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Infectious arthritis

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What is infectious arthritis?

Every body is an open biological system. This means that he constantly interacts with the environment, which in different ways affects the livelihoods of individuals: positively or negatively. The invasion of infectious pathogens disrupts the functioning of all organ systems and mobilizes the defense mechanisms.

Infectious arthritis is an inflammatory process in the joints, caused by the penetration into the body of infectious pathogens. Otherwise this kind of arthritis is called suppurative, pyogenic (causing the formation of pus) or septic. At the initial stage of pus in the synovial fluid may be missing. Infection with germs may be local and confined to the joint or common. Sepsis is a common infection of the blood.

Depending on the localization of the following types of arthritis:

  • ankle;
  • arthritis of the metatarsal or tarsal;
  • knee;
  • hip;
  • sacroiliac - sacroiliitis;
  • spinal;
  • wrist;
  • elbow;
  • shoulder;
  • acromioclavicular and sternoclavicular;
  • infectious arthritis of the fingers, hands or feet.

    • Microorganisms in synovial fluid (number of leukocytes 10-100h109/l and neutrophils more than 90%), blood (leukocytosis, increased ESR – erythrocyte sedimentation rate), sputum, cerebrospinal fluid, smear from genital or urine detected by laboratory studies. For the analysis used type of gram staining. This research method involves the identification of gram-positive (stain) and gram-negative microorganisms based on their reactions to a special solution.

    Special diagnostic tests:

    • radiography in two projections;
    • biopsy (excision) of a piece of the synovial tissue;
    • tests the reaction of the Wright samples the'byrne;
    • computed tomography - imaging of sequestered bone. Sequestration - dead plotbone tissue;
    • magnetic resonance imaging;
    • ultrasound examination;
    • radioisotope scanning.

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

    Morbidity statistics: gonococcal infectious arthritis occur in 0.6 - 3% of women and 0.1 - 0.7% of men suffering from gonorrhea. Predominant age: up to 40 years and after age 60. 25 - 50% of patients with dissemination of gonorrhea occurs mono - or oligoarthritis. The last struck only two or three joints. The newborns of the infectious arthritis develops when released into their blood gonococci from mother, who was sick with gonorrhea. Approximately 70% of cases of infectious arthritis is possible to avoid the irreversible destruction of the joints.

    If the inflammatory process cannot stop fast enough, the complications of infectious arthritis:

    • ankylosis – fusion of the articular surfaces;

    • cellulitis;

    • the displacement of the bones;
    • osteoarthritis due to destruction of cartilage;
    • fibrosis;

    • osteomyelitis ("bone inflammation");

    • spondylitis – inflammation of the spine;
    • shortening of the limb due to the violation of the zone of bone growth in children;
    • Legg - inflammatory process in bone and cartilage;

    • abscess - an abscess;

    • septic shock, causing multiple organ dysfunction syndrome.

    If not to take emergency measures to fight infection, possible death. Infectious arthritis may occur in children. They have it occurs in an acute form and requires emergency medical intervention.


    Symptoms of infectious arthritis

  • the increase in body temperature above 38% (low-grade value);

  • the chills - painful sensation of cold;

  • sweating;

  • nausea and vomiting (mostly in children) as signs of intoxication;

  • weakness, lethargy;
  • aching muscles;
  • malaise;
  • pain in the joint;
  • the limited movements of the affected limb - stiffness;
  • redness in the joint area;
  • high local temperature at the place of infection;
  • the accumulation of joint effusion of fluid from blood vessels;
  • swelling;

  • syndrome shoulder - dermatitis: migratory polyarthralgia, fever hectic type (febris hectica), tendosynovit and dermatitis ("dermatitis") is a maculopapular or vesicular, and then vesiculo-pustular eruptions.

    • If infectious arthritis is accompanied by other disease, the symptomatology is broader. When shoulder inflammation covers the capsule, ligaments, tendons and muscles. Arthralgia is a flying pain in the joints. Tendosynovit is an inflammation of the synovial lining of the tendon. Papule means "knot". It little bumps on the skin. A vesicle is a vesicle with liquid contents. The pustules – the primary element of the rash.

    The peculiarity of the occurrence of infectious arthritis – it is the suddenness and rapid progression. To accurately diagnose the causative agent of inflammation of the joint without additional research it is impossible. Its symptom is too similar to signs of other diseases. These include gout, rheumatic fever, Lyme disease and some other diseases.

    Causes of infectious arthritis

    There are the following causes of infectious arthritis:

    • the penetration of videotitle through the broken skin as a result of puncture, surgery or trauma (bruise, burn, wound , etc.) – primary arthritis;

    • the transfer of the pathogen along with the lymph or blood, i.e. by hematogenous – secondary arthritis.

    Any inflammation present a danger to the whole organism.

