Treatment of body stiffness. Damage to the joints of a rheumatoid nature. Morning stiffness in the body

> Muscle stiffness

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Be sure to consult with a specialist!

Muscle stiffness is their increased tone, which makes voluntary movements difficult. medical name such a condition is muscle rigidity.

The causes of this syndrome are not fully understood. It is associated with a violation of the conduction of neuromuscular impulses due to various pathologies central or peripheral nervous system. Muscle stiffness is accompanied by some neurological diseases such as Parkinson's disease. The cause of muscle rigidity can be injuries of the spinal cord and brain, atherosclerosis of cerebral vessels. This syndrome can occur with various intoxications, for example, with poisoning carbon monoxide or manganese. Sometimes he is side effect in the treatment of some medications. One of the causes of muscle stiffness syndrome is pathology musculoskeletal system such as osteochondrosis. Provoke such a state of stress, prolonged exposure to an uncomfortable position, hypothermia.

Clinical signs of pathology

The disease begins most often with a slight lesion of the muscles of the trunk and head. Complaints about a feeling of discomfort and stiffness of the back muscles are characteristic. Symptoms worsen with nervous overload. Patients have sleep disturbances, manifested by frequent awakenings at night. Occasionally in initial stage severe attacks are observed, which can last several hours or even several days. Often, seizures occur against the background of a state of neurosis.

With the progression of the syndrome of muscle stiffness, the muscles of the limbs become tense, and their painful spasms. The exacerbation of the syndrome most often occurs at moments of emotional overload, for example, with fright, surprise, sadness, as well as with rapid movements. Patients begin to move as slowly as possible, they often have lumbar lordosis(curvature spinal column in lumbar forward).

AT final stages diseases of stiffness and spasms affect the vast majority of the muscles, including the muscles of the face and throat.

Consequences of the syndrome of stiff muscles

Stiffness syndrome can lead to depression in patients, they experience difficulty in the process of work, while eating, in communicating with others and driving a car. Severe spasms can be complicated by joint deformities, muscle ruptures, and fractures.

What examinations can the doctor prescribe?

With such complaints, you should contact a neurologist. A doctor diagnoses stiffness syndrome based on an examination of the patient and the results of a blood test that detects specific antibodies. Magnetic resonance spectroscopy is prescribed to detect biochemical changes in muscle tissues. If necessary, the doctor sends the patient for consultations with a psychiatrist, orthopedist, surgeon and other narrow specialists.

Treatment and prevention of muscle stiffness

For effective treatment, it is necessary to eliminate all provoking factors and treat the diseases that caused muscle stiffness syndrome. Specific sedatives, muscle relaxants (drugs that relax muscles), B vitamins, sometimes antiepileptic drugs. Plasmapheresis may be effective. Apply massage and manual therapy, reflexology, physiotherapy. Ointments and gels are locally prescribed. To unload the spine, a special Shants collar is sometimes used. After pain relief and improvement general condition exercise therapy is used.

To prevent muscle stiffness, it is not recommended to stay in the awkward position, supercool. It is necessary to avoid stress and monitor the intake of a sufficient amount of B vitamins into the body. It is recommended to sleep on flat and low pillows. All medical prescriptions must be strictly observed.

Articular pathologies are extremely common among the population of various age groups. They are diagnosed in both the elderly and young people after 30-40 years. The type of damage to the articular structures can be different, and the degree of intensity of the pathological process is also not the same. But almost always, regardless of nosology (type of disease), in the clinical picture there is stiffness of the joints in the morning.

It can last no more than an hour, followed by full recovery joint performance. In other cases, joint stiffness can persist throughout the day. In addition, it rarely manifests itself in isolation, in most cases it is observed in combination with other pathological signs. Depending on what kind of disease a person has, stiffness can be observed either in one joint, or in several at once, for example, in the fingers.

The mechanism of development of stiffness

The main task of any joint is to ensure the full range of motion provided by physiology. To accomplish it, all the articular components work simultaneously and harmoniously. Bone structures slide relative to each other due to the smoothness and elasticity of hyaline cartilage, the synovial membrane produces a lubricating fluid and delivers cartilage tissue oxygen and necessary nutrition.

