Infectious arthritis is a pathology caused by damage to the joints by a fungal or bacterial infection. The disease is characterized by severe fever, pain, chills, limited mobility of the affected joint and swelling in its area.
The disease can occur in patients of any age. Even children can be susceptible to it. The knee joint is the most common joint to become infected. In childhood, polyarthritis becomes a common consequence of infectious arthritis.
The risk group includes:
The causative agent of infectious arthritis of the knee joint can be a fungal, bacterial or viral infection if it enters the joint along with the bloodstream, during surgery or by other means. In newborns, infectious arthritis can be caused by the fact that the mother suffered from gonorrhea during pregnancy. Infection can be caused by various medical procedures, for example, insertion of a catheter.
At the age of up to 2 years, the most common causative agents of the disease are Haemophilus influenzae or Staphylococcus aureus
In adolescence, the most likely reason for the development of the disease is too early and active sexual activity. In this case, the causative agent is gonococcus. The same virus causes the development of gonorrhea.
Symptoms of the disease usually appear suddenly. But it is also possible for them to appear within a few weeks. Depending on the infection that caused knee arthritis, the symptoms have certain characteristics. But there are also common ones that are characteristic of infectious arthritis of the knee caused by any pathogen:
In children, the disease is often accompanied by nausea and vomiting. Other characteristic symptoms are also present.
Movement often becomes limited. This causes an accumulation of fluid in the affected joint.
If the causative agent is a fungal infection or tuberculosis, then the symptoms may be less severe than in other cases. Typically, such infections affect only one joint. Infecting two or three is already a rarity.
Viral infections, including gonococcal, usually affect several joints at the same time.
Joint destruction as a result of infectious arthritis can occur very quickly. Therefore, it is recommended to seek professional diagnosis as early as possible. First of all, the doctor conducts a thorough examination of the knee, and sometimes other joints, and examines the medical history. Based on the results of the initial diagnosis, laboratory tests are prescribed.
Other joint diseases can cause the same symptoms as infectious arthritis: rheumatic fever, gout and others.
For laboratory tests, fluid is taken from the joint.
This allows you to determine the causative agent of the infection. There is usually a very high content of white blood cells in the fluid, as well as flakes of pus. If laboratory testing of fluid from the joint does not give the desired results, and the pathogen cannot be determined, then a biopsy of the synovial tissue located next to the joint is prescribed. Additional diagnostic methods can include urine, blood, sputum, and cerebrospinal fluid tests.
In most cases, treatment is carried out in a hospital setting. To get rid of the disease, drug therapy and physiotherapy are prescribed. Infectious arthritis can destroy the knee joint in a very short period. Therefore, a course of antibiotics is often prescribed even before the diagnosis has been confirmed. In the future, the prescription is adjusted depending on what pathogen caused the disease.
When affected by viral infections, non-steroidal anti-inflammatory drugs are necessarily prescribed. Antibiotics are administered intravenously for 2 weeks, then the course can be extended, with the injections being replaced by oral medications.
As part of complex therapy, painkillers are prescribed to alleviate the patient’s condition. Compresses are prescribed for local impact. Splints are often used to secure them. When the main symptoms are eliminated, a set of exercise therapy exercises can be prescribed. During the rehabilitation period, such exercises allow you to return the knee joint to its function and increase the range of motion. The complex must be selected by a methodologist. When performing any therapeutic exercises, the patient should not feel pain.
If conservative treatment does not give the desired result or if it is not possible to take a puncture from the joint, surgical intervention is prescribed. The operation involves draining the joint. If the case is severe and the infection has severely destroyed the joint, then after it is eliminated, surgery to reconstruct the joint is prescribed.
To relieve pain, a physiotherapy procedure such as mid-wave ultraviolet (WUV) irradiation is most often prescribed. As a result of the procedure, biochemical processes in tissues are activated. Blood circulation in the affected area improves. As a result, pain decreases. The painful area must be isolated from other areas of the skin with a simple towel. For the physiotherapy to be effective, it is necessary to gradually increase the radiation dose.
Mud therapy is a simple and effective method to alleviate the patient’s condition
During the procedure, the effect is on the reflex zones of the spinal cord and skin. Therapeutic mud is heated and applied in a thick layer to the lower back. A canvas cloth is placed on top and the sore spot is wrapped. For an effective effect, it is necessary to hold the compress for 15-30 minutes. As a result of several sessions of such procedures, the range of motion increases and inflammation is relieved. This effect is achieved by improving tissue nutrition in the area of the affected joint and stimulating metabolic processes in articular tissues.
