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"code": "L83",
"name": "Acanthosis nigricans",
"icd_name": "Acanthosis nigricans",
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0
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"lead": "редкий дерматоз, характеризующийся огрубением кожи и появлением на ее поверхности бородавчатый разрастаний черно-бурого цвета. \r\n",
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"etiology": "<p>Причины возникновения данной патологии до конца не выявлены. Многие специалисты считают, что заболевание вызывает генетическая предрасположенность наследственного характера. Однако точно была установлена взаимосвязь черного акантоза со злокачественными заболеваниями внутренних органов. Согласно многочисленным исследованиям злокачественное заболевание внутренних органов было выявлено у пациентов в 50-100% с черным акантозом. Ученые это связывают как с многочисленными биохимическими реакциями, происходящими в организме, так и с дисфункцией в работе иммунной системы. Причем развитие ракового заболевания отличается по половому признаку у мужчин и женщин. Так, например, у мужчин чаще развивается рак простаты, рак желудка и поджелудочной железы, а у женщин рак яичников и молочных желез. С равной частотой как у мужчин, так и у женщин развивается рак легких. Черный акантоз, сопутствующий раковому заболеванию называют злокачественным акантозом.<br /><br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p>Окончательный диагноз устанавливается после проведения гистологического исследования биоптата. Образец тканей при черном акантозе содержит большое скопление кератозных клеток и повышенное скопление пигмента. В случае подозрения на злокачественную форму акантоза необходимо провести исследование внутренних органов на предмет обнаружения раковой опухоли. Пациента направляют на ультразвуковое исследование (УЗИ), магнитно-резонансную томографию (МРТ), компьютерную томографию (КТ) и на обследование крови (онкомаркеры). Если была выявлена доброкачественная форма или псевдоакантоз, то больного направляют на консультацию к эндокринологу, который назначит комплексное исследование, направленное на выявление нарушений в работе гормональной или эндокринной системы.<br /><br /><br /></p>",
"treatment": "<p>Больным назначается реаферон внутримышечно, амиксин, неовир. Показано использование средств общеукрепляющего действия – аскорбиновая кислота, ретинол, препарата железа, витамина группа B. Используется и местное лечение. Больным назначают применение антисептических, противовоспалительных мазей и присыпок. Полезны общие ванны с добавлением KMnO4. Обязательно нужно проводить лечение основной патологии. В зависимости от выявленных патологий больным назначается гормонозаместительная терапия – прием инсулина, эстрогенов, кортикостероидов. Кстати, инсулин обязательно нужно принимать тем, кто более сахарным диабетом. По показаниям может быть назначен прием антибактериальных средств, нейротропных препаратов. При наличии обширных разрастаний на коже используется разрушающая терапия. Образования удаляют методом криодеструкции (действием жидкого азота), электрокоагуляции. В том случае, если основной причиной развития акантоза стал прием лекарств, необходимо отменить их прием, подобрав более безопасные аналоги. Больным с ожирением рекомендуют соблюдение диеты.<br /><br /></p>",
"prevention": "<p>Профилактика развития заболевания заключается в регулярном прохождении медосмотров. Необходимо следить за массой своего тела, регулярно контролировать уровень глюкозы в крови. При необходимости лечения гормональными препаратами не превышать длительность курса и рекомендованные дозы.<br /><br /></p>",
"clinical_picture": "<p>Основными симптомами данного заболевания является кератоз (<a href=\"/symptom/mozoli_i_omozolelosti/\" title=\"Перейти на страницу симптома Мозоли и омозолелости\">утолщение кожи</a>), гиперпигментация и сосочковые разрастания на пораженных участках. Пораженные участки локализуются симметрично, чаще всего в паховых и в подмышечных складках, в местах локтевых и коленных сгибаний, в межъягодичной области, в области задней части шеи и под молочными железами. Очень редко заболевание развивается на слизистых оболочках рта и в области половых органов. Заболевание начинается внезапно с появлением желтых пятен, которые впоследствии приобретают очень темный, почти черный цвет. На пораженных участках кожа утолщается, становится сухой и шершавой, с плотными рядами сосочковых разрастаний, что придает ей бугристо — бородавчатый вид. Сосочковые разрастания внешне напоминают остроконечные кондиломы.</p>\r\n<p>Рост папилломотозных высыпаний также развивается на слизистых оболочках рта, но в этом случае не наблюдается пигментная дистрофия слизистых оболочек. При поражении языка, он приобретает шершаво — морщинистую поверхность. Порой черные пятна выглядят весьма неприглядно, так как возникает ощущение грязного, немытого тела, что в свою очередь может вызвать у больного дискомфорт психологического характера.</p>\r\n<p>Обычно при черном акантозе не существует субъективных ощущений: больные не жалуются на боль, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> или раздражение кожи. Очень редко у некоторых больных возникает легкий <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> и ощущение покалывания на пораженных участках. Степень проявления симптомов зависит от формы заболевания. <br /><br /><br /></p>",