All components of a joint work together to ensure its functionality.

If any failure occurs in this mechanism of normal movements, then first of all their amplitude suffers, which becomes much smaller. Subjectively, this phenomenon is felt by a person precisely as stiffness and stiffness, or the inability to fully bend or straighten a limb, fingers, less often the spine.

Joint stiffness in the morning is not an independent diagnosis, it is always a symptom of some pathology. If the synovial membrane is affected, then it thickens and decreases in elasticity, and the amount of lubricating fluid decreases. This necessarily affects the ability to perform a full range of motion in the joint. When the layer of cartilaginous tissue is destroyed, the bone structures do not begin to slide, but constantly touch each other, which also reduces the amplitude. In each case, the restriction of movement is combined with other symptoms; most often the development pain syndrome and signs of inflammation.

Therefore, all mechanisms for the formation of morning stiffness can be divided into three groups:

• Degenerative-dystrophic processes in the cartilaginous tissue, which gradually lead to the destruction of hyaline cartilage, the formation of osteophytes (bone growths) and fibrous degeneration of the synovial membrane.
• Inflammatory processes in the joint, which can be of various origins (aseptic, infectious, allergic, autoimmune) and affect all joint structures.
• Tumor processes that are less common and disrupt the functionality of the joints mechanically (the neoplasm compresses the tissues and prevents them from performing their functions).

The more severe the disease, the more pronounced all its manifestations, including joint stiffness. But there are also pathologies in which morning stiffness in the joints does not always last long, regardless of the severity. This characteristic of the symptom, as well as its combination with other signs, is very helpful in differential diagnosis almost all joint pathologies.

Feeling of stiffness is often associated with pain

Causes of morning stiffness

As already noted, stiffness different localization stands only separate characteristic any disease. Therefore, the causes of morning stiffness are a wide variety of pathologies. And not always the painful process affects the joint. There are diseases in which the bony articulations, hyaline cartilage, synovial membrane and capsule remain intact, but the surrounding ligaments and muscles suffer, often as a result of a violation nervous regulation. Such pathologies include, for example, Parkinson's disease or the consequences acute violation cerebral circulation(ischemic or hemorrhagic stroke), when the innervation of the muscle groups surrounding the joint changes according to a certain type. As a result, the formation of articular stiffness is also noted.

In cases of a high degree of obesity, one should speak of false stiffness. The decrease in the amplitude of movements in these situations is associated, rather, with general motor insufficiency and muscle weakness than with pathological changes in the joints.

Short-term or longer-term stiffness can have various origins. It can form as a result of trauma, physical overload or surgical interventions.

But most often it is various diseases, and the most extensive group among them has an inflammatory nature. These are arthritis.

• rheumatoid;
• infectious (nonspecific and specific);
• gouty;
• Bechterew's disease, or ankylosing spondylitis;
• systemic;
• psoriatic;
• allergic.

In every disease in this group there is always a stiffness in the joints, large or small, which develops only in the morning or persists much longer. Because pathological process wears inflammatory character, there are other characteristic features.

The feeling of joint stiffness in obesity is often considered false.

This may be swelling and hyperemia (redness) skin, pain different intensity, joint deformity, pronounced violations movements, changes in skin sensitivity as a result of concomitant lesions of the central or peripheral nervous system. With each nosology, there is a certain combination of these signs, changes in the biological environment of the body (blood and urine), as well as morphological disorders (changes in the anatomy and structure of tissues), which are diagnosed using additional instrumental methods.

Another group of pathologies is more often associated with an inflammatory process or traumatic injury only at the beginning of its development. These are arthrosis, or osteoarthrosis, which can be of very different localization: in the joints of the arms, legs, spinal column. With each of them, inflammation “starts” a destructive degenerative process in the joint, which, starting with slight stiffness, gradually progresses and ends with almost complete joint immobility.

Of course, what to treat morning stiffness separately from others pathological manifestations doesn't make sense. After the full complex diagnostic measures for each patient, an individual treatment regimen is developed, which is designed to deal with certain disease. Therefore, it will be more convenient to consider each pathology separately, indicating the most characteristic symptoms and methods of treatment.

