Infectious joint diseases - causes, symptoms, diagnosis, treatment methods and prevention. Symptoms and treatment of infectious arthritis

Joint pain (arthralgia) is a very common problem that can be associated with infection or toxicity, injury, inflammation or wear and tear of the cartilage.

In most cases, joint pain goes away on its own within a few days. However, some situations require contacting a doctor as early as possible. Determining exactly why joints hurt can be difficult even for an experienced specialist, since early symptoms can be deceptive, and the full picture of the disease sometimes takes only 1-2 months or more to develop.

The information provided in this article will help you navigate the variety of diseases and conditions that cause arthralgia. And modern diagnostic methods will allow you to determine the exact cause of the ailment and choose the right treatment tactics together with your doctor.

In this article we will look at situations where several joints throughout the body hurt. Sometimes one joint starts to hurt, and other joints quickly join in. It happens that the pain seems to migrate from one part of the body to another over several days or weeks. A number of diseases cause pain in a group of joints in the form of attacks - attacks, when the pain either subsides or appears again.

The causes of pain in any one joint are described in separate materials:

Joint pain due to viral infections

Most often, arthralgia occurs during various viral infections: due to the direct impact of viruses on the joints or under the influence of toxins that accumulate in the blood during the acute period of many infectious diseases.

Most often, pain appears in the small joints of the arms and legs, knee joints, and sometimes in the joints of the spine. The pain is not severe, aching. It is called joint pain. Mobility is usually not impaired, and there is no swelling or redness. In some cases, a skin rash similar to hives may appear, which quickly disappears. In most cases, viral arthralgia becomes the first symptom of illness and is accompanied by fever, muscle pain, and weakness.

Despite the deterioration in overall health, joint pain due to viral diseases is usually not a cause for serious concern. Relief can be provided by taking non-steroidal anti-inflammatory drugs, drinking plenty of fluids and rest. After a few days, the pain goes away and the function of the joint is completely restored. There are no irreversible changes in the structure of the joint.

Viral arthralgia is characteristic, for example, of influenza, hepatitis, rubella, mumps (in adults).

Reactive arthritis

This is a group of diseases in which joint pain occurs after an infection: both viral and bacterial. The immediate cause of reactive arthritis is an error in the immune system, which causes inflammation to develop in the joints, although they have not been affected by infection.

Joint pain appears more often 1-3 weeks after an acute respiratory infection, intestinal infection or diseases of the genitourinary system, for example, urethritis or sexually transmitted infections. Unlike viral arthralgia, joint pain is intense, accompanied by swelling and impaired mobility. Body temperature may rise. Arthritis often begins with damage to one knee or ankle joint. Within 1-2 weeks, pain develops in the joints of the other half of the body, and small joints of the arms and legs begin to ache. Sometimes the joints of the spine hurt.

Joint pain usually goes away with treatment or on its own, leaving no consequences. However, some types of reactive arthritis take a chronic form and worsen from time to time.

Reiter's disease- one of the types of reactive arthritis, which develops after chlamydia and can take a chronic course. Joint pain in Reiter's disease is usually preceded by disturbances in urination - a manifestation of chlamydial urethritis (inflammation of the urethra), which often goes unnoticed. Then problems with the eyes appear, conjunctivitis develops. For treatment you must consult a doctor.

Reactive arthritis can develop after adenovirus infection, sexually transmitted infections (especially chlamydia or gonorrhea), intestinal infections associated with infection with salmonella, klebsiella, shigella, etc.

Joint pain due to wear of cartilage

Diseases that are accompanied by gradual wear and tear of cartilage on the articular surfaces of bones are called degenerative. They most often occur at the age of 40-60 years and older, but they also occur in younger people, for example, those who have suffered joint injuries, professional athletes who are exposed to frequent intense exercise and in obese people.

Osteocondritis of the spine is another common degenerative disease. Its cause is the thinning and destruction of cartilage between the vertebrae. A decrease in the thickness of cartilage leads to compression of the nerves coming from the spinal cord and blood vessels, which, in addition to pain in the joints of the spine, causes many different symptoms. For example: headaches, dizziness, pain and numbness in the arms, shoulder joints, pain and interruptions in the heart, chest, pain in the legs, etc. A neurologist usually deals with the diagnosis and treatment of osteochondrosis.

Autoimmune diseases as a cause of joint pain

Autoimmune diseases are a large group of diseases whose causes are not fully known. All these diseases are united by the peculiarity of the immune system: cells of the immune system begin to attack the body’s own tissues and organs, causing inflammation. Autoimmune diseases, unlike degenerative diseases, most often develop in childhood or young adults. Their first manifestation is often pain in the joints.

Joint pain is usually of a fleeting nature: today one joint hurts, tomorrow another, the day after tomorrow a third. Arthralgia is accompanied by swelling, redness of the skin, impaired mobility in the joints, and sometimes fever. After a few days or weeks, the pain in the joints goes away, but after some time it recurs. Over time, joints can become significantly deformed and lose mobility. A characteristic sign of autoimmune joint inflammation is morning stiffness. In the first morning hours, the affected joints have to be kneaded from 30 minutes to 2-3 hours or more. The greater the load on the joint the day before, the more time you need to spend on warming up.

Gradually, arthralgia is accompanied by symptoms of damage to other organs: heart, kidneys, skin, blood vessels, etc. Without treatment, the disease progresses. It is impossible to cure it, but modern drugs can slow down the process. Therefore, the earlier treatment is started, the better the result.

If the cause of arthralgia is an inflammatory reaction, drugs that can reduce inflammation are used to treat the joints. These are, first of all, non-steroidal anti-inflammatory drugs (NSAIDs): indomethacin, ibuprofen, diclofenac, nimesulide, meloxicam and many others. If these drugs are not effective enough, drugs from the group of corticosteroids are prescribed in the form of injections into the joint cavity or tablets. When the cause of pain is infection, antibiotics are prescribed.

Special treatment regimens are used for autoimmune diseases. For continuous use, the doctor selects the minimum effective doses of drugs that can strongly inhibit the inflammatory response or suppress the immune system. For example: sulfosalazine, methotrexate, cyclophosphamide, azathiaprine, cyclosporine, infliximab, rituximab and others.

There are no specific drugs known for degenerative joint diseases (osteochondrosis, osteoarthrosis). Treatment of diseased joints consists of prescribing anti-inflammatory and painkillers during an exacerbation, as well as taking metabolic agents based on chondroethin sulfates and hyaluronic acid. Although the effectiveness of the latter is currently not recognized by all doctors.

If joint function deteriorates irreversibly, surgery is required. Currently, there are various methods of endoprosthetics that allow the implantation of artificial joints or parts thereof to replace damaged or worn ones.

Pathogenic microorganisms can settle not only on the skin, mucous membranes or internal organs, but also in the joint cavity. This phenomenon is diagnosed by doctors as infectious arthritis, which, depending on the type of pathogen, can be bacterial, viral or fungal. The disease is accompanied by swelling of the soft tissues, increased body temperature, and inflammatory processes of the musculoskeletal system.

