How is infectious arthritis treated? brucellosis infectious arthritis

Infectious arthritis is a disease that is characterized by severe damage to the joints against the background of a bacterial or fungal infection. The disease affects people of any age, but mostly occurs in children and people over 60 years of age. Modern development Surgical technologies and medications have practically not changed the picture of the prevalence of the disease, so today, like many years ago, every third patient develops an irreversible loss of joint function.

Causes

As the name suggests, the main cause of the disease is a fungal, bacterial or viral infection. However, depending on age, it enters the body in a specific way and under the influence of various factors risk. For example, infectious arthritis in children infancy more often occurs in families where the mother had gonorrhea during pregnancy. If a child has a catheter in the hospital, the risk of the disease is increased. In children under the age of two years, the disease is more often caused by Haemophilus influenzae and Staphylococcus aureus. In older children, the joints are affected by Staphylococcus aureus and bacteria of the genus Streptococcus viridans and Streptococcus pyogenes.

The disease affects adolescents due to active sexual life. They most commonly carry the neisseria gonorrhoeae virus, better known as gonococcus, the microorganism that causes gonorrhea.

In older age, infectious arthritis is most often caused by bacteria of the genus Salmonella and Pseudomonas aeruginosa.

Pathogenic microorganisms enter the joints with the bloodstream, but rarely - and during surgery or intra-articular injections. There are certain high-risk groups, which include patients with chronic rheumatoid arthritis, carriers of complex systemic infections, including HIV and gonorrhea, people who prefer homosexual sexual preferences, cancer patients, people with alcohol and drug addiction, diabetics, patients with systemic lupus erythematosus or sickle cell anemia. In addition, those who have recently undergone joint surgery, as well as patients who are prescribed intra-articular injections, should be checked at the first symptoms of infectious arthritis.

Symptoms

Since the joints are affected by various types of pathogens in infancy, adolescence and old age, the symptoms of the disease also wear different character. General signs include pain in the affected joint, which only gets worse with movement. As the disease progresses, the joint swells, its contour changes. The patient's temperature rises, the skin turns red. Over time, the limb of the patient is deformed.

In children, infectious arthritis most commonly presents with fever, joint pain, and restlessness. The child cannot always explain what exactly worries him, but instinctively limits the movement of the affected limb, since touching the joint is rather painful. In infants, symptoms develop gradually, which cannot be said about adolescents and adults - they are characterized by sudden development illness. The main symptoms in older age are sudden reddening of the joint, fever and soreness in the affected area, due to the inflammatory process. Fluid accumulates in the diseased joint, due to which swelling is formed, and mobility is reduced. Chills are possible.

TO characteristic symptoms diseases include the localization of the lesion - most often it is the knee, shoulder, wrist, hip, elbow joint. Finger joints are often affected. If the disease is caused by causative agents of tuberculosis or a fungal infection, the symptoms are less pronounced. These microorganisms affect mainly one joint, rarely two or three. A symptom of infectious arthritis of gonococcal and viral nature is the defeat of many joints at the same time.

Diagnostics

Lack of timely treatment can lead to the fact that the affected joint will collapse within a few days. Diagnosis includes the collection of joint fluid for analysis for leukocytes and the presence of painful microflora. The fluid taken from the affected joint is usually cloudy and contains purulent flakes, as well as a high percentage of white blood cells. Gram-staining identifies gram-positive bacteria, and culture allows you to clarify the gram-negative type of the pathogen. If neither stain nor culture reveals the pathogen, a biopsy is performed. synovial tissue next to the joint. In addition to the puncture, a blood test, sputum test, cerebrospinal fluid and urine.

Diagnosis should also differentiate infectious arthritis from others. possible diseases with similar symptoms - Lyme disease, rheumatic fever, gout, etc. In some situations, the diagnosis is helped by determining the nature of the pain and the location of the affected areas.

Treatment

The disease requires urgent medical and long-term physiotherapy treatment, because in short time can cause permanent joint damage. At the first suspicion, antibiotics are prescribed even before the final diagnosis. Treatment may be adjusted later after the specific causative agent has been identified. For example, with a viral infection, non-steroidal anti-inflammatory drugs are prescribed. Further therapy includes a two-week antibiotic regimen, which may be continued depending on signs of inflammation. The doctor may extend antibiotic therapy for two or four weeks.

In the case when the infection is resistant to antibiotics or the affected joint is difficult to access for puncture, an operation to drain the joint is prescribed. This method of treatment is used for penetrating gunshot wounds. If the cartilage and bones are particularly severe, surgery may be prescribed to reconstruct the joint, but before that, measures are taken to treat the infection.

Treatment usually requires pain medication. A compress can be applied to the inflamed areas, and to prevent accidental movements, the affected joint is fixed with a splint. During the recovery period, the patient is prescribed exercises that gradually increase the amplitude of joint mobility. Therapeutic exercise should not lead to pain.

Infectious arthritis is an inflammatory disease that can affect different joints. The disease is not limited to local symptoms, and affects different systems organism. Such arthritis is also called septic and pyogenic arthritis. Infection occurs immediately after the pathogen enters the tissues of the joint. Localization can be different, but most often the disease affects the joints of the legs and arms, due to constant stress and mobility.

There are primary and secondary infectious arthritis.

The first type is the entry of the pathogen into the tissues of the joints from the outside.
Secondary arthritis occurs after infection of the joints from other tissues.

The etiology of the disease can be as follows:

Both the elderly and adults, as well as children and newborns, can get sick. Therefore, the disease is very common.

When is arthritis called polyarthritis?