Rheumatoid arthritis

This is a very common joint disease that occurs in almost 2% of the population and is often one of the causes of disability in young and middle age. Many joints suffer at once, mostly small ones, according to the destructive-erosive type. In fact, rheumatoid arthritis is a polyarthritis that affects connective tissue, which makes up the main part of the synovial membrane.

Any joint injury can cause arthritis.

By nature, rheumatoid arthritis is considered autoimmune pathology, that is, a peculiar and perverted reaction of the body to its own tissues, in particular, to the connective. As a result, the resulting immune complexes cause an inflammatory process in the synovial membrane of the joints, its own tissue is destroyed, and fibrous structures are formed in its place.

These pathological processes affect the condition and functionality synovial bag. It loses its elasticity, smoothness and elasticity, becoming rigid and uneven, which begins to interfere with the execution of movements in the joint with the required amplitude. Additionally, the production of lubricating fluid is also reduced, and its deficiency significantly affects the nutrition of cartilage tissue, leading to the onset of destruction of hyaline cartilage.

That is why one of the most characteristic manifestations rheumatoid arthritis is morning stiffness in the joints. At first, it is noted in the small joints of the hands and fingers, but then, as the autoimmune process progresses and spreads, it moves to the medium and large joints of the whole body. Stiffness is felt by the patient as a feeling of tightness or constriction that does not allow movement.

After a few hours, as a rule, this symptom disappears and movements in the joints are partially or completely restored, but other manifestations of rheumatoid arthritis remain:

• swelling of the joint zone;
• redness of the skin;
• symmetry of the lesion;
• pain syndrome, most severe in the afternoon and at night;
• the pain intensifies when pressed and when trying to make a movement in the joint;
• the formation of dense nodules under the skin in natural folds, which is explained systemic lesion connective tissue;
• symptoms chronic intoxication(weakness and malaise, headache, loss of appetite, weight loss);
• the gradual formation of joint deformity, which is manifested by a characteristic curvature, for example, of the fingers and is accompanied by a violation of blood circulation in them.

Diclofenac is used in almost all types of arthritis

To get rid of stiffness in the joints, which, as can be seen from the indicated complex of clinical symptoms, is not the most painful and pronounced manifestation rheumatoid arthritis, it is necessary to carry out treatment aimed at the nature of the pathology. It becomes lifelong, since arthritis of autoimmune origin cannot be completely cured, the disease will proceed with alternating exacerbations and remissions.

However, the intensity and frequency of exacerbations can be reduced and reduced using a set of the most strong drugs to date. These are non-steroidal anti-inflammatory drugs (Diclofenac, Indomethacin, Ibuprofen and their derivatives), hormonal preparations(Prednisolone, Dexamethasone), as well as the so-called basic drugs (Azathioprine, Methotrexate, Cyclophosphamide) and biological agents (Actemra, Halofuginon, Humira, Orencia).

infectious arthritis

The clinical picture of infectious, or septic, arthritis is always pronounced, and the manifestation (the onset of pathology) occurs suddenly and acutely, that is, the symptoms develop quickly and with maximum intensity of manifestations. As a rule, the inflammatory process in separate joint the whole organism reacts, responding with the formation of an intoxication syndrome.

Therefore, in most cases, septic arthritis has the following symptoms:

• a feeling of stiffness is quickly replaced by a pronounced pain syndrome, which is aggravated by palpation (palpation) or an attempt to move;
• no symmetry of the lesion;
• the inflamed joint swells and swells, the skin over it turns red and becomes sharply painful and hot;
• the patient tries to keep the injured leg or arm in forced position, which somewhat reduces the severity of pain;
• expressed syndrome acute intoxication: fever up to 39-40 degrees, severe headache, severe weakness.

Staphylococcus aureus causes severe joint damage

Ankylosing spondylitis, or ankylosing spondylitis, is quite rare (about 400 thousand patients in Russia) and affects mainly small joints that connect the processes of the vertebrae, as well as the vertebral bodies themselves. However, there are other forms of the pathological process, which is localized in larger joints, such as the knee.

In Bechterew's disease, the synovial membrane primarily suffers, in which chronic inflammation. The formation of fibrous nodes in it and later joining bone growths significantly worsen the condition of the joints of the spine or limbs.