Types of infectious lesions

Pyogenic or infectious arthritis is a disease caused by pathogenic flora entering the joint cavity. Microbes accumulate in large quantities in the synovial fluid, causing inflammation. Depending on the method of penetration, the nature of the disease and the risk factors that provoked their occurrence, joint diseases associated with the infectious process are divided into three types:

	Specific routes of infection	Risk factors
Directly infectious arthritis	bacteria, fungi or viruses penetrate the synovial fluid and affect nearby soft tissues	surgery near the joint; prosthetics; skin infection; wounds, injuries, burns.
Septic	inflammation occurs due to the presence of infection in the body, which enters the joint cavity through the blood	diseases of the gastrointestinal tract; genitourinary system; Lyme disease; venereal diseases; immunodeficiency pathologies; rubella; use of non-sterile syringes or other medical equipment. equipment; hepatitis.
Reactive	symptoms of joint damage occur 2-4 weeks after the infection, while the pathogen is absent in the synovial fluid, the cause is the body’s immune response	intestinal infections; urogenital; inflammatory diseases of the respiratory tract;
Short-term joint pain	are a symptom of another infectious disease, more often a viral one, go away on their own after treatment, while no organic damage to the joints is observed	flu; angina; Infectious mononucleosis; ARI (acute respiratory disease); pneumonia.

Bacterial joint damage

This type of arthritis most often affects children of preschool and school age, as well as older people. Bacterial joint infections occur for several reasons. On the one hand, there is the penetration and reproduction of bacteria in the synovial membrane, on the other hand, there is a decrease in the body’s immune forces. Bacteria enter the joint more often hematogenously (with blood or lymph), after recent infectious viral diseases or due to exacerbation of chronic diseases:

• tonsillitis, sinusitis;
• dental granuloma;
• pleurisy;
• infective endocarditis;
• cholecystitis or cholangitis;
• pyelonephritis;
• prostatitis;
• osteomyelitis
• brucellosis.

Viral infections

Rubella, hepatitis C or B, herpes virus, parvovirus B19 or HIV can provoke infectious diseases of the joints of viral etiology. The viruses themselves, as a rule, are located outside the joint, but cause its inflammation. The disease is often accompanied by signs of ordinary arthritis: inflammation, stiffness, pain. If the inflammation occurs as a result of hepatitis, then the arthritis will go away on its own. Depending on the patient’s age, a viral joint infection can be localized in different places:

• In children, the joint parts of the hands and metatarsal joints of the feet are more often affected.
• In adults, the knee and ankle joints become symmetrically inflamed.

Fungal infections

Fungal strains enter the joint cavity through the lymphatic or circulatory system from the initial site of infection or through open wounds on the skin. Inflammation is accompanied by swelling, purulent formations under and above the skin, fever, symptoms of general intoxication of the body. There are several types of fungal infection:

• Histoplasmosis. Infection occurs after inhalation of contaminated soil particles, animal or bird excrement. In the acute stage, histoplasmosis often occurs in the form of polyarthritis with nodular formations.
• Cryptococcosis. Infection occurs by airborne droplets. Persons with weakened immune systems and young children are most susceptible to infection. In approximately 10% of patients, cryptococcosis causes osteomyelitis.
• Aspergillosis. The second name of the pathology is hospital syndrome. The disease is so nicknamed because inflammation occurs when the fungus is inhaled by patients with weakened immune systems who are being treated in a surgical or trauma department. It is extremely rare that aspergillosis is transmitted through rotting plants.
• Actinomycosis. Fungi enter the human body through damaged skin and live on the mucous membranes of the eyes or mouth. The primary chronic course occurs with the formation of fistulas and dense granulomas, asymmetry of the limbs or face.
• Blastomycosis. The disease is diagnosed in men in 90% of cases. The fungus enters through sexual contact or through the air. Primary foci of inflammation are localized in the lungs, spine, hands, ribs, and skull.
• Candidiasis. The initial site of infection is the mucous membranes of the mouth or vagina. In the absence of proper treatment, harmful microorganisms spread to surrounding tissues, cartilage and bones.
• Sporotrichosis. Frequent routes of infection with this type of fungus are through the respiratory tract, open wounds on the body, and splinters. In 80% of cases, only one joint is inflamed.

What infections cause joint pain?

Doctors believe that all known microorganisms can be potentially dangerous to cartilage and bone tissue. Scientists were able to separately identify infections that cause inflammation of the joints in most cases:

• gram-positive aerobic bacteria;
• Staphylococcus aureus;
• streptococci;
• salmonella;
• Pseudomonas aeruginosa;
• gram-negative aerobic bacteria;
• anaerobic microorganisms - peptostreptococci, clostridia, fusobacteria, bacteroides;
• diphtheroids;
• Klebsiella;
• enterobacteria;
• tuberculosis bacillus;
• all strains of mushrooms;
• gonorrheal bacillus;
• meningococci.

Staphylococcal infection

Diseases caused by staphylococcus are the most frequently diagnosed. In addition, this opportunistic microorganism, entering the blood of patients with diabetes mellitus or rheumatoid arthritis, often leads to purulent sepsis. There are two types of staphylococcus that provoke inflammatory processes:

• Staphylococcus aureus - Staphylococcus aureus, penetrates the human body through external damage to the skin, and under favorable conditions very quickly leads to the destruction of cartilage tissue.
• Staphylococcus epidermidis - epidermal staphylococcus, is dangerous for people suffering from drug addiction and those patients who have recently undergone an endoprosthetics procedure.

Streptococci

The second most frequently detected bacteria are Streptococcus haemolyticus (group A), aerobic gram-positive bacteria of a purulent nature. The danger of β-Streptococcus is that the microbe can provoke complications of bronchitis, rheumatism, scarlet fever, myocarditis, glomerulonephritis and leads to the destruction of red blood cells. β-hemolytic streptococcus predominantly affects people with autoimmune diseases, drug addicts, patients with purulent dermatological diseases, or those who have suffered massive limb trauma.

Gonococci

Somewhat less common are Neisseria gonorrhoeae - gram-negative intracellular diplococci, causative agents of sexually transmitted diseases. Inflammation of the joints most often develops in individuals with acute or chronic forms of gonorrhea when bacteria spread through the blood from the genitourinary tract. Women are more susceptible to the disease, which is facilitated by the onset of menstruation or pregnancy. The development of gonococcal arthritis is usually divided into two phases:

• bacteremic – lasts only 2-4 days and is characterized by fever, migrating pain;
• septic – can develop asymptomatically for a long time, gradually leading to damage to the knee, ankle, elbow and wrist joints.

Gram-negative gut bacteria and respiratory infections

Haemophilus influenzae is detected by laboratory tests of synovial fluid in only 10% of cases. Gram-negative respiratory infections are diagnosed mainly in infants or children under two years of age who have lost their natural immunity, transmitted from woman to baby through mother's milk, and were transferred to artificial feeding too early. In adults, gram-negative intestinal and respiratory infections can occur for the following reasons:

• injection drug addiction;
• long-term hospitalization of elderly patients;
• weakened immunity, regardless of the patient’s age;
• genitourinary infection.

Meningococcal infection

Epidemic cerebrospinal meningitis is caused by the bacterium Neisseria meningitidis, a gram-negative bacillus that enters the skull through the nasopharynx, causing inflammation of the meninges. Often the underlying disease occurs with complications, the most common of which is arthritis. Mostly large joints are affected - knee, hip, ankle. In this case, meningococci are not detected in the synovial fluid.

Infectious diseases of the joints respond well to adequate therapy, and the symptoms of arthritis disappear on their own without residual changes in cartilage tissue. Otherwise, sepsis begins after 2-3 days. Purulent inflammation rapidly progresses, affecting parallel joints, leading to loss of the ability to move independently. When high doses of antibiotics are prescribed, joint mobility is almost always restored.

