Who treats the joints

– walking without a break (climbing stairs),

Sore knees: which doctor should you see – traumatologist, neurologist, osteopath

When treating knee pain, it is necessary to select an individual set of therapeutic exercises, learn the technique of their implementation and exclude exercises with contraindications.

With this symptom, it is important to regularly attend therapy sessions, undergo full treatment in a specialized center and remain healthy and preventive in the future.

All therapeutic exercise videos

Knee pain can occur unexpectedly or last for years. This painful symptom may indicate a knee injury or the development of a joint problem in a limb.

Very few people know when knee pain is considered treated. And is it worth giving priority to self-treatment?

Should you put it off or make an appointment?

Doctors clearly do not recommend postponing the problem of knee pain.

• A medical consultation makes it possible to assess the severity of the disease.
• Early contact with a competent specialist reduces the risk of complications from musculoskeletal disorders.
• With a correct diagnosis, the pain can be relieved through preventive measures and effective medications.

When to see a specialist: Warning signs

There are various joint diseases, but the most common are osteoarthritis and arthritis. They have similar symptoms, but different mechanisms of development and therefore different treatments. Once the disease is diagnosed, it is almost impossible to cure it completely. Therefore, experts recommend seeing a doctor at the first signs of problems in order to slow down and delay serious pathologies.

• Pains;
• impairment of fine motor skills;
• swelling in the joint area;
• Crunch;
• Discomfort while driving
• general weakness and malaise
• fever with a background of pain;
• Thickening of the finger bones.

These symptoms may appear suddenly or be the result of hypothermia or physical fatigue. A doctor must also be consulted if there are isolated and temporary symptoms of joint problems that subside spontaneously.

Your GP can carry out an initial assessment for joint pain and will give you recommendations and refer you to a specialist.

When is a referral to an arthrologist made?

An arthrologist treats diseases of the joints and periarticular tissue. His area of responsibility includes, among others, the following diseases:

The arthrologist determines the diagnosis and treatment. It is the first point of contact for patients with symptoms that indicate pain in the joints and surrounding tissues. If the joints hurt, the doctor prescribes painkillers and addresses the cause of the pain directly.

To make an accurate diagnosis, the patient undergoes a series of general and detailed blood tests, an X-ray examination of the joints, an ultrasound scan and a thorough description of the factors and nature of the pain.

Myth 3: Destroyed cartilage can be restored with medication.

There are now many medications that are advertised to regenerate cartilage. These contain the cartilage components chondroitin and glucosamine. However, their effect is not enough to compensate for the daily loss of cartilage cells. It turns out that chondroprotectors must be taken for life and in high doses for this purpose. Experts at the American Academy of Orthopedic Surgeons emphasize that there is no evidence of their effectiveness. Although there may be exceptions.

Healthy cartilage is only a few millimeters thick

Myth 4: Hyaluronic acid is a quick pain reliever.

Hyaluronic acid is another component of cartilage. Sodium hyaluronate serves as a basis for cartilage tissue, protects its surface from degradation and acts as a lubricant. Hyaluronic acid preparations are injected into the joint in several injections spaced one week apart. The aim of this osteoarthritis treatment is to compensate for the lack of synovial fluid (lubrication) and to stop friction.

The effect is achieved over several injections - do not expect quick pain relief. It is also a misconception to believe that hyaluronic acid can completely cure knee pain. Arthritis cannot be cured, but destructive processes in the joints can be controlled.

To prevent possible allergic reactions and side effects, many orthopedic surgeons recommend using its higher molecular weight synthetic equivalent Noltrex instead of sodium hyaluronate. This medication has a longer shelf life because it takes longer to break down.

Intra-articular hyaluronic acid injections do not provide immediate pain relief

Forms and stages of inflammation

Depending on the overall symptoms, different types of arthritis can develop in a typical or atypical manner and can be mild, moderate or severe. The duration of the inflammatory process can be acute (up to 2 weeks), subacute (2-4-6 weeks) and chronic.