This disease may present various forms masquerading as others articular pathologies. Its symptoms may differ in men and women and depend on age category. In general, in women, the disease develops somewhat more slowly and does not begin in such a young age like men.

The main symptoms of Bechterew's disease are:

• pain and stiffness (not only in the morning) in the spine, upper or lower limbs;
• pain is characterized by significant irradiation;
• limitation of the range of motion in the affected joints;
• in the blood test, the ESR rises sharply, up to 60 mm / h.

In ankylosing spondylitis, the spine is primarily affected.

It is impossible to completely cure this disease, like rheumatoid arthritis, but modern ways treatment can significantly slow down the rate of its progression. For this, non-steroidal anti-inflammatory drugs, hormonal and basic agents, glucocorticoids, immunosuppressants, and cytostatics are used. Additionally, massage, physiotherapy, therapeutic exercises are needed.

Other types of arthritis

Arthritis of a gouty nature develops if the metabolism is disturbed in the human body. uric acid. At the same time, its crystals can linger both in renal tissue, and inside the joints, forming salt deposits on the synovium. In response to this, the inflammatory process begins to progress, negatively affecting all articular structures. A feeling of stiffness and pain, swelling and hyperemia, difficulty in movement and intoxication of the body are the main signs of this type of arthritis. Therapy consists in the use of a complex medications, local procedures and following a strict diet.

Systemic arthritis, like rheumatoid arthritis, has an autoimmune nature, with a pronounced element of heredity. If it starts at childhood, then referred to as "Still's disease", or systemic juvenile arthritis. In addition to pain and stiffness in the joints, characteristic changes in the skin in the form of a rash are observed around them. Treatment is long and complex, including medications (NSAIDs, immunomodulators, hormones), physiotherapy and special physical education.

Arthritis of psoriatic origin is often called a variety of rheumatoid arthritis. very similar clinical pictures these diseases, with a predominantly symmetrical lesion small joints and their characteristic deformation. Psoriasis, gradually developing, "transfers" from the skin to the bone-articular frame and leads to the formation of arthropathy. His treatment is to use the complex medicines, diets, folk methods local therapy.

Arthritis allergic nature can develop in a person with an allergic predisposition. Most often this is possible if there is an allergy to certain products nutrition, less often pollen or household allergens. In the mechanism of development of this arthritis, the immune mechanism is pronounced, therefore, all signs of the disease (pain, stiffness, swelling, hyperemia) can be stopped using means of influencing the immune system. First among them are antihistamines, hormones, immunosuppressors, cell membrane stabilizers.

Almost all diseases of the joints are accompanied by the presence of stiffness, often it becomes the very first manifestation of the pathology and signals trouble in the body. Therefore, with the development given symptom it is necessary to consult a doctor, diagnose and urgently begin treatment of the identified disease.

The main manifestations of the rigid person syndrome include: increasing muscle tension(rigidity) and muscle spasms. The process begins with the muscles of the trunk, after a few months it spreads to the muscles of the proximal limbs. The disease is based on an increase in the excitability of the alpha motor neurons of the anterior horns. spinal cord, but this state has not yet been established.

Treatment of muscle stiffness in rigid person syndrome is symptomatic. The patient is prescribed GAMergic agents: benzodiazepines ("Clonazepam", "Diazepam") and "Baclofen", which affects neuromuscular transmission. Drugs block increased activity spinal motor neurons and reduce the severity of reflex, spontaneous muscle spasms and rigidity.

How to take drugs for the treatment of rigid person syndrome

The most commonly used "Diazepam" ("Sibazon", "Relanium"). It enhances GABAergic transmission and simultaneously inhibits noradrenergic transmission. The drug is started with minimum dose(2.5 mg), it is taken 1-2 times a day. Then the daily amount is gradually increased until the desired effect is achieved, taking the medicine 3-4 times. Range therapeutic doses depends on the individual sensitivity of the patient and can vary from 10 to 200 mg per day.