Anaerobic infections

The most common causative agent of anaerobic arthritis is the bacterium Fusobacterium spp. In most cases, the triggering mechanism is previous Simanovsky-Plaut-Vincent angina, which is often complicated by purulent thrombophlebitis of the cervical arteries and hematogenous spread of infection. With the development of pharmaceuticals and the advent of broad-spectrum antibiotics, anaerobic arthritis has become very rare, mainly in people with AIDS or patients who have had prosthetic limbs.

Factors provoking the development of the disease

Infectious joint diseases are diagnosed regardless of age group. In adults, inflammation of the lower extremities or hands is more common. In children, polyarthritis dominates with parallel damage to the knee, elbow, shoulder joints or hip area. Joint infection occurs more often in patients:

• suffering from chronic rheumatoid arthritis;
• having autoimmune diseases or systemic infections (HIV, gonorrhea);
• homosexual orientation;
• drug or alcohol addicts;
• with diabetes mellitus;
• vitamin deficiency;
• sickle cell anemia;
• systemic lupus;
• have suffered a gunshot wound, trauma, or surgery;
• with obesity;
• those who regularly experience intense physical activity (athletes, salespeople, security guards);
• with a genetic predisposition;
• with diseases of the genitourinary system.

Symptoms of infectious arthritis

Signs of the disease differ depending on the pathogen that caused the inflammation, the age and gender of the patient. Children experience the disease more acutely and cannot always describe their condition, which makes diagnosis and choosing the right treatment tactics much more difficult. In cases where symptoms of infectious arthritis appear in children, the success of therapy will depend on how quickly the parents seek medical help.

Infectious diseases of the joints provoked by nonspecific microflora (streptococci, staphylococci) are characterized by an acute onset with pronounced general symptoms - fever, chills, weakness, excessive sweating. Other signs of purulent-infectious arthritis are:

• sharp pain on palpation of soft tissues, with active movements or at rest;
• burning eyes;
• tearfulness;
• migratory arthralgia;
• conjunctivitis;
• redness of the skin at the site of pain;
• increase in local temperature;
• swelling of soft tissues.

If the body reacts too violently to the pathogen, an allergic reaction occurs, which provokes infectious-allergic arthritis. Allergenic microorganisms include infections that cause respiratory viral diseases. The symptoms of this form of pathology are similar to those described above. Arthritis of gonococcal nature manifests itself differently. It most often affects the ankle, elbow or small joints of the hands and is accompanied by:

• primary manifestations of urogenital infection;
• multiple rashes on the skin or mucous membranes - papules, pustules, petechiae;
• myalgia;
• inflammation of the connective membranes next to the tendons.

Arthritis caused by the tuberculosis bacillus is prone to a destructive chronic course. It affects large joint parts of the body - hip, knee, wrist. Changes in cartilage tissue occur gradually over 2-6 months. The symptoms are similar to general intoxication of the body (nausea, vomiting, fever, weakness) and local synovitis (accumulation of effusion in the joint cavity); sometimes “cold” abscesses occur. The slightest movements cause acute pain and muscle spasms.

Viral arthritis is characterized by a short-term course, and the inflammation goes away on its own without residual effects after successful treatment of the underlying disease. The main symptoms include swelling of soft tissues, painful movements, weakness. With gonorrhea and syphilis, symptoms of exudative oligoarthritis and syphilitic osteochondritis occur. Fungi cause mycotic lesions of bone and cartilage tissue and provoke the formation of fistulas. After the fungal form, complications often develop - osteoarthritis or bone ankylosis.

Diagnosis of diseases

If you suspect an infectious disease of the joints, you must urgently consult a doctor - a therapist, rheumatologist, infectious disease specialist, or phthisiatrician. Among the priority diagnostic measures, a visual examination of the patient, collection of complaints and anamnesis are performed. It is important to differentiate the obtained data from rheumatoid or gouty arthritis, purulent bursitis, and osteomyelitis. To clarify the diagnosis, instrumental diagnostic methods are prescribed:

• Radiography. In the early stages of infection, it helps to get a general picture of the inflammatory process; in the later stages, it helps to see the destruction of cartilage or bone tissue. If the X-ray image does not show any signs of pathology, the doctor may prescribe more sensitive diagnostic methods - ultrasound, computed tomography or magnetic resonance imaging (CT or MRI).
• Scintigraphy is a procedure performed using special radiological equipment with the introduction of a radioisotope substance into the human body. The study helps determine the exact location of the inflammatory process, assess the degree of degeneration, and exclude the presence of oncological tumors.
• Puncture of synovial fluid. If infection is present, the liquid has a cloudy tint and purulent inclusions. Analysis for joint infections reveals an increased content of neutrophils, leukocytes, and a decrease in glucose levels.
• Bacteriological culture of synovial fluid with Gram stain. The analysis helps determine the presence of gram-negative or gram-positive bacteria and their sensitivity to antibiotics. Bacterial culture is ineffective in the presence of gonococci.
• A general blood test reveals nonspecific signs of inflammation - an increase in the number of leukocytes and a shift in the formula to the left, an increase in ESR (erythrocyte sedimentation rate).
• A blood test for antibodies, genital smears, urine tests, and a cerebrospinal fluid biopsy are performed to fully verify the diagnosis.

Treatment of joint infection

In the acute period of the disease, the patient is hospitalized. Drug therapy includes the use of antibiotics, which are selected taking into account the pathogen, and detoxification measures. Among the medications, in addition to antibacterial agents, nonsteroidal anti-inflammatory drugs are prescribed, and when diagnosing tuberculous arthritis, chemotherapy drugs are prescribed. After stopping the infection, preventive measures are carried out: massage, exercise therapy (physical therapy), hardening.

Conservative treatment methods

In case of acute pain, complete immobilization of the damaged joint is carried out, fixing the limb on special spacers. After the infection subsides, physical activity is gradually resumed. In case of a purulent-inflammatory process, a drainage tube is inserted to pump out pus. To relieve pain, external agents (Bystrumgel, Voltaren Emulgel, Indomethacin) or painkillers (Ibuprofen, Analgin, Diclofenac), and local antiseptics are prescribed.

In addition to symptomatic treatment, empirical antibacterial therapy is used. If the pathogen has not yet been identified, broad-spectrum drugs are prescribed - penicillins, aminoglycosides, cephalosporins. Treatment takes a long time (from 3 to 8 weeks), but with proper drug therapy the prognosis is good - in 90% of patients the mobility of the limbs is completely restored. The issue of surgical treatment is considered only in the absence of results of conservative therapy.

Surgery

Surgical treatment is the main method of restoring the functionality of the joints in patients who are resistant to antibiotics, have damage to large parts of the body, or the joint was damaged as a result of a penetrating gunshot wound. The following surgical methods are used:

• Arthroscopy is a minimally invasive intervention; through punctures, bone growths and adhesions are removed or the affected area of ​​soft tissue is excised (synovectomy).
• Arthrodesis is a procedure for complete immobilization of a joint part of the body.
• Endoprosthetics or arthroplasty is a complete or partial replacement of a joint or its components.

How to treat infectious joint inflammation

The choice of the right medications is made by the doctor, based on the patient’s complaints, analysis results, and the individual characteristics of the patient. Preference is given to antibiotics that are effective against specific groups of microorganisms. If a fungus is detected, nonsteroidal anti-inflammatory drugs (NSAIDs) or antimycotics are prescribed. If necessary, medications are administered directly into the joint cavity.

Injections of glucocorticosteroids to relieve acute inflammation

Corticosteroids or glucocorticosteroids are steroid hormones that are normally produced in sufficient quantities by the adrenal cortex. These substances can inhibit the formation of phospholipase, disrupting the synthesis of inflammatory mediators and preventing bacteria from spreading further. They have antiallergic and immunoregulatory properties.