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"etiology": "<p>Чаще всего на пораженных участках кожи выявляются такие микроорганизмы, как Streptococcus haemolyticus, Staphylococcus aureus, S. albus. Эти кокки выделяют различные экзотоксины и ферменты, которые определяют клиническое отличие различных пиодермий.Пиодермия развивается под влиянием различных экзогенных и эндогенных факторов.</p>\r\n<p>Экзогенные факторы</p>\r\n<ul>\r\n<li>Травматизация кожи.</li>\r\n<li>Загрязнение кожи, несоблюдение гигиенических норм, чрезмерное обезжиривание кожи.</li>\r\n<li>Нарушение секреторной функции кожи.</li>\r\n</ul>\r\n<p>Эндогенные факторы</p>\r\n<ul>\r\n<li>Фокальная инфекция.</li>\r\n<li>Заболевания желудочно-кишечного тракта.</li>\r\n<li>Нарушения обмена веществ.</li>\r\n<li>Заболевания эндокринной системы.</li>\r\n<li>Неврозы, психическая травма.</li>\r\n<li>Хроническая интоксикация.</li>\r\n<li>Иммунный дефицит, ВИЧ-инфекция.</li>\r\n</ul>",
"pathogenesis": "<p><span id=\"docs-internal-guid-aca276b1-7fff-925e-dd63-afdf2c6451d4\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Процесс формирования язвы при гангренозной пиодермии проходит три стадии. На стадии иммунных реакций происходит накопление специфических для определённого вида антигена антител. При этом иммунные лимфоциты и антитела класса Е из крови переходят в ткани кожи, сенсибилизируя её. На второй (патохимической) стадии заболевания повторное попадание чужеродного антигена вызывает активацию протеолитических ферментов клеток и тканей с нарушением их функций. Эпидермальные клетки начинают вырабатывать биологически активные вещества, провоцирующие воспаление. На третьей (патофизиологической) стадии возникает специфический ответ кожи на внедрение патологического антигена в виде дегрануляции клеток, разрушения сосудов, нарушения трофики и локальной деструкции ткани. Глубина деструкции зависит от количества патогенного антигена и степени устойчивости иммунной системы.</span></span></p>",
"diagnostics": "<p>Клинический диагноз ставится дерматологом на основании анамнеза, специфической симптоматики и консультаций узких специалистов, поскольку гангренозная пиодермия является междисциплинарным заболеванием. Гистология очага поражения не показательна, но в сложных случаях полезна. Выявляется тромбоз сосудов, гранулематозные инфильтраты, островки деструкции в эпидермисе и дерме. Дополнительно проводят электрофорез сывороточного белка, исключают микотическую природу язвы, берут кровь на RW.</p>",
"treatment": "<p><span id=\"docs-internal-guid-86eb6e11-7fff-fefe-229c-1391e5ce073a\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Терапию гангренозной пиодермии начинают с коррекции соматической патологии у профильных специалистов, поскольку кожный патологический процесс без этого плохо поддаётся терапии. Целью дерматологического лечения является снятие воспалительных проявлений, болезненных ощущений, восстановление кожных покровов. Для этого проводят курсы гормонотерапии и антибиотикотерапии. В тяжёлых случаях подключают цитостатики, иммуносупрессоры, калия иодид, внутривенно вводят иммуноглобулин. Показан плазмаферез. Наружно при гангренозной пиодермии очищают поверхность дефекта кожи с помощью вибрационно-турбулентных ванн, антисептических растворов. Применяют влажно-высыхающие повязки с растворами серебра, гормональные препараты. С учётом патергии стараются избегать хирургических манипуляций.</span></span></p>",
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"etiology": "<p>Гранулема формируется в ответ на проникновение в кожу плохорастворимого агента. Плохорастворимые агенты могут быть:</p><p> - инфекционные (лейшманиоз, различные микозы: бластомикоз, хромомикоз, криптококкоз, споротрихоз и др);</p><p> - инородные тела эндогенные (холестерин, кератин, кожное сало и др, например, разрыв эпидермоидной кисты);</p><p> - инородные тела экзогенные (шовные нити, при татуировках, парафин и др);</p>",
"pathogenesis": "<p>В процессе формирования гранулемы ведущая роль принадлежит клеточному иммунитету. Присутствие в коже плохорастворимого агента активируют имунные клетки, которые фагоцитируют и разрушают внедриагент или, отграничивают его.</p><p> </p>",
"diagnostics": "<p>Диагноз можно поставить при визуальном осмотре, применяя некоторые инструментальные методы (диаскопия). Для уточнения диагноза выяснения причины, используют гистологическое исследование.</p>",
