Swelling of the joints occurs with traumatic injuries, rheumatic, orthopedic, infectious, endocrine diseases. May affect one, several or many joints. It is accompanied by an increase, a change in the contours of the periarticular areas. Often combined with pain, redness, increased local temperature. The cause of the swelling is determined using interview data, physical examination, radiography, other imaging techniques, and laboratory tests. Before diagnosis, functional rest is recommended, sometimes the use of topical agents is acceptable.
Why do joints swell
Rheumatoid arthritis
One of the most common types of arthritis is rheumatoid arthritis. A distinctive feature is bilateral symmetrical damage to the joints. Pathology often debuts against the background of the change of seasons, hormonal changes, general infection, trauma, hypothermia. Manifests acutely or subacutely, subsequently acquires a chronic character. Perhaps initially chronic course. Swelling of the joints is complemented by pain, local hyperemia, hyperthermia, transient or permanent stiffness, dysfunction.
There are special forms of the disease - Felty's syndrome and juvenile arthritis. Felty's syndrome develops on average 1 year after the onset of the first symptoms of the seropositive form of the disease. There is damage to small joints in the arms and legs. Hepatosplenomegaly, leukopenia, myocarditis, episcleritis, polyserositis are detected.
Juvenile rheumatoid arthritis develops in childhood or adolescence, resembles pathology in adults, but differs from it in some ways. Perhaps a predominant lesion of the joints, a combination with severe systemic manifestations. The process often involves large joints of the arms and legs. In addition to swelling, deformities and gait disturbances are detected. Sometimes hernial protrusions are formed.
Other aseptic arthritis
Diseases often occur chronically with alternating exacerbations and remissions. Swelling of the joints is combined with pain, stiffness of movements, signs of local inflammation. The symptom is detected in the following types of arthritis:
- Psoriatic. Possible asymmetric oligoarthritis, rheumatoid-like lesions, involvement of the distal joints of the hands. Swelling develops some time after the appearance of skin changes, less often articular symptoms precede skin symptoms.
- Gouty. In the vast majority of cases, the I metatarsophalangeal joint suffers. The disease begins acutely with sharp pains, swelling, redness of the skin, dysfunction. Subsequent attacks gradually become more frequent. Migrating pains, mono- and oligoarthritis of large joints or hands are less common.
- Reactive. Asymmetric swelling of the joints occurs 1-4 weeks after the onset of symptoms of a urogenital or intestinal infection. In a typical course (Reiter's syndrome), symptoms of urethritis, conjunctivitis are noted. Possible skin changes, lymphadenitis, damage to internal organs.
Joint swelling
Infectious arthritis
They are provoked by specific or nonspecific pathogenic microflora. Along with swelling, pain, redness, local hyperthermia are often accompanied by general symptoms: fever, chills, weakness, fatigue, intoxication syndrome. There are the following types of infectious arthritis:
- Nonspecific purulent. Bacterial arthritis usually affects one large leg joint: the knee, hip, and ankle. The swelling grows, is combined with sharp jerking pains, general hyperthermia, and other signs of inflammation. Possible rapid destruction of the articular surfaces.
- Viral. Swelling and pain are moderate or slight, migrating. Symptoms persist for several weeks or months, the outcome is favorable.
- Fungal. It develops against the background of immune disorders. There is a tendency to a long course, the destruction of the nearby bone, the formation of fistulas, the formation of ankylosis.
- Gonococcal. The ankle, knee, elbow joints swell, sometimes the hands. Multiple rashes appear on the skin and mucous membranes. Manifestations of urogenital infection (urethritis, cervicitis) may be smoothed or absent.
- Syphilitic. It is observed both in congenital and acquired syphilis. A symmetrical lesion of both knee joints, recurrent synovitis is revealed. Perhaps the formation of dactylitis with swelling, subsequent deformation of the fingers.
- Tuberculous. It proceeds chronically, affects one of the large joints of the arm or leg. Swelling is initially expressed slightly, subsequently progresses due to synovitis, the formation of cold abscesses.
- Brucella. Swelling is small, supplemented by short-term pain. There are pronounced symptoms of an infectious disease: fever, heavy sweats, chills, swollen lymph nodes, liver, spleen.
Panarthritis is a complication of nonspecific or gonorrheal arthritis involving surrounding tissues. Pathology is accompanied by significant swelling of the joint, a symptom of fluctuation due to the accumulation of pus in the tissues, fever, a drop in blood pressure, and sometimes impaired consciousness.
