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Contents: - Causes and classification - Symptoms - Symptoms of acute synovitis - Symptoms of chronic synovitis - Diagnostics - Treatment - Treatment of acute traumatic synovitis - Treatment of acute infectionsynovitis - treatment of rheumatoid, psoriatic synovitis - treatment of tuberculous synovitis - treatment of non-infectious synovitis (on the background of osteoarthritis) - treatment migrating synovitis - treatment villous-nodular synovitis - treatment of gouty synovitis - People's treatment of synovitis There is not a lot of diseases that any person is required to meet in my life. Diseases of the joints and bones - are headed this list. Musculoskeletal structures can be damaged due to constant static loads, injuries, infections and so on. And even in the absence of these factors, over time, develop osteoarthritis and osteochondrosis, as cartilage grow old together with the whole organism, worsening of the blood supply and nutrition. first sign of joint disease - synovitis, ie inflam According to statistics from the National Association of Trauma, knee joint disease first frequency of occurrence among lesions musculoskeletal structures. Therefore synovitis often arises in this site. Causes and classification There are many factors that lead to the development of synovitis. They are divided into 3 groups: - traumatic; - infectious - damage to the joint elements of the bacteria; - noncommunicable - inflammation of the synovial membrane, without the action of microorganisms. Since the cause depends on the treatment of synovitis of the knee in clinical practice is used more detailed classification: If reliably determine the cause of the disease is not possible, then indicate "unspecified synovitis" in the diagnosis of the doctors. Symptoms Symptoms of knee joint synovitis is not dependent on the development of the cause (with the exception of acute infectious synovitis). They are determined by the duration of the course and the severity of the pathological process. Therefore considered independently of each other acute and chronic forms. Symptoms of acute synovitis main feature of this form - the rapid emergence and exacerbation of symptoms. Primarily pain. It has the features of: - applies to the whole of the joint area, but not limited to a specific point; - usually quite intense pain; - pain gets worse in the morning and in the evening weakened (due to the production of anti-inflammatory hormones); - alone is weakening slightly. Soon after the appearance of pain can be formed "swelling" in the joint, due to the increased production of synovial fluid. Active Movement in a joint slightly limited (at 10-15o) as full extension / flexion increases pain. If the patient has an acute infectious synovitis, the local symptoms may be attached signs of intoxication: fever (up to 37-38 ° C), weakness, headache, decreased appetite. In the absence of adequate treatment, bacterial synovitis can lead to phlegmon knee. Symptoms of chronic synovitis Unlike the acute form, chronic synovitis occurs periods of exacerbation and remission (disappearance of symptoms). Pain, in the first few years of onset, is almost the same as that in the acute form. However, subsequently, begins a gradual destruction of articular cartilage, ligaments are weakened, thinner joint capsule. This leads to: - increased pain; - significant limitation of motion in the knee joint; - «instability» joint - dislocation in such patients will meet much more often. fever is not typical for the chronic form. During exacerbations, may increase the temperature to 37 ° C. With adequate treatment, the patient remains only moderate symptoms of synovitis, which practically does not reduce the quality of his life. Diagnostics After collecting complaints can suspect the presence of synovitis. To determine the shape you need to pay attention to the presence of the causes of disease in the patient's past. However, to confirm the diagnosis is necessary to conduct additional tests: - Blood tests: - in the general analysis of blood can detect signs of inflammation: increased