Instead of "Diazepam" you can use "Clonazepam" in the amount of 2-10 mg / day. With the ineffectiveness of benzodiazepines, Baclofen (an agonist of type B GABA receptors) is prescribed. It is taken along with one of the benzodiazepines or used as monotherapy. The daily dose of the drug is increased gradually. Maximum amount is 100-120 mg per day (in 3 divided doses).

At simultaneous reception Baclofen and benzodiazepine healing effect achieved with a lower dose than with monotherapy. This reduces the risk of side effects. It is necessary to avoid abrupt discontinuation of drugs, as this is fraught with a deterioration in the condition and the development of pronounced vegetative changes.

In case of intolerance or ineffectiveness of these drugs, valproic acid preparations are prescribed: Depakin in a daily dose of 600-2000 mg, Tiagabin in a dose of 4-12 mg per day or Vigabatrin in a daily amount of 1500 mg. These drugs also enhance GABAergic transmission. The use of antiadrenergic drugs ("Clonidine", "Tizanidin") gives a less permanent therapeutic effect. AT severe cases Botulinum toxin A is injected into the paraspinal muscles.

This condition occurs in almost all chronic inflammatory diseases joints - arthritis. In most cases, arthritis is accompanied by inflammation of the synovium (synovitis). This shell is normally responsible for the production of a special fluid, which is a "lubrication" for rubbing articular surfaces.

With inflammation of the synovial membrane, the amount, composition, viscosity and other characteristics of such a "lubrication" change. Articular surfaces lose their ability to move normally.

morning stiffness joints is just one of the symptoms of some disease. She can meet the following diseases or states:

• Rheumatoid arthritis.
• Arthritis, as one of the manifestations of another disease - rheumatism, psoriasis, etc.
• Bechterew's disease.
• Osteoarthritis (osteoarthritis) of various localization and others.

Below we briefly review the main manifestations of these diseases. More detailed information about this or that disease can be obtained in the corresponding section of our website.

Of course exact reason only a doctor should establish such a condition.

Rheumatoid arthritis

The cause of this disease is still unknown. It has been established that joint damage and other extra-articular manifestations in this disease are of autoimmune origin.

The prevalence of this disease among the population is approximately 2%. Men are more often ill. The age peak onset of the disease is 30–55 years.

Symptoms

The disease may begin acutely or gradually. Damage to several small and / or legs at once (polyarthritis) is characteristic. Sometimes large joints are also involved - shoulder, knee. Course of the disease:

1. At the beginning of the disease, pain of varying intensity in the affected joints, morning stiffness in them are characteristic. Difficulty in making movements in rheumatoid arthritis lasts at least an hour. Observed muscle weakness, which is manifested, for example, by a decrease in the grip force of the hand. The skin over the affected area remains unchanged.
2. With the progression of the disease, a characteristic deformity of the affected joints develops with deep violations their functions.
3. Rheumatoid arthritis is usually accompanied by common manifestations: fever, progressive weakness, weight loss. This disease often affects other organs and systems: the heart, lungs, skin, nervous system and etc.

Diagnostics

Based on specific clinical symptoms and results additional research. In addition to general clinical tests, specific immunological studies play an important role in the detection of rheumatoid arthritis.

These include: determination of rheumatoid factor (RF) and antibody titer to the cyclic citrulline-containing peptide - ACCP or anti-CCP.

Additional research methods (X-ray, CT, MRI, etc.) allow you to identify the degree of damage to the joints and other organs.

Treatment

Treatment of rheumatoid arthritis is a long process. Both medicinal and non-pharmacological agents are used. From medicines wide application found:

• Non-steroidal anti-inflammatory drugs.
• Glucocorticoids.
• Basic (or disease-modifying) antirheumatic drugs.
• Medicines for treatment accompanying symptoms- damage to the heart, lungs, anemia, etc.

Non-drug methods - exercise therapy, physiotherapy, diet, etc., are auxiliary and are used in conjunction with drug therapy.

Arthritis manifested in other diseases

Such joint inflammations (arthritis) are not independent nosological unit. They act as one of the symptoms of some other disease. Very often, articular syndrome, in which there is stiffness of the joints in the morning, occurs with psoriasis, rheumatism, systemic lupus erythematosus and some other diseases.