Allergic arthropathy
Pain, swelling of the joints (usually insignificant) appear immediately after contact with the allergen or after a few days. They are combined with skin rash, rhinitis, conjunctivitis, lymphadenitis, broncho-obstructive syndrome, and other manifestations of allergies. Swelling of the joints in some cases is detected with Quincke's edema in children. It is considered a constant sign of allergic sepsis, which is also more often diagnosed in pediatric patients.
Arthropathy in infectious diseases
For arthropathies in parasitic and infectious diseases, a mildly pronounced swelling, unstable symptoms, which quickly disappear with the treatment of the underlying pathology, are typical. Swelling of the joints can be observed in diseases such as:
- Rubella. The joints are involved symmetrically.
- Parotitis. The symptoms are similar to rheumatoid arthritis.
- Chicken pox. One or more joints swell for a short time.
- Meningitis. Puffiness appears a week after the onset of the disease, one knee suffers, polyarthritis is less common.
- Viral hepatitis. Swelling of the knees and hands precedes the development of jaundice.
- HIV infection. The knees and ankles are more often affected, swelling is combined with severe pain, restriction of movement.
Arthropathy in endocrine pathologies
Articular changes develop against the background of endocrine diseases or normal age-related changes. Occurs in the following cases:
- Climax. The knees and feet are more likely to swell in overweight women. Stiffness, pain, crunch are observed.
- Diabetes. The feet are affected, less often the knee, ankle joints, the hands are even less often affected. Swelling occurs due to edema and progressive deformity.
- Hyperparathyroidism. Typical acute mono- or polyarthritis with short-term swelling of the joints.
- Hypothyroidism. The large joints of the legs suffer. Puffiness, joint, muscle pains come to light.
Other arthropathies
Swelling can occur with bowel diseases, vasculitis, taking certain medications, inflammation against the background of the formation of calcifications:
- Diseases of the intestines . Nonspecific ulcerative colitis, Crohn's disease is sometimes accompanied by swelling, other symptoms of arthritis of the legs.
- Vasculitis . Swelling of the joints, transient pain are noted in Wegener's granulomatosis, Shenlein-Genoch disease, Kawasaki disease, Behcet's syndrome.
- Hydroxyapatite arthropathy. Calcium hydroxyapatite deposits form in the periarticular tissues. One or more joints are involved. Swelling and soreness are minor.
- Medicinal arthropathy. It develops with the use of NSAIDs, glucocorticoids, anti-tuberculosis drugs. Localization, severity of swelling, the presence of other symptoms depend on the type of drug.
Arthrosis
For the initial stages of arthrosis, swelling is uncharacteristic, occurs only during periods of exacerbations, is more pronounced with the development of synovitis. With the progression of the process, the swelling becomes permanent, the change in the contours of the joint is caused not only by swelling of the soft tissues, but also by bone deformities. The symptom is clearly visible in arthrosis of the knee joint, lesions of the hands with the formation of Heberden's and Bouchard's nodes.
Injuries
Swelling of varying degrees is accompanied by the following traumatic injuries:
- Injury. Edema is small, local, short-term. The contours of the joint are not changed, the functions of the leg or arm are preserved, some limitation of movements is possible.
- Ligament damage. The joint swells mainly in the projection of the damaged ligament. There are also bruises. The degree of edema increases in direct proportion to the severity of the injury. Functions are limited, instability is possible.
- Dislocation. The contours of the joint are grossly disturbed, movements are impossible, the function is lost. The patient is experiencing very intense pain. With a fresh dislocation, the deformity visually predominates; in the absence of medical care, the edema progresses rapidly.
- Intra-articular fracture. Diffuse swelling is combined with very sharp pain, deformity, impossibility of support. Sometimes crepitus, pathological mobility are determined.
Against the background of injuries, hemarthrosis often occurs. Due to the accumulation of blood, the joint becomes swollen, spherical. The swelling is diffuse, soft elastic or elastic. fluctuation is determined.
Other reasons
Swelling of the periarticular region is accompanied by the following pathologies:
- Soft tissue diseases : bursitis, tendinitis, tendovaginitis, enthesopathy.
- Parasitoses : dracunculiasis, chinga.
- Hematological diseases : sickle cell anemia.
Local swelling of the wrist joint occurs with hygroma, the back surface of the knee - with Becker's cyst. Swelling, deformation are also detected in neoplasms originating from bone and cartilage tissue. Can be caused directly by neoplasia, reactive inflammation, synovitis.
