| Abstract | Mnoge se reumatoidne, upalne i degenerativne bolesti zglobova klinički prezentiraju glavnom tegobom boli, te mnogim općim, lokalnim i ostalim znakovima. Za razumijevanje je potrebno poznavati fiziologiju bola. Bol može bit akutna, kao obrambena reakcija na oštećenje, u svrhu očuvanja funkcije. Njezin prijenos do viših moždanih centara je složen. Kronična bol često se razvija iz akutne boli, te znatno narušava kvalitetu života bolesnika. Somatska ili visceralna bol može biti površinska ili dubinska. Postoje tri teorije bola: teorija specifiteta, uzorka i nadzora ulaza. Kako bih prijenos bola mogao početi, postoje receptori bola u samim zglobovima, te A-delta vlakna koja odgovaraju na bol. Bol se može modulirati i to sustavom intrinzične analgezije koja je dokazana pomoću električnog podraživanja sive tvari, što dovodi do supresije bola. Evaluacija stanja bolesnika prvi je i najvažniji korak u pristupu bolesniku. Kreće se od anamneze koju valja uzeti detaljno. Naglasak je na tome da se dobije što više informacija o samoj boli, kada je počela, kakve je naravi, točan anatomski smještaj boli, koliko traje. U daljnjoj obradi bolesnika treba ispitati i opće znakove, kao što su oteklina, ograničenost pokreta, zakočenost, poremećaj mišićne snage, umor, promjene obujma, poremećaj funkcije, šepanje, kontrakture, abnormalna gibljivost zglobova, krepitacije. Od lokalnih znakova mogu biti prisutni crvenilo kože, porast temperature oteklina, smanjenje ili gubitak funkcije. Iako je ovdje riječ o bolestima zglobova, nerijetko se bolesti mogu manifestirati i na ostale sustave, kao što su koža, sluznice, oči, probavni sustav i neurogeni poremećaji. |
| Abstract (english) | Many rheumatoid, inflammatory and degenerative joint disease are clinically presenting with leading complaint of pain, and many general, local and other signs. For understanding we need to know the physiology of pain. The pain can be acute, as a defensive reaction to the damage, in order to preserve function. Its transfer to higher centers in the brain is very complex. Chronic pain often develops from acute pain, and significantly impairs quality of life of patients. Somatic or visceral pain can be superficial or deep. There are three theories of pain: theory of specifity, theory of sample and theory of control inputs. There are pain receptors in the joints, and also there are A - delta fibers that respond to pain. Pain can be modulated by the intrinsic analgesia system which was evidenced by the electrical stimulation of the gray matter, resulting in suppression of pain. Evaluation of the patient's state is the first and most important step in the approach to the patient. It ranges from patients history that should be taken in detail. The emphasis in taking the anamnesis is how to gain as much information about the pain such as when it began, what is the nature of pain, the exact anatomical locations of pain, how long has it occur. The further evaluation should include the examination of general signs, such as swelling, limitation of movement, stiffness, impaired muscle strength, fatigue, changes in volume of the extremities, dysfunction, limp, contractures, abnormal mobility of joints and crepitation. At some joints there may be present skin redness, swelling, temperature increase, decrease or loss of function. Often the disease of joints may manifest itself in other systems, such as skin, mucous membranes, eyes, digestive system and neurogenic disorders. |