If several joints are inflamed, the disease is called polyarthritis. Inflammation can occur both simultaneously and alternately. Can cause polyarthritis various violations immune system, metabolism and other diseases. Accompanied by disease constant pain, which are most intense at night and in the early morning. Swelling appears on the joints.

Treatment of polyarthritis should be comprehensive. It includes stopping the development of the infection, restoring the affected tissues and stopping the pain process.

Causes of the disease

Inflammation develops as a result of infection, various viruses, bacteria, or microorganisms entering the bloodstream. Infection of the joint can occur through an open untreated wound, during surgery or puncture.

The most main reason development of pyogenic arthritis - infection or virus. It assumes not only an infection that can enter the body from external environment. Trigger can become long relapsing chronic diseases with a complex course. Infectious arthritis can develop in people suffering from:

Chronic tonsillitis.
Gonorrhea.
Flu.
SARS.

The above list of diseases is far from complete. There are many factors that cause joint inflammation. It is important to understand that, despite its danger, septic arthritis remains very rare disease. Only 0.2 percent per 100,000 people on our planet suffer from it.

The fact is that even an open injury does not necessarily threaten the development of arthritis. If the joint is healthy, then its membranes produce substances that can resist bacteria. There are risk groups who are more likely to develop septic arthritis than others:

Conditions of immunodeficiency.
Joint changes caused by other arthritis or arthrosis.
Foci of infection near the joint that caused pain.

A number of bacteria cause infectious arthritis. In addition to all known staphylococci and streptococci, this includes various gram-negative bacteria and Haemophilus influenzae, which are among the consequences for the young organism.

Pathogens enter the joint with the bloodstream, or from outside the body. Surgical intervention, trauma can give a direct infection to the tissue, which makes the inflammation process faster.

Newborns mostly suffer from arthritis caused by gonococcal infection. The bacterium enters the body of the child from the mother in a hereditary way. Medical manipulations are also often the cause of infection.

Risk group

with chronic rheumatoid arthritis;
who received intra-articular injections;
after surgical operation on the joint;
suffering from malignant tumors;
unconventional orientation;
suffering from HIV or gonorrhea;
suffering from diabetes;
suffering from lupus erythematosus;
suffering from alcoholism or drug addiction.

Bacterial arthritis always develops for only one reason - it is a reaction to an infectious agent of a bacterial, viral or fungal nature. In fact, any acute infectious disease can trigger the development of septic arthritis - whether it be tonsillitis or even gonorrhea.

Traditional medicine notes a certain dependence of the characteristic causative agent of the disease on the age of the patient:

septic arthritis in young people at the peak of sexual activity is often caused by gonococcal infection. Infectious arthritis in children is also caused mainly by this pathogen: children become infected with it from an infected mother in utero;
another form viral inflammation joints, which is also common, is an ailment caused by a bacterium Staphylococcus aureus;
sometimes manifestations of the bacterial form of the disease can be provoked by streptococci;
atypical pathogens are the least common: fungal infections and opportunistic pathogens(mainly in patients with immunodeficiency).

The disease is provoked by bacterial, viral or fungal infections that enter the bloodstream, and from it into the joint. However, an alternative route of infection is intra-articular injections during surgery or located inside the patient himself in the foci of infection. The presence of pathogenic factors will depend on the age group.

Newborns are at risk of gonococcal infection, transmitted from a mother who has gonorrhea. The disease may be the result of hospital procedures. In most cases, during the introduction of the catheter. In children under 2 years of age, infectious arthritis is provoked by staphylococcus aureus or haemophilus influenzae.

The causative agent of infectious arthritis is considered to be infection with streptococcus and, for example, a banal sore throat. Dysfunction occurs common organs, primarily heart valves and connections. And there are a million such cases. It hurts to swallow, the throat is swollen red, and it would seem that everything is curable. But over time, you begin to notice discomfort in large joints.

Few people think that common colds: sinusitis, chronic tonsillitis, SARS, pneumonia, scarlet fever, influenza can provoke infectious arthritis and be dangerous.

The infection tries to become related to the cells of the body, but as soon as you catch a cold, weaken, endure stress or get nervous, the streptococcus crawls out of the cell and immediately spreads to neighboring still healthy cells, as a result, infectious arthritis is likely to appear.

Signs of illness are often found in the elderly, people with brain damage, various tumors, hepatitis of all kinds, blood cancer. In many cases, the syndrome affects alcoholics and those who use drugs.

When we are talking about adolescents and children, here the malaise is associated primarily with gonococcus. More often it is transmitted from mother to child, in 25% if not correct delivery, infected birth canal, non-sterile instruments.

Types of arthritis and their symptoms

Infectious arthritis is a common disease - it is diagnosed in every third patient with joint problems - and can develop in a person of any gender and age (even in newborns - in this case, one of the ways of infection is the transmission of infection from a sick mother during pregnancy or in the process of birth, when the child passes through birth canal).

The code for this type of joint pathology according to ICD-10 (the tenth version of the International Classification of Diseases), depending on its type, is defined as M00, M01, M02 and M03.

According to the etiological classification, septic arthritis is divided into:

Post-traumatic arthritis is a separate group. Their cause is joint trauma.

If the causative agent of the infection enters the joint from the outside, then such arthritis is called primary. When the source of infection located inside the body becomes its cause, experts speak of secondary arthritis.

Infectious arthritis can be divided into different types depending on the number of affected joints, depending on the form of the disease,
depending on the way the pathogen enters the joint area, depending on the type of infectious agents.

Infectious arthritis - monoarthritis.

