Infectious (septic) arthritis: the symptoms and treatment of different forms of the disease
Septic arthritis: the infection destroys our joints
Infectious or septic arthritis is an inflammatory lesion 1 or more joints caused by multiple reasons.
The disease can develop at any age, including newborn babies.
The process leads to the destruction of joints, dysfunction of them. To avoid such an outcome, there is a medical emergency.
Features of the disease
The disease is acute, subacute and chronic. Inflammation of 1 joint is called monoartrit, 2 – oligoarthritis, more than 2 polyarthritis. Often affects the joints of the limbs.
Infectious arthritis (IA) in the acute form develops over a few hours, sometimes days. The microbes penetrate into the joint from the hearth in the neighboring areas (osteomyelitis) or remote from it, spreading through the blood or lymph.
In direct contact of the pathogen in the joint (trauma or surgery) develops primary arthritis, and the introduction of microorganisms from other tissues and lesions – secondary.
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Every third case of the disease is associated with infectious beginning.
Depending on the causative agent of the inflammation of the joints are divided into:
Cause disease can such types of pathogens:
- bacteria: gonococcus, Streptococcus, Staphylococcus, tubercle Bacillus, etc.;
- viruses: hepatitis, mumps, HIV, rubella, etc.;
- pathogenic fungi, causing candidiasis, aspergillosis, actinomycosis, etc.;
- parasites: Echinococcus, cat Fluke, filarial etc.
In adults, often develop bacterial process.
The main ones are:
- Yersinia arthritis.
Acute pathology can develop angina, furunculosis, pyelonephritis, pneumonia and other diseases.
Gonorrheal, tuberculous and syphilitic IA specificitem to treat arthritis.
At high risk of developing the disease include people:
- suffering from sexually transmitted diseases;
- non-traditional sexual orientation;
- with immunodeficiency;
- suffering from osteoarthritis, rheumatoid arthritis;
- with diabetes, obesity, systemic lupus erythematosus;
- consumers of narcotic drugs;
- abuse alcohol;
- experiencing increased physical activity, including sports;
- injured joints;
- having chronic foci of infection in the body;
- with a genetic predisposition to joint damage;
- undergoing surgery on the joints, including intra-articular injections.
An increased risk of infection in artificial joints (during and after the surgery). Endoprotezirovanie joints affected more often. In 2/3 of patients the disease develops in the first year after surgery.
Contribute to the defeat of the joint-prosthesis for a previous injury. Some patients for several months and have no complaints, then there are soreness under load, alone, joined by other symptoms.
Symptoms and signs depending on the affected joint
Infectious arthritis is characteristic symptoms depending on the affected area:
- Driving (damage to the knee joint) can be acute (sudden onset and rapid course) or chronic (long duration with exacerbations), bilateral and unilateral. Symptoms depend on the extent of the lesion: pain and stiffness in the morning (step 1.) before deformation of the joint, persistent impairment of the function (step 3.) and disability.
- Cox or defeat of the hip joint are more common in the elderly, although it can occur even in infants. In young patients with purulent coxitis more rapid development. Sometimes, in the beginning prevalent symptoms of intoxication, resembling colds, then there are signs from the joint. In advanced cases there is complete loss of mobility.
- The most common causes of joint inflammation of the hand are infection, trauma (bruise, sprain, fracture), metabolic (diabetes). Risk group consists of persons whose work is associated with hypothermia. Arthritis of the carpal joints with pain syndrome for no apparent reason. Stiffness leads to an inability to perform even simple movements. In the later stages there is a pronounced deformation of the brushes.
- Signs of damage to the toes first appear when walking. For the acute phase of disease is characterized by all the symptoms, chronic may experience some manifestations. Develops pathology at any age. Main reason – wrong choice of tight shoes, but may have value and previous infection. Deformation will develop any arthritis of the foot in severe cases.
In the diagnosis of such methods:
- a survey of patient complaints and history of disease;
- examination of the joints, which assesses the configuration of the joint, swelling, pain at palpation and movement, temperature, volume of movements.
Laboratory studies depending on the presumed causes IA:
- General analysis of blood;
- bacteriological blood;
- the analysis for syphilis;
- smears for gonorrhea;
- ELISA and PCR;
- arthrocentesis and analysis of synovial fluid obtained by determination of susceptibility to antibiotics;
- x-rays of the joint (in the first 2 weeks of illness is not informative);
- the bone scan;
- consultation of doctors of other specialties (if necessary).
Acute infectious arthritis — its features
A feature of septic arthritis (SA) is a sudden onset, rapid development, the progression. The increase in symptoms that occurs from 3 days to 2 weeks.
Typically monoartrit (hip, knee, ankle joints).
Symptoms of acute IA:
- joint pain: in the beginning the motion, then at rest, at palpation;
- fever in the range of 380C with chills;
- limitation of range of motion;
- skin redness and increased temperature over the joint (may be noted);
- configuration changes, swelling due to accumulated fluid (or pus) in the articular cavity;
- manifestations of intoxication (weakness, aching muscles, General malaise).
If gonorrhea is characterized by: more common lesion of the elbow, knee, ankle joints and hands, migrating pain, rashes on the skin and mucous membranes (in the form of punctate hemorrhages, vesicles, etc.).
Half of patients with fever no. The manifestations of genitourinary system may not be.
Bacterial (not gonorrheal) SA have all the characteristic General and local symptoms. Aggressive disease course with joint damage over the 2 days noted in cases of arthritis caused by Staphylococcus aureus with the development of septic shock and fatal outcome.
Viral polyarthritis lasts 2-3 weeks, they are fully reversible, do not give residual changes.