The drugs are administered intramuscularly, intravenously or locally (directly into the intraarticular cavity). Direct indications for injections are:

• gout;
• osteoarthritis;
• traumatic, juvenile, psoriatic or reactive arthritis;
• periarthritis of the shoulder;
• synovitis of the knees and pelvis that occurs after plastic surgery;
• systemic vasculitis;
• lupus erythematosus;
• scleroderma.

For infectious lesions, such therapy is not used, since, by inhibiting the local immune response, it promotes the spread of microorganisms. The drugs have multiple contraindications and often cause side effects from various organs and systems of the body. In order to prevent them, therapy is carried out under the supervision of a doctor and only if NSAIDs have not brought results within two weeks. As a rule, they are prescribed:

• Dexamethasone - administered intra-articularly 2 mg at a time. The drug is not used for long-term therapy.
• Prednisolone – 25-50 mg. The medicine is administered intramuscularly or intravenously only in emergency cases; during complex treatment, preference is given to Prednisolone tablets.
• Methylprednisolone is used for pulse therapy: rapid infusion of maximum doses of the drug at 500-1000 mg per administration. The course of such treatment should not exceed three days. In case of exacerbation of rheumatic diseases, Methylprednisolone is administered in a stream of 100-500 mg. When performing intra-articular injections, the solution is administered at a dose of 20-80 mg.

Antibacterial therapy

After conducting tests and establishing the type of pathogen, the doctor selects antibiotics that are effective against a specific group of microorganisms:

• If streptococci are detected, the following is prescribed:

1. Penicillin intramuscularly, intravenously or endolumbarally in dosages from 250 thousand to 60 million units.
2. Vancomycin - the dose for adults is 2 grams of the drug intravenously, every 6 hours, 500 mg.

• If staphylococci are detected, it is recommended:

1. Clindamycin for adults: 1 capsule 4 times a day every 5-6 hours.
2. Nafcillin for adults 0.25-1 g orally 6 times a day, for children 50-100 mg in 4 doses.

• For meningococcal or gonococcal infection:

1. Levomycetin 250-500 mg 3-4 r/day.
2. Ceftriaxone for meningitis - 100 mg/kg body weight 1 time per day, for the treatment of gonorrhea - 1 g once.

• Against gram-negative bacteria:

1. Every 8 hours, 1.5 mg per kg of body weight of Gentamicin is administered intramuscularly in combination with ampicillin and penicillin.

Antifungal agents

For the treatment of fungal arthritis, various antimycotic agents are used in combination with Amphotericin-B. Fungicidal preparations are selected depending on the type of pathogen:

• When treating blastomycosis, histoplasmosis or sporotrichosis, Itraconazole is prescribed. The dosage and course of treatment are chosen by the doctor; as a rule, the initial dose is 100 mg once a day, and the course of treatment is 3-6 months.
• For candidiasis, flucytosine is used intravenously, dosage is 100 mg per 1 kg of body weight.

Physiotherapy and restorative massage

Manual or hardware massage has a beneficial effect on the functionality of joints. It helps improve blood flow, has an antispasmodic and relaxing effect. Along with massage procedures for prevention, it is often recommended to undergo a course of physiotherapeutic treatment. Preferred directions are:

• laser therapy;
• magnetic therapy;
• ultrasound;
• electrophoresis;
• balneotherapy.

Folk remedies for the treatment of infectious diseases of the joints

As an aid to the treatment of infectious diseases of the joints, you can resort to traditional medicine. The following recipes are popular:

• You need to take 20 grams of horse chestnut inflorescences, pour 0.5 liters of strong alcohol (vodka, alcohol, moonshine). Cover the solution with a lid, wrap the container with foil, and put it in a dark place. Leave for 2 weeks, then rub into sore spots 1-2 times a day. The course of treatment is 1-2 months.
• Take 1 tbsp. l. chopped purslane, pour 1 liter of water. Bring the mixture to a boil, leave for 10-20 minutes, and filter. You need to take 1 tbsp of tincture. l. 3-4 times a day until complete recovery.
• Compresses with kerosene, apply moistened gauze under the film for 1-2 hours.

Video

This disease is an infectious disease of the joints. There are also other names for infectious arthritis, including septic arthritis or pyogenic arthritis. It is a serious infectious problem and is accompanied by pain, chills, fever, swelling and redness of one or more joints. The disease also causes loss of mobility in the affected joint.

If you suspect infectious arthritis, you should immediately and without unnecessary delay seek emergency medical help.

Features of infectious arthritis

Doesn't depend on age group. It occurs even in children and infants. In the adult population, the disease usually affects the joints, which bear a special weight load, in the vast majority of cases, the knees, but also the hands. Approximately 20 percent of adults seeking medical attention will experience symptoms in more than one joint.

In children, due to infection, polyarthritis mainly develops and usually affects the knee, hip and shoulder joints.

The high-risk group for this disease is::

• patients suffering from chronic rheumatoid arthritis;
• patients with serious systemic infections, including HIV, gonorrhea;
• women or men of homosexual sexual orientation;
• patients suffering from certain types of cancer;
• alcohol and drug addicts;
• patients with diabetes, systemic lupus erythematosus, sickle cell anemia;
• patients who have recently undergone joint surgery or injury;
• patients with intra-articular infections.

Causes of infectious

The disease is caused by bacterial, viral or fungal infections that enter the bloodstream and from there into the joint. However, an alternative route of infection is intra-articular injections during surgery or inside the patient at 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 catheter insertion. In children under 2 years of age, infectious arthritis is provoked by staphylococcus aureus or haemophilius influencae.

In children after two years of age, as well as in adults, the provocateur of the disease is the already familiar staphylococcus aureus, which is joined by streptococcus viridans and streptococcus pyogenes. If Staphylococcus epidermidis is involved in the process, then only during surgery. In the sexually active teenage population, the causative agent of the disease is Neisseria gonorrhoeae. In older people, infectious arthritis occurs as a result of the presence in their body of gram-negative bacteria, including Salmonella and Pseudomonas.

Symptoms of infectious arthritis

Appears suddenly. However, there are cases when the disease manifests itself within three days to two weeks. Accompanied by swelling of the affected joint. During movement, severe pain symptoms are felt. In cases of infectious arthritis of the hip joint, pain may occur in the groin area and will increase with movement. A diseased joint always reacts painfully to any touch; it may feel hot to the touch, but not always. This effect depends on the depth of the location of the source of infection. In the vast majority of cases, there will be an increase in body temperature and chills. In some cases, the temperature increases slightly.

In children, the disease may cause nausea and/or vomiting. In any case, the disease is regarded as an extremely serious threat to the patient’s health and even his life. In the worst case, complete destruction of cartilage and bone tissue can occur. There is a huge risk of developing so-called septic shock and death. For example, Staphylococcus aureus destroys cartilage tissue in just one or two days. Such destruction leads to subluxation or displacement of both the joints themselves and the bones. If infectious arthritis is caused by bacteria, there is a risk that the infection will spread to the tissues surrounding the joint or enter the bloodstream.

Accordingly, abscesses or, in extreme cases, blood poisoning should be expected. The most common complication that infectious arthritis can cause is osteoarthritis.

Diagnosis of infectious arthritis

Establishing a diagnosis of septic arthritis is possible solely on the basis of appropriate laboratory tests, as well as a subsequent thorough examination of the affected joint by the attending physician, followed by a careful study of the patient’s medical record. It is important to understand that common symptoms include:

• increased body temperature;
• pain in the stomach.