This type of infectious arthritis is characterized by the fact that one joint is affected. If the causative agent is a fungus or a tubercle bacillus, then
one joint is affected. You can get this form of monoarthritis at any age. In adults, the knees and hands are more commonly affected.

Infectious arthritis - polyarthritis.

This type Infectious arthritis is distinguished by the fact that several joints become inflamed at the same time. Viruses and gonococci affect several joints at once.
Young children are characterized by polyarthritis in the shoulders, knees and hip area.

Infectious arthritis is acute.

Acute infectious arthritis is characterized by severe pain, fever, reddening of the skin, and swelling of the affected one or more joints. Availability
intraarticular effusion.

There is a violation of the mobility of the joints in which the inflammatory process occurs. General state accompanied
exhausting fever.

Such a lightning-fast reaction is explained by the fact that in acute infectious arthritis, a quick response of the body is activated in the form
systemic pathological reaction to severe infection pathogenic microbes.

An infectious agent that has entered the joint space
causes toxic shock. Humoral immunity is activated.

With this type of infectious arthritis, the joints can completely
deform in a few weeks.
.

Infectious arthritis is chronic.

Chronic infectious arthritis develops over several weeks and is usually caused by mycobacteria, fungi, or low-virulence bacteria.
Chronic infectious arthritis accounts for about 5% of all infectious arthritis.

The course of the disease is usually sluggish, with a gradual increase in edema,
an increase in local temperature, minimal hyperemia of the skin over the joint or without it, soreness. Usually one joint is affected.

long current
and the lack of effect of antibiotic therapy suggests a mycobacterial or fungal nature of the process.
.

Infectious arthritis primary.

With this type of infectious arthritis, the pathogen enters directly into the articular region. That is, the infection in primary infectious arthritis enters the
joint tissues from the outside.

The general condition will improve. He is under the supervision of a doctor.

Synovial fluid and other tests are examined daily. There are times when splinting is recommended.

Undesirable action of the joint is completely excluded.

When the drug needs to be injected into the joint itself, an anesthetic drug is used along with antibiotics. Lotions are applied to the lesion. Help comes ethnoscience.

The disease requires several days of inpatient treatment, which is accompanied by medication, as well as physiotherapy sessions that are applied for several weeks or even months.

As you already know, delayed medical treatment can lead to serious joint damage or other complications. That is why the course of drug treatment begins with the immediate intravenous administration of antibiotics even before the pathogen is accurately identified.

After its recognition, an antibiotic is prescribed, which acts specifically on this infectious agent: a bacterium or a virus.

Usually, nonsteroidal drugs anti-inflammatory actions are prescribed in the presence of a viral infection. The course of intravenous administration of antibiotics is about fourteen days, whether it can be delayed until the focus of inflammation is completely eliminated. After the injections are completed, the patient may be prescribed a course of antibiotics in tablets or capsules for two or four weeks.

Surgical intervention

Separate forms diseases require a different approach to prescribing medicines, But general principles treatments are similar. They are aimed at removing the pathogen from the tissues of the joint and reducing inflammatory symptoms:

Treatment of infectious arthritis of any origin necessarily involves the appointment of anti-inflammatory drugs. Powerful drugs (Diclofenac, Ketoprofen) are administered in the form of a course of injections, which allows you to suppress the main symptoms of inflammation.
In bacterial and fungal arthritis, antimicrobial drugs with a wide spectrum of action are prescribed. A drug of a narrow focus is used only after receiving the results of sowing, which will determine the type of pathogen.
Antibiotics are selected on the basis of two factors - the breadth of action and the possibility of administration with syringes. A group of protected penicillins is usually used - Amoxiclav, or cephalosporins (Cefazolin, Cefotaxime).
Often a combination of several antibiotics different groups to completely block the possibility of reproduction of microbes. But this option is possible only in a hospital setting, in order to exclude mutual side effect.
To destroy fungi, drugs with a wide spectrum of action are also prescribed - Amphotericin B, Nystatin.
With viral arthritis, no specific drugs are required - the treatment itself colds lead to a reduction in symptoms. To do this, use plenty of drink and fortifying drugs - vitamins.

But it often happens that conservative therapy becomes ineffective - this is due to shortcomings in the diagnosis or choice of medicine. Then you have to use artificial interventions - therapeutic punctures of the joint.

With the help of them, the inflammatory fluid with microbes is removed, after which multiple washings of the joint cavity are performed. This allows you to mechanically remove most of the pathogen, reducing the intensity of inflammation.

Did you manage to recognize, at least notice the first signs of infectious arthritis right away? You are lucky! After all, an ailment not detected in a timely manner has a huge chance of crushing and undermining your health in a couple of weeks. That is why timely established therapy is of great importance.

Before you start serious treatment for infectious arthritis, you will need to take a number of clinical analyzes: on the level of leukocytes, a blood test for the presence of antibodies of viruses, biochemical analysis blood, urinalysis and feces.

Infectious arthritis is usually treated with antibiotics. Assign them immediately, at the first suspicion serious condition sick.

First of all, they are used to destroy the pathogen in order to slow down and then completely stop the development of infectious arthritis. The drug is administered intravenously to get into the joint tissues maximum amount liquid, the effect of improvement usually occurs after 2 days.

If pus is found in the joints, it must be pumped out. It uses drainage, a tube and a needle.

In more difficult situations surgery is likely, but this cure is rare. Not earlier than in a couple of weeks, you need to undergo an ultrasound and x-ray examination in order to detect cartilage destruction, if any.

At the advanced stage, a puncture from the joint can be used. Usually the above methods are sufficient to prevent malaise.