white blood cell count (more than 9.0 * 109 / l), increased erythrocyte sedimentation rate (above 15); - in the biochemical analysis should pay attention to C-reactive protein. His significant increase (more than 10 ng / mL) is an indirect sign of immune inflammation (rheumatoid or psoriatic synovitis); - in serological tests can detect antibodies to streptococci (antistreptokinaza, ASO, antistreptogialuronidaza) - a reliable sign of rheumatoid synovitis or migrating. - fluorography - to exclude tuberculous synovitis (but often it takes place at the "clean" light as the extrapulmonary pathology); - Radiography (in two standard projections - direct and lateral) of the affected joint; - Arthroscopy - performed in difficult diagnostic cases. During this procedure, the doctor makes an incision and inserts a camera into the joint cavity with a flashlight. Often, upon detection of the pathological center, the doctor treats "on the spot". reliably confirm the presence of synovitis and its shape, you can define the tactics of treatment. Treatment How to treat synovitis of the knee? It depends on two main issues: the causes of disease and the mechanism of its development. If the doctor will be able to get rid of these factors, synovitis for the patient to remain in the past. Unfortunately, there are a number of diseases in which to cure it permanently fails. These include: - osteoarthritis; - rheumatoid and psoriatic arthritis; - gout and others. For each form of synovitis developed regimens that allow you to regain normal joint function or maintain the quality of life of the patient at the appropriate level. Treatment of acute traumatic synovitis treatment regimen of this form of synovitis can be divided into the following items: - Treatment injury - if it is an open fracture, the surgeon restores the normal position of bones within the joint, stitches damaged ligaments and portions of the capsule (if damaged) and the skin is sutured over the wound; - When intraarticular fractures (closed or open) is required to put the patient on a "skeletal traction" - through the bones that form the joint, threaded needles and suspended load, to avoid re-displacement. Typically, this phase lasts about 3 weeks, if the operation was carried out; - If you have any symptoms of synovitis in any period of time, the patient is prescribed: - nonhormonal drugs anti-inflammatory action (NSAIDs) or by intramuscular injection in the form of tablets. Most often used: Diclofenac, Ketorolac (Ketoprofen, Ketorol), Ibuprofen, Nimesulide (Nise); - To eliminate the side effects (formation of stomach ulcers and 12 duodenal ulcer), together with any NSAID necessarily prescribe "proton pump inhibitors" - omeprazole, rabeprazole, and so on. - On the "skeletal traction," the patient is carried out physiotherapy (in Russia this magneto or phototherapy) that accelerate the healing of tissue. They also possess anti-inflammatory effect, reducing the severity of synovitis; - If there is significant swelling in the knee or methods of examination found a large amount of fluid within the joint, the patient carried a puncture and remove the excess amount. - After removing the spokes , injured leg plaster, at least 6-8 weeks. During this period, synovitis is quite rare. And even if it occurs, it can be discovered only by removing the plaster cast. Treated by the above scheme. Should I use a NSAID ointment? Currently, it is common opinion that the ointment are best tablets or intramuscular injections NSAID drugs, as they are applied directly to the affected area. Recent clinical studies have shown that this is misleading. All NSAIDs act on an enzyme that promotes the formation of inflammatory substances, regardless of the site of administration. Ointments are the worst absorption of these forms, so they are not recommended for use at the moment. On average, symptoms of synovitis, with adequate treatment, go through 5-11 days. Treatment of acute infectious synovitis In this form, in addition to joint excess liquid is pus and bacteria, which gradually destroys the cartilage, ligament and capsule. Therefore, it is crucial