves known by pain when pressing on the joints. At first, in the morning, there is the so-called starting pain, which quickly subsides with movement. Further on, as the disease progresses, joint pain is felt when the joints are loaded. See - Main symptoms of osteoarthritis

And when the joints hurt even at rest, and their mobility does not improve after prolonged rest (and creates a feeling of blocked joints), it is an indicator of a fairly advanced stage of osteoarthritis. There are four stages in total: from virtually painless to severe - with severe pain; the stages are determined by the degree of pathological changes in the contralateral joints visualized on X-ray (using the Kellgren-Lawrence scale). Polyarthrosis of the 1st degree corresponds to stage I-II, polyarthrosis of the 2nd degree corresponds to stage III-IV of degenerative-dystrophic changes in bone and cartilage structures of joints.

A common symptom of polyosteoarthritis is also crunching or crackling in the joint when moving. This is due to the fact that deforming polyarthrosis develops - with the formation of bone growths (osteophytes) on and around the joint, causing deformity.

There are certain types, clinical forms and variants of osteoarthritis. The joints of the extremities are most often subjected to pathological changes.

In the upper extremities, this is polyarthrosis of the hands, which can extend to the first metacarpophalangeal, carpal-carpal, navicular-carpal and proximal/distal interphalangeal joints. Polyarthrosis of the interphalangeal joints can be deforming, with bony protrusions (Heberden's and Bouchard's nodules), and erosive, with the formation of cystic cavities in the subchondral bone. [6]

Polyarthritis of the joints of the lower extremities can affect:

Polyarthrosis of the spine may develop - with degenerative damage to the articular cartilage of the articular (facet) joints in the form of spondyloarthrosis (usually of the cervical or lumbar spine) or osteoarthritis of the spine. Its clinical manifestations include back pain (in cervical osteoarthritis, neck pain radiating to the shoulder) and problems with spinal mobility and flexibility.

Complications and consequences

As the disease progresses, it can affect the ability to perform certain activities, change a person's posture and gait, leading to instability and reduced range of motion. And it can affect the muscles with loss of muscle mass (called muscle fiber atrophy).

A complication of gonarthrosis can be inflammation of the synovial membrane of the joint (synovitis), as well as the formation of a herniated hamstring (Baker's cyst), pressing on the tibial nerve, which leads to numbness of the leg below the knee, soft tissue swelling and venous thrombosis.

A serious consequence of spinal joint lesions is stenosis (narrowing) of the spinal canal, which leads to weakness in the legs and claudication of neurogenic origin.

Diagnostics of the polyarthritis of the joints

How multiple degenerative osteoarthritis is diagnosed, read the publications:

Differential diagnosis

Differential diagnosis of polyarthrosis should exclude polyarthritis; rheumatoid, juvenile idiopathic, psoriatic and reactive arthritis; gout; osteochondrodysplasia and ankylosing spondyloarthritis; neurogenic and other arthropathies. See also - Differential diagnosis of osteoarthritis

Who to contact?

Rheumatologist

Treatment of the polyarthritis of the joints

Standard treatment for polyarthritis includes reducing the intensity of pain and managing other symptoms.

In medication treatment of osteoarthritis, including generalized osteoarthritis, various drugs are used. Details in the articles:

Conducted topical treatment of osteoarthritis, the applied ointments for polyarthritis are:

Contributes to improving the condition of patients physiotherapy treatment and exercise therapy for polyarthrosis. All details in the materials:

An optimally balanced diet is also recommended - diet for polyarthrosis, details ref. - Diet for osteoarthritis

In cases when pain becomes unrelenting, when degenerative-dystrophic changes in the bone and cartilage structures of the affected joints make it impossible to perform any movement, including walking, surgical treatment is performed, more details:

Prevention

Can polyarthritis of the joints be prevented? There is no specifically designed prevention of osteoarthritis. However, an active lifestyle with moderate physical activity, getting rid of excess weight and paying attention to the condition of the musculoskeletal system can reduce the risk of developing the disease or stop its progression.

Forecast

The overall prognosis depends on the degree of damage to the articular cartilage and subchondral bone, the number of affected joints and their localization. In many cases, the loss of joint function results in disability.

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