In addition to the use of drugs, you can use compresses to narrow the joints, take courses in physiotherapy, and physical therapy will be effective. Many cases with a positive picture of treatment and stable results guarantee you recovery and full life in move.

Infectious arthritis - medical treatment.

Medical treatment of infectious arthritis in the early stages involves the appointment of antibiotics a wide range action, non-steroidal
anti-inflammatory agents. If treatment is delayed, there is a risk of serious joint damage and other complications.

That's why
intravenous antibiotics should be started immediately, even before exact definition infectious agent. After identifying the pathogen
infections, a doctor may prescribe a medicine that specifically targets the bacteria or virus.

Non-steroidal anti-inflammatory drugs are usually
appointed at viral infections. Forecast at proper treatment favorable.

Inflammation of the joint can end without residual effects.

The content of the article

Such arthritis is divided into 2 types:
1) actually infectious or septic, in which the infectious agent is located in the joint cavity, which determines the purulent nature of the synovial fluid;
2) parainfectious, or reactive, arising in chronological connection with a specific infection, but in the absence of pathogens in the joint cavity, sometimes with the formation or deposition in the joints of the corresponding immune complexes.
The latter include rheumatoid arthritis, tuberculous rheumatism (Poncet polyarthritis), arthritis in dysentery, salmonellosis, yersiniosis, etc.

Acute infectious (septic) arthritis

Acute infectious (septic) arthritis may be a manifestation of sepsis caused by bacteria, fungi or viruses, due to wound, postoperative, generic infection, criminal abortion, or in the presence of a focus in internal organs. The disease-causing microorganism can almost always be isolated from intra-articular fluid, tissues, and blood. Infection of the joint is more often the result of a hematogenous introduction of bacteria from a distant focus of infection, less often there is a direct penetration of the infection into the joint during injuries, stab wounds feet, acupuncture, repeated injections into the joint, etc.
The main causes of septic arthritis are staphylococcal, streptococcal, gonococcal infections, as well as gram-negative microorganisms (E. coli, Proteus), etc. Acute infectious arthritis can occur against the background of furunculosis, tonsillitis, pneumonia, after cystoscopy, operations on organs abdominal cavity And genitourinary system etc. Diabetes mellitus predisposes to the development of infectious arthritis, malignant neoplasms, RA and other diseases, chronic alcoholism.
Joint damage (in 80% of cases - monoarthritis) develops against the background of other symptoms of sepsis. The knee and hip joints are most often affected, less often the shoulder, elbow, wrist, and ankle joints.
Typically acute onset of arthritis, with sharp pains, fever, chills. The infected joint is sharply painful, reddened, hot and swollen, contains effusion, mobility and function are sharply limited due to pain. In a hip infection, pain may radiate to the anterior thigh or knee; in a sacroiliac joint infection, pain may radiate to the buttocks, lower back, or sciatic nerve. Multiple joint damage in septic arthritis is rare, more prone to it patients with SLE receiving immunosuppressive agents.

Arthritis caused by fungi and mycobacteria

Arthritis caused by fungi and mycobacteria, also usually monoarthritis, begin and proceed more imperceptibly.
When examining the synovial fluid, a high cytosis (20-104/ml) is found with a predominance (up to 90%) of neutrophils. The liquid is turbid, its viscosity is reduced, the mucin clot is loose. Radiologically, stretching of the capsule and swelling of the periarticular tissues are noted, epiphyseal osteoporosis, narrowing of the joint space, subchondral erosions are detected very early, and with inadequate treatment, rapid destruction of cartilage and bone.
The outcome of the disease may be secondary deforming osteoarthritis or bone ankylosis of the joint.
Opportunity infectious etiology arthritis should be considered in all cases of acute mono- and oligoarthritis. The diagnosis is confirmed by examining the synovial fluid - viewing Gram-stained smears, isolating a culture of microorganisms.
Used for septic arthritis antimicrobials and provide adequate drainage of the joint cavity. The earlier treatment is started, the greater the chance of maintaining joint function, so antibiotic therapy is started before synovial fluid culture results are obtained. Once the pathogen has been identified, treatment may be revised if necessary. Antibiotics that easily penetrate into the joint from the blood are administered parenterally. Intra-articular administration of antibiotics is not necessary and may cause irritation of the synovial membrane. With streptococcal and staph infection use penicillin at 250,000 U / kg per day, on average for adults 12-20 million U intravenously, distributing the dose into 4 injections, or tseporin at 60-100 mg / kg per day in 2-3 doses. Treatment is carried out within 3-6 weeks.
For gram-negative flora, a combination of an aminoglycoside (eg, gentamicin) with a broad-spectrum antibiotic is recommended ( penicillin series, cephalosporin).
Shown daily or every other day drainage of the joint cavity, with aspiration of pus, which allows you to save the articular cartilage. It is necessary to ensure the rest of the limb until pain and inflammation decrease, sometimes it is immobilized with a splint. Passive exercises can be started a few days after the start of treatment, and active exercises - after the inflammation subsides, the load on the joint is prohibited until the symptoms of active inflammation completely disappear.
The course of treatment is 1 - 1.5 months.
With insufficiently effective treatment, the disease takes long course with the formation of a persistent defiguration of the joint and limitation of mobility.