to carry out a puncture of the knee joint with introduction of disinfecting solutions. How to spend a puncture of the knee? The patient does not require any preparation.FIELD puncture first treated with alcohol (70% solution) twice, then with a solution of iodine. After that, the local anesthetic lidocaine or novocaine the skin and make the puncture. First evacuated joint content, then it is washed with an antiseptic and re-evacuated until completely purulent contents will be deleted. After the puncture, prescribe antibiotics and NSAIDs. The anti-inflammatory therapy is carried out similarly to that in acute traumatic synovitis. Antibiotics are prescribed penicillin or macrolides. They have better effect with a minimum of side effects. Showing the following drugs: - Penicillin : - Amoxicillin; - Ampicillin; - Amoxiclav (if the above medications are not effective or the patient has recently taken antibiotics). - Macrolides : - Erythromycin; - Azithromycin; - Josamycin (recommended for admission in children or pregnant women). Physiotherapy is not carried out with infectious processes, as these procedures contribute to the growth of bacteria. Therefore, this treatment is not used in infectious synovitis. How to treat revmatoidnyyo, psoriatic synovitis This synovitis develops on the background of rheumatoid arthritis. Therefore, to eliminate the symptoms you need to treat the underlying disease. Therapy should be conducted in a comprehensive and include the following elements: - anti-inflammatory treatment - if you have a good effect of NSAIDs may be limited to the regular use of these drugs in combination with omeprazole. If inefficient doctor prescribes hormones (prednisolone, hydrocortisone, etc.), calculating individual dose; - chondroprotective funds - designed to preserve the joint tissues. Inexpensive and effective drug is chondroitin; - Physiotherapy - these procedures are aimed at the patient's anesthesia. You can use any methods: electroplating, magnetic and phototherapy, UHF-therapy, and so on; - Reducing the load on the affected joint - also reduces the pain. Unloading of the knee can be performed by recommending the patient to use a cane when walking. treatment should be engaged rheumatologist. Alone it is not recommended for treatment of this form of synovitis. Treatment of tuberculous synovitis This special form of synovitis, which only occurs as a complication of pulmonary tuberculosis. His treatment is carried out only in specialized clinics, along with the underlying disease. Treat as suspected presence of tuberculosis synovitis should be a doctor, a TB specialist or therapist who will direct the patient to a specialist. As a rule, the favorable outcome of the disease. After adequate treatment, which lasts about 9 months, synovitis symptoms completely disappear. Therapy non-infectious synovitis (on the background of osteoarthritis) Synovitis arising on a background of osteoarthritis, requires a special approach in treatment. As a primary therapy used NPVSy. However, this is not enough. To prevent recurrence of synovitis, it is necessary to improve the blood supply to the joint. The easiest way to do this with the help of physical therapy, which can be started from the first day of illness. Treatment migrating synovitis To get rid of this form, there should be not only the complex therapy of synovitis, and rheumatic fever. It recommended the following regimen: - Bed rest for 2-4 weeks; - Penicillin - an antibiotic designed to eliminate streptococcus, which became the cause of the disease; - NSAIDs (Ketorolac or ibuprofen) - to eliminate the pain and reduce the severity of inflammation; - Intravenous infusion with saline solution (formulation of intravenous sodium chloride) - it is necessary to eliminate the toxicity. If necessary, your doctor may extend the treatment regimen. When migrating synovitis requiring hospitalization, the average time which can be up to 30 days. Therapy villous-nodular synovitis By its nature, this form of synovitis is a benign tumor. The most effective method is to delete it. At the moment, for this purpose use arthroscopic surgery: - make two small incisions, 1-2 cm; - introduce instruments into the joint. One of them is a camera with a flashlight, and the second - an electric knife or tweezers; - using them remove the tumor; - after the procedure sutured incisions. Complications after such manipulations are very rare. They require long hospitalization - on average, the patient stays in the hospital 4-7 days. Full course - 2 months.