Infectious arthritis can cause serious complications, including complete destruction of the knee joint. First of all, cartilage tissue is destroyed, resulting in bone displacement. Destruction most likely occurs when the joint is affected by Staphylococcus aureus. It may take just a few days for the infection to develop.
Complications of the disease can be fatal if infectious arthritis causes septic shock.
To avoid complications and get rid of the disease as quickly as possible, you must consult a doctor in a timely manner for diagnosis and treatment. It is also important to follow all the doctor’s recommendations so that the treatment brings maximum benefit.
Since rheumatoid arthritis is an autoimmune disease (that is, one in which antibodies are produced against the body’s own tissues), many organs can be affected. In addition to joints, the inflammatory process may involve the heart, the wall of blood vessels, skin, lungs, nervous tissue, eyes, and kidneys.
These are not just complications of arthritis, these are all manifestations of the same disease associated with systemic damage to the body. They can occur immediately or occur as the patient’s condition worsens.
Rheumatoid arthritis has the following clinical and anatomical forms:
The first form manifests itself only as arthritis, the next two include various extra-articular manifestations. The severity of systemic manifestations often determines the severity of the disease itself.
Depending on the nature of the progression of joint destruction and extra-articular manifestations (systemic), the following variants of the course of rheumatoid arthritis are distinguished:
Based on the location of the lesion, the following possible complications can be identified:
Sometimes complications can be associated with drug therapy for rheumatoid arthritis, i.e. be a side effect of the drugs used. This possibility should also not be forgotten.
The diagnosis usually does not cause difficulties. The specialist is quickly able to establish a connection between systemic manifestations and rheumatoid arthritis.
Diagnosis is the same as for arthritis:
To make a diagnosis of rheumatoid arthritis, the American College of Rheumatology criteria are used:
The assessment is carried out as follows: the diagnosis is made if at least 4 out of 7 criteria are met, while points one to four must be maintained for at least 6 weeks.
Exacerbation of the disease and the development of extra-articular complications are indications for hospitalization.
Therapy necessarily includes:
Only the main approaches to therapy are listed here. The treatment plan may vary depending on the severity of extra-articular and articular manifestations, the presence of other complications, and the individual characteristics of the body.
The resulting changes increase the risk of heart attacks, strokes, gastrointestinal bleeding, severe infections and other life-threatening conditions. The prognosis of vasculitis especially worsens is the early development of atherosclerosis.
If any of the complications occur, you should consult a doctor. Perhaps he will prescribe an additional examination, refer you to a specialist, or adjust your therapy.
Remember that after 20 years from the onset of the disease, 60% of patients lose their ability to work, and a third become completely disabled. Be carefull!
While the causes of rheumatoid arthritis today are still not precisely known and are believed to be related to a pathological malfunction of the immune system, genetic inheritance and some undetected mysterious infection, then this type of arthritis has a clearer scientific definition. We are talking about infectious arthritis (IA) - an inflammatory disease of the joints caused by a bacterial or viral infection .
However, this does not mean that infectious arthritis is much easier to diagnose - too many microorganisms can cause it:
The following pathogenic microorganisms can be a direct cause of IA:
Streptococcal or staphylococcal infectious arthritis is more likely to develop after age 15
Infectious arthritis is caused by the following reasons:
Children under 14 years of age are especially susceptible to gram-negative infections
The reasons that increase the danger of IA are:
Infectious arthritis can have both obvious articular symptoms and extra-articular manifestations, which often complicate diagnosis
Complications of infectious arthritis may include:
Laboratory diagnostics are carried out on the eve of treatment:
Laboratory diagnostics can be supplemented with special studies:
Depending on the type of infection that caused the disease, either antibiotics or antifungal drugs are selected:
Surgical treatment of infectious arthritis is carried out:
Infectious arthritis occurs at any age, and different ages have their own characteristics of the lesion and “favorite” pathogens. For adults, damage to the joints of the hands or knees, which experience the most intense stress, is typical. Usually one joint is affected, and only 1 in 5 patients develop polyarthritis. Children are more likely to have multiple joints affected, usually the knees, hips and shoulders.
Infectious arthritis (septic, pyogenic) is a severe infectious lesion of the joint, manifested by severe pain, hyperemia and swelling of the joint, and accompanied by general symptoms of intoxication (high fever, chills, headache). Simultaneous damage to several joints is often observed.