Gonococcal arthritis

Gonococcal arthritis- one of the variants of septic arthritis. It develops in patients with acute and chronic gonorrhea with hematogenous spread of infection from the genitourinary tract. It is more common in young women, which often has an asymptomatic course of the disease, as well as menstruation and pregnancy that contribute to bacteremia.
In the development of gonococcal arthritis, 2 phases are distinguished - a short (2-4 days) "bacteremic", characterized by fever, chills, migrating arthralgia, and a long "septic" with damage to one or two joints (often knee, ankle, elbow, wrist). Gonococcal infection is characterized by inflammation of the calcaneal tendon, as well as damage to the ankle joints with the development of the so-called "flat gonorrheal foot". The latter is associated with the spread of infection with ankle joint on the joints of the metatarsus and tarsus with simultaneous atrophy of the muscles of the foot and lower leg and the development of flat feet. The outcome of gonococcal arthritis, as a rule, is secondary deforming osteoarthritis.
The diagnosis of the disease is confirmed by a positive blood culture, the detection of gonococcus in the synovial fluid, or specific skin manifestations of infection - papules on a red base, usually filled with purulent contents with necrosis in the center and localized on the back, distal extremities or around the joints.
Differential diagnosis of gonococcal arthritis should primarily be carried out with arthritis in Reiter's syndrome.
In gonococcal arthritis, massive doses of antibiotics are effective. The following combinations of drugs can be used: penicillin 10 million units intravenously per day until the clinical manifestations of arthritis decrease, then ampicillin 2.0 g for 7-10 days or high doses of penicillin intravenously or intramuscularly for 3 days, then ampicillin 3.5 g in day within 7 days. Repeated daily synovial fluid aspirations and administration of non-steroidal anti-inflammatory drugs are advisable.
Osteoarticular tuberculosis- one of the most frequent extrapulmonary forms of tuberculosis. There are tuberculous arthritis, spinal tuberculosis (Pott's disease) and Poncet's polyarthritis.

tuberculous arthritis

tuberculous arthritis- chronic destructive form of septic arthritis caused by Mycobacterium tuberculosis. It is more common in men over the age of 50-60 years. The combination of joint and lung involvement is not mandatory. The development of tuberculous arthritis is more often associated with the hematogenous spread of infection, the formation of a primary bone focus (osteitis) and the transition of a specific inflammatory process to the joint. Much less often, the primary synovial form of tuberculous arthritis is detected.
As a rule, a large joint is affected - knee, hip, ankle, wrist. The affected joint is edematous, warm to the touch, moderately painful, movements in it are limited. In a number of patients, the function of the joint is limited due to pain and reflex muscle contractures. May develop muscular atrophy. When the wrist joint is affected, “carpal tunnel syndrome” often develops, which is clinically manifested by infringement of the median nerve. Often in pathological process periarticular tissues are involved with the development of a "cold abscess", i.e., an abscess without severe erythema and tenderness on palpation. In the synovial fluid, the number of leukocytes (mainly neutrophils) exceeds 10,000; in about 20% of patients, Mycobacterium tuberculosis is sown from the synovial fluid. X-ray in the early stage of arthritis reveals diffuse osteoporosis, marginal bone defects, rarely - a limited bone cavity with a sequester. In the late stage of arthritis, the destruction of the articular ends of the bones, their displacement and subluxations often occur.
To establish a diagnosis importance has the sowing of a specific culture from the joint cavity, a biopsy of the synovial membrane with the detection of characteristic tuberculous granulomas in its histological study, the detection of other tuberculous foci in the body, positive reactions to tuberculin in skin tests (Pirquet, Mantoux reactions).
Tuberculosis of the spine (Pott's disease) occurs predominantly in children and humans. young age(up to 30 years). In adults, the lower thoracic and upper lumbar regions are more often affected, in children - thoracic region spine. Specific bone changes are localized along the edges of the vertebral bodies, while one or two adjacent vertebrae are affected. As a rule, lysis and sclerosis of the bone with destruction articular cartilage, as indicated by the narrowing of the joint space. As the bones break down, the anterior portion of the adjacent vertebrae shrinks, contributing to the formation of a hump. The process often passes to the intervertebral cartilage, paravertebral tissues, which is accompanied by the formation of paraspinal cold abscesses. Abscesses may extend along the spine or ribs and reach chest or chest. When cranial nerves are involved in the pathological process, severe neurological symptoms are often detected, up to paraplegia. The defeat of the lumbar region is observed less frequently and is clinically manifested, as a rule, by unilateral sacroiliitis.
For the diagnosis of tuberculosis of the spine, data are important x-ray examination And computed tomography. Similarly, in the diagnosis of tuberculous arthritis, the final diagnosis is based on bacteriological examination of the contents of a cold abscess.
Differential diagnosis is carried out with lesions of the spine in other infections, tumor metastases in the spine. Ponce polyarthritis - reactive arthritis developing against the background of visceral tuberculosis. Characterized by damage to small joints. Clinically noted permanent prolonged pain in the joints and their swelling. There is no suppuration of the joints and the formation of fistulas in them. There is a strict parallelism between the acuteness of the main process and the clinical manifestations of joint damage. When tuberculosis subsides visceral organs changes in the joints are completely gone. Differential diagnosis is carried out with RA. With tuberculosis musculoskeletal system, as well as tuberculosis of the visceral organs, long-term (usually at least 2 years) treatment with two bactericidal drugs, such as isoniazid (tubazid) in combination with streptomycin, PAS or rifampicin, or other anti-tuberculosis drugs is carried out. In addition, it is necessary to widely use special orthopedic methods of treatment.