They can signal completely different diseases:

• arthritis;
• rheumatic fever;
• gout;
• borreliosis or Lyme disease.

In some cases, it may be necessary to consult an orthopedist or rheumatologist to exclude errors in diagnosing the disease.

The importance of medical history in infectious arthritis

Analysis of the patient's medical history provides the doctor with the opportunity to determine whether the patient belongs to one of the possible risk groups. Sudden pain in the joints is also important.

Medical checkup

The doctor assesses the degree of pain and swelling of the affected joint, as well as its temperature and many other indicators that are signs of an infectious process. Sometimes their location can provide a clue to the true diagnosis. For example, damage to the pelvic joints or sternoclavicular joints occurs in drug addicted patients.

Lab tests

With their help, the diagnosis of the disease we are considering is confirmed. A puncture of the joint, or in other words a puncture with a special hermetic syringe, will be required to extract a sample of synovial fluid, which is a lubricant produced by the tissues that surround the joint. Next, the withdrawn liquid will be sent to the laboratory for subsequent culture. The synovial fluid of the affected joint contains purulent flakes and is visually cloudy. Septic arthritis will be indicated by:

• high level of leukocytes (above 100 cells/mm3);
• the neutrophil proportion is more than 90 percent.

To identify the infectious pathogen, the so-called Gram stain is used. Based on the existence of gram-negative and gram-positive bacteria, the sensitivity of the antibiotics used will also depend. For this purpose, culture of the withdrawn synovial fluid is performed. If the expected result is not achieved, a biopsy and culture of synovial tissue around the joint may be prescribed.

Other tests include:

1. Blood culture;
2. Urine culture;
3. Seeding the mucus that the uterus secretes.

All of them are used as additional to puncture.

Hardware diagnostics of infectious arthritis

It is not effective in the early stages of the disease. X-rays are not able to detect the destruction of cartilage or bone tissue for 10 to 14 days from the onset of the first symptoms. However, it justifies itself in the case of a deep location of the infectious focus in the joint.

Acute infectious arthritis

When talking about infectious arthritis, it is necessary to remember the acute form of this disease. As mentioned above, the joint is damaged by microorganisms from any primary foci or by direct contact, for example, in the case of injury to the joint. The disease is provoked:

• scarlet fever;
• furunculosis;
• pneumonia;
• sore throat;
• infective endocarditis;
• peritonsillar abscesses;
• inflammation of the middle ear;
• wound infection;
• surgical intervention to organs, the genitourinary system, the abdominal cavity;
• cystoscopy.

There are cases when it is not possible to identify the primary source of infection. In dominant cases, acute infectious arthritis is observed in individuals :

1. Elderly.
2. Weakened by general diseases: blood diseases, malignant tumors.
3. Those who were on long-term treatment with immunosuppressive or corticosteroid therapy.
4. Alcohol abusers.
5. Premature babies.

From the above, it turns out that all the mentioned cases indicate the development of primary or secondary immunodeficiency.

Infectious-allergic arthritis

Occurs in both children and adults. It is an inflammatory benign allergic lesion of the joints, as a reaction of the body to various kinds of antigens, which are completely reversible in nature. Based on the above, we can safely say that such arthritis is nothing more than a manifestation of a general allergic reaction. It is worth clarifying that in most cases, children who are prone to allergies suffer from this disease.

Infectious-allergic arthritis develops under the influence of various allergens:

• pollen;
• medicinal;
• food;
• animal hair.

Has all the symptoms of acute arthritis. It is easily reversible, but can cause relapses if the causative allergen re-enters the human/child’s body or in the case of an untreated allergic disease. This type of arthritis cannot be identified with other forms of the same disease. Another name for infectious-allergic arthritis is reactive. During the course of this disease, antibodies, immune complexes and other agents accumulate in the joint tissues.

It is impossible to say anything specifically about treatment, since the entire course will be aimed at eliminating the root cause of the disease, namely removing from the body the allergens that cause such a violent reaction.

Rheumatoid infectious arthritis

The reasons for its occurrence have not been fully studied. It relates to our topic indirectly. It is believed to be caused by unspecified infectious diseases. It is also assumed that:

• flu;
• angina.

Again, infectious rheumatoid arthritis is assumed to be a complication of acute infectious arthritis. This disease is characterized by nonspecific inflammation of the joints with progressive subsequent deformation. Damage to other organs and systems of the body is observed. Occurs against the background of hypothermia, physical or mental trauma.

Symptoms are very different: from minor changes in the joints without observing a significant change to an exacerbation with subsequent deformation of the joint/joints of small limbs with subsequent thickening of the interphalangeal joints. The disease often involves the jaw joints and spine.

Infectious nonspecific arthritis

The origin of the disease is streptococcal. Develops against the background of focal chronic infection:

• tonsillitis;
• sinusitis;
• otitis;
• carious teeth;
• periapical abscesses;
• pyelitis;
• cholecystitis;
• bronchiectasis;
• prostatitis.

The development of the disease is possible under the influence:

• hypothermia;
• physical stress;
• fatigue;
• intestinal intoxication;
• seasonal catarrh.

Very often it has a pronounced allergic character. From an anatomical and clinical point of view, there are three periods in the development of the disease:

• The first period is accompanied by acute inflammatory reactions;
• II period. It is characterized by the transition of an acute inflammatory process to a subacute or chronic one;
• The third period manifests itself through the replacement of granulation tissue with scar tissue and progressive fibrosis. Also observed: subluxations and dislocations with significant and persistent limitation of the functioning of the joint/joints up to bone ankylosis.

Considering the disease in the clinical picture, its two main forms are distinguished:

• infectious nonspecific polyarthritis, acute exudative. Typical for the age group from 20 to 30 years. Already the first attack is characterized by awkwardness, stiffness of movements, slight pain, sometimes swelling, accelerated ROE;
• infectious nonspecific polyarthritis, chronic fibrous ankylosing. It develops slowly, like a chronic disease. It is most common among the female population, especially during menopause. The typical age of the disease is 40 years. There are no bright inflammatory-exudative manifestations, leukocytosis and significant increases in temperature.

Treatment consists of:

1. Finding the source of chronic infection and its sanitation.
2. Impact on the general immunobiological reactivity of the body.
3. Impact on the local inflammatory process occurring in the joints.
4. Using functional movement therapy.

Treatment of infectious arthritis

The disease requires several days of hospital treatment, which is accompanied by medication, as well as physical therapy sessions that are used over several weeks or even months.

Drug treatment

As you already know, delayed drug 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 precisely identified. After recognizing it, an antibiotic is prescribed that acts specifically on this infectious agent: bacteria or virus.

As a rule, non-steroidal anti-inflammatory drugs are prescribed in the presence of a viral infection. The course of intravenous antibiotics is about fourteen days or may last until the source of inflammation is completely eliminated. After completing the injections, the patient may be prescribed a course of antibiotics in tablets or capsules for two or four weeks.

Surgical intervention

In some cases, surgical drainage of the infected joint cannot be avoided. The same method is also applied to patients who are insensitive to antibiotics or have affected joints that are difficult to access for puncture (hip). If infectious arthritis is caused by a gunshot or any other penetrating wound, this method cannot be avoided.

If the patient has a severe form of damage to cartilage or bone tissue, then even reconstructive surgery may be necessary, which can only be performed after complete recovery.