"treatment": "<p>При лечении гранулематозных поражений кожи применяют несколько групп препаратов:</p><p> - антибиотики и противогрибковые средства при гранулемах, вызванных инфекционными и грибковыми агентами;</p><p>- противомикробные средства из группы сульфонов (дапсон);</p><p>- глюкокортикостероиды. Чаще используют в виде мазей или внутрикожных иньекций;</p>",
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"lead": "диффузное заболевание соединительной ткани, характеризующееся системным иммунокомплексным поражением соединительной ткани и её производных, с поражением сосудов микроциркуляторного русла.",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Красная волчанка – это хроническое мультисистемное воспалительное заболевание соединительной ткани аутоиммунной природы, которое может поражать суставы, почки, кожу, слизистые оболочки и стенки кровеносных сосудов.</span></p>",
"etiology": "<p class=\"disease\">Различают две основные формы: системную красную волчанку (СКВ) и кожную форму (КФ). При кожной форме процесс затрагивает лишь кожные покровы. При СКВ кроме кожи поражаюся так же суставы и внутренние органы («системная» значит, что в патологический процесс вовлечен весь организм). Кожная форма может перейти в системную. Причина возникновения данного заболевания до сих пор остается неясной.</p>\r\n<p class=\"disease\">При СКВ могут поражаться различные органы, поэтому симптоматическая картина чрезвычайно многообразна и варьируется от случая к случаю. Типичным является появление на коже лица высыпании в виде бабочки, кожи к солнцу и ревматоидные поражения суставов.</p>\r\n<p class=\"disease\">В основном болеют женщины детородного возраста (25-35 лет). При этом часто заболевание появляется или во время беременност или непосредственно после нее, что подчеркивает возможную роль женских гормонов (эстрогенов) в развитии заболевания.</p>\r\n<p class=\"disease\">Точные причины заболевания неизвестны. Предполагается, что заболевание является мультифакториальным, то есть вызывается не одной причиной, а их сочетанием.</p>\r\n<p class=\"disease\">Так как красная волчанка во вмногих слуучаях носит семейный характер (как и в случае других аутоиммунных заболеваний), то считается генетически обусловленной, но не наследственной! Генетическая предраспложенность может вызвать развитие болезни только в сочетании с другими факторами.</p>\r\n<p class=\"disease\">К таким факторам относятся:</p>\r\n<ul>\r\n<li>Ультрафиолетовое облучение</li>\r\n<li>Женские гормоны (эстрогены, оральные противозачаточные средства</li>\r\n<li>Возможно, определенную роль в развитии процесса играют инфекции.</li>\r\n</ul>\r\n<p class=\"disease\">СКВ относится к аутоиммунным заболеваниям, то есть иммунная система агрессивно воздействует на собственный организм. В случае красной волчанки поражается кожа и мелкие сосуды различных органов, что вызывает воспалительные процессы.</p>\r\n<p class=\"disease\">Особые формы СКВ:</p>\r\n<ul>\r\n<li>Волчанка, обусловленная приемом медикаментозных препаратов: заболевание протекает в мягкой форме. При ней поражаются суставы и кожа. Симптомы исчезают после отмены приема данных лекарственных средств.</li>\r\n<li>Антифосфолипидный синдром: характеризуется склонностью к артериальным и венозным тромбозам, тромбозы плаценты являются причиной повторяющихся выкидышей.\r\n<p> </p>\r\n</li>\r\n</ul>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патогенез связан с нарушением аутоиммунных процессов, в результате чего вырабатываются антитела к здоровым клеткам организма.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">На этапе первичного обращения, пострадавший проходит диагностику, в ходе которой устанавливается характер течения патологии. Обследование обязательно включает лабораторное обследование:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">клинический анализ крови; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">анализ на антинуклеарные антитела (АНА); </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">р</span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">еакция Вассермана; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">тест на ЛЕ-клетки.</span></li>\r\n</ul>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основой лечения служат кортикостероидные гормоны. При этом заболевании они могут наноситься на очаги в виде мазей, вводиться с помощью инъекций непосредственно в очаг пораженной кожи. В тяжелых случаях возможно назначение системных кортикостероидов. В качестве альтернативы или для усиления терапии возможно нанесение на очаги препаратов ингибиторов кальциневрина.</span></p>\r\n<p class=\"disease\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В случаях тяжелого поражения кожи, недостаточном эффекте от наружного лечения проводится системная терапия с использованием антималярийных препаратов (хлорохин, гидроксихлорохин), противовоспалительных препаратов (метотрексат, микофенолат, дапсон, азатиоприн и др.).