INFORMATIVENESS OF ARTHROSCOPIC EXAMINATION IN THE CLINICAL DIAGNOSTICS OF MONOGONARTHROSIS

Abstract

Clinical and X-ray symptoms, laboratory indicators of blood and synovial fluid are non-specific for the diagnosis of the knee joint osteoarthritis, especially in the early stages. It is necessary to search for informative diagnostic signs of gonarthrosis. The object of the research is the clinical, radiological and arthroscopic examination protocols of 125 patients with monogonarthrosis in the acute stage. Research methods: clinical with the study of orthopedic status; radiological; laboratory diagnostics with an emphasis on biological markers of inflammation of blood (erythrocyte sedimentation rate (ESR); C-reactive protein (CRP); monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), neutrophil/monocyte ratio (NMR)) and synovial fluid (biochemical analysis with determination including the concentration of rheumatoid factor), diagnostic arthroscopy. The results of the research of the biological markers of general inflammation, ESR and CRP in the blood, as well as the specific inflammation marker rheumatoid factor in the synovial fluid, made it possible to divide patients into the following groups: seronegative (group A1; 56.8% (71/125)) and seropositive (group A2; 37.6%; 47/125) monogonarthrosis, as well as seropositive unspecified rheumatoid monoarthritis (group B; 5.6% (7/125)). The concentration of formed blood elements according to the general clinical analysis in patient groups A1 and A2 was within normal limits. The most informative in our material was the ratio of the number of neutrophils to the number of lymphocytes, which in groups A2 and B exceeded the threshold value of NLR≥2.1 and thus could serve as a predictor of the severe course of the disease. Biochemical analysis of the synovial fluid of patients with monogonarthrosis showed signs of general inflammation in the form of an increased concentration of lactate dehydrogenase (in groups A2 and B p<0.01) and total protein (p<0.001 for all groups), a decrease in the level of glucose (p<0.001 for groups A2 and B) compared to normal indicators. However, these findings are not specific to patients with knee osteoarthritis. Diagnostic arthroscopy with examination and assessment of structural changes in the soft tissue elements of the knee joint, determination of clinically significant damage and performance of medical procedures in the amount necessary for an every patient is the most informative for monogoarthrosis.

Keywords

• monogonarthrosis,clinical blood analysis,erythrocyte sedimentation rate,c-reactive protein,rheumatoid factor,arthroscopy.