What is Intermittent Hydroarthrosis (Intermittent Dropsy of the Joint)?
Intermittent hydrarthrosis, or intermittent dropsy of the joint, is a recurrent disease, manifested by periodic exudate in the joint cavity. It is found in both children and adults, mainly at the age of 20-40 years. Women get sick more often than men.
Causes of Intermittent Hydroarthrosis (Intermittent Dropsy of the Joint)
The etiology and pathogenesis is not clear. In some patients, a familial susceptibility to the development of the disease, a connection with trauma, endocrine disorders, in women with menstruation is detected. Since many patients have an allergic history, indications of angioedema, hydrartrosis is believed to be a manifestation of this edema. However, antihistamines for this disease are ineffective, the SCS also does not prevent the development of dropsy of the joint. Intermittent hydrarthrosis, like palindromic rheumatism, in some cases, apparently, is a prodroma of RA or another RB. Histological examination of the synovial membrane can reveal proliferation of villi, tissue infiltration by lymphocytes and plasma cells, which is typical of chronic synovitis.
Symptoms of Intermittent Hydrarthrosis (Intermittent Dropsy of the Joint)
The clinical picture is characterized by rapid (within 12-24 h) appearance of effusion in one of the joints, as a rule, in the knee, slight soreness, or rather discomfort in it and limitation of joint mobility due to mechanical obstacles associated with large effusion. The skin above the joint is not changed, there is no inflammatory edema of the periarticular tissues. The process is usually one-way, sometimes two-way. Much less frequently than the knee joints, the ankle, hip or joints of the upper limbs are affected.
Effusion persists for 2-5 days, then comes clinical remission. Relapses occur after 7-30 days or more, while the intervals between attacks are the same for each patient. Attacks can be repeated throughout life, and sometimes spontaneously cease after 20 years or more. The general condition of the patient during the attack does not change. ESR is not increased, the RF in the serum and synovial fluid is not determined. The number of cells in the synovial fluid is increased (2 YUl), most of them are neutrophilic leukocytes. Otherwise, in terms of its properties, synovial fluid approaches the transudate, which is different from that of RA and other chronic diseases of the joints.
Diagnosis of Intermittent Hydrarthrosis (Intermittent Dropsy of the Joint)
Radiographic changes in the joint in the acute period indicate the presence of effusion: some expansion of the joint space, its “veiling”, an increase in the shadow of soft periarticular tissues. During the remission period there are no abnormalities.
Establishing diagnosis. The diagnosis is easy to install. A clear periodicity of attacks, painlessness of articular attacks, involvement of the same (knee) joints in the process distinguish Intermittent hydrarthrosis from palindrome rheumatism. Sometimes it is necessary to exclude other inflammatory as well as microcrystalline arthritis.
Treatment of Intermittent Hydroarthrosis (Intermittent Dropsy of the Joint)
NSAIDs, fluid aspiration (intraarticular administration of glucocorticosteroids, as a rule, is ineffective). In patients with the most severe course of intermittent hydrarthrosis, it is possible to use gold salts, synovectomy.