</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфические профилактические рекомендации отсутствуют. Они сводятся к общим правилам:</span></p>\r\n<p> </p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">исключить воздействие стрессов; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">избегать продолжительного контакта с прямыми солнечными лучами; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">правильно питаться; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">заниматься лечением инфекционных и воспалительных заболеваний; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">заниматься физкультурой; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">отказаться от приема пероральных контрацептивов с повышенной долей эстрогена.</span></li>\r\n</ul>",
"clinical_picture": "<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Красная сыпь на лице в виде бабочки, с поражением щек, либо другие виды сыпи, характерные для волчанки</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выпадение волос без рубцевания</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Язвочки на слизистой оболочке рта или носа</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Воспаление суставов или болезненность и скованность суставов в утреннее время</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Скопление жидкости вокруг легких, сердца или других органов </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение функции почек</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение функции нервов или головного мозга</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p class=\"disease\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы волчанки у больных широко варьируются. Симптомы могут развиваться внезапно, начинаясь с повышенной температуры и напоминая внезапную инфекцию. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В других случаях симптомы развиваются постепенно, в течение месяцев или лет, с приступами жара, недомогания или любого из перечисленных ниже симптомов, перемежающимися с периодами отсутствия симптомов или их минимальных проявлений. </span></p>",
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"slug": "akusherstvo_i_ginekologiya",
"lead": "Область медицины, включающая в себя лечение 739 заболеваний. В 1042 клиниках России оказывается помощь по этому направлению медицины.",
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"slug": "hirurgiya_hirugiya_transplantaciya_organov_i_tkaney_i_kombustiologiya",
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},
"code": "M00",
"name": "Пиогенный артрит",
"icd_name": "Пиогенный артрит",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "m00_piogennyy_artrit",
"lead": "воспалительное заболевание суставов, обусловленное попаданием инфекции в полость сустава через повреждения на коже или возникающее вследствие наличия острых или хронических заболеваний, вызванных бактериями",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пиогенный артрит, называемый также септическим артритом или инфекционным артритом, является серьезной болезнью суставов, характеризующейся болью, температурой, ознобом, покраснением и отеком одного или нескольких суставов, а также потерей подвижности пораженных суставов.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Развитию инфекционного артрита способствуют следующие факторы:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">различные хронические артриты</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">системные инфекционные заболевания</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">системные заболевания соединительной ткани</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">иммунодефицитные состояния (как правило, у пациентов, страдающих иммунодефицитом, развивается полиартрит)</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">онкологические заболевания</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">внутрисуставные инъекции или хирургические вмешательства на суставах, в ходе которых в ткани сустава может быть занесена инфекция</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сахарный диабет</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">травмы</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие протезов суставов</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">алкоголизм и наркомания (наркозависимые пациенты часто страдают поражением суставов осевого скелета)</span></li>\r\n<li><span id=\"docs-internal-guid-552472a8-7fff-8131-83f0-95ef23c608a6\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">прием ряда препаратов, в том числе гормональных</span></span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Как правило, возбудитель артрита попадает в сустав с током крови или лимфы. В зависимости от того, какой именно возбудитель вызвал заболевание, различают бактериальный, вирусный, грибковый и паразитарный артриты.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если возбудитель попадает в сустав извне, то такой артрит называется первичным. Если очаг воспаления находится в самом организме, то есть инфекция попадает из других органов и тканей, то артрит называется вторичным.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также инфекционный артрит может развиться в результате травмы сустава и попадания возбудителей воспаления в рану. </span></p>",
