Infectious arthritis: etiology, pathogenesis and clinical course
Arthritis is a term that encompasses various inflammatory diseases of the joints. There are many causes of this disease. The inflammatory process, in particular, could be the result of various infectious diseases.
So there is infectious arthritis. What diseases may cause this pathology? What specific symptoms does infectious arthritis? What are the main methods of diagnosis and treatment? The answers to these and many other questions you can get through this review.
- Infectious arthritis of the knee joint
- Pyogenic arthritis of different Genesis
- Viral polyarthritis
Infectious (or pyogenic) arthritis: etiology and pathogenesis
The causes of such diseases as polyarthritis, a variety. It can be bacterial, and fungal infectious agents. Often infectious (or pyogenic) arthritis is a secondary disease, that is in the patient’s body there is a hotbed of infection, resulting in the blood and lymph is infection of one or several joints. Less frequently there is a direct infection of the joint. Among the risk factors of infection of joint are the following:
- acute or chronic infectious diseases;
- immunodeficiency of various origins;
- some forms of arthritis, chronic (rheumatoid arthritis, gouty, psoriatic and other forms);
- various diseases of connective tissue (lupus erythematosus);
- intra-articular infection;
- diabetes mellitus;
- cancer and chemotherapy;
- various blood diseases (anemia of various Genesis);
- surgery or intra-articular injections;
- open fractures of the joints;
- hormonal medications.
This is not a complete list of factors that may cause such pyogenic arthritis. It should be noted that this pathology is considered to be life threatening to the patient and requires immediate medical intervention.
Clinical features of the disease in children
There is a perception that arthritis is a disease. which affects more often the elderly. This statement is fundamentally wrong. Quite often diseases of the joints occur in children of all ages. Are no exception newborns and infants. During pregnancy (vertically from mother to fetus), childbirth or through breast-feeding the baby can be infected from the mother a wide range of different infections. In children under 3 years cause of the inflammatory process in the joints is often a infection Haemophilus influenzae, or Staphylococcus aureus.
In a later age, children increasingly suffer from various infectious diseases. This is mainly an infectious disease of the upper respiratory tract caused by pathogens such as streptococci and staphylococci. Among these diseases — sore throat, tonsillitis, laryngitis, pharyngitis, mumps, and many others. After the disease, after a certain period of time, children have the phenomenon of post-infectious arthritis.
In most cases we are talking about infectious-allergic arthritis, that is, the child is allergic to pathogen infection (staphylococcal or streptococcal microflora). The defeat exposed one or two joints (mono — or oligoester), but there are times when the affected 3 or more joints (polyarthritis).
The whole difficulty lies in the fact that the child may not always tell parents or doctor about what and where he hurts. You should pay special attention to or what are the symptoms of arthritis in children? First of all, the baby feels pain in the joints. It becomes less movable, often lying down or sitting, sometimes starts to limp. In the area of the affected joint may experience swelling, itching or local hyperthermia. General physical condition of the little patient; he could be fever, chills, significant General increase in body temperature. The child becomes capricious and irritable, reluctantly plays and refuses to eat.
If you notice one or more of these symptoms in your toddler, you should immediately seek the help of experts.
Because of the imperfection of the immune system, the disease in children is developing very fast, which can lead to irreversible consequences. Only the doctor can put the correct diagnosis and to appoint effective treatment. The sooner you get to the doctor, the more likely your child can avoid complications.
What forms is arthritis in children?
There are several forms of joint diseases that occur in children aged 0 to 15 years. Violation of the immune system, injuries and illness contribute to the development of these pathologies in the joints. The following is a description of the most common forms of this disease.
Rheumatoid arthritis in children occurs against a background of rheumatic fever and is most often the result of infectious diseases caused by Streptococcus. In the pathological process are involved as the joints and periarticular tissues. There are several extra-articular pathological changes in various organs and systems.
Among the most common diagnostic signs are commonly distinguished arthritis General increase in body temperature of the child. There is a sharp pain in the joints, they lose their mobility, increase in size, there is swelling and hyperthermia in the area of the affected joints. For rheumatoid arthritis the characteristic symmetry, that is, in the inflammatory process involved both elbow, knee or other large joints.
Such phenomena are observed for 5-7 days and if the correct treatment is fully tested. The mobility of the joints fully restored. Diagnosis involves a series of laboratory investigations that allow experts to determine the leukocyte count and the erythrocyte sedimentation rate that might indicate the presence of inflammation in the body. Important analysis that determines the presence of antibodies to Streptococcus, increased quantity which indirectly indicates the etiology of the disease. Radiological and other methods of visual studies are diagnostic value, as infectious arthritis rarely gives destructive or degenerative changes in the structures of the joint.
Among the most common complications of rheumatoid States of the various disorders in the cardiovascular system. Due to lesions of the heart valves, the patient may experience heart disease or secondary cardiomyopathy. It is recommended constant monitoring of ECG.
On the background of intestinal infection or infection of the genitourinary system often occurs a disease such as reactive arthritis. Such infections lead to certain disorders in the immune system that is a permanent factor in the development of infectious diseases of the joints. The difficulty lies in the fact that reactive arthritis is manifested through quite a long period of time after infection (up to 1 month). This is the reason that infectious arthritis is not associated with the previously transferred disease. If your child has had any infection, you should inform the doctor. Among the most common pathogens — Salmonella, dysentery, and chlamydia.