    Inflammatory products are easily carried to other organs. Risk factors for septic inflammation of the joints:

    • prematurity;
    • chronic arthritis;
    • gonorrhea – a sexually transmitted disease that affects the urinary tract;

    • abrasions, accompanied bythe appearance of boils;

    • peritonsillar abscess behind the tonsils;

    • tonsillitis - inflammation of the mucous membrane of the throat;

    • scarlet fever (mainly in children);

    • inflammation of the middle ear;

    • pneumonia - inflammation of the lungs;

    • infectious endocarditis - inflammation of the inner lining of the heart - endocardium;
    • immunodeficiency States;
    • recurrent septicemia;
    • joint prostheses;

    • diabetes mellitus is an endocrine disorder due to insulin deficiency;

    • sickle cell anemia - anemia;

    • chronic tonsillitis– inflammation of the tonsils;

    • tooth decay - the destruction of dental tissues;

    • tumor;

    • hypogammaglobulinemia - protein deficiency;

    • alcohol dependence;

    • the use of drugs.

    The types of infectious agents:

    • bacteria;
    • viruses;
    • parasites;
    • disease-causing fungi.

    Bacteria:

    • staphylococci;

    • gonorrhea;

    • streptococci;

    • hemophilic Bacillus - we did Haemophilus influenzae influencae;
    • gram-negative bacteria, e.g., Pseudomonas or Salmonella - Salmonella.

    The Types Of Staphylococcus:

    • Staphylococcus aureus;
    • epidermal Staphylococcus is Staphylococcus epidermidis.

    The Types Of Streptococcus:

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

    Viruses:

    Parasites are the causative agents of the following diseases:

    • opisthorchiasis;

    • strongyloidiasis - cochinchina diarrhea;
    • dracunculiasis - Guinea worm disease;
    • hookworm - rash-miners, excavation scabies or Egyptian chlorosis;
    • shistosomes;

    • hydatid cyst of the liver;

    • filariasis, including vuhererioz, brugioz and onchocerciasis;
    • Loos causing kalebaskew 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 limski (Lyme disease);
    • Yersinia;
    • dysentery;
    • Salmonella.

    Methods of treatment depending on the type of agent changes slightly, so the antibiotics begin to enter immediately after the detection of inflammation. Based on the results of diagnostics of the chosen course can be adjusted. Additionally it is prescribed, for example antiparasitic drugs.


    Treatment of infectious arthritis

    Priority measures – pain management, antibiotic therapy and fever reduction. Pain management with analgesics and splinting – immobilization of the patient's joint.

    Antibiotics and/or antifungal drugs at the beginning of treatment is injected intravenously or directly into the joint. The pus is evacuated with drainage. Antibiotics are used for at least two weeks after disappearance of symptoms of inflammation, but take them for oral. In some types of infectious arthritis are also used antiparasitic drugs, the projection area of the affected joint overlap compresses.

    The type and combination of drugs are determined by the kind of causative agent of arthritis:

    • Penicillin g sodium or Ceftriaxone (anti-gonococci, meningococci);
    • Cephalothin, Vancomycin, Clindamycin, Nafcillin (staphylococci);
    • Penicillin g sodium and Vancomycin (streptococci);
    • Gentamicin, for example, or Tseporin Ampicillin (gram-negative bacteria);
    • Chloramphenicol - Chloramphenicol (microorganisms of the genus Haemophilus).

    If there is no positive dynamics, it is necessary to review the methodology of treatment. Possibly ineffective medication orcorrectly matched their dosage. When infected prosthetic joint shows the removal of the prosthesis and replace it with a new one.

    Analgesics are assigned a variety of:

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

    Relieve inflammation through non-steroidal means. They also possess analgesic and antipyretic effect:

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

    Also reduce the inflammatory process steroid hormones:

    • Hydrocortisone;
    • Prednisone;
    • Triamcinolone;
    • Kenalog;
    • The Detralex.

    The cartilage is reduced by chondroprotectors:

    • Chondroitin sulfate;
    • Glucosamine;
    • Hondrolon;
    • Structum;
    • Artra.

    Chondroprotectors are taken prolonged courses, even after completing primary treatment.

    Learn more: List of modern drugs and medicines for joints

    They significantly accelerate the regeneration of cells and slow the process of destruction of cartilage. Forms of drugs prescribed for arthritis:

    • capsules or tablets (e.g., Diclofenac);
    • solutions for intramuscular and intra-articular injections (e.g. corticosteroids);
    • gels (for example, Diklak);
    • cream;
    • ointments (e.g., Bischofite, Nikofleks, Menovazin);
    • solutions for compresses (for example, Dimexide).

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

    • arthroscopy - removal of shoots from the bones and other manipulations through a micro-incision;
    • arthroplasty - the replacement of components of joint implants;
    • arcades – complete immobilization of the joint;
    • arthrosis or surgery Wolff - excision of fibrotic adhesions;
    • a synovectomy - removal of the affected synovium;
    • osteotomy - removing part of the bonein order to reduce pressure on the joint;
    • resection – removal of a joint or part;
    • arthroplasty - joint replacement.

    To accelerate rehabilitation are assigned to the physical therapy and special therapeutic physical exercises. Of physiotherapy the following apply:

    • magnetic therapy;
    • amplipuls or sinusoidal-modulated currents;
    • electrophoresis, in which drugs get into by means of constant electric current;
    • laser;
    • ultrasound – phonophoresis;
    • physical therapy with paraffin or ozokerite.

    Only prompt treatment allows you to avoid unpleasant complications and disability. Deaths from complications of infectious arthritis is 5 - 30%.