Psoriasis

Articular syndrome occurs in approximately 6% of patients with psoriasis. It occurs in conjunction with skin manifestations, but sometimes precedes them. In psoriasis, both large and small joints of the limbs are affected and, as a rule, asymmetric.

Characteristic for psoriatic arthritis is the “axial” lesion of the finger of the hand: redness and swelling of it from the base to the very tip.

Such changes in the finger resemble a "sausage". These joint changes are accompanied by pain and a short feeling of stiffness in the morning. The pathological process in psoriasis often involves the mucous membrane, eyes, mouth and genitals.

Diagnosis of the disease is usually not difficult. Treatment of articular syndrome is carried out in conjunction with the therapy of the underlying disease.

Rheumatism

Represents systemic disease, due to the pathological influence of group A beta-hemolytic streptococcus. That is why there is a direct connection between the occurrence of rheumatism and a previous streptococcal infection of the pharyngeal region - acute tonsillitis, pharyngitis, chronic tonsillitis.

Joint damage in rheumatism has several characteristic features:

• Involvement in the inflammatory process mainly of large joints.
• Symmetry and "volatility" of the lesion.
• Redness of the skin over the affected joints. The skin is hot to the touch.
• Pain is sometimes very intense.
• Morning stiffness in the joints is short, usually up to half an hour.

In addition to the articular syndrome, rheumatism often affects the heart with the formation of defects. Diagnosis and treatment of rheumatoid arthritis is carried out in conjunction with the underlying disease.

Reactive arthritis

It develops as a reaction to the penetration of infection into the body. The most common cause of reactive arthritis is infection. genitourinary system(gonococci, chlamydia, ureaplasma) and gastrointestinal tract. Typical manifestation reactive arthritis is Reiter's syndrome.

Reiter's syndrome

Appears in response to infection with pathogens of the urogenital area, most often - chlamydia and gonococci. Reiter's syndrome is characterized by a triad of symptoms:

1. Inflammation of the mucous membrane of the eyes - conjunctivitis.
2. Joint syndrome.
3. Defeat urinary organs- urethritis, as well as cervicitis (inflammation of the cervix) in women.

With articular syndrome, several joints on the lower extremities are most often affected - both small and large. Inflammation of the joints is asymmetric, accompanied by pain and swelling. Morning stiffness is short, sometimes absent. Often, small joints of the foot are involved in the pathological process with inflammation of their tendons (tendonitis) and articular bags - bursitis.

Comprehensive treatment of urinary tract infections is crucial in the treatment of reactive arthritis.

Bechterew's disease

Otherwise, this disease is called ankylosing spondylitis. It is a chronic inflammation of the joints with predominant lesion spinal column. Young men are more often ill. The disease has a genetic predisposition.

With Bechterew's disease obligatory symptom is a lesion of the spine, most often in the lumbosacral region.

Often, in parallel with this, large or small joints of the limbs are involved in the inflammatory process.

Manifestations

The characteristic symptoms are intense pain in the lumbosacral region and stiffness of movements in the same area. Stiffness occurs at rest and in the second half of the night, closer to the morning. It usually lasts for several hours, sometimes it is necessary to perform special exercises to reduce its intensity.

As the disease progresses, stiffness of the spine occurs, the ability to turn to the sides and bend over sharply decreases. The muscles of the back are tense, subsequently their atrophy occurs - a decrease in strength and size.

With ankylosis - fusion of the intervertebral joints, there is a stoop and a sharp decrease in the patient's height. Bechterew's disease often affects the heart, eyes and kidneys.

Diagnosis and treatment

In the blood of patients, a specific antigen B 27 of the HLA system (HLA-B27) is determined. Changes in the joints are determined by MRI and radiography.

There is no specific treatment. Held symptomatic treatment aimed at reducing the intensity of pain and inflammation.

Osteoarthritis

In osteoarthritis, the primary lesion occurs articular cartilage. As it is destroyed, various manifestations of this disease occur. Any joint can be involved in the pathological process in osteoarthritis.

However, most often osteoarthritis occurs in those joints that carry the greatest physical load, that is, they are exposed to greater trauma. These are the hips, knees, and shoulders.

The disease is quite common - depending on the region of residence, it affects 20-40% of the world's population. Elderly people, mostly women, get sick more often.