"diagnostics": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на развитие инфекционного артрита пациента направляют на рентген или УЗИ суставов. Также необходимо сделать анализ крови, иммунограмму, исследовать внутрисуставную жидкость, для анализа берутся мазки из половых путей. При подозрении на туберкулезную природу артрита проводится исследование для выявления очагов туберкулеза.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные принципы лечения инфекционных артритов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">подавление инфекции, вызвавшей поражение суставов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">дезинтоксикационная терапия – выведение из организма токсических продуктов воспаления;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">предупреждение рецидивов заболевания и дальнейшего разрушения суставов.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Разные клинические формы инфекционного артрита требуют разного подхода к лечению. Так, острые гнойные и другие, протекающие тяжело артриты, лечатся только стационарно. При хроническом течении возможно амбулаторное лечение или его сочетание со стационарным во время обострения. На этом этапе основными методами лечения инфекционного артрита являются хирургическое и медикаментозное в сочетании с иммобилизацией (созданием неподвижности) пораженных суставов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В дальнейшем, на стадии восстановления присоединяются немедикаментозные методики: лечебная гимнастика, массаж, физиотерапевтические процедуры, курсы рефлексотерапии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение острых гнойных артритов</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При нагноительном процессе в суставах проводят следующие хирургические манипуляции и операции:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">артроцентез - пункция сустава (прокол иглой со шприцем) с последующим удалением гнойного экссудата, промыванием (лаважем) суставной полости дезинфицирующим раствором и введением антибиотиков;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">лечебная артроскопия – та же самая процедура, но проводится при помощи эндоскопической аппаратуры (артроскопа); во время артроскопии можно удалить не только гной, но и кусочки некротизированной ткани, секвестры костей;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">артротомия с проточно-аспирационным дренированием – проводится при большом скоплении гноя и деструкции сустава; полость сустава раскрывается традиционным хирургическим способом, после чего проводится удаление гноя,регулярное промывание суставной полости дезинфицирующими растворами с введение в нее антибиотиков.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<p><span id=\"docs-internal-guid-aa0d875c-7fff-a70d-1da2-4fa91cfb01c1\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Инфекционный артрит можно предупредить, занимаясь закаливанием, спортом без тяжелых физических нагрузок, правильно питаясь и вовремя пролечивая все инфекции.</span></span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Проявления инфекционного артрита могут различаться, в зависимости от того, какой возбудитель стал причиной заболевания. Однако можно выделить ряд симптомов, общих для всех форм инфекционного артрита:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сильная боль в суставе в покое или во время движения; сустав болезненный даже при прикосновении</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушение функции сустава, вынужденное положение конечности</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">изменение контуров сустава</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">отечность, покраснение и повышение температуры кожи в районе сустава</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общее плохое самочувствие, повышение температуры тела</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">тошнота и рвота</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">слабость, повышенное потоотделение</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если инфекционный артрит вызван гонококками, то могут быть и кожные проявления в виде высыпаний на коже и слизистых. Золотистый стафилококк является причиной такой формы артрита, при которой разрушение хрящей происходит очень быстро, буквально в течение 2-3 дней.</span></p>",
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