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Sadržaj: - Uzroci i podjela - Simptomi - Simptomi akutni sinovitis - Simptomi kroničnom upalom sinusa - dijagnostiku - tretman - liječenje akutnog traumatskog sinovitis - liječenje akutne infekcijesinovitis - liječenju reumatoidnog, psorijatičnog sinovitis - tretman tuberkulozan sinovitis - liječenje ne-upalni sinovitis (na pozadini osteoartritisa) - tretman migraciju sinovitis - tretman dlakavi-nodularni sinovitis - tretman kostoboljan sinovitis - Narodne liječenje sinovitis ne postoji mnogo bolesti koje svaka osoba potrebnih za ispunjenje u životu.Bolesti zglobova i kostiju - na čelu ovaj popis.Mišićno-koštani strukture mogu se oštetiti zbog stalnih statičkih opterećenja, ozljede, infekcije i tako dalje.A čak u nedostatku tih čimbenika, s vremenom, razviti osteoartritis i osteochondrosis, jer hrskavica ostariti zajedno s cijelim organizmom, pogoršanja opskrbe krvi i prehranu. prvi znak bolesti zglobova - sinovitis, odnosno upala sinovijalne membrane.Nalazi se na unutarnjoj površini z Prema statističkim podacima iz Nacionalne udruge traume, zglob koljena bolesti prvoj frekvenciji pojavljivanja među lezija mišićno-koštani struktura.Stoga sinovitis često javlja u tom mjestu. Uzroci i klasifikacija Postoje mnogi faktori koji dovode do razvoja sinovitis.Oni su podijeljeni u 3 skupine: - traumatski; - zarazni - štetu na zajedničkim elementima bakterija; - nezaraznih - upala sinovijalne membrane, bez djelovanja mikroorganizama. Budući da je uzrok ovisi o liječenju sinovitis koljena u kliničkoj praksi koristi detaljnije klasifikacije: Ako pouzdano utvrditi uzrok bolesti nije moguće, onda se pojaviti "neodređeni sinovitis" u dijagnozi liječnika. Simptomi Simptomi zgloba koljena sinovitis ne ovisi o razvoju uzroka (s izuzetkom akutne zarazne sinovitis).Se određuje vrijeme trajanja tijek i težinu patološkog procesa.Stoga smatra neovisno jedan od drugih akutnih i kroničnih oblika. Simptomi akutni sinovitis glavna značajka ovog oblika - brzi nastanak i pogoršanje simptoma.Prvenstveno bol.Ona ima značajke: - odnosi na cijelu zglob, ali nije ograničeno na određenu točku; - obično vrlo intenzivna bol; - bol pogorša ujutro i navečer oslabljen (zbog proizvodnje protuupalnih hormona); - sama je blago slabljenje. Ubrzo nakon pojave boli može biti formirana "bubrenja" u zglobu, zbog povećane proizvodnje sinovijalne tekućine.Aktivno pokret u zglobu ponešto ograničena (na 10-15o) kao punu ekstenziju / fleksija povećava bol. Ako pacijent ima akutni upalni sinovitis, lokalni simptomi mogu biti vezani znakove opijenosti: groznica (do 37-38 ° C), slabost, glavobolja, smanjen apetit.U nedostatku adekvatnog liječenja, bakterijske sinovitis može dovesti do flegmona koljena. Simptomi kroničnom upalom sinusa Za razliku od akutnog oblika, kronični sinovitis javlja razdoblja pogoršanja i remisije (nestanak simptoma).Bol, u prvih nekoliko godina od pojave, gotovo isto kao da je u akutnom obliku.Međutim, nakon toga, počinje postupno uništavanje zglobne hrskavice, ligamenti su oslabile, tanji zglobna čahura.To dovodi do: - povećana bol; - značajno ograničenje pokreta u zglobu koljena; - «nestabilnost» joint - dislokacija u tih bolesnika će zadovoljiti mnogo češće. groznica nije tipično za kronični oblik.Tijekom pogoršanja bolesti, može povećati temperaturu na 37 ° CUz odgovarajuće liječenje, pacijent ostaje samo umjerene simptome sinovitis, koji praktički ne smanjuju kvalitetu života. dijagnostika Nakon prikupljanja pritužbe može sumnjati na prisutnost sinovitis.Da bi se odredio oblik što je potrebno obratiti pozornost na prisutnost uzroka bolesti kod pacijenta prošlosti.Međutim, za potvrdu dijagnoze potrebno je provesti dodatna