Medical observation of a recovering patient and concomitant therapy

During the period of inpatient treatment, the patient is under constant and careful supervision of the attending physician. Every day, synovial fluid is sampled for culture to monitor the body's response to the antibiotics used. Based on the fact that infectious arthritis is always accompanied by severe pain, the patient is prescribed painkillers, and compresses are applied to the affected joint. In rare cases, immobilization is used by placing a splint on the arm or leg to prevent accidental movements of the joint. After immobilization is completed, the patient must undergo a special course aimed at expanding the range of motion before the onset of pain.

Infectious arthritis, also called septic arthritis or pyogenic arthritis, is an inflammatory process in the joint fluid or joint tissues, which is a serious infectious disease of the joints.

Infectious arthritis is associated with the direct entry of infectious agents into the joint tissue during injury due to their lympho- or hematogenous introduction or the formation and deposition of immune cells in the joint tissues that cause inflammation. When considering a joint disease such as infectious arthritis, it is important to consider various factors, namely:

INFECTIOUS ARTHRITIS - SYMPTOMS.

Symptoms of infectious arthritis depend on the type of pathogen, but there are some that are characteristic of all types. Most often, infectious arthritis begins suddenly. Symptoms of infectious arthritis may resemble intoxication. Chills, increased local and body temperature, headache, nausea, and possible vomiting may be observed. The joint swells, the size of the swelling gradually increases, the contours change, the pain intensifies with touch and movement, and mobility is limited.

Viral forms of infectious arthritis affect large joints and disappear immediately after the underlying disease is cured.

INFECTIOUS ARTHRITIS - CAUSES OF APPEARANCE.

Toxic-allergic infectious arthritis is characterized by inflammation of the synovial membrane and pain in many joints, but occurs without significant changes in the joints.

Bacterial-metastatic infectious arthritis is characterized by severe damage to one or more joints with infection spreading into the synovial fluid.

INFECTIOUS ARTHRITIS - DIAGNOSIS.

The diagnosis of infectious arthritis is made based on laboratory tests, a thorough medical examination of the affected joint, and a careful review of the patient’s medical record. In some cases, the doctor is forced to consult an orthopedist or rheumatologist to rule out an error in diagnosis.

Hardware diagnostics of infectious arthritis is ineffective in the early stages of development. X-rays do not detect bone or cartilage destruction until 10 to 14 days after symptoms begin. Obtaining any images can only sometimes be effective if the source of infection is in a deep joint.

Carrying out punctures of synovial fluid and biopsy examination is of great importance for making the correct diagnosis of infectious arthritis.

INFECTIOUS ARTHRITIS - TYPES.

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

If we consider the number of inflamed joints, infectious arthritis is divided into:

Infectious arthritis is monoarthritis.

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

Infectious arthritis - polyarthritis.

This type of 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.

Depending on the form of its occurrence, infectious arthritis is divided into:

Infectious arthritis is acute.

Acute infectious arthritis is characterized by severe pain, fever, redness of the skin and swelling of the affected one or more joints. Presence of intra-articular effusion. There is a violation of the mobility of the joints in which the inflammatory process occurs. The general condition is accompanied by debilitating fever. This lightning-fast reaction is explained by the fact that in acute infectious arthritis, the body’s rapid response is activated in the form of a systemic pathological reaction to severe infectious infection by pathogenic microbes. An infectious agent entering the joint space causes infectious-toxic shock. Humoral immunity is turned on. With this type of infectious arthritis, the joints can become completely deformed within 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, increased local temperature, minimal or no hyperemia of the skin over the joint, and pain. Usually one joint is affected. A long course and lack of effect of antibacterial therapy suggests a mycobacterial or fungal nature of the process.

According to the method of entry of the pathogen into the joint area, infectious arthritis is divided into:

Primary infectious arthritis.

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

Infectious arthritis is secondary.

Secondary infectious arthritis is characterized by the fact that the disease begins after infection enters the joint area through the lymph. That is, the development of secondary infectious arthritis occurs when the infectious process spreads to the joint from surrounding tissues or distant purulent foci. The knees, shoulders, wrists, elbows, fingers and hip areas are most often affected.

Infectious arthritis can be divided into different types depending on the type of infectious agent, namely:

Infectious arthritis brucellosis.

Infectious arthritis of this type is a common manifestation of brucellosis infection. A characteristic feature of brucellosis arthritis is inflammation of the sacroiliac joints. Usually it is one-sided. Inflammation in infectious arthritis of this type also occurs in the ankle, knee, wrist, elbow, shoulder joints, sternoclavicular joint and lumbar spine. Particularly characteristic of brucellosis infectious arthritis is simultaneous inflammation of the lumbar spine and sacroiliac joints. In the acute stage of the disease, antibacterial therapy is carried out in accordance with the treatment of brucellosis, during periods of remission it is necessary to carry out massage, exercise therapy, and spa treatment.

Infectious arthritis is viral.

Viral infectious arthritis sometimes develops with viral diseases. It can appear during any period of mumps, rubella, measles and other viral diseases. Arthritis rarely develops with the flu. It is characterized by pain in the joints and muscles, which are associated with intoxication of the body. However, influenza can activate a coccal or other infection in the body. Treatment of viral infectious arthritis is carried out with antibiotics or sulfonamides in accordance with the underlying disease, as well as antirheumatic drugs.

Infectious arthritis gonorrheal.

Gonorrheal infectious arthritis can develop with acute or chronic gonorrhea. It mainly affects young people. The onset of gonorrheal arthritis is almost always acute, with very severe pain in the joints. The arthritis then usually becomes concentrated in one joint, usually the ankle, knee or wrist. All forms are accompanied by excruciating pain, high fever, and a general serious condition of the patient. Pathological changes in the joint quickly develop: deformation, persistent limitation of flexion movements, muscle atrophy. In the acute stage of gonorrheal infectious arthritis, a course of antibiotic therapy, sometimes corticosteroids and autohemotherapy is required. During periods of remission, massages, exercise therapy, and spa treatment are useful.

Infectious fungal arthritis.

Fungal infectious arthritis is possible with radiofungal disease, maduromycosis, blastomycosis and sometimes with coccidiosis. The joint is usually affected from a nearby focus of mycosis of the bone. Sometimes the spread of infection can occur through the blood and affect joints and bones far from the primary site. Fungal infection of bones and joints is characterized by the formation of fistulas and a long course. Treatment of fungal infectious arthritis is carried out with antibiotics or sulfonamides, sometimes surgical removal of the lesion is necessary.

Infectious arthritis dysentery.

Dysenteric infectious arthritis can rarely develop immediately after dysentery or several weeks later. Characterized by severe pain in the joints, swelling and deformation. The sacroiliac joints are often susceptible to inflammation. Dysenteric arthritis is usually curable, but in a chronic course, deformation and fibrous restriction of joint mobility may develop. Treatment of dysenteric infectious arthritis involves antibiotics and sometimes corticosteroids.

Infectious arthritis of this type develops when bones are damaged by echinococcus. Typically, echinococcus is localized in the spine. Long tubular bones and pelvic bones are less commonly affected. Joint pain is usually associated with toxicosis or allergies due to processes in nearby bone tissue. Treatment specific for echinococcosis.

Infectious arthritis pneumococcal.

This type of infectious arthritis can be caused by lobar pneumonia in children or young adults. Purulent bacterial-metastatic arthritis of the legs or arthritis of the foot is usually concentrated in one joint - the knee or ankle. Treatment of pneumococcal infectious arthritis is carried out in accordance with acute purulent arthritis. The toxic-allergic form affects many joints, but is characterized by a mild course and complete reversibility of all processes. Does not require specific treatment.

Infectious arthritis septic.

