Infectious Arthritis - Causes, Symptoms And Treatment Of Infectious Arthritis

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Infectious arthritis

Content:

• What is Infectious Arthritis?
• Symptoms of Infectious Arthritis
• Causes of Infectious Arthritis
• Treating Infectious Arthritis

What is Infectious Arthritis?

Any organism is an open biological system. This means that he constantly interacts with the environment, which affects the life of the individual in different ways: beneficially or negatively. The invasion of infectious pathogens disrupts the functioning of all organ systems and mobilizes defense mechanisms.

Infectious arthritis is an inflammatory process in the joints caused by the penetration of infectious agents into the body. Otherwise, this type of arthritis is called purulent, pyogenic (causing the formation of pus) or septic. At the initial stage, pus in the synovial fluid may be absent. Infection with microbes can be local and limited only to the joint or general. Sepsis is a common blood poisoning.

Depending on the location, the following types of arthritis are distinguished:

• ankle;
• arthritis of the metatarsus or tarsus;
• knee;
• hip;
• sacroiliac - sacroiliitis;
• vertebrate;
• radiocarpal;
• elbow;
• brachial;
• acromioclavicular and sternoclavicular;
• infectious arthritis of the fingers, hands, or feet.

Microorganisms in the synovial fluid (the number of leukocytes is 10-100x10 ⁹ / l, with more than 90% neutrophils), blood (leukocytosis, an increase in ESR - erythrocyte sedimentation rate), sputum, cerebrospinal fluid, a smear from the genitals or urine are detected using laboratory tests. Gram stain is used for analysis. This research method involves the identification of gram-positive (staining) and gram-negative microorganisms, depending on their reaction to a special solution.

Special diagnostic tests:

• radiography in two projections;
• biopsy (excision) of a piece of synovial tissue;
• tests of the Wright reaction and the Burne test;
• computed tomography - visualization of sequestered bone tissue. Sequestration - a dead area of bone tissue;
• Magnetic resonance imaging;
• ultrasonography;
• radioisotope scanning.

The main danger of infectious bacterial arthritis is the very rapid destruction of joint tissues.

Morbidity statistics: gonococcal infectious arthritis occurs in 0.6 - 3% of women and 0.1 - 0.7% of men with gonorrhea. Prevailing age: under 40 and over 60. Mono- or oligoarthritis occurs in 25-50% of patients with disseminated gonococcus. With the latter, only two or three joints are affected. In newborns, infectious arthritis develops when gonococci enter their blood from a mother with gonorrhea. In about 70% of cases of infectious arthritis, permanent joint damage is avoided.

If the inflammatory process cannot be stopped quickly enough, then complications of infectious arthritis arise:

• ankylosis - fusion of articular surfaces;
• phlegmon;
• displacement of bones;
• osteoarthritis due to cartilage damage;
• fibrositis;
• osteomyelitis ("inflammation of the bone");
• spondylitis - inflammation of the spine;
• shortening of the limb due to a violation of the bone growth zone in children;
• osteochondritis - an inflammatory process in bone and cartilage tissue;
• abscess - an abscess;
• septic shock provoking multiple organ failure syndrome.

If you do not take emergency measures to fight the infection, then death is possible. Infectious arthritis can also occur in children. They have it in an acute form and requires emergency medical intervention.

Symptoms of Infectious Arthritis

• an increase in body temperature above 38% C (subfebrile value);
• chills - painful sensation of cold;
• sweating;
• nausea and vomiting (mainly in children) as signs of intoxication;
• weakness, lethargy;
• muscle aches;
• malaise;
• joint pain;
• limited movement of the diseased limb - stiffness;
• redness of the skin in the articular region;
• high local temperature at the site of infection;
• accumulation of effusion in the joint - fluid from the blood vessels;
• swelling;
• syndrome of periarthritis - dermatitis: migratory polyarthralgia, hectic-type fever (febris hectica), tenosynovitis and dermatitis ("skin inflammation") - maculopapular or vesicular, and then vesicular-pustular rash.

If infectious arthritis is accompanied by another disease, the symptoms will be broader. In periarthritis, inflammation covers the capsule, ligaments, tendons and muscles. Arthralgia is a flying pain in the joints. Tendosynovitis is an inflammation of the synovial lining of a tendon. The papule means "knot" in translation. These are small bumps on the skin. A vesicle is a vial of liquid content. The pustule is the primary element of the rash.

The peculiarity of the course of infectious arthritis is its suddenness and rapid progression. It is impossible to accurately diagnose the causative agent of joint inflammation without additional research. Its symptom complex is too similar to the signs of other diseases. These include gout, rheumatic fever, borreliosis, and some other pathologies.

Causes of Infectious Arthritis

The following causes of infectious arthritis are distinguished:

• penetration of pests through damaged skin as a result of puncture, surgery or injury (bruise, burn, injury, etc.) - primary arthritis;
• transfer of the pathogen along with lymph or blood, i.e. by hematogenous route - secondary arthritis.

Any foci of inflammation pose a danger to the whole body.

The products of the inflammatory process are easily carried to other organs. Risk factors for septic joint inflammation:

• prematurity;
• chronic arthritis;
• gonorrhea - a venereal disease that affects the urinary tract;
• furunculosis, accompanied by the appearance of boils;
• peritonsillar abscess behind the tonsils;
• angina - inflammation of the mucous membrane of the throat;
• scarlet fever (mainly in childhood);
• inflammation of the middle ear;
• pneumonia - pneumonia;
• infective endocarditis - inflammation of the inner lining of the heart - the endocardium;
• immunodeficiency states;
• recurrent septicemia;
• joint prostheses;
• diabetes mellitus - an endocrine disease due to insulin deficiency;
• sickle cell anemia - anemia;
• chronic tonsillitis - inflammation of the tonsils;
• caries - destruction of dental tissue;
• tumor;
• hypogammaglobulinemia - protein deficiency;
• alcohol addiction;
• drug use.