The reactive form of the disease often manifests itself as arthritis of the knee, less commonly affects the joints of the ankle. The most characteristic symptom of reactive arthritis — the pain in the heel region, which increases with movement. The rest of the symptoms are similar to other types of this disease. It is important to know that in reactive arthritis is the most characteristic extra-articular manifestation of the disease — vision loss. The patient may receive lacrimation, phenomena of blepharitis or conjunctivitis, eye redness or photophobia. Violated the General psychosomatic condition of the child: drowsiness, fever, poor appetite, muscle weakness, etc.
The differential diagnosis puts the physician on the basis of clinical and laboratory results (screening for chlamydia and other infectious agents). The disease has a fairly long duration, however, has no irreversible consequences.
After complete recovery, the pain stops completely, recovered all of their functions, and the patient can return to normal life. When re-infected by a particular pathogen may start a recurrence.
This form of arthritis is a very serious disease that requires immediate treatment. The risk group includes kids aged up to 3 years, but this does not mean that other patients can feel safe. This pathology occurs as a result of entering into the joint of viruses, bacteria and fungi of various origins. Most often this inflammatory disease develops on the background of various infectious lesions of the skin (dermatitis of various etiologies), hereditary and acquired infections (gonorrhea, etc.), intestinal infections of different origin.
Infection occurs through the blood and lymph circulation. In the pathological process involved, usually large joints of the lower extremities. As a consequence there is septic arthritis knee, hip or ankle joint. The disease at a high temperature, the baby acute pain in the joints, which increases with movement. It is for this reason the child refuses to move, then to speak of «false paralysis». At high temperature there may be nausea and vomiting, drowsiness, or, conversely, hyperactivity of the child.
At first suspected septic arthritis should immediately consult the doctor and undergo appropriate testing. May need biopsy or synovial fluid analysis, ultrasonography and other clinical tests.
Important differential diagnosis, as infectious arthritis of different etiology has similar symptoms. It is especially difficult to diagnose an infant that is not walking, and therefore to evaluate the functional state of the joints is quite difficult. The correct diagnosis — a task that only an experienced specialist.
The most common form of the disease in adults
For a number of reasons for the disease in adult patients has some peculiarities. They relate to both etiology and pathogenesis, and localization of the inflammatory process and clinical manifestations. During surgical interventions often are infected by pathogenic Staphylococcus on the skin in a healthy person, however, once inside the joint, such microflora causes inflammation. Infectious arthritis can be caused by various sexually transmitted infections (gonococcal microorganisms, chlamydia, etc.), and infectious diseases of the gastrointestinal tract and the genitourinary system. The cause of the disease can become viruses and fungi, which thrive in patients with a weakened immune status.
Following are some of the most common forms of inflammatory joint disease in adults who have an infectious etiology.
Infectious arthritis of the knee joint
Among all diseases of musculoskeletal system arthritis of the knee joint is the most common form of this disease. Arthritis of the knee joint can be divided into primary and secondary. Primary arthritis occurs as a result of various injuries, and the second is a consequence of the inflammatory process. The joint gets infected blood or lymph, which becomes a cause of the disease. In most cases, the disease is acute, which is characterized by severe pain in the affected joint, swelling and hyperthermia. The patient may be disturbed by a General medical condition.
The diagnosis is not difficult for experts, because visually, the affected joint is significantly different from the healthy. If the patient has suspected arthritis of the knee joint, the first priority is determining the cause of inflammation (pathogen). Only addressing the root causes may be the key to successful treatment. When re-infection arthritis of the knee joint can recur.
Pyogenic arthritis of different Genesis
Often patients having articular manifestations of various infectious diseases. In such cases there is a specific fever, caused by various pathogens. Pyogenic arthritis has the following varieties:
This arthritis affects the joints of the skeleton. The disease is acute, accompanied by severe pain and limitation of joint mobility and worsening of the General condition of the patient. In blood — increased erythrocyte sedimentation rate, leucopenia. In severe cases, hospitalization and constant surveillance of doctors.
Pyogenic arthritis of viral etiology often begins as the result of a viral infection. It is noteworthy that viral arthritis can occur at any stage of the clinical course of the disease background. Sometimes this occurs after full recovery of the patient, which complicates the differential diagnosis. Viral arthritis can be a consequence of diseases such as:
- whooping cough;
- viral hepatitis;
- human parvovirus B19;
- the herpes virus;
- the alpha viruses;
- HIV infection and other.
It should be noted that viral arthritis in children can develop even after vaccination against rubella and pertussis. Such conditions require no treatment and disappear on their own. In other cases there is a medical emergency.
Basic principles of diagnosis and treatment
Of great importance are diagnostic measures that help to pinpoint the causative agent. The main method of diagnosis is the clinical study of synovial fluid. With this purpose the patient taking puncture. Also common urine and blood samples, which provide the ability to determine overall picture of the disease. Based on the obtained results choose a certain treatment.
Treatment of infectious diseases of the joints has two main directions: the treatment of the causative agent and symptomatic therapy. If articular capsule accumulates purulent, debridement of the joint cavity with various antiseptic solutions and antibiotics. Also, patients prescribed systemic antibiotic therapy depending on the causative agent. Significantly reduce pain and eliminate the phenomena of inflammation non-steroidal anti-inflammatory drugs. If their application is ineffective, then the patient is administered certain hormonal intra-articular injection.
If treatment is not initiated in a timely manner, the patient may begin irreversible destructive processes. In this case, surgical treatment, which includes full replacement of the affected joint.
To avoid such situation, you need the first manifestations of arthritis to consult a doctor and not to self-medicate. If timely medical assistance forecast to be favorable.