The state of health remains good (at a temperature of 39 ° C and above, he can read books, play chess, watch TV). There are no other signs of general intoxication. Does not threaten the life of the patient, even without etiotropic treatment, it ends in recovery. All groups of lymph nodes are moderately enlarged, some are sensitive. By the end of the first week - an increase in the liver and spleen. In the study of blood leukopenia, ESR is not increased. The main difference is the absence of focal changes (metastases). Without antibiotic therapy, the duration of fever is 3-4 weeks or more.
Chronic forms sometimes develop immediately, bypassing the acute form, sometimes after a while after the acute septic form. According to the clinic, primary chronic metastatic and secondary chronic metastatic forms do not differ. The difference is the presence or absence of bystolic pills septic form in history. Clinic. prolonged subfebrile temperature, weakness, increased irritability, poor sleep, impaired appetite, decreased performance. Generalized lymphadenopathy is soft, tender or painful on palpation, there are small very dense painless sclerotic lymph nodes (0.5-0.7 cm in diameter). Enlargement of the liver and spleen. Against this background, organ lesions are detected, most often on the part of the musculoskeletal system, followed by the nervous and reproductive systems. Pain in muscles and joints, mainly in large ones, polyarthritis, with a new exacerbation, metastases of other localization appear. Periarthritis, paraarthritis, bursitis, exostoses, osteoporosis is not observed. The joints swell, mobility in them is limited, the skin over them is of normal color.
Violation of mobility and deformation are caused by the growth of bone tissue. The spine is affected, more often in the lumbar region. Typical sacroiliitis (Eriksen's symptom. on the table on the back or on the side and put pressure on the crest of the superior iliac bone when positioned on the side or squeeze with both hands the anterior superior iliac crests in the supine position. With unilateral sacroiliitis pain on the affected side, with bilateral - pain in the sacrum on both sides). Symptom of Nahlas, lay on the table face down and bend the legs at the knee joints. When lifting a limb, pain in the affected sacroiliac joint. Symptom of Larrey on the table on the back, the doctor takes both hands on the protrusions of the wings of the iliac bones and stretches them to the sides, while pain appears in the affected side (with unilateral sacroiliitis). Symptom of John-Beer. the patient is in the supine position, with pressure on the pubic joint perpendicularly down, pain in the sacroiliac joint.
Myositis pain in the affected muscles. The pains are dull, prolonged, the intensity of their connectionsana with weather changes. On palpation, more painful areas are determined, and painful seals of various shapes and sizes are felt in the thickness of the muscles. Fibrositis (cellulitis) in the subcutaneous tissue on the legs, forearms, back and lower back. Sizes from 5-10 mm to 3-4 cm soft oval formations, painful or sensitive. In the future, they decrease, can completely resolve or sclerosis and remain for a long time in the form of small dense formations, painless.