Joint fibrosis

Introduction Articular fibrosis refers to the long-term "sexual" working state of the joint, resulting in poor venous blood and lymphatic reflux, serous fibrous exudate and fibrin deposition in the interstitial space, resulting in slow internal and external tissue. Fibrous adhesions. The disease mainly causes bone and joint disorders, such as morning stiffness, stiffness of the back and back, limited mobility, pain, etc. Puncture is often due to the hard texture of the tissue, tissue biopsy can be seen fibrous tissue hyperplasia. Usually increase joint activity and strengthen muscle strength exercise.

Cause

As people age, some articular surfaces will gradually become fibrotic, especially for mental workers and those engaged in light physical work. Because of too little activity, the joints are in a "sexual" working state for a long time, so that venous blood and lymph fluid return are not Chronic deposition of serous fibrous exudates and fibrin in the interstitial space, resulting in slow fibrous adhesions in the internal and external tissues of the joint.

an examination

Related inspection

Bone and joint plains of the extremities, joint cavity fluid, routine examination of synovial fluid, erythrocyte sedimentation rate (ESR), bone and joint soft tissue CT examination

1. Laboratory examination: ESR, blood cell count, normal blood biochemistry, and positive heat agglutination test.

Synovial joint examination can be used to distinguish degenerative joint disease from rheumatoid arthritis and infectious arthritis. When acute inflammation occurs and joints accumulate large amounts of fluid, joint fluid examination is the same as normal synovial fluid. At this time, the joint fluid is clear, transparent, yellowish, sticky, and does not form a clot. The cell count is normal from 60 to 3000, and is mainly composed of monocytes. The sugar concentration is the same as blood, and the protein content does not exceed 5.5g/100mL.

In contrast, synovial fluids of rheumatoid arthritis are thin, turbid, and clotted liquids upon standing. The Ropes test was positive, while osteoarthritis was negative. The cell count is often increased by more than 3000, mainly polymorphonuclear cells, the total protein of synovial fluid is often above 8g, and the concentration of globulin often equals or exceeds albumin.

When osteoarthritis is associated with rheumatoid arthritis, synovial fluid can manifest as two diseases. Therefore, although synovial fluid has a special manifestation of typical rheumatoid arthritis, it can not be excluded from osteoarthritis, so only the main cause of joint diagnosis can be confirmed by synovial fluid. In addition, when synovial fluid has the characteristics of osteoarthritis, rheumatoid arthritis may also be in a stationary phase. Once both of these diseases are suspected to be present, repeated synovial examinations must be performed.

2. X-ray inspection.

Early X-ray examination of osteoarthritis was normal. Lateral joint stenosis gradually appeared, reflecting the thinning of the articular cartilage layer covering the cortex. Finally, the progressive development of osteoarthrosis, the joint space is obviously narrowed, the joint edge is sharp, bone spurs or osteophytes are formed at the edge, and the subchondral bone is thickened and hardened, which occurs at the largest part of the subchondral bone compression. Bone cyst. Negative X-ray film does not rule out osteoarthritis. On the contrary, X-ray examination has a typical performance, and it is not certain that it is primary osteoarthritis. Degenerative changes often have other diseases at the same time, and gout, infectious arthritis, and rheumatoid arthritis are worth noting.

Differential diagnosis

1. Aplastic anemia and myelofibrosis Although there are many similar symptoms, they are two different diseases, and the treatment methods and prognosis are also very different. Myelofibrosis is the end stage of myeloproliferative diseases. It can not be cured except for stem cell transplantation. The goal of treatment can only improve the quality of life and prolong survival of patients. The positive ablation can be 30-50% after active treatment. The patient can be cured, so the diagnosis should be confirmed first in order to achieve a good therapeutic effect. The identification of the two is based solely on symptoms such as anemia, bone marrow failure, fever infection, and pain.

2. Aplastic anemia generally has no symptoms of hepatosplenomegaly; while patients with middle-to-late medullary fibrosis have basically enlarged spleen, and most patients have symptoms of hepatomegaly.

3. Patients with myelin have extramedullary hematopoiesis, so teardrop-like red blood cells and nucleated red blood cells will appear in the peripheral blood of patients with advanced disease. Large hospitals with conditions can also detect hematopoietic lesions in the spleen, liver and lymph nodes of patients. And patients with aplastic anemia do not have extramedullary hematopoiesis, and there are no teardrop-shaped red blood cells and nucleated red blood cells in the peripheral blood.

4. Bone marrow pathological biopsy of myelin patients showed significant proliferation of fibrous tissue, while aplastic anemia showed an increase in adipocytes and non-hematopoietic cells.

5. According to academic literature, pluripotent hematopoietic stem cells (CD34 hematopoietic stem cells) in peripheral blood of patients with medullary fibers are much higher than normal people, generally several times to several tens of times higher. The reason may be that the fibrous tissue in the bone marrow of patients with medullary fibers hyperplasia, occupying the space of red bone marrow and yellow bone marrow, making CD34 hematopoietic stem cells have nowhere to be, but forced to migrate to the peripheral blood, and finally in the spleen, liver and lymph nodes. Middle roots form a new hematopoietic foci. Normal bone marrow sites in patients with myelin still have normal hematopoietic function, while bone marrow in patients with aplastic anemia exhibit increased non-hematopoietic tissue and increased adipose tissue.

6. Due to the size of the spleen, the teardrop-shaped red blood cells in the peripheral blood and the CD34 hematopoietic stem cells are easier to observe and test, the medical expenses are also less, and the medical equipment is simple. Therefore, in the place where the treatment conditions are not ideal, not only can the identification be further The basis of the barrier and myelin, for patients with long-term true red can also be used as an important indicator to observe the progress of myelofibrosis. It is recommended that patients with a true red disease duration of 5 to 8 years should also regularly check the cells of peripheral blood. Morphology (mainly to observe teardrop-shaped red blood cells), in order to timely take the necessary treatment according to the progress of myelofibrosis. Because bone marrow puncture and biopsy are often performed after all, it is unlikely.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.