Infectious arthritis can be associated with direct entry of the pathogen into the joint (infectious arthritis itself) or develop after infection due to the deposition of immune complexes in the joint tissues - post-infectious arthritis (for example, arthritis with viral hepatitis, chlamydia, meningococcal infection). Reactive arthritis is not classified as infectious, since although there is a connection with a specific infection, neither the pathogen nor its toxins are detected in the joint cavity.
Depending on the method of entry of the pathogen into the joint, there are primary (the pathogen immediately enters the joint) or secondary (the pathogen is transferred from another source of infection in the body with blood or lymph) infectious arthritis. Moreover, it is not always possible to find the primary source of infection.
Infectious arthritis is a life-threatening condition that requires emergency medical attention.
Infectious arthritis can be caused by viral, bacterial or fungal infections. Typically, the pathogen enters the joint from another source of infection (including chronic tonsillitis, diseases of the oral cavity) through the bloodstream or lymph (secondary infectious arthritis), less often it penetrates directly from the outside as a result of intra-articular injections, surgical manipulations or injuries (primary infectious arthritis ).
The etiology may vary among different age groups. For example, newborns and infants are more likely to become infected from their mother. In children under 2 years of age, the disease is often caused by Haemophilus influencae or Staphylococcus aureus. In older adults, the cause of the disease is usually Staphylococcus aureus, group A β-hemolytic streptococcus (Streptococcus pyogenes) and Streptococcus viridans.
During surgical operations, infection usually occurs with epidermal staphylococcus (Staphylococcus epidermidis), which belongs to the opportunistic microflora and normally inhabits the skin. In adults, arthritis can often be caused by gonococcus (Neisseria gonorrhoeae), which is sexually transmitted. In old age, arthritis can often be caused by gram-negative microflora (including salmonella or Pseudomonas aeruginosa).
Viral particles can cause joint damage in people of any age. Most often these are rubella viruses, mumps, hepatitis B, and parvoviruses.
Mycobacterium tuberculosis and fungal infections usually lead to a chronic course of infectious arthritis, and fungal infection occurs in people with significant defects in the immune system.
Let us consider the features of the course of the most common infectious arthritis of various etiologies.
Occurs most often 2-4 weeks after the onset of symptoms of gonorrhea (acute gonococcal urethritis). If the disease is accompanied by the presence of prostatitis, chronic urethritis or cystitis, then joint damage may develop much later.
The process usually involves one or two joints, less often – more. Characterized by damage to the knee, ankle, elbow and wrist joints, metatarsal and tarsal joints.
The beginning is sharp. Severe pain in the joints, exudation phenomena. The skin over the affected joint becomes hyperemic. There may be pain in the heels due to osteoperiostitis of the calcaneus, subcalcaneal bursitis, and Achilles bursitis.
The disease early leads to the development of muscle atrophy, destruction of bones and cartilage, and ankylosis.
Diagnosis is not difficult if gonorrhea is suspected in time.
Therapy is associated with the treatment of the underlying disease and the prescription of non-steroidal anti-inflammatory drugs.
Its occurrence is associated with the introduction of Mycobacterium tuberculosis from another focus with lymph flow into the articular ends of long tubular bones. In places where microorganisms “settle”, osteitis is formed, which undergoes caseous necrosis with the formation of a sequestrum (a dead area of bone tissue) or with its breakthrough into the joint cavity or onto the surface of the skin.
There are primary bone and primary synovial forms of joint tuberculosis. Typically the hip, knee, ankle and wrist joints are affected.
It proceeds sluggishly, hidden, and can “masquerade” as other diseases for a long time. There may be no pain, or it may be unexpressed “aching.” Gradually it becomes more intense, local swelling appears over the affected joint. General symptoms of intoxication predominate: weakness, lethargy, low-grade fever (up to 38? C), sweating.
Often leads to the development of muscle atrophy and joint deformation.
Tuberculosis is also characterized by reactive infectious-allergic polyarthritis (Poncet rheumatoid). Its course resembles that of true rheumatoid arthritis, and its severity depends on the activity of the tuberculous process in other organs.
In diagnosis, it is important to promptly suspect the course of tuberculosis, since radiological signs of arthritis may appear months after the onset of the disease.
Treatment of tuberculous arthritis is carried out by a phthisiatrician with the prescription of specific drugs against Mycobacterium tuberculosis.
In recent years it has become less and less common. This arthritis usually occurs in middle-aged and elderly people with brucellosis.
Polyarthralgia or arthritis with synovitis are characteristic. Large joints are most often affected, causing bursitis and fibrositis. The spine may be involved, mainly the lumbar region (unilateral or bilateral sacroiliitis, spondylitis, osteochondritis). Joint deformity is not typical.
