Arthropathy in congenital lipid metabolism disorders

Health And Medical Video: Hereditary Disorders Of Lipid Metabolism - Crash! Medical Review Series (January 2019).


Due to the increase in the number of people who are obese, acquired or congenital (hereditary), more and more arthropathies are associated with lipid metabolism disorders, and in the first place - cholesterol.

Most often, inflammatory changes in joints develop on the background of hereditarily caused violations of lipid metabolism, called dyslipoproteinemii, or dyslipidemia.

Often, this pathology is traced in families of several generations and is always accompanied by high levels of cholesterol (hypercholesterolemia) and other lipids in the serum, and disturbances in the ratio of their fractions. This leads to their excessive deposits not only in the walls of the arteries and skin, but also in other organs and tissues, including articular.

At the same time there are phenomena of synovitis - inflammation of the inner lining lining the cavity of the joints and an articular bag (bursa). This is due to the output of the joint of cholesterol crystals from the synovial membrane and other periaryticular tissues, in which surplus lipids accumulate.

There are 5 types of this hereditary disease, but arthropathies often develop in the second and fourth types.

Main manifestations of dyslipoproteinemia

This disease often manifests itself in childhood. In this case, parents notice the appearance of a child on the back surface of the elbow and knee joints, as well as the feet and brushes of multiple yellow tints of plaques of various shapes and sizes, slightly protruding above the surface of the skin, called xanthomas.

With age, they usually increase, and their surface becomes more convex. Over the years, many patients are similar, but smaller plaques (xanthelasms) are formed on the eyelids, often on the upper, and on the edge of the cornea is a thin (1-2 mm) lipoid arc of grayish color.

Almost all patients have an early development of atherosclerosis and associated multiple manifestations (coronary heart disease, impaired cerebrovascular and peripheral circulation, etc.), as well as obesity. Sometimes there is a development of sclerotic processes in the aortic valve of the heart, which significantly impairs the prognosis of the disease.

Manifestations of arthropathy in dyslipoproteinemia

The defeat of the joints is often manifested in the form of polyarthritis with severe pain syndrome, edema of the articular tissues and the accumulation of effusion in the joint cavity, reddening of the skin and an increase in its temperature. But manifestations of this exacerbation are not accompanied by a fever and, as a rule, do not last more than a week, so they are often taken for an attack of gout. At this time, in the analysis of blood, you can detect a pronounced acceleration of ESR.

In cases where the disease immediately takes subacute, delayed nature, the duration of exacerbation can reach 2-4 weeks. In such a patient, osteoarthritis with periodic manifestations develops over time and is gradually lengthened to several months by exacerbations. This is accompanied by a limitation of the volume of movements in the joints, the formation of flexural contracture and the development of enlargements synovial membrane. Subsequently, manifestations of deforming osteoarthritis develop, which reduces the patient's performance.

With excessive deposition of lipids in the tendons, they also have an inflammatory process accompanied by edema, pain, limitation of movements, and in the future, by compression and loss of elasticity. Most often this is observed in the Achilles tendon and tendons-extensors of the fingers, with their painful and unsupathy skin with dense rounded nodules 3-10 mm in diameter on their back surfaces.

A similar affection of joints, skin and tendons is observed in all types of dyslipoproteinemia, but with congenital dyslipoproteinemia of the third, fourth and fifth types, the development of secondary gout, caused by an increase in serum uric acid in the joints and deposits in the joints, is very often noted.

Arthropathy in congenital lipid metabolism disorders
Category Of Medical Issues: Diseases