Septic infectious arthritis can develop with a general purulent infection in the body. Usually caused by Escherichia coli, coccal microflora, etc. When toxic-allergic in nature, it occurs in the form of acute or subacute migratory polyarthritis with a small serous or serous-fibrinous effusion and the reversibility of all processes. Treatment of septic infectious arthritis consists of antibacterial therapy of sepsis with anti-inflammatory drugs.

Infectious arthritis syphilitic.

Syphilitic infectious arthritis occurs rarely, but can appear with congenital syphilis or at any stage of acquired syphilis. The course of syphilitic infectious arthritis depends on the severity of the underlying disease. Treatment specific for syphilis.

Infectious arthritis tuberculous.

The form of tuberculous infectious arthritis can be toxic-allergic and bacterial-metastatic. The tuberculosis bacillus usually enters the joint through blood from the primary focus. Often a tuberculosis infection spreads to the joint from the adjacent bones. Tuberculous infectious arthritis is a chronic disease, its course is associated with general intoxication of the body and local synovitis. Lack of treatment or poor quality treatment of osteoarticular tuberculosis complicates the disease by the appearance of an abscess, which, breaking out, leaves behind fistulas that do not heal for a long time.

INFECTIOUS ARTHRITIS - TREATMENT.

Treatment of infectious arthritis is usually carried out in a hospital. The complex of therapeutic measures includes resting the joint and puncture of its cavity, followed by treatment. Treatment of infectious arthritis, depending on the type and severity of the disease, is carried out using various methods:

Infectious arthritis is treated with medication.

Drug treatment of infectious arthritis in the early stages involves the prescription of broad-spectrum antibiotics and non-steroidal anti-inflammatory drugs. If treatment is delayed, there is a risk of serious joint damage and other complications. Therefore, intravenous antibiotics should be started immediately, even before the causative agent of the infection is accurately identified. After identifying the causative agent of the infection, the doctor can prescribe a medicine that specifically affects these bacteria or viruses. Nonsteroidal anti-inflammatory drugs are usually prescribed for viral infections. The prognosis with proper treatment is favorable. Inflammation of the joint can end without residual effects.

Infectious arthritis - surgical intervention.

In some cases of infectious arthritis, surgical drainage of the infected joint is necessary. This applies to patients who are refractory to antibiotic treatment, or who have lesions in the hip or other joints that are difficult to access, as well as if infectious arthritis is caused by various wounds. Patients with severe bone and cartilage lesions may require reconstructive surgery, but surgery should only be performed once the infection has completely resolved.

Infectious arthritis - physiotherapy.

In parallel with medications in the treatment of infectious arthritis, the doctor may prescribe physiotherapeutic procedures.

Infectious arthritis - physical therapy

Physical therapy for infectious arthritis is mandatory, since without it the joint can become stiff. Loading the joint with physical therapy exercises should be done gradually and performed slowly with a small amplitude, gradually increasing it.

INFECTIOUS ARTHRITIS - PREVENTION.

Some types of infectious arthritis can be prevented by appropriate lifestyle choices: abstinence from drug use, abstinence or monogamous sexual relationships, and prompt evaluation and treatment if gonorrhea is suspected.

Infectious arthritis occurs at any age, and different ages have their own characteristics of the lesion and “favorite” pathogens. For adults, damage to the joints of the hands or knees, which experience the most intense stress, is typical. Usually one joint is affected, and only 1 in 5 patients develop polyarthritis. Children are more likely to have multiple joints affected, usually the knees, hips and shoulders.

Infectious arthritis (septic, pyogenic) is a severe infectious lesion of the joint, manifested by severe pain, hyperemia and swelling of the joint, and accompanied by general symptoms of intoxication (high fever, chills, headache). Simultaneous damage to several joints is often observed.

Infectious arthritis can be associated with direct entry of the pathogen into the joint (infectious arthritis itself) or develop after infection due to the deposition of immune complexes in the joint tissues - post-infectious arthritis (for example, arthritis with viral hepatitis, chlamydia, meningococcal infection). Reactive arthritis is not classified as infectious, since although there is a connection with a specific infection, neither the pathogen nor its toxins are detected in the joint cavity.

Depending on the method of entry of the pathogen into the joint, there are primary (the pathogen immediately enters the joint) or secondary (the pathogen is transferred from another source of infection in the body with blood or lymph) infectious arthritis. Moreover, it is not always possible to find the primary source of infection.

Infectious arthritis is a life-threatening condition that requires emergency medical attention.

• chronic arthritis of various origins (rheumatoid, psoriatic, gouty and others);
• systemic infectious diseases;
• primary and secondary immunodeficiency conditions (including HIV infection);
• oncological diseases;
• alcoholism and drug addiction;
• intra-articular injections;
• injuries or surgical operations on joints;
• diabetes;
• systemic connective tissue diseases (systemic lupus erythematosus and others);
• sickle cell anemia;
• therapy with hormonal drugs, cytostatics.

Etiology and pathogenesis of infectious arthritis

Infectious arthritis can be caused by viral, bacterial or fungal infections. Typically, the pathogen enters the joint from another source of infection (including chronic tonsillitis, diseases of the oral cavity) through the bloodstream or lymph (secondary infectious arthritis), less often it penetrates directly from the outside as a result of intra-articular injections, surgical manipulations or injuries (primary infectious arthritis ).

The etiology may vary among different age groups. For example, newborns and infants are more likely to become infected from their mother. In children under 2 years of age, the disease is often caused by Haemophilus influencae or Staphylococcus aureus. In older adults, the cause of the disease is usually Staphylococcus aureus, group A β-hemolytic streptococcus (Streptococcus pyogenes) and Streptococcus viridans.

During surgical operations, infection usually occurs with epidermal staphylococcus (Staphylococcus epidermidis), which belongs to the opportunistic microflora and normally inhabits the skin. In adults, arthritis can often be caused by gonococcus (Neisseria gonorrhoeae), which is sexually transmitted. In old age, arthritis can often be caused by gram-negative microflora (including salmonella or Pseudomonas aeruginosa).

Viral particles can cause joint damage in people of any age. Most often these are rubella viruses, mumps, hepatitis B, and parvoviruses.

Mycobacterium tuberculosis and fungal infections usually lead to a chronic course of infectious arthritis, and fungal infection occurs in people with significant defects in the immune system.

• sudden, very rarely – gradual onset (up to 2-3 weeks);
• symptoms of intoxication (temperature usually above 38ºС, chills, pain in joints and muscles, headache, in children - nausea and vomiting);
• sudden swelling of the affected joint, which gradually increases, causing a change in the contours of the affected joint;
• severe pain when moving (if the hip joint is affected, the pain can be localized in the groin area and intensifies when trying to walk), touch;
• restriction of movement, forced position in a joint;
• there may be a local increase in temperature over the affected joint (the joint becomes hot to the touch);
• rarely – involvement of small joints in the process;
• in old age, symptoms may be “erased.”

Let us consider the features of the course of the most common infectious arthritis of various etiologies.

Gonococcal arthritis

Occurs most often 2-4 weeks after the onset of symptoms of gonorrhea (acute gonococcal urethritis). If the disease is accompanied by the presence of prostatitis, chronic urethritis or cystitis, then joint damage may develop much later.

The process usually involves one or two joints, less often – more. Characterized by damage to the knee, ankle, elbow and wrist joints, metatarsal and tarsal joints.

The beginning is sharp. Severe pain in the joints, exudation phenomena. The skin over the affected joint becomes hyperemic. There may be pain in the heels due to osteoperiostitis of the calcaneus, subcalcaneal bursitis, and Achilles bursitis.