The diagnosis is usually straightforward and is made on the basis of the clinical picture of brucellosis, specific tests (positive Wright and Burnet reactions) and radiographic data (the appearance of marginal erosions on the anterior-superior surface of the intervertebral discs, which are later replaced by bone growths, destruction of the discs and narrowing of the intervertebral discs). cracks and other changes).
Antibiotic therapy, nonsteroidal anti-inflammatory drugs, and desensitizing drugs are indicated.
After starting treatment, the inflammation usually resolves within a few months, but the pain may persist for a considerable time.
Characteristically, there are concomitant symptoms of the disease (erythema migrans, intoxication, enlarged spleen and lymph nodes, neck and back stiffness, muscle pain, radiculitis, neuritis, and others), as well as a history of a tick bite. Arthritis occurs suddenly between 2 weeks and 2 years after the onset of the disease. One joint is affected. Chronicity of the process and destruction of the joint are rare.
Diagnosis is based on a characteristic clinical picture and detection of antibodies to the pathogen.
Yersinia arthritis develops 1-3 weeks after the onset of intestinal syndrome (abdominal pain, diarrhea). Dysenteric and salmonella arthritis develop at 2-3 weeks of illness.
Combined with other symptoms of the disease. Usually several joints are affected (usually large joints of the legs, acromioclavicular and sternoclavicular joints, spine, sacroiliac joints). The distal joints of the first toes and hands are often affected (unlike rheumatoid arthritis).
Intense pain occurs in the affected joints. Pain may also occur in other joints. Tenosynovitis or tendoperiostitis may occur in the area of the ankle, wrist and shoulder joints. With a prolonged course, unilateral sacroiliitis appears.
First of all, the underlying disease is treated.
They can develop with viral hepatitis, rubella, and mumps.
With rubella and viral hepatitis, the damage usually occurs as a type of polyatritis, reminiscent of rheumatoid. The occurrence of tenosynovitis is characteristic. With mumps, one or two joints are usually affected, usually large ones.
With viral hepatitis, the duration of arthritis is up to several months; they disappear on their own and without consequences immediately after the appearance of jaundice.
Treatment includes therapy of the underlying disease, non-steroidal anti-inflammatory drugs.
The prognosis is usually favorable, the disappearance of all symptoms of the disease occurs from 2 weeks to 2 months.
They can develop with opisthorchiasis, strongyloidiasis, dracunculiasis, hookworm, schistosomiasis, echinococcosis, filariasis, wuchereriosis, loiasis, onchocerciasis, brugiosis.
More often develops in the acute stage of the disease. Polyarthralgia and polyarthritis occur. Combined with polymyalgia. Characteristically, small joints of the hands and feet are affected. Articular syndrome is always combined with other symptoms of the disease (rash, itching, eosinophilia).
Treatment is antiparasitic drugs.
Septic arthritis is a life-threatening condition and requires emergency medical care. It can quickly lead to the destruction of articular cartilage (for example, Staphylococcus aureus can destroy cartilage in 1-2 days) and bone tissue, the formation of new abscesses, septic shock and death.
The most common complications of infectious arthritis can be:
First of all, it is carried out with other types of arthritis: gouty, rheumatoid, reactive and others.
Treatment should be started promptly to prevent irreversible joint damage and complications. Usually treatment is inpatient. Complete rest of the affected joint is indicated for 1-2 weeks.
In addition to drug therapy, it may be recommended to apply compresses to the affected joint, and in some cases, immobilize the affected joint to prevent accidental movements in it.
After discharge, continued treatment on an outpatient basis, courses of physiotherapy, physical therapy to develop movements in the joint are indicated.
If treatment is started in a timely manner, it is favorable. Destruction of cartilage and bone can subsequently lead to subluxation of joints and bones.
The later the patient goes to the hospital, the higher the risk of irreversible changes in the joint and the development of complications.
Some types of arthritis can be prevented by sanitation of foci of chronic infection (including chronic tonsillitis, caries) and timely treatment of acute infectious diseases, giving up bad habits.
Infectious arthritis is quite common and poses a danger to human health. It is possible to become infected with the disease at any age. Signs of infectious inflammation of the joints differ depending on the type and location of the pathological process. In adults, infectious arthrosis predominantly manifests itself in the knee or wrist joint.
