a painless joint effusion in a child, usually in the knee, caused by inflammation of the synovial membranes due to congenital syphilis. [H. H. Clutton (1850–1909), British surgeon]
For hip-joint disease, see under JOINTS, DISEASES OF.... hip-joint
All movable joints involve four structures: the bones whose junction forms the joint; a layer of cartilage covering the ends of these, making them smooth; a ?brous sheath, the capsule, thickened at various points into bands or ligaments, which hold the bones together; and, ?nally, the synovial membrane, which lines the capsule and produces a synovial ?uid, lubricating the movements of the joint. In addition, the bones are kept in position at the joints by the various muscles passing over them and by atmospheric pressure. Where the ends of the bones do not quite correspond, a subsidiary disc of ?bro-cartilage may help to adapt the ends of the bones more perfectly to each other. Larger cavities may be ?lled by movable pads of fat under the synovial membrane, giving additional protection to the joint.
Varieties After this main division of joints into those which are ?xed and those movable, the movable joints may be further subdivided. In gliding joints, such as the wrist and ankle, the bones have ?at surfaces capable of only a limited amount of movement. In hinge joints, such as the elbow and knee, movement takes place around one axis. Ball-and-socket joints, exempli?ed by the shoulder and hip, allow free movement in any direction. Subsidiary varieties are named according to the shape of the bones which enter the joint.... joints
Pain and inflammation may be relieved by analgesic drugs, nonsteroidal anti-inflammatory drugs, and injections of corticosteroid drugs.
Swelling usually reduces with rest, firm bandaging, icepacks, and keeping the affected joint raised.
In some cases, the fluid is drawn out with a needle and syringe.... effusion, joint
The procedure is usually successful in relieving arthritic pain and enabling the patient to use his or her hands again, but it rarely restores normal movement.... finger-joint replacement
BURSITIS, TENDINITIS and non-speci?c back pain (see BACKACHE).
Osteoarthritis (OA) rarely starts before 40, but by the age of 80 affects 80 per cent of the population. There are structural and functional changes in the articular cartilage, as well as changes in the collagenous matrix of tendons and ligaments. OA is not purely ‘wear and tear’; various sub-groups have a genetic component. Early OA may be precipitated by localised alteration in anatomy, such as a fracture or infection of a joint. Reactive new bone growth typically occurs, causing sclerosis (hardening) beneath the joint, and osteophytes – outgrowths of bone – are characteristic at the margins of the joint. The most common sites are the ?rst metatarsal (great toe), spinal facet joints, the knee, the base of the thumb and the terminal ?nger joints (Heberden’s nodes).
OA has a slow but variable course, with periods of pain and low-grade in?ammation. Acute in?ammation, common in the knee, may result from release of pyrophosphate crystals, causing pseudo-gout.
Urate gout results from crystallisation of URIC ACID in joints, against a background of hyperuricaemia. This high concentration of uric acid in the blood may result from genetic and environmental factors, such as excess dietary purines, alcohol or diuretic drugs.
In?ammatory arthritis is less common than OA, but potentially much more serious. Several types exist, including: SPONDYLARTHRITIS This affects younger men, chie?y involving spinal and leg joints. This may lead to in?ammation and eventual ossi?cation of the enthesis – that is, where the ligaments and tendons are inserted into the bone around joints. This may be associated with disorders in other parts of the body: skin in?ammation (PSORIASIS), bowel and genito-urinary in?ammation, sometimes resulting in infection of the organs (such as dysentery). The syndromes most clearly delineated are ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF), psoriatic or colitic spondylitis, and REITER’S SYNDROME. The diagnosis is made clinically and radiologically; no association has been found with autoantibodies (see AUTOANTIBODY). A particularly clear gene locus, HLA B27, has been identi?ed in ankylosing spondylitis. Psoriasis can be associated with a characteristic peripheral arthritis.
Systemic autoimmune rheumatic diseases (see AUTOIMMUNE DISORDERS). RHEUMATOID ARTHRITIS (RA) – see also main entry. The most common of these diseases. Acute in?ammation causes lymphoid synovitis, leading to erosion of the cartilage, associated joints and soft tissues. Fibrosis follows, causing deformity. Autoantibodies are common, particularly Rheumatoid Factor. A common complication of RA is Sjögren’s syndrome, when in?ammation of the mucosal glands may result in a dry mouth and eyes. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and various overlap syndromes occur, such as systemic sclerosis and dermatomyositis. Autoantibodies against nuclear proteins such as DNA lead to deposits of immune complexes and VASCULITIS in various tissues, such as kidney, brain, skin and lungs. This may lead to various symptoms, and sometimes even to organ failure.
Infective arthritis includes: SEPTIC ARTHRITIS An uncommon but potentially fatal disease if not diagnosed and treated early with approriate antibiotics. Common causes are TUBERCLE bacilli and staphylococci (see STAPHYLOCOCCUS). Particularly at risk are the elderly and the immunologically vulnerable, such as those under treatment for cancer, or on CORTICOSTEROIDS or IMMUNOSUPPRESSANT drugs. RHEUMATIC FEVER Now rare in western countries. Resulting from an immunological reaction to a streptococcal infection, it is characterised by migratory arthritis, rash and cardiac involvement.
Other infections which may be associated with arthritis include rubella (German measles), parvovirus and LYME DISEASE.
