Peripheral Chronic Arthropathy
Peripheral chronic arthropathy is defined as a chronic disease which affects the peripheral arteries (in the limbs). Atherosclerosis is the main risk factor in the development of peripheral chronic arthropathy.
A decrease in blood flow to the legs will cause an intermittent pain known as claudication.
Atherosclerosis is a condition that associates a number of risk factors for its occurrence. The main risk factors are: smoking, diabetes, hypertension and elevated cholesterol levels (especially LDL fraction).
The development of atherosclerosis comes with peripheral chronic arthropathy. Manifestations occur after the lumen of the blood vessel is narrowed. This narrowing and hardening of the blood vessel is explained by the cholesterol deposits in the blood vessel walls, followed by generating an inflammatory response in the area.
Other factors that can contribute to the development of peripheral chronic arthropathy are a number of degenerative diseases which may affect the integrity of the vascular wall (e.g. Collagen diseases – lupus, fibromuscular dysplasia, Takayasu’s disease, etc.)
The main manifestation of peripheral chronic arthropathy is represented by the intermittent pain known as claudication. The reason is the pain felt in the muscle due to the low oxygen.
Low intake of oxygen in the muscle tissue causes it to shift their energy source on anaerobic metabolism (without oxygen); after switching, there are a series of compounds that will lead to the suffering of the muscle and pain (claudication).
Pain due to peripheral chronic arthropathy may be atypical in diabetics because their nerve structures responsible for transmitting painful stimuli are also altered.
Other symptoms associated with this condition are: numbness, cold skin, etc.
The general signs of illness are given by atherosclerosis, which is the main determinant of peripheral chronic arthropathy and which affects more than the vessels in the limbs. The correlation between atherosclerosis and impaired coronary arteries is also well known.
A patient with claudication may also present angina (chest pain with a constrictive character that radiates to the neck, jaw and left arm) due to reduced blood flow through the coronary arteries – thus causing poor irrigation and ischemia.
Local signs in peripheral chronic arthropathy are: cold, paleness skin with little hair and fat, thickened nails, ulcers caused by ischemia and dermatitis (inflammation of the dermis).
Classification of the symptoms
To make a classification of the severity of the disease, the main clinical sign was mostly taken into account: claudication (pain). Fontaine made the following classification of peripheral chronic arthropathy:
- a) Stage I – is an asymptomatic stage – this disease is only emphasized by using techniques and medical devices;
- b) Stage II – is divided in turn into two other stages:
B.1) Stage IIa – claudication occurs after walking a distance of> 200 m;
B.2) stage IIB – claudication occurs after a walk distance of <200 meters;
- c) Stage III – claudication occurs at rest – without the patient making an effort;
- d) Stage IV – the pain is accompanied by ulcerative lesions (ulcers) in the affected limb.
As the stage of the disease is higher, the prognosis is worse.
In order to diagnose peripheral chronic arthropathy there are used a range of tools that guide the diagnosis and the medical tests.
1) Complete Blood Count – is the analysis that brings information on the constituent elements of blood (red cells, white cells and platelets);
2) Other biologic determinations – ESR (erythrocyte sedimentation rate), and fibrinogen, which represent markers of inflammation (their increase signifies inflammation in the body);
3) Serum biochemistry – glucose, creatinine, uric acid, total cholesterol plus its fractions (LDL – bad cholesterol and HDL – good cholesterol). An increased amount of HDL is thought to have protective effect on blood vessels.
4) The ankle-brachial index – a determination which implies the following: the voltages at the ankle and in the arm are measured and the voltage of the ankle/the voltage of the arm = X. Thus, if X is between 0.90 – 1.3, the value is normal; a ratio <0.9 is abnormal; if X = 0.5 – 0.8 it means there are symptoms; X <0.5 suggests a significant degree of ischemia in the affected limb.
6) Effort test – is a technique that determines how soon the symptoms appear. The patient is monitored while running on a treadmill and the time and distance at which symptoms appear are important.
The differential diagnosis of peripheral chronic arthropathy is with other conditions that can cause similar pain.
Other arterial diseases that are taken into account are: atherosclerosis, acute thrombosis (formation of thrombi in the arterial wall), inflammatory arthritis (inflammation of an artery after an inflammatory process), and congenital lesions.
Differential diagnosis is made with:
- a) Sciatic pain – radiating along the course of the sciatic nerve;
- b) Muscle disease;
- c) Joint disease;
- d) Diseases of the venous system.
Peripheral chronic arthropathy is a disease that can have serious repercussions on the limb if not diagnosed and treated on time. Due to serious complications, the disease may bring the patient in the situation of having to undergo an amputation of the affected limb.