ispitivanja: - Krvni testovi: - u općoj analizi krvi može otkriti znakove upale: povećana broja bijelih krvnih stanica (više od 9,0 * 109 / l), povećan brzina sedimentacije eritrocita (iznad 15 godina); - u biokemijskoj analizi treba obratiti pozornost na C-reaktivnog proteina.Njegov značajno povećanje (više od 10 ng / ml) je indirektni znak imunološkog upale (reumatoidnom ili psorijatičnom sinovitis); - u serološkim testovima mogu otkriti antitijela na streptokoke (antistreptokinaza, ASO, antistreptogialuronidaza) - pouzdan znak reumatoidnog sinovitis ili migraciju. - fluorografiju - isključiti tuberkulozan sinovitis (ali često se odvija na "čiste" svjetlo kao izvanplućni patologije); - radiografija (u dvije standardne projekcije - izravne i bočne), zahvaćeni zglob; - Artroskopija - izvedena u teškim dijagnostičkih slučajeva.Tijekom ovog postupka, liječnik čini rez i umeće kameru u udruženom šupljine sa svjetiljkom.Često, nakon otkrivanja patoloških centar, liječnik tretira "na licu mjesta". pouzdano potvrditi prisutnost sinovitis i njegov oblik, možete odrediti taktiku liječenja. Liječenje Kako liječiti sinovitis koljena?To ovisi o dva glavna pitanja: uzroka bolesti i mehanizam njegovog razvoja.Ako liječnik će biti u mogućnosti da biste dobili osloboditi od tih čimbenika, sinovitis za pacijenta da ostane u prošlosti.Na žalost, postoji niz bolesti u kojima se liječe se trajno ne uspije.To su: - osteoartritis; - reumatoidnog i psorijatičnog artritisa; - gihta i drugi. Za svaki oblik sinovitis razvio režime koji omogućuju vam da povrate normalnu zajedničku funkciju ili održavanje kvalitete života pacijenta na odgovarajućoj razini. Liječenje akutnog traumatskog sinovitis režima liječenja ovog oblika sinovitis mogu se podijeliti u sljedeće stavke: - Liječenje ozljede - ako je otvoren prijelom, kirurg vraća na normalan položaj kosti unutar zgloba, uboda oštećeni ligamenti i dijelovi kapsule (ako je oštećena), a koža zašije se preko rane; - Kad intraartikularne frakture (zatvoreni ili otvoreni) potrebno je staviti pacijenta na "skeletnim vuče" - kroz kosti koje čine zglob, s navojem igle i visećih tereta, kako bi se izbjeglo ponovno pomicanje.Tipično, ova faza traje oko 3 tjedna, ako je provedena operacija; - Ako imate bilo kakve simptome sinovitis u bilo koje vrijeme, pacijent je propisana: - nonhormonal lijekovi protuupalno djelovanje (NSAID) ili intramuskularne injekcije u obliku tableta.Najčešće se koristi: diklofenak, ketorolak (Ketoprofen, Ketorol), ibuprofena, nimesulid (nom); - Kako ukloniti nuspojave (stvaranje čireva na želucu i dvanaesniku 12), zajedno sa svim NSAID nužno propisati "inhibitori protonske pumpe" - omeprazol, rabeprazola, i tako dalje. - Na "skeletne vuče" pacijent provodi fizikalnu terapiju (u Rusiji ovaj magnet ili fototerapiju) koji ubrzavaju zacjeljivanje tkiva.Oni također posjeduju protuupalno djelovanje, smanjenje ozbiljnosti sinovitis; - Ako postoji značajan oteklina u koljenu ili metodama ispitivanja otkrili veliku količinu tekućine u zglobu, pacijent nosio punkciju i uklonite višak. - Nakon uklanjanja žbice , ozlijedio nogu gips, najmanje 6-8 tjedna.Tijekom tog razdoblja, sinovitis je vrlo rijetka.A čak i ako se dogodi, može se otkriti jedino uklanjanjem gips.Liječi gornjoj shemi. Trebam li koristiti NSAID mast?Trenutno, to je uobičajeno mišljenje da je mast su najbolje tablete ili intramuskularne injekcije NSAID lijekovi, kao što su oni primjenjuju izravno na zahvaćena područja.Nedavne kliničke studije su pokazale da je ovo zabludu.Svi NSAIDs djeluju na enzim koji pospješuje formiranje upalne tvari, bez obzira na mjestu primjene.Masti su najgori apsorpcija tih oblika, pa se ne preporučuje za primjenu u ovom trenutku. U prosjeku, simptomi sinovitis, uz adekvatan tretman, proći kroz 5-11 dana. Liječenje akutne infektivne sinovitis U ovom obliku, osim zajedničkog viška tekućine je gnoj i bakterije, koji se postupno uništava hrskavice, ligamenata i kapsule.Stoga je od ključne važnosti da se provede puknuće zgloba koljena s uvođenjem dezinfekciju. Kako provesti punkciju koljena?Pacijent ne zahtijeva nikakvu pripremu.Područje uboda najprije