Brucella arthritis

Brucella arthritis is relatively rare. It develops against the background of other clinical manifestations of brucellosis - undulating fever with chills and heavy sweats, enlarged lymph nodes, liver, spleen, changes in nervous system, more often in chronic forms. Occurs in persons who have contact with animals with brucellosis, or use products from such animals.
In acute brucellosis, arthralgia and myalgia are short-term, quickly disappear when antimicrobial therapy is prescribed, and can disappear on their own. Most often, brucellosis develops spondylitis and sacroiliitis, especially in the elderly with a severe course of the disease. Sacroiliitis develops in the 1st month of illness. It can be unilateral or bilateral. The lumbar spine is usually affected. Often, the intravertebral disc is involved in the process, which is manifested by narrowing of the intervertebral spaces; observed destruction of the vertebral bodies and calcification of the longitudinal ligaments at the level of the affected discs (ossifying ligamentitis). Vertebral osteoporosis, periosteal thickenings, paravertebral abscesses can be detected. Damage to the intervertebral joints is not typical.
The diagnosis is difficult. To establish it, an epidemiological history is needed, specific tests for brucellosis - Wright's test in a titer of more than 1:200, a skin test with a brucellosis antigen (Burne's positive reaction).
Differential diagnosis is carried out with Bechterew's disease, tuberculous spondylitis, osteomyelitis.
The most effective combined use of antibiotics: tetracycline 500 mg 4 times a day for 6 weeks and streptomycin 1 g intramuscularly per day for 2 weeks.

Lyme disease

Lyme disease, or system tick-borne borreliosis, - an infectious disease that affects mainly the skin, nervous system, heart and joints. Known relatively recently, singled out as an independent nosological form only in 1977. The name of the disease comes from the name of the village of Lyme in Connecticut (USA), where the epidemic of this infection was first recorded. It has now been proven that the disease is common not only in the United States, but everywhere. Epidemics have been registered in Europe, Australia; Asia, China, Japan. The disease is caused by one of the varieties of spirochetes - Borrelia burgdorferi, carried by ixodid ticks. The peak incidence occurs in the summer months, mainly children and young men are ill.
The main clinical sign is erythema migrans, more often on the thighs, in the inguinal and axillary regions. Fever, chills, headache, myalgia, lymphadenopathy, splenomegaly.
Sometimes they reveal neurological disorders- neuritis, especially with damage to the cranial nerves, paresis is often observed facial nerves. In severe cases note clinical picture serous meningitis, encephalitis. Heart damage develops in 4-8% of patients, the most common violation of atrioventricular conduction, up to the development of a complete transverse blockade. Myocarditis with left ventricular failure, pancarditis can be observed.
Joint damage develops in 60% of patients within a few months to 2 years from the onset of the disease. One or more large joints (knee, elbow, shoulder, etc.) are usually affected, symmetrical polyarthritis is often found. Arthritis resolves on its own within 1-2 weeks, but may recur over a number of years. Some patients develop chronic arthritis with erosions of cartilage and bones, ankylosis of the joints is extremely rare.
The diagnosis is established in the presence of characteristic skin lesion- tick-borne erythema. It is necessary to take into account the epidemiological factor: the disease occurs in areas where there are carriers - ixodid ticks. The presence of typical clinical manifestations of the disease - neurological, cardiac and articular lesions- allows you to confirm the diagnosis. If skin erythema absent, diagnosis should be based on findings serological study. Abroad, a sensitive and highly specific enzymological immunosorbent method (ELISA) is used to confirm the diagnosis.
Differential diagnosis at the first stage of the disease during the period of erythema is carried out with skin lesions of a different nature, with complications from the nervous system - primarily with tick-borne encephalitis, which is also transmitted by ticks and occurs in middle lane Russia.
In the early stages of the disease, tetracycline 250 mg 4 times a day, penicillin, erythromycin are effective. Arthritis is treated with vibramycin (doxycillin hydrochloride) 100 mg 2 times a day, penicillin 20 million units (fractional) per day for 14 days.

Viral arthritis

Viral arthritis occur in acute viral hepatitis, rubella, mumps, smallpox, arbovirus infection, infectious mononucleosis, etc. With influenza, arthritis develops rarely, arthralgia and myalgia associated with general intoxication are more common. The pathogenesis of joint damage in viral infections may be associated with the deposition of immune complexes containing the antigen, and with the direct effect of the virus on the synovial membranes. Characteristic features viral arthritis are the short duration of damage to the joints and usually the complete reversibility of the process.
In acute viral hepatitis, arthralgia often develops, less often - migratory arthritis. Both small and large joints are involved in the process. Arthralgias or arthritis may appear in the prodromal period, disappearing in the midst of jaundice. Arthritis can be combined with hives and headaches. Sometimes the articular syndrome persists for several months, simulating a picture of RA. Cases of the development of classical RA in patients with viral hepatitis are also described.
Rubella arthritis is common, predominantly in women, and in children and adults after vaccination with a live vaccine. Arthritis symptoms may be detected at the same time as the rash appears or may appear later. The most characteristic is the defeat of the small joints of the hands. The duration of arthritis is on average up to 2-3 weeks. Residual effects are usually absent, although the role of the rubella virus in the development of RA is not excluded.
With epidemic parotitis arthritis is rare (in 0.5% of patients), more often in people older than 20 years. It appears on the 8-21st day from the onset of the disease, in some patients simultaneously with the development of mumps or even before the appearance of swelling parotid glands. Usually the joints are affected in patients with bilateral parotid glands, often along with other complications (orchitis, pancreatitis). The appearance of arthritis is accompanied by a new wave of fever in the body. Swelling of the joints develops, movements become painful. The most characteristic is the defeat of large joints, but small joints of the hands and feet can also be involved in the process. The duration of arthritis is from two to several months. It ends with a full recovery.
Paraneoplastic arthropathies. Nonspecific bone and joint changes observed in malignant tumors of various localization, within the paraneoplastic syndrome, may long precede the appearance of other symptoms of the tumor (“articular masks” of tumors), develop simultaneously with them or later.
Clinical manifestations of the disease are varied. The most common are Marie-Bamberger syndrome (hypertrophic osteopathy), amyloid, dysmetabolic (gouty) arthropathies, nonspecific mono-, polyarthritis, arthralgia, tendovaginitis, myalgia.