Diagnostics
Rheumatologists are engaged in establishing the cause of swelling of the joints. According to the indications, patients are referred to traumatologists-orthopedists, infectious disease specialists, endocrinologists, and other specialists. The doctor interrogates the patient, performs an external examination: studies the configuration of the joint, color, temperature of the skin, palpates, evaluates the range of motion. Depending on the results of the primary objective examination, the following diagnostic procedures can be prescribed:
- Radiography. It is the basic research method, performed in two projections. The images visualize changes in the contours of the articular ends of the bones, narrowing of the joint space, marginal defects, areas of destruction, osteolysis.
- Sonography. It is used to study the condition of soft tissues. Detects effusion, hemorrhage, calcification in the periarticular structures. Allows you to quickly determine the cause of swelling.
- CT and MRI . They are carried out at the final stage of the examination with ambiguous results of radiography and ultrasound. They make it possible to detail and differentiate inflammatory, tumor, traumatic lesions, to clearly determine the volume, localization of the pathological process.
- Joint puncture. Indicated for synovitis, hemarthrosis. The resulting liquid is sent for bacteriological, cytological, immunological examination to clarify the nature of the disease.
- Arthroscopy. Recommended for a detailed visual examination of the joint, biopsy sampling. A biopsy is performed with suspicion of autoimmune arthritis, tuberculosis, neoplasm. Sometimes diagnostic arthroscopy is supplemented by therapeutic measures.
- Laboratory tests . A complete blood count confirms the presence of inflammatory changes, eosinophilia with allergies. According to the results of biochemical and serological analyzes (presence of rheumatoid factor, CRP, CEC), autoimmune diseases are confirmed.
Joint puncture
Treatment
Help at the prehospital stage
To reduce swelling, it is recommended to ensure peace, an elevated position of the limb. In case of injuries, the leg is fixed with a splint, a scarf bandage is applied to the arm, cold is applied, and an anesthetic is given. In non-traumatic lesions with mild symptoms, short-term use of local anesthetics and anti-inflammatory drugs is acceptable. Progressive swelling, sharp pains, worsening of the general condition are the reasons for an immediate visit to the doctor.
Conservative therapy
In patients with traumatic injuries, dislocations are reduced, fractures are repositioned, plaster bandages are applied, and skeletal traction is applied. The rest of the patients are recommended a protective regimen, selected taking into account the characteristics of the disease. Medical therapy includes the following:
- Antibiotics . They are prescribed for infectious arthritis. First, broad-spectrum drugs are used, and then antibiotic therapy is adjusted taking into account the sensitivity of the pathogen. In severe cases, two-drug combinations are recommended.
- NSAIDs . Reduce pain, reduce the severity of the inflammatory process. In the form of tablets and injections, they are usually used for a short time due to the negative effect on the gastric mucosa, the functioning of the liver, and kidneys. The application of gels, ointments is allowed for long courses.
- Corticosteroids . They have a pronounced anti-inflammatory effect, are the basis of drug therapy for collagenoses. If necessary, combined with immunosuppressants.
- Chondroprotectors . They improve the nutrition of cartilage tissue, contribute to its restoration by activating the synthesis of proteoglycans. They are prescribed intramuscularly, orally, injected directly into the joint cavity.
- Vitamin and mineral complexes . Contribute to the correction of metabolic disorders, improve immunity, increase the effectiveness of drug therapy for joint diseases.
Other medicines include hormonal agents for the correction of endocrine disorders, chemotherapy drugs for the fight against malignant neoplasms. Drug therapy is supplemented with physiotherapeutic procedures: UHF, laser therapy, magnetotherapy, electrophoresis, and other methods. Patients are prescribed massage, exercise therapy. Perform intraarticular and periarticular blockade.
Surgery
The tactics of surgical treatment is determined by the characteristics of the pathology:
- Traumatic injuries : open reduction of dislocations, osteosynthesis of intra-articular fractures, ligament plastics.
- Infectious arthritis : arthrotomy and drainage of the joint, excision of the tuberculous focus, reconstructive interventions.
- Tumors and tumor-like formations : removal of hygroma, excision of Baker's cyst, resection of tubular bones, amputation, exarticulation.
With contractures and ankylosis caused by a pathological process in the joint, arthrodesis or arthroplasty is performed. According to the indications, endoprosthetics is performed.