Symptoms

The disease in the initial stage often proceeds without any obvious manifestations. As the articular cartilage breaks down, joint pain occurs. At first, it appears only when physical activity- "mechanical" pain. Then the pain worries at rest.

In addition to pain, the occurrence of stiffness of movements in the morning is characteristic. It is usually short - up to 20-30 minutes. As the movements of the affected limb are made, the stiffness disappears.

With the progression of the disease, a crunch in the joint, pathological mobility or a sharp restriction of movement in it also appears. All of these changes can lead to disability over time.

Diagnostics

The main method for diagnosing osteoarthritis is x-ray. In this case, there are several characteristic signs of the disease: narrowing of the joint space, osteophytes (bone growths), compaction bone tissue etc. Sometimes CT or MRI is required.

Treatment

The treatment of osteoarthritis is complex. Includes protective regime, taking medications and non-drug treatments.

It is necessary to reduce the load on the affected joint. For this, various bandages, orthoses, etc. are used.

Drug therapy is aimed at reducing the intensity of pain and inflammation. Also, drugs are prescribed that improve the blood supply to the affected joint and cartilage. Physiotherapy, exercise therapy, massage, treatment in specialized sanatoriums are widely used.

As we can see, stiffness in the joints in the morning is a manifestation of a fairly large range of joint diseases. But we should not forget that the final diagnosis of this pathological condition should only be done by a doctor.

In the end, irritability, internal dissatisfaction with oneself and all those vegetative-vascular manifestations that were mentioned above appear.

At first, they do not always occur, but only after some noticeable psycho-emotional experiences. The hypersthenic phase of the disease is characterized by increased excitability of patients, irascibility. A previously calm, balanced person becomes impatient, irritable, emotionally unrestrained. Understanding and appreciating the changes, the patient controls his behavior in society all the time, which leads to unnatural tension. stiffness in mental sphere transmitted to muscular system. Hence - a feeling of weakness, the appearance of pain in the muscles of the whole body. “It was as if they were carrying water on me,” patients often notice.

At home, in the family circle, tension subsides somewhat, control over emotions decreases, irascibility and incontinence are more pronounced. Relatives of the patient begin to experience inconvenience from communicating with him, express displeasure. Hotbeds of tension in the family are created, which further exacerbates the situation. The smallest irritants become excessive, significant, cause outbursts of anger. Against this background, absent-mindedness often appears, difficulty concentrating on important facts. Hence the frequent complaints of patients about memory loss, the inability to learn anything. However, here we are dealing with the pathology of attention rather than memory. The patient focuses on some very significant problem for him, which has not yet been resolved despite a lot of efforts. He is absorbed by it, cannot be distracted from it, and life goes on around him. You need to participate in it, make contacts, resolve a number of issues, give and carry out orders, read, write, eat, sleep, and raise children. Thoughts are tied to only one question, occupied with only one idea. For the rest, there is neither time, nor strength, nor desire. Any new stimuli only increase the feeling of dissatisfaction, as if being attracted by a magnet to the focus of stagnant excitation in the brain.

Sleep disorders are very painful for a neurasthenic. Insomnia is one of the cardinal symptoms of neurasthenia. She “... kills the joy of life, undermines strength, like a vampire, sucks blood from the heart and brain. At night, it forces a person to remember what he seeks to forget in a fertile sleep, and during the day it makes him forget what he wants to remember. First, the memory dies, then the waves wash away friendship, love, a sense of duty and even compassion. Only despair clings to the doomed ship, only to smash it against the rocks. Voltaire was right in putting sleep next to hope,” Axel Munte wrote so figuratively about insomnia, although he exaggerated considerably.