A viral disease that occurs in the form inflammatory processes in joints and bone tissues, is called infectious arthritis.

Symptoms of the disease

Inflammation in the joints leads to:

pain;
swelling (due to the accumulation of fluid in the joint);
difficulty in movement, pain when walking;
joint redness;
an increase in temperature (the joint becomes hot as a result of the development of an infection in it).

Most often, inflammation occurs in the knee joint, and arthritis can also be hip, elbow, finger, wrist, shoulder.

Symptoms of the disease may vary, it all depends on the pathogen this disease. At fungal infection signs of inflammation are sometimes hidden, indistinct. With gonococcal viral infection As a rule, several joints are susceptible to infection at once. Almost all of the above symptoms in the patient are present and expressed quite clearly.

Causes of the disease

Infectious arthritis in children often occurs due to the development Gram-negative bacteria or staphylococci.

In adults, it is often associated with hepatitis, mumps, rubella, gonococcus, or streptococcus viruses entering the bloodstream. HIV disease also leads to arthritis. Often becomes a provocateur fungal infection and tuberculosis bacillus.

However, arthritis does not develop in every case with open injuries or acute infectious diseases. If the joint is healthy, then it can take care of itself and resist infection by producing bactericidal substances for the cells to absorb and destroy bacteria. The infection can only penetrate into an unprotected and weakened joint.

People suffering from drug addiction, alcoholism, blood diseases, bronchial asthma, arthrosis, rheumatoid arthritis, congenital immunodeficiency, diabetes mellitus, malignant tumors, osteomyelitis, the presence of boils, erysipelas, HIV, skin diseases, as well as those infected through dog or insect bites, are at risk and most susceptible to the development of infectious arthritis.

Types of arthritis and their symptoms

Arthritis usually affects the joints of the lower extremities, it can be ankle, knee, hip. Symptoms occur exactly at the site of inflammation. If the knee joint has undergone arthritis, then the patient complains of intense pain in the knee area, the inability to bend, straighten the leg. Fluid begins to accumulate in the joint cavity, when you feel the patella, you can notice its balloting, shift. If , then it is observed sharp pain under the thigh, which gives to the buttocks, groin, thighs, knees. Sometimes it hurts and it's hard to even stand on your feet. The joint looks edematous, especially in the buttocks, it starts to hurt more on palpation, the pain even radiates to the heels. This type of arthritis progresses rapidly, if left untreated, it leads to sepsis. If, then it is impossible to step on the foot, all movements become painful.

The nature of the origin of arthritis is different, inflammation can occur in acute, chronic, purulent form.

Acute arthritis is accompanied by:

rise in temperature;
pain sensations migrating from one joint to another;
redness of the skin;
swelling of the affected joint;
cartilage destruction;
changes in the joint, a violation of its functionality;
intoxication of the body, weakness, pallor of the skin, sweating, nausea;
headache, dizziness;
decrease in appetite.

As a rule, it has mild symptoms and is accompanied by:

an increase in temperature (not higher than 37.5);
non-intense pain in the joints, manifested by seizures;
weak, almost imperceptible puffiness;
when the skin over the edematous joint becomes hyperemic, becomes pale, takes the form of a small tumor.

Purulent arthritis is the most dangerous, can lead to sepsis, toxic shock. Accompanied by:

temperature rise up to 40 degrees;
a sharp drop in blood pressure;
loss of consciousness, delirium;
weak, unexpressed pulse;
pallor, cyanosis of the skin.

When these symptoms appear, emergency treatment otherwise inflammation can lead to respiratory, hepatic, cardiac, renal failure and the outcome can be unpredictable.

Against the backdrop of transferred viral diseases(rubella, measles) can develop viral arthritis. It can also develop after a severe flu that activates a gonococcal infection in the body. This arthritis is treated with antibiotics, drugs for rheumatism. With blood poisoning, development purulent infection septic arthritis may appear, caused by coccal or Escherichia coli. It usually affects large joints, is toxic in nature, leads to polyarthritis, filling the joints with serous contents. Inflammation is treated with antibiotics, indomethacin, glucocorticosteroids.

Joint disease leads to exhaustion connective tissue, fluid accumulation, inflammation, swelling of the joints. Young children cannot explain what exactly hurts them, so it can be difficult for doctors to assess the disease.

Parents should take care of the health of babies.

If swelling, redness of the legs is noticed, you should not hesitate, but see a doctor as soon as possible.

The disease may well arise as a result of hypothermia, previously transferred other infectious diseases that gave complications, blood infection, metabolic disorders, lack of vitamins and calcium in the body. Children's arthritis is treated only in a hospital setting. The disease in its advanced form can turn into a chronic form, and the child will suffer from arthritis throughout his life. In addition to drug treatment, physiotherapy, massage, exercise therapy are prescribed. In order to avoid relapses, the child must periodically undergo examinations, take tests.