Treatment Septic arthritis is the only type that can be cured using antibiotics, while the principles of treatment for the others are similar: to reduce risk factors (such as hyperuricaemia); to suppress in?ammation; to improve function with physiotherapy; and, in the event of joint failure, to perform surgical arthroplasty. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) include aspirin, paracetamol and many recently developed ones, such as the proprionic acid derivatives IBUPROFEN and naproxen, along with other drugs that have similar properties such as PIROXICAM. They all carry a risk of toxicity, such as renal dysfunction, or gastrointestinal irritation with haemorrhage. Stronger suppression of in?ammation requires corticosteroids and CYTOTOXIC drugs such as azathioprine or cyclophosphamide. Recent research promises more speci?c and less toxic anti-in?ammatory drugs, such as the monoclonal antibodies like in?iximab. An important treatment for some osteoarthritic joints is surgical replacement of the joints.... joints, diseases of
Potato Poultice. 1 part potato juice to 3-4 parts hot water, applied on suitable material. Cover with protective. ... big toe joint, inflammation
When sensation to pain is lost, abnormal stress and strain on a joint do not stimulate the protective reflex spasm of the surrounding muscles; this failure of the protective reflex allows exaggerated movement that can damage the joint. Osteoarthritis, swelling, and deformity are features of a neuropathic joint.An orthopaedic brace or caliper splint may be necessary to restrict any abnormal movement of the joint.
Occasionally, an arthrodesis (a surgical operation to fuse a joint) is performed.
The nerve damage is irreversible.... neuropathic joint
Accumulation of toxins (M,S,B):
Angelica, white birch, carrot seed, celery seed, coriander, cumin, sweet fennel, grapefruit, juniper, lovage, parsley.
Aches and pains (M,C,B):
Ambrette, star anise, aniseed, French basil, West Indian bay, cajeput, calamintha, camphor (white), chamomile (German & Roman), coriander, eucalyptus (blue gum & peppermint), silver fir, galbanum, ginger, immortelle, lavandin, lavender (spike & true), lemongrass, sweet marjoram, mastic, mint (peppermint & spearmint), niaouli, nutmeg, black pepper, pine (longleaf & Scotch), rosemary, sage (clary & Spanish), hemlock spruce, thyme, turmeric, turpentine, vetiver.
Arthritis (M,S,C,B):
Allspice, angelica, benzoin, white birch, cajeput, camphor (white), carrot seed, cedarwood (Atlas, Texas & Virginian), celery seed, chamomile (German & Roman), clove bud, coriander, eucalyptus (blue gum & peppermint), silver fir, ginger, guaiacwood, juniper, lemon, sweet marjoram, mastic, myrrh, nutmeg, parsley, black pepper, pine (longleaf & Scotch), rosemary, Spanish sage, thyme, tumeric, turpentine, vetiver, yarrow.
Cellulitis (M,S,B):
White birch, cypress, sweet fennel, geranium, grapefruit, juniper, lemon, parsley, rosemary, thyme.
Debility/poor muscle tone (M,S,B):
Allspice, ambrette, borneol, ginger, grapefruit, sweet marjoram, black pepper, pine (longleaf & Scotch), rosemary, Spanish sage.
Gout (M,S,B):
Angelica, French basil, benzoin, carrot seed, celery seed, coriander, guaiacwood, juniper, lovage, mastic, pine (longleaf & Scotch), rosemary, thyme, turpentine.
High blood pressure & hypertension (M,B,V):
cananga, garlic, true lavender, lemon, sweet marjoram, melissa, clary sage, yarrow, ylang ylang.
Muscular cramp & stiffness (M,C,B):
Allspice, ambrette, coriander, cypress, grapefruit, jasmine, lavandin, lavender (spike & true), sweet marjoram, black pepper, pine (longleaf & Scotch), rosemary, thyme, vetiver.
Obesity (M,B):
White birch, sweet fennel, juniper, lemon, mandarin, orange (bitter & sweet).
Oedema & water retention (M,B):
Angelica, white birch, carrot seed, cypress, sweet fennel, geranium, grapefruit, juniper, lavage, mandarin, orange (bitter & sweet), rosemary, Spanish sage.
Palpitations (M):
Neroli, orange (bitter & sweet), rose (cabbage & damask), ylang ylang.
Poor circulation & low blood pressure (M,B):
Ambrette, Peru balsam, West Indian bay, benzoin, white birch, borneol, cinnamon leaf, coriander, cumin, cypress, eucalyptus blue gum, galbanum, geranium, ginger, lemon, lemongrass, lovage, neroli, niaouli, nutmeg, black pepper, pine (longleaf & Scotch), rose (cabbage & damask), rosemary, Spanish sage, hemlock spruce, thyme, violet.
Rheumatism (M,C,B):
Allspice, angelica, star anise, aniseed, Peru balsam, French basil, West Indian bay, benzoin, white birch, borneol, cajeput, calamintha, camphor (white), carrot seed, cedarwood (Atlas, Texas & Virginian), celery seed, chamomile (German & Roman), cinnamon leaf, clove bud, coriander, cypress, eucalyptus (blue gum & peppermint), sweet fennel, silver fir, galbanum, ginger, immortelle, juniper, lavandin, lavender (spike & true), lemon, lovage, sweet marjoram, mastic, niaouli, nutmeg, parsley, black pepper, pine (longleaf & Scotch), rosemary, Spanish sage, hemlock spruce, thyme, turmeric, turpentine, vetiver, violet, yarrow.
Sprains & strains (C):
West Indian bay, borneol, camphor (white), chamomile (German & Roman), clove bud, eucalyptus (blue gum & peppermint), ginger, immortelle, jasmine, lavandin, lavender (spike & true), sweet marjoram, black pepper, pine (longleaf & Scotch), rosemary, thyme, turmeric, vetiver.... circulation, muscles and joints:
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