Many pathogens that enter the body in different ways can provoke infectious arthritis in children and adults. Often the source of pathology in children is staphylococcus or streptococcus. Pathogenic microorganisms enter directly into the joint or are a consequence of a pre-existing disease of infectious origin. If the parasites immediately invade the joint tissue, then they speak of a primary infection. Secondary infection is diagnosed when pathogens are transferred from one site to another through the blood or lymph flow.
The main cause of this type of arthritis lies in a weakened immune system that is unable to resist infection.
The following sources influencing the disease are identified:
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Although infectious arthritis is caused by different pathogenic microorganisms, there is still a common clinical picture that is characteristic of all varieties. Joint damage due to infection is accompanied by the following symptoms:
An infection of this type, which destroys the joints, has recently been rarely diagnosed, and is more likely to affect older people who suffer from brucellosis. In brucellosis infectious arthritis, large mobile joints localized in the lumbar region are predominantly damaged. With such a disorder, an x-ray is sufficient to make a correct diagnosis.
Infectious arthritis of this nature is quite contagious and occurs in a person when there is an existing tuberculosis bacterium, which is transferred through the lymph flow to the joints. In the damaged area, osteitis is observed, in which necrosis of bone tissue occurs. The integrity of the knee, hip or ankle joint is predominantly damaged. For a long time, a person does not observe any characteristic symptoms and is not aware of the development of tuberculous arthritis. As it progresses, the clinical picture appears:
Against the background of tuberculous damage to mobile joints, polyarthritis of infectious-allergic origin often appears.
Infectious arthritis of the knee and other moving joints is often associated with Lyme disease. As a rule, with such an infectious disease no more than one joint is damaged. Pathogenic microorganisms that cause this type of pathology manifest themselves as follows:
Such infectious arthritis makes itself felt 14-30 days after the onset of gonorrheal symptoms. If the patient has inflammation of the prostate gland, urethra or bladder, the clinical picture may not appear for longer. It is extremely rare for multiple joint lesions to occur in gonococcal arthritis. The disease develops acutely and is characterized by the following manifestations:
When joints are infected by parasites, parasitic arthritis occurs. It is a consequence of such deviations:
It is predominantly acute and causes the development of polyarthritis. Polymyalgia is often associated with an infectious disease. With pathology, the structure of small movable joints of the hand or foot is disrupted. The deviation is also characterized by rashes in the damaged area and itchy sensations. To eliminate infectious diseases of this etiology, it is necessary to influence the root cause of the problem, namely, remove parasites.
Viruses that affect joints are the least dangerous and do not cause complications with timely treatment. Viral arthritis can be triggered by rubella, paraproctitis or hepatitis caused by viruses and bacteria. The duration of the disease ranges from several weeks to 1-2 months. It is necessary to treat the underlying disorder in time and then the manifestations of bacterial arthritis will go away on their own.
When a person develops intestinal syndrome, signs of yersinia arthritis may appear after 7-21 days. These types of joint disorders are often accompanied by many symptoms. With pathology, severe pain is noted in the damaged joints. Often the patient experiences a unilateral inflammatory process in the sacroiliac movable joint.
Often the patient is diagnosed with septic arthritis, in which pathological manifestations bother the patient 7-14 days after the onset of infection. Large joint joints are predominantly damaged, causing the person to experience severe pain. A fungal type of disease is also not uncommon, which is characterized by the penetration of various fungi into the joints. Against the background of such a disorder, the patient’s normal mobility of cartilage is gradually disrupted, accompanied by mildly noticeable pain.
Infectious arthritis can cause serious complications if not treated promptly with antibiotics. Often it becomes chronic, as a result of which the patient’s general condition worsens. Staphylococcal and streptococcal types of disease develop rapidly and in less than a week can lead to serious destruction of cartilage. Also, against the background of the pathological process, a septic shock condition occurs, which threatens the patient’s life. With the bacterial etiology of arthritis, infection of neighboring tissues and penetration of bacteria into the bloodstream is possible, which will lead to an abscess.
Often patients with an infectious joint disorder suffer from osteoarthritis.
Detection of streptococci and other pathogenic microorganisms that provoke post-infectious arthritis is possible only with a comprehensive diagnosis. It is important to conduct a differential analysis so as not to confuse the disease with other articular lesions. The patient may need additional consultation with a rheumatologist and orthopedist. The main manipulations that reveal pathology of infectious origin are:
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The basis of treatment for infectious arthritis is antibiotics, which are prescribed to each patient individually in a special dosage. The drugs can be injected into a muscle or vein, depending on the severity of the deviation. Medicines with a wide range of effects are used. The table shows the main groups of antibacterial medications used in the treatment of infectious arthritis.