Types of infectious agents:

• bacteria;
• viruses;
• parasites;
• pathogenic fungi.

Bacteria:

• staphylococci;
• gonococci;
• streptococci;
• Haemophilus influenzae - Haemophilius influencae;
• gram-negative bacteria such as Pseudomonas or Salmonella - Salmonella.

Staphylococcus species:

• Staphylococcus aureus;
• epidermal staphylococcus - Staphylococcus epidermidis.

Streptococcus species:

• β-hemolytic group A streptococcus - Streptococcus pyogenes - is activated in gram-positive flora;
• streptococci of other groups.

Viruses:

• human immunodeficiency virus - HIV;
• rubella;
• mumps;
• hepatitis B;
• parvoviruses.

Parasites are the causative agents of the following diseases:

• opisthorchiasis;
• strongyloidosis - Cochin's diarrhea;
• dracunculiasis - Rishta disease;
• hookworm infection - miners' rash, earthen scabies, or Egyptian chlorosis;
• schistosomiasis;
• echinococcosis of the liver;
• filariasis, including wuchereriasis, brugiosis, and onchocerciasis;
• loiasis causing a Calabar tumor.

So, the main types of bacterial infectious arthritis, depending on the etiology - the causes of its occurrence:

• gonococcal;
• tuberculous primary bone or primary synovial form;
• brucellosis;
• borreliosis or Lyme (with Lyme disease);
• yersiniosis;
• dysenteric;
• salmonella.

The method of treatment, depending on the type of pathogen, changes slightly, so antibiotics begin to be administered immediately after inflammation is detected. Based on the diagnostic results, the chosen course can be adjusted. So, additionally prescribed, for example, antiparasitic drugs.

Treating Infectious Arthritis

The primary measures are pain relief, antibiotic therapy and fever reduction. Pain is relieved with analgesics and splinting - immobilization of the diseased joint.

Antibiotics and / or antifungal drugs are administered intravenously or directly into the joint at the beginning of the treatment course. Pus is pumped out by drainage. Antibiotics are used for at least two weeks after the symptoms of inflammation disappear, but they are already taken orally. For some types of infectious arthritis, antiparasitic drugs are also used, compresses are applied to the projection area of the affected joint.

The type and combinations of medications are determined by the type of arthritis pathogen:

• Benzylpenicillin sodium salt or ceftriaxone (against gonococci, meningococci);
• Cephalothin, Vancomycin, Clindamycin, Naftsilin (staphylococci);
• Benzylpenicillin sodium salt and Vancomycin (streptococci);
• Gentamicin and, for example, Ampicillin or Zeporin (gram-negative bacteria);
• Chloramphenicol - Levomycetin (microorganisms of the genus Haemophilus).

If there is no positive trend, then it is necessary to revise the treatment method. Perhaps the drugs are ineffective or the dosage is incorrect. If a prosthetic joint is infected, the removal of the prosthesis and its replacement with a new one is indicated.

The most diverse analgesics are prescribed:

• Acetaminophen;
• Paracetamol;
• Analgin;
• Capsaicin;
• Tylenol;
• Oxycodone;
• Methadone;
• Tramadol;
• Ibuprofen.

Inflammation is relieved with non-steroidal drugs. They also have analgesic and antipyretic effects:

• Acetylsalicylic acid;
• Nimesulide;
• Movalis or Meloxicam;
• Piroxicam;
• Celebrex;
• Nimesil;
• Indomethacin.

Steroid hormones also reduce the inflammatory process:

• Hydrocortisone;
• Prednisolone;
• Triamcinolone;
• Kenalog;
• Detralex.

Cartilage tissue is restored using chondroprotectors:

• Chondroitin Sulfate;
• Glucosamine;
• Chondrolone;
• Structum;
• Arthra.

Chondroprotectors are taken for long courses even after the end of the main treatment.

Find out more: List of modern drugs and drugs for joints

They significantly accelerate cell regeneration and slow down the destruction of cartilage tissue. Forms of medications prescribed for arthritis:

• capsules or tablets (for example, Diclofenac);
• solutions for intramuscular and intraarticular injection (eg, corticosteroids);
• gels (for example, Diklak);
• cream;
• ointments (for example, Bishofit, Nikoflex, Menovazin);
• solutions for compresses (for example, Dimexide).

Surgery is used only in very severe cases. Surgical treatments:

• arthroscopy - removal of bone processes and other manipulations through a micro-incision;
• endoprosthetics - replacement of joint components with implants;
• arthrodesis - complete immobilization of the joint;
• arthrolysis or Wolff's operation - excision of fibrous adhesions;
• synovectomy - removal of the affected synovium;
• osteotomy - removal of a piece of bone to relieve pressure on a joint
• resection - removal of a joint or part of it;
• arthroplasty - joint replacement.

To accelerate rehabilitation, a course of physiotherapy and a special physiotherapy exercises complex are prescribed. Of the physiotherapy procedures, the following are used:

• magnetotherapy;
• amplipulse or sinusoidally modulated currents;
• electrophoresis, in which drugs are ingested through direct electric current;
• laser;
• ultrasound - phonophoresis;
• physiotherapy with paraffin or ozokerite.

Only timely treatment can avoid unpleasant complications and disability. The mortality rate from complications of infectious arthritis is 5-30%.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.