The type of acute synovitis of the joint may depend on the provoking factor:

Chronic arthritis is characterized by a long-lasting, undulating course with phases of exacerbation and remission.

There are four stages in the development of arthritis:

Depending on the location and extent of the inflammation, arthritis is divided into 3 groups:

• Monoarthritis (disease of 1 joint)
• Oligoarthritis (inflammation of 2-3 joints)
• Polyarthritis (consecutive or simultaneous involvement of 4 or more joints or specific groups of joints).

diagnostic methods

A number of diagnostic measures are used to identify, diagnose and clarify the joint syndrome:

• Clarification of the complaints, taking anamnesis
• physical examination
• general clinical laboratory examination
• X-ray examination
• Ultrasound examination of the joints
• COMPUTED TOMOGRAPHY
• MRI
• Thermography
• Arthroscopy with puncture and examination of the joint fluid

In addition, rheumatological screening, HLA-B27 genotyping, radionuclide scintigraphy, etc. may be recommended.

MRI is considered the most informative imaging method for arthropathies of various origins. It allows the detection of free synovial fluid without the need to use other methods and the determination of the extent of damage in rheumatoid arthritis and other joint syndromes.

Possible causes of joint pain

There is no single cause of joint pain, but there are a number of possible causes.

• Injuries, sports overload. Not uncommon among professional athletes, extreme athletes and bodybuilders.
• Hypothermia. Pain syndrome caused by hypothermia lasts for several days.
• Overweight. Each additional kilogram increases the load on the joints, and pain appears over time.
• Congenital anomalies and resulting malformations of the apparatus. In this case, a child or adolescent may also develop pain and should see a doctor as soon as possible.
• Circulatory problems and long-lasting muscle cramps. Lack of exercise, sedentary lifestyle and chronic stress affect the system and cause muscle spasms in the neck, back and legs, which eventually lead to pain syndrome.
• Infectious diseases and autoimmune diseases. Various diseases (chickenpox, acute respiratory infections, chronic tonsillitis, certain allergies, rheumatoid arthritis) cause the body to produce large amounts of toxins that also affect the joints. Such pain requires, first of all, treatment of the underlying disease.
• Age-related joint changes. Joints wear out with age, and this process cannot be completely prevented, but it can be slowed or symptoms alleviated in older people.

It is rare for a person to be able to self-diagnose the cause of their pain. For example, if the pain is caused by trauma or hypothermia. Patients over 40 years old should undergo mandatory diagnostics.

Types of joint pain

Reflects. Characteristic of diseases of the pelvic organs, heart disease and certain other internal diseases. In this case, the pain does not occur in the joint itself, but is simply a 'reflection' of the pain in one of the organs.

beginning. If the joint has been resting for a long time, this type of pain occurs when we start to move. This type of pain can occur at any age.

Mechanically. In people with joint problems, this pain occurs at the end of the day after exercise. They subside after a break, but reappear when you exert yourself again. In neglected cases even after walking.

Congestive 'nocturnal' pain. During sleep, the muscles that hold the joint in the correct position relax and blood flow to the joint slows, leading to increased pain.

Other symptoms such as redness of the skin around the joint, swelling, increase in body temperature should be noted. This indicates the inflammatory nature of the joint pain.

Common Complications of Coronavirus

Studies have shown that even a mild form of the disease has more or less serious consequences: shoulder, elbow, ankle or hip joints become inflamed and knees hurt after coronavirus disease. The most common joint complications after coronavirus disease in men and women show the following symptoms. Rheumatoid arthritis after coronavirus disease affects small symmetrical joints on the hands, feet, elbows or knees. It manifests itself through varying degrees of pain, swelling and redness. If left untreated, it leads to complete destruction of the affected joint tissue. Myositis is an inflammation of muscle tissue that leads to the destruction of fibers and proteins in the bloodstream. The calf, buttocks or thigh muscles are most commonly affected. If left untreated, it leads to kidney congestion and subsequent kidney failure. The exacerbation of polyarthritis is a continuous inflammation of the joints, often the shoulder or hip. It is accompanied by swelling, pain and joint deformation.