The disease early leads to the development of muscle atrophy, destruction of bones and cartilage, and ankylosis.

Diagnosis is not difficult if gonorrhea is suspected in time.

Therapy is associated with the treatment of the underlying disease and the prescription of non-steroidal anti-inflammatory drugs.

Tuberculous arthritis

Its occurrence is associated with the introduction of Mycobacterium tuberculosis from another focus with lymph flow into the articular ends of long tubular bones. In places where microorganisms “settle”, osteitis is formed, which undergoes caseous necrosis with the formation of a sequestrum (a dead area of ​​bone tissue) or with its breakthrough into the joint cavity or onto the surface of the skin.

There are primary bone and primary synovial forms of joint tuberculosis. Typically the hip, knee, ankle and wrist joints are affected.

It proceeds sluggishly, hidden, and can “masquerade” as other diseases for a long time. There may be no pain, or it may be unexpressed “aching.” Gradually it becomes more intense, local swelling appears over the affected joint. General symptoms of intoxication predominate: weakness, lethargy, low-grade fever (up to 38ºC), sweating.

Often leads to the development of muscle atrophy and joint deformation.

Tuberculosis is also characterized by reactive infectious-allergic polyarthritis (Poncet rheumatoid). Its course resembles that of true rheumatoid arthritis, and its severity depends on the activity of the tuberculosis process in other organs.

In diagnosis, it is important to promptly suspect the course of tuberculosis, since radiological signs of arthritis may appear months after the onset of the disease.

Treatment of tuberculous arthritis is carried out by a phthisiatrician with the prescription of specific drugs against Mycobacterium tuberculosis.

In recent years it has become less and less common. This arthritis usually occurs in middle-aged and elderly people with brucellosis.

Polyarthralgia or arthritis with synovitis are characteristic. Large joints are most often affected, causing bursitis and fibrositis. The spine may be involved, mainly the lumbar region (unilateral or bilateral sacroiliitis, spondylitis, osteochondritis). Joint deformity is not typical.

The diagnosis is usually straightforward and is made on the basis of the clinical picture of brucellosis, specific tests (positive Wright and Burnet reactions) and radiographic data (the appearance of marginal erosions on the anterior-superior surface of the intervertebral discs, which are later replaced by bone growths, destruction of the discs and narrowing of the intervertebral discs). cracks and other changes).

Antibiotic therapy, nonsteroidal anti-inflammatory drugs, and desensitizing drugs are indicated.

After starting treatment, the inflammation usually resolves within a few months, but the pain may persist for a considerable time.

Characteristically, there are concomitant symptoms of the disease (erythema migrans, intoxication, enlarged spleen and lymph nodes, neck and back stiffness, muscle pain, radiculitis, neuritis, and others), as well as a history of a tick bite. Arthritis occurs suddenly between 2 weeks and 2 years after the onset of the disease. One joint is affected. Chronicity of the process and destruction of the joint are rare.

Diagnosis is based on a characteristic clinical picture and detection of antibodies to the pathogen.

Yersinia, dysentery and salmonella arthritis

Yersinia arthritis develops 1-3 weeks after the onset of intestinal syndrome (abdominal pain, diarrhea). Dysenteric and salmonella arthritis develop at 2-3 weeks of illness.

Combined with other symptoms of the disease. Usually several joints are affected (usually large joints of the legs, acromioclavicular and sternoclavicular joints, spine, sacroiliac joints). The distal joints of the first toes and hands are often affected (unlike rheumatoid arthritis).

Intense pain occurs in the affected joints. Pain may also occur in other joints. Tenosynovitis or tendoperiostitis may occur in the area of ​​the ankle, wrist and shoulder joints. With a prolonged course, unilateral sacroiliitis appears.

First of all, the underlying disease is treated.

They can develop with viral hepatitis, rubella, and mumps.

With rubella and viral hepatitis, the damage usually occurs as a type of polyatritis, reminiscent of rheumatoid. The occurrence of tenosynovitis is characteristic. With mumps, one or two joints are usually affected, usually large ones.

With viral hepatitis, the duration of arthritis is up to several months; they disappear on their own and without consequences immediately after the appearance of jaundice.

Treatment includes therapy of the underlying disease, non-steroidal anti-inflammatory drugs.

The prognosis is usually favorable, the disappearance of all symptoms of the disease occurs from 2 weeks to 2 months.

Can develop with opisthorchiasis, strongyloidiasis, dracunculiasis, hookworm, schistosomiasis, echinococcosis, filariasis, wuchereriosis, loiasis, onchocerciasis, brugiosis.

More often develops in the acute stage of the disease. Polyarthralgia and polyarthritis occur. Combined with polymyalgia. Characteristically, small joints of the hands and feet are affected. Articular syndrome is always combined with other symptoms of the disease (rash, itching, eosinophilia).

Complications of infectious arthritis

Septic arthritis is a life-threatening condition and requires emergency medical care. It can quickly lead to the destruction of articular cartilage (for example, Staphylococcus aureus can destroy cartilage in 1-2 days) and bone tissue, the formation of new abscesses, septic shock and death.

The most common complications of infectious arthritis can be:

• (during the transition of the inflammatory process to soft tissues);
• osteoarthritis (if bone tissue is involved in the process);
• the formation of “” pus, which can open on their own (when the joint capsule ruptures and pus spreads through the tendon and intershell spaces);
• damage to other joints (development
  1. The main diagnostic criterion is the characteristic clinical picture of the disease, which quickly and accurately leads to the correct diagnosis. Other studies are used to confirm it.
  2. Laboratory studies: “inflammatory changes” are characteristic in general and biochemical blood tests, immunological studies: an increase in the number of leukocytes with a shift of the formula “to the left”, acceleration of ESR, an increase in C-reactive protein, shifts in protein fractions and others.
  3. Puncture of the affected joint is indicated, followed by microscopic and bacteriological examination of the resulting puncture.
  4. X-ray examination can be used no earlier than 10-14 days from the onset of the disease, since it does not reveal the destruction of bones or cartilage earlier. First, epiphyseal osteoporosis occurs, and then - narrowing of the joint space. In advanced cases, destruction of cartilage and bone occurs, and secondary deforming osteoarthritis occurs. In some cases, an x-ray may not reveal any changes in the joint at all.

  Treatment should be started promptly to prevent irreversible joint damage and complications. Usually treatment is inpatient. Complete rest of the affected joint is indicated for 1-2 weeks.

  In addition to drug therapy, it may be recommended to apply compresses to the affected joint, and in some cases, immobilize the affected joint to prevent accidental movements in it.

  After discharge, continued treatment on an outpatient basis, courses of physiotherapy, physical therapy to develop movements in the joint are indicated.

  Drug therapy

  
  

  1. Antibiotic therapy. Usually begins with intravenous (at least 2 weeks) and/or intra-articular administration of drugs, then continued oral antibiotics (from 2 to 4 weeks).
  2. Non-steroidal anti-inflammatory drugs. Prescribed to reduce pain and symptoms of intoxication.
  3. Surgical intervention. If there is pus in the joint cavity, its drainage is indicated, followed by the introduction of antibiotics orally.

  Prognosis of infectious arthritis

  If treatment is started in a timely manner, it is favorable. Destruction of cartilage and bone can subsequently lead to subluxation of joints and bones.

  The later the patient goes to the hospital, the higher the risk of irreversible changes in the joint and the development of complications.

  Prevention of infectious arthritis

  Some types of arthritis can be prevented by sanitation of foci of chronic infection (including chronic tonsillitis, caries) and timely treatment of acute infectious diseases, giving up bad habits.