Agents chronic process often is fungi, Mycobacterium tuberculosis, a little aggressive bacteria. It’s formed by 5% of all patients with IA.
Most chronic is noted in patients with HIV infection, rheumatoid arthritis, artificial joint, but can develop in other entities.
In the chronic form of the disease tissue synovitis expands and destroys not only the articular cartilage and the underlying bone sections. To clarify the diagnosis echocardiography allows: develop osteosclerosis and marginal erosions.
The disease is lethargic, gradually increasing swelling, pain, fever and slight redness over the joint.
Antibacterial therapy is ineffective. Effective long-term treatment of infectious arthritis in accordance with the sensitivity of the isolated pathogen.
Allergic infectious arthritis associated with a history on the eve of an acute infection or exacerbation of chronic, improve allergic mood of an organism.
Often the disease affects young women with chronic foci of infection (dental caries, chronic pyelonephritis, tonsillitis, cholecystitis, etc.) – they account for 75% of all cases.
The process often with multiple joint involvement (small and large), has a relapsing course, but joint destruction is not typical. Appears limitation of motion, pain, swelling. In the blood may increase leukocytosis and erythrocyte sedimentation rate, radiographs are no signs.
Manifestations of these unstable: amazed that one, another joint and after a few days (or weeks) the symptoms of the disease disappear without residual changes.
In some cases (especially without treatment) of infectious-allergic arthritis can go to rheumatoid osteoporosis and deformity of the joints.
Peculiarities of disease in children
Acute form of arthritis can develop in any child, even infants. 1 often affects the large joint of limbs, at least – the small joints.
The causative agents of disease in young children are predominantly Staphylococcus aureus, hemolytic Streptococcus, hemophilic Bacillus.
Newborns can be infected with gonorrhea from the sick mother. Infection can occur and medical manipulation (catheterization of veins, etc.).
Viruses (causative agents of childhood droplet infections, viral hepatitis, infectious mononucleosis, etc.), helminthic infection also can cause disease. Infectious-allergic arthritis is often associated with streptococcal infection in the nasopharynx.
Distinctive features of the disease in children are:
- migrating redness in the groin, on the thigh, under the arm;
- symptoms of intoxication (headache, weakness, vomiting, etc.);
- fever with chills;
- frequent lesion of cranial and peripheral nerves;
- forced position of the limb;
- changes of the heart.
Features of therapy
Treatment of infectious arthritis prolonged.
In case of acute illness (or exacerbation of chronic) it is held in the hospital with continuation on an outpatient basis.
Treatment goals: pain relief, control of infection, safeguarding the integrity and function of the joint.
Apply conservative and surgical methods.
Conservative methods include:
- Drug treatment: antibiotics; analgesics; anti-inflammatory drugs; anti-Allergy drugs.
- Not medical methods. Immobilization (immobility) of the joint; physiotherapy; exercise therapy and massage; Spa treatment.
Operative methods of treatment used in extremely severe cases:
- arthroscopy (removal of bone spurs);
- artrosis (excision of adhesions);
- a synovectomy (removal of the affected area synovitis);
- osteotomy (resection of the bone);
- arthrodesis (complete immobility of the joint);
- removal (resection) of a joint or part of it;
- joint replacement and arthroplasty (replacement of the joint or its components).
Reconstructive operations are performed after treatment of the infection.
Antibiotics most often used drugs cephalosporin, aminoglycosides, semisynthetic penicillins. Based on the results of the study, the correction of antibiotic therapy is carried out according to susceptibility.
Drugs can be administered intramuscularly, in severe – intravenously, after discharge from the hospital go to the reception inside. According to testimony carried detoxification therapy.
The important treatment is the removal of the purulent content of joint: aspiration (1 or more times a day), irrigation of the joint cavity (lavage) drugs or arthrotomy.
Immobility of the limb to relieve pain is achieved by using a splint for a few days with a gradual increase in movement mode and exercise therapy during the recovery period to prevent contractures.
In viral arthritis are prescribed nonsteroidal anti-inflammatory drugs (Nimid, Ibuprofen, Aspirin, Movalis etc.).
A fungal infection requires the use of antifungal drugs (Fluconazole, Ketoconazole, Diflucan, etc.). Specific chemotherapy drugs used for the treatment of tuberculous arthritis.
When infectious-allergic arthritis used anti-allergic drugs.
During the period of rehabilitation prescribed physiotherapy:
- magnetotherapy treatment;
- applications of paraffin wax (ozokerite).
Consequences and complications
Septic arthritis is a threat to health and life resulting from the destruction of the structure of the joint, development of complications such as septic shock, with possible fatal outcome.
An important role plays the type of pathogen. So, Staphylococcus aureus may 1-2 day lead to the destruction of bone and cartilage and their subsequent displacement and shortening of the limb.
Bacteria into the blood, are recorded in the various organs with the formation of abscesses.
The most common complication of disease is a deforming osteoarthritis.
You may contact fusion of the articular surfaces (ankylosis). Not conducted in a timely manner treatment may cause complications such as osteomyelitis (inflammation of all parts of the bone), spondylitis (inflammation of spine).
The prognosis depends on the timeliness and completeness of treatment. If it is started late, the mortality rate of complications is 30%.
If a timely request for assistance, the favorable course of the disease up to 70% of patients can avoid irreversible changes and destruction of the joints.
The rest develops partial deformity, contractures and osteoarthritis.
The expressed infringement of function of joints can lead to disability of the patient.
When infectious-allergic arthritis, the prognosis is favorable.
Arrhythmias can develop at any age and hit different joints. When running the process, the treatment may not give complete results. Only timely treatment to the doctor can prevent severe consequences such as destruction of the joint, immobility, disability.