• Accumulation of toxins resulting from the death of infected cells
• prolonged use of antibiotics, antiviral and symptomatic drugs
• reduced physical activity
• Weight gain

• immuno-inflammatory rheumatic diseases
• Arthritis, arthrosis, rheumatism of other causes
• chronic diseases requiring long-term anti-inflammatory treatment
• older patients

According to WHO statistics, women are more likely to be affected by post-Covid joint syndrome than men.

Treatment of joints after Covid-19

If joint pain occurs after a coronavirus infection, a rheumatologist should be consulted. The condition requires a comprehensive examination that includes laboratory tests and instrumental techniques such as CT, MRI and ultrasound. Based on the results of the examination, medication and physiotherapy are prescribed.

If joints hurt after a stroke, the following warning signs should be taken into account:

• Increase in subfebrile body temperature
• Redness, swelling, overheating of the joint area
• Joint and muscle pain of varying intensity
• In the case of knee or hip joints, pain that radiates to the sacrum, limping and discomfort when standing on the leg.

Massive inflammation is also indicated by swollen lymph nodes.

What symptoms does a rheumatologist look for?

Modern medicine knows dozens of diseases that fall under the purview of the rheumatologist. The symptoms of systemic abnormalities in the body are extremely diverse. They often disguise themselves as skin diseases, diseases of the musculoskeletal system or cardiovascular diseases. Make an appointment with a rheumatologist if you have any of the following symptoms:

• Prolonged increase in body temperature. Hyperthermia of unknown cause that lasts longer than two weeks may be a symptom of chronic inflammation, an autoimmune disease or a connective tissue disease (rheumatoid arthritis, polyarthritis, systemic lupus erythematosus). In 45-55 % of cases, hyperthermia is caused by an infectious process and only in 10-15 % of cases by rheumatic diseases, but a persistent increase in body temperature is not the norm and therefore requires a comprehensive examination of the patient.
• Pain in one or more joints. Joint pain is one of the most common symptoms of rheumatic disease. Joint pain occurs in rheumatism, systemic vasculitis, arthritis, ankylosing spondylitis, osteoarthritis and other diseases. In addition to pain, patients often complain of swelling, redness of the skin in the affected joints, morning stiffness and limited mobility.
• Rashes and hemorrhages. The clinical manifestations of many rheumatic diseases include dermatological changes. Although the skin syndrome is not leading, its correct interpretation is of great diagnostic importance. For example, in rheumatoid arthritis, patients may present with small nodular subcutaneous masses (rheumatoid nodules), in Still's disease with a maculopapular or maculopapular rash, in hemorrhagic vasculitis with fine petechiae, in psoriatic arthritis with psoriatic skin lesions.
• Enlargement of lymph nodes. Lymphadenopathy can occur as a result of autoimmune and inflammatory connective tissue diseases in dermatomyositis, rheumatoid arthritis, Sjögren's syndrome, Still's disease, and systemic lupus erythematosus. Rheumatoid lymphadenopathy can be localized, widespread, or generalized. This condition requires a thorough examination of the patient to determine the cause of the abnormal changes.
• Myalgia with unclear etiology. Polymyalgia rheumatica is characterized by muscle pain and stiffness that is worse in the morning and resolves throughout the day. As a rule, the pain is localized in the muscles of the neck, shoulder girdle, spine, hips and buttocks, has a pulling, aching or stabbing character and is not associated with weather changes. It is more common in women over 50 years old, and laboratory and instrumental tests are helpful to confirm the diagnosis.
• Pain in the sternum, abnormal heart rhythm. Cardiovascular disorders develop as a result of systemic rheumatic inflammation and atherosclerotic disease of the coronary arteries. Sternal discomfort and palpitations may occur in patients with rheumatoid arthritis, spondyloarthropathy, psoriatic arthritis, gout, systemic lupus erythematosus, and some other systemic connective tissue diseases. Cardiovascular diseases are rarely recognized in the overall clinical picture of the disease, so the rheumatologist must examine the patient carefully and thoroughly. The systemic manifestations of rheumatic diseases, including cardiac disease, determine the overall prognosis, which is why early detection and targeted treatment are so important.