Treatment of infectious arthritis

It is important to prevent complications and the development of sepsis. First, an examination is carried out, hospital treatment. The doctor chooses the tactics of treatment, while first of all it is necessary to stop the inflammatory process. An enhanced antibiotic therapy by administering drugs (cephalosporins, macrolides, aminoglycosides, penicillin) intramuscularly or intravenously.

Depending on the patient's condition with viral arthritis, antiviral drugs are additionally prescribed, antifungal drugs. The course of treatment lasts 10 days, after which tests are taken for sowing to adjust the treatment. For pain, non-steroidal painkillers are prescribed: Diclofenac, Nimesulide, Ibuklin, Ibuprofen, Ketorol, Aspirin, Analgin, Paracetamol.

If sepsis has developed, the patient is transferred to intensive care, an enhanced detoxification of the body is carried out.

Sometimes surgery is required. The inflamed joint is subjected to immobilization, i.e. complete immobility. If there is an effusion, a puncture is taken to drain the inflamed joint, pumping fluid out of it. If there is no effect and osteomyelitis is developed, the doctor can open the joint cavity, drain it, excise and remove damaged tissues, and clean the joint.

During the recovery period, warming and analgesic ointments and compresses are used at home. It is important to strengthen the immune system, make up for the lack of calcium in the body. As decoctions, it is good to drink sage, calendula, plantain, burdock, golden mustache, eucalyptus.

It is good to warm up the diseased joint, apply hot salt in a canvas bag to the leg. Good to take internally Herb tea, fruit drinks from berries, ground eggshells.

Prevention of infectious arthritis

It is important to prevent complications, relapses of the disease. Once a year, you need to be examined by a doctor, to re-examine the synovial fluid.

After the main treatment for recovery and normal functioning joints must undergo massage courses, recreational gymnastics, physiotherapy.

Multivitamins, calcium, chondroprotectors should be taken regularly. It is important to eat right, strengthen immunity, protect your health by getting rid of promiscuity, which can cause purulent arthritis. Timely undergo fluorography, vaccinate children, Mantoux test.

Arthritis is an insidious disease that has many causes and causes. When the first symptoms appear, especially in children, you should see a doctor. Only treatment for early stage will help to quickly restore the functionality of the joint and prevent further development inflammation.

> Bacterial arthritis

This information cannot be used for self-treatment!
Be sure to consult with a specialist!

What is bacterial arthritis?

Bacterial arthritis - acute inflammation joint of infectious origin. Occurs as a result of the penetration of microorganisms into the articular cavity. Another bacterial arthritis is called purulent or septic. Most frequent way the entry of a microorganism into the joint is hematogenous, that is, through the blood from an already existing focus of infection. Localization of the primary focus can be any: oral cavity (dental granuloma), lung or other organ (abscess, etc.), oropharynx (chronic tonsillitis), ENT organs (sinusitis, otitis media, etc.).

Possible causative agents of the disease

Many microorganisms can cause arthritis, but there are several specific types: gonococcal, meningococcal, erysipeloid arthritis, rat bite disease. The first two types develop as complications of the corresponding diseases - gonorrhea and bacterial meningitis. Erysipeloid develops when a person comes into contact with pigs with a specific disease (erysipeloid), which is caused by Erysipelothrix rhusiopathiae. The rat bite disease occurs, respectively, after the bite of a rat (even a domestic one) due to the specific bacteria contained in the saliva of healthy animals - Streptobacillus moniliformis.

in the risk group for this disease includes patients with pre-existing chronic diseases joints ( rheumatoid arthritis), suffering from diabetes, cancer patients, HIV-infected.

Clinical picture of bacterial arthritis

All bacterial arthritis are characterized by general symptoms, having discovered which, you should consult a doctor as soon as possible. Among them, it should be noted the acute onset of the process, the appearance of swelling, hyperemia, and soreness in the area of the affected joint. In most cases, one joint is affected, but in severe cases, oligoarthritis develops in 10% of patients, when 2-3 joints are affected. Leading in frequency of injury knee joints, hip and carpal. Elbows and ankles suffer much less frequently. The general body temperature also rises, which is accompanied by heavy sweat. Bacterial arthritis is characterized by regional lymphadenitis - inflammation of nearby lymph nodes.

How does a doctor diagnose this disease?

Diagnosis of bacterial arthritis consists in taking an anamnesis and identifying the above clinical signs. Additional information will provide general analysis blood, where signs of inflammation are determined, the study of synovial (articular) fluid - it becomes cloudy, its viscosity increases. This fluid is also cultured on culture media to identify the pathogen, but this procedure is effective only in 50-60% of cases. X-ray of the joint can reveal the narrowing of the joint space, with damage to the joint anaerobic bacteria a gas layer forms in the joint.

Possible Complications

Lack of treatment can lead to following complications: ankylosis (fusion of articular surfaces of bones and complete immobility of the joint), osteomyelitis ( purulent lesion bone tissue). In young children, limb shortening may occur after bacterial arthritis.

Basic Treatments for Bacterial Arthritis

Treatment consists in the appointment of broad-spectrum antibiotics with the indispensable sanitation of the primary focus of infection. These measures are necessary in order to avoid the development of relapses of the disease. Additionally, the joint itself is drained - joint punctures are performed daily with the removal of inflammatory exudate. Perhaps short-term splinting of the joint (ensuring its immobility) to reduce damage to the articular surfaces and prevent ankylosis. The criteria for recovery are the disappearance of signs of inflammation of the joint, the normalization of temperature.

Prevention

Prevention consists in sanitizing foci of chronic infection (treatment of carious teeth, chronic tonsillitis etc.), timely treatment of any infections, including sexually transmitted ones. People at risk are advised to adequate therapy underlying disease.