Patients with neurasthenia hardly fall asleep, several times a night they wake up in a cold sweat from nightmares. Often, going to bed, a neurasthenic long and persistently analyzes the events of the day, criticizes his actions, and makes plans for the next day. A kaleidoscope of thoughts captures the patient, but sooner or later they all converge on that main problem, which has not been resolved. Even falling asleep, the patient sees events in a dream that are somehow connected with her. She, like a nail in a shoe, all the time reminds of herself, all the time she torments the patient. After such a heavy sleep, which does not bring a feeling of relief, rest, the patient gets up broken, with a heavy head, as if from a hangover. The pains resemble the feeling of a helmet or hoop squeezing the head. Sometimes there is a feeling of something shimmering in the head, a feeling of confusion and chaos. Such is the heavy morning of the neurasthenic! He waits for morning and night as punishment, as something unpleasant and inevitable. Already in the morning, the neurasthenic is tired. His fatigue is different from the usual fatigue, which, as you know, comes at the end of the working day. Only by the middle of the day the condition improves somewhat, vivacity appears, a feeling of freshness, but by the evening, along with thoughts about the upcoming hard night, it is replaced by poor health, headache. Its occurrence is associated with a change in the tone of the vessels of the brain and with a constant tension in the muscles of the back of the head and neck.

Where does the tension of these muscles come from, and not others?

Neurasthenics are usually reluctant to blame anyone but themselves for their failures. The patient may experience this feeling all the time. Imagine a person who is being reprimanded for something, and he knows that he is really guilty. Such a person usually bows his head and shoulders low, as if drawing it in, he is ashamed to look into the eyes of other people, a heavy burden makes him take a guilty pose. To keep the head and shoulders in a normal state, in order to see others, the patient must strain the muscles of the neck, shoulder girdle and back all the time. From here almost constant feeling heaviness in the head, neck, back; feeling of stiffness and weakness. It is not in vain that we talk in everyday life about the "gravity of guilt", about the "gravity of worries" that do not fall somewhere, but on the shoulders, it is our head that cracks from worries, from unresolved problems.

Irritability, excitability in a neurasthenic are combined with rapid exhaustion, leading to fatigue, fatigue. Hence, in fact, the name of the disease. Neurasthenia means "weakness of the nerves" (from the Greek "asthenos" - weak). Fatigue is almost constant. It seems that the patient is constantly doing overwork. He gets tired easily even during a conversation with a doctor. Most often, patients with neurasthenia call fatigue the cause of poor health, although this is a symptom of the disease, and not its cause. To confirm, the volume of work, difficulties, lack of sleep are listed.

Ordinary fatigue (physical or mental), no matter how severe it may be, after rest, a night's sleep passes. How often do people who are physically or mental labor in the process of favorite work, creative inspiration, they work hard for many hours in a row. Often, tired of work, they fall asleep right there, at their workplace. having slept a short time, with new energy, plunge into work, getting pleasure from it. If the case is successful, no matter how much time, physical or mental strength is spent on it, there will be no neurosis. A sense of satisfaction from the work done, joy for success in such cases prevail over fatigue, give strength and energy in order to continue active creative work. Short break- a reward for success.

If physical and psychic powers spent in good faith, but in vain, if the results are not visible, such work will not bring satisfaction, but will only cause a feeling of annoyance, resentment. Recall that neurasthenics are hypersocial, honest, and tend to blame only themselves for failures. The patient is tired and sees his failures well. He would like to rest, but he cannot afford it, he believes that he does not deserve it. After all, rest is a reward! And what kind of reward can we talk about for unfulfilled work. That is why the fatigue of the neurasthenic seeks no rest. Patients with neurasthenia often report that they have not been on vacation for several years, that they are the first to come to work, and the last to leave, and this is true. Often they are considered iron men”, “two-core”, in which “instead of nerves - ropes”. Colleagues are often surprised that their colleague fell ill, broke down "on a nervous basis."

In the hyposthenic stage, fatigue intensifies even more, turning into almost complete apathy, indifference to the environment. Feeling unwell becomes permanent, as does the painful feeling of inferiority. The range of interests narrows: “Everything is indifferent, nothing is nice”, “I don’t want to see anyone” - these are frequent statements of neurasthenics. Tiring not only work, but also rest. Movies, theatre, books, friends - everything is uninteresting. If we add to this picture the symptoms of vegetative-vascular instability, which, as a rule, accompany neurasthenia, the whole complex of painful sensations and experiences of the patient will become clear. The neurasthenic is one of the most honest people in the world. His only mistake: he does not really trust others, he wants to do everything himself, while overestimating his capabilities.