Our rheumatologists can help you

What does a rheumatologist treat?

A rheumatologist treats autoimmune diseases and local or systemic connective tissue diseases:

• Rheumatoid arthritis;
• psoriatic arthritis;
• gouty arthritis;
• rheumatic fever;
• synovitis, synovitis, vasculitis;
• Osteoporosis;
• Systemic lupus erythematosus;
• systemic scleroderma;
• dermatomyositis;
• Bechterew's disease;
• Sjogren's syndrome and other diseases.

What diseases is treated by a pediatric rheumatologist?

Children's bodies, especially the musculoskeletal system, have significant anatomical and physiological differences from those of adults. The bone tissue contains more water and organic substances, fewer minerals, the ligaments have high elasticity but less strength, and the formation of the articular surfaces is only completed by the age of 13-16. Due to these characteristics, many rheumatic diseases in children take a different course than in adults, which is why their diagnosis and treatment is carried out by a pediatric rheumatologist.

What does a pediatric rheumatologist treat?

Rheumatological diseases in children are usually autoimmune, infectious or hereditary. The clinical picture, especially in systemic lesions, is extremely diverse. A rheumatological disease can manifest itself as joint and muscle pain, persistent fever, swelling and redness of the skin in the joints, weight loss, weakness and fatigue without an apparent cause. These symptoms require consultation with a pediatric rheumatologist, examination of the child and, if necessary, long-term pharmacotherapy.

A pediatric rheumatologist deals with a wide range of diseases. The most common rheumatological diseases in children include:

Consultation of a good rheumatologist in Moscow

A rheumatologist is a doctor who specializes in the prevention, diagnosis and treatment of diseases associated with damage to the joints, connective tissue and periarticular soft tissues, accompanied by pain and limitation of movement. If you are looking for a good rheumatologist in Moscow, make an appointment at the SM clinic and benefit from high-quality medical services.

Rheumatic diseases are characterized by a chronic course, exacerbations and serious complications that shorten life expectancy and lead to disability in 70 % of cases. To prevent the progression and negative effects of the disease, it is helpful to make an appointment with a rheumatologist at the SM Clinic. If you have symptoms of the disease, you should quickly make an appointment with a rheumatologist at the SM Clinic. Remember that if the disease is not treated in a timely manner, more and more bone and muscle tissue will be attacked, leading to limitation of movement, deterioration in mood and quality of life in general. Inflammation or deformation of cartilage, ligaments, muscles and tendons can be recognized by various symptoms.

Reasons for visiting a rheumatologist

A highly trained rheumatologist will assess your condition and determine whether further diagnostic testing is necessary.

Highly precise diagnosis of rheumatic diseases using the most modern equipment and laboratory methods makes it possible to choose the best possible treatment options. To detect rheumatological diseases, the SM Clinic uses:

– play an important role in the diagnosis of systemic rheumatic diseases: X-rays allow joint changes to be monitored during treatment.

Diseases of the joints and periarticular soft tissues (muscles, ligaments, cartilage, tendons) - performed using the latest equipment that provides clear images of the smallest structures.

– It is carried out using the most modern Siemens equipment to obtain the highest quality images of joints, connective tissue and periarticular tissue and to detect internal injuries and degenerative changes in the muscle-joint system.

– One of the most powerful laboratory methods for detecting the presence or absence of autoantibodies – markers of rheumatological diseases – in human biological fluids (blood, urine, cerebrospinal fluid, etc.).

Causes of Osteoarthritis

The main mechanism that triggers cartilage destruction is a disruption in the synthesis of proteoglycan molecules by cartilage cells. The development of osteoarthritis is preceded by a period of metabolic imbalance that is latent in nature. This metabolic imbalance is characterized by damage to proteoglycans and their components (chondroitin, glucosamine, keratan), accompanied by fragmentation and degradation of the cartilage matrix. The collagen fibers in the cartilage lamina break, the influx of vital metabolic products is impaired and the water balance is disturbed (first the cartilage is hydrated, then the amount of water molecules is drastically reduced, which further promotes the formation of cracks).