pomiješa s alkoholom (70% -tna otopina) dva puta, a zatim s otopinom joda.Nakon toga, lokalni anestetik lidokain ili novokain kožu i čine punkciju.Prvo evakuirani zajednički sadržaj, zatim se ispere s antiseptik i ponovno evakuirana dok se potpuno ne gnojni sadržaj će biti izbrisan. Nakon uboda, propisati antibiotike i NSAR.Protuupalni terapija se izvodi slično onoj kod akutne traumatske sinovitis.Antibiotici su propisani penicilin ili makrolide.Imaju bolji učinak s najmanje nuspojava.Prikazuje se na slijedeće lijekove: - Penicilin : - amoksicilin; - ampicilin; - amoksiklav (ako gore navedene lijekovi nisu učinkoviti, ili pacijent je nedavno uzima antibiotike). - Makrolidi : - eritromicin; - Azitromicin; - josamicin (preporučuje se za upis u djece ili trudnica). Fizioterapija ne provodi s infektivnim procesima, kao što su ovi postupci doprinijeti rastu bakterija.Stoga, ovaj tretman se ne koristi i upalni sinovitis. Kako liječiti revmatoidnyyo, psorijatičnog sinovitis Ovo sinovitis razvija na pozadini reumatoidnog artritisa.Stoga, kako bi se uklonili simptome trebate liječiti osnovne bolesti.Terapija bi trebala biti provedena u sveobuhvatan i uključuje sljedeće elemente: - protuupalno tretman - ako imate dobar učinak nesteroidnih protuupalnih lijekova može biti ograničena na redovnu upotrebu ovih lijekova u kombinaciji s omeprazola.Ako neučinkovit liječnik propisuje hormone (prednizolon, hidrokortizon, itd), računajući individualne doze; - zaštitnog fondovi - namijenjen za očuvanje zajedničke tkiva.Jeftin i učinkovit lijek je hondroitin; - Fizioterapija - ovi postupci su usmjereni na pacijenta anestezije.Možete koristiti bilo koje metode: galvansko, magnetski i fototerapija, UHF-terapija, i tako dalje; - smanjuje opterećenje na zahvaćena zajedničkom - također smanjuje bol.Istovar koljena može se provesti preporuku pacijenta koristiti štap pri hodanju. liječenje treba biti angažiran reumatologa.Sam se ne preporučuje za liječenje ovog oblika sinovitis. liječenje tuberkulozan sinovitis Ovaj poseban oblik sinovitis, koji se javlja isključivo kao komplikacija plućne tuberkuloze.Njegovo liječenje se provodi samo u specijaliziranim klinikama, uz osnovne bolesti.Tretirati kao sumnje na prisutnost tuberkuloze sinovitis trebao biti liječnik, tuberkulozu stručnjaka ili terapeut koji će uputiti pacijenticu na specijalistu. U pravilu, povoljan ishod bolesti.Nakon adekvatan tretman, koji traje oko 9 mjeseci, sinovitis simptomi u potpunosti nestati. terapija nisu zarazne sinovitis (na pozadini osteoartritis) sinovitis proizlazi na pozadini osteoartritisa, zahtijeva poseban pristup u liječenju.Kao primarne terapije koristi NPVSy.Međutim, to nije dovoljno.Kako bi se spriječilo ponavljanje sinovitis, potrebno je poboljšati dotok krvi u zglobu.Najlakši način da to učinite uz pomoć fizikalne terapije, koja se može pokrenuti iz prvog dana bolesti. Liječenje migraciju sinovitis biste dobili osloboditi od ovaj oblik, ne bi trebalo biti ne samo kompleks terapija sinovitis, i reumatske groznice.Ona preporučuje sljedeće režim: - mirovanje tijekom 2-4 tjedana; - Penicilin - antibiotik dizajniran kako bi se uklonili Streptococcus, koji je postao uzrok bolesti; - NSAID (ketorolaka ili ibuprofen) - kako bi se uklonili bol i smanjiti ozbiljnost upale; - Intravenozna infuzija s fiziološkom otopinom (formulacija intravenoznu natrijev klorid) - potrebno je eliminirati toksičnosti. Ako je potrebno, liječnik može produljiti režim liječenja.Kad migriraju sinovitis je potrebna hospitalizacija, prosječno vrijeme koje može biti i do 30 dana. terapija dlakavi-nodularni sinovitis Po svojoj prirodi, ovaj oblik sinovitis je benigni tumor.Najučinkovitiji način je da ga izbrisati.U ovom trenutku, u tu svrhu korištenje artroskopski operacije: - čine dvije male rezove, 1-2 cm; - uvesti instrumente u zglobu.Jedan od njih je i kamera sa svjetiljkom, a drugi - električni nož ili pincete; - pomoću njih ukloniti tumor; - nakon postupka sašivena rezova. Komplikacije nakon takvih manipulacija su vrlo rijetke.Oni zahtijevaju dugu hospitalizaciju - u prosjeku, pacijent ostaje u bolnici 4-7 dana.Cijeli tečaj - 2 mjeseca.