The primary pathological processes negatively affect the chondrocytes, which are very sensitive to the surrounding matrix. Changes in chondrocytes lead to the synthesis of defective proteoglycan molecules and short chains of collagen fibers. These defective molecules cannot combine well with hyaluronic acid and therefore quickly leave the matrix. Osteoarthritis also causes a cytokine boom - the released cytokines disrupt collagen and proteoglycan synthesis and stimulate inflammation of the synovial membrane.

The main causes of osteoarthritis can be different:

• Excessive weight, which increases stress on joints;
• wearing poor quality footwear;
• accompanying diseases of the musculoskeletal system;
• Joint injuries.

What rheumatologists treat

• arthritis (from the shoulder joints to the fingers);
• Rheumatism (can be a side effect of flu or cold);
• Osteoporosis;
• Gout.

Advanced rheumatic diseases, the development of which is inevitably accompanied by complications, pose a serious risk to patients. If the pathological process affects the entire supporting connective tissue (cartilage, bones, ligaments), the patient faces global problems such as limited mobility in the affected areas or disability.

When a patient comes to a rheumatologist with a complicated form of the disease, he is not always able to treat it. Rheumatologists at Yusupov Hospital offer therapy that reduces the severity of the symptoms of the disease, prevents complications and prolongs the period between attacks of the disease. The improved therapy can improve the performance of connections and restore the patient's ability to move independently at home and on the street without resorting to outside help.

Rheumatological diseases affect a person's psychological state by affecting family relationships, social fulfillment and mental performance. For this reason, Yusupov Hospital has a whole team of specialists who help patients with this difficult pathology in all areas.

• Infectious arthritis;
• Rheumatoid arthritis;
• osteoarthritis;
• Reiter's syndrome or reactive arthritis;
• Idiopathic juvenile arthritis;
• Bechterew's disease or ankylosing spondylitis;
• Fatty arthritis associated with inflammatory bowel disease;
• Other types of arthritis;
• Still's disease;
• Gout and Pseudopodagra.
• Rheumatologists also treat diffuse connective tissue diseases:
• Sjogren's syndrome;
• lupus erythematosus;
• dermatomyositis;
• Systemic scleroderma.

diagnosis

As practice shows, patients are not treated directly by a rheumatologist, but on referral from related specialists. Since rheumatology is closely linked to other medical disciplines, the manifestations of rheumatological diseases are very similar to those of other diseases. These are primarily infectious diseases, heart diseases, oncological diseases and hematological diseases.

The first step in the instrumental diagnosis of rheumatological diseases is X-ray examination. Rheumatologists use magnetic resonance imaging (MRI) and computer tomography (CT) as additional methods. MRI is a technique in which the doctor scans the patient's body layer by layer using a magnetic field and radio waves. MRI scanning helps to clarify the condition of the soft tissues surrounding the affected area. It is used to clarify the diagnosis and further treatment of rheumatic diseases of the intervertebral discs, nerve fibers and ligaments. A CT scan (computed tomography) is carried out using X-rays, which provide information about the physical properties of the affected organ.

At the Yusupov Hospital, rheumatologists use a modern diagnostic method - densitometry. It includes a thorough examination of bone density. This method plays an important role in the diagnosis of osteoporosis. As a standard, a general blood test is also carried out to find out whether an inflammatory process is taking place in the body or whether there are other specific signs of an inflammatory process.

Yusupov Hospital specialists adhere to the recommendations of Russia's chief rheumatologist and international protocols. They diagnose and treat patients using the latest equipment from leading European manufacturers and use innovative treatment regimens with modern medications in accordance with current protocols. A good rheumatologist is also a general practitioner, nephrologist and cardiologist. Autoimmune diseases can affect the nervous, endocrine and digestive systems. That is why appropriate specialists are involved in the treatment process at Yusupov Hospital.

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