Joints are in danger. What are infectious arthritis?

General information about the disease

Infectious arthritis is inflammation of a joint caused by a local or general infection. The symptoms of the disease and its course largely depend on the infection that caused the infectious process.

Codes for infectious arthritis according to ICD-10:

• staphylococcal - M00.0;
• pneumococcal - M00.1;
• streptococcal - M00.2;
• caused by other specified bacterial pathogens - M00.8;
• pyogenic unspecified - M00.9;
• tuberculosis – M01.1;
• gonococcal - M01.3;
• viral – M01.5.

The disease is very common and can cause permanent impairment of joint function. A quarter of patients seeking treatment for joint diseases suffer from infectious arthritis.

Causes of infectious arthritis

The cause of the disease is infection - a purulent infection from nearby foci (cellulitis, abscesses) or carried through the bloodstream in cholecystitis, tonsillitis, as well as general infectious diseases. When infectious pathogens enter the joint, the immune system begins to fight them, causing an inflammatory process, the course of which is directly related to the characteristics of the infectious pathogen.

Inflammation can be:

• nonspecific
  - that is, have general symptoms characteristic of inflammatory processes; such processes are caused by pyogenic pathogenic and conditionally pathogenic microflora - staphylococci, streptococci, Pseudomonas aeruginosa and Escherichia coli, etc.; the inflammatory processes they cause are usually of an acute purulent nature and occur acutely, especially in children;
• specific
  - with such inflammation, both general symptoms characteristic of all arthritis and symptoms characteristic of this infection develop; Such infections include tuberculosis, brucellosis, gonorrheal, viral, fungal, parasitic inflammatory processes.

Infectious arthritis has two development mechanisms:

• bacterial-metastatic
  - inflammation begins due to the presence of infection in the joint;
• toxic-allergic
  – inflammation develops due to general intoxication and an inadequate immune response to the introduction of infection into the body;
• mixed
  - both mechanisms operate.

Factors predisposing to the development of infectious arthritis: bad habits, heavy lifting, excess body weight, diabetes. Purulent joint lesions develop especially often in women suffering from rheumatoid arthritis.

Symptoms of infectious atritis

Infectious arthritis usually begins and progresses acutely, sometimes subacutely. But with some specific infections it has an imperceptible onset and a long course.

Onset of the disease and first symptoms

With an acute onset, the main symptoms of infectious arthritis are: severe fever, chills, flying muscle-joint pain combined with severe pain in the affected joint, swelling and hyperemia of the skin over it. Infectious arthritis in children is almost always acute.

The subacute course has a less noticeable onset, the body temperature is normal or subfebrile. Swelling, hyperemia and joint pain are moderate.

The most dangerous is the hidden, imperceptible course characteristic of tuberculous arthritis. Characterized by vague pain in the joints, crunching, decreased motor activity. The disease occurs against the background of tuberculosis, a slight increase in temperature may also not attract attention, so tuberculous arthritis is rarely detected in the early stages.

Pain and swelling are characteristic of the initial stage of infectious toxic-allergic arthritis in children and adults

Obvious symptoms

Acute purulent arthritis develops very quickly, the condition worsens every day, fever, swelling, hyperemia and pain increase. It is possible that the patient will require surgical care.

With a slower course, the symptoms of infectious arthritis develop gradually, general malaise and weakness appear, joint pain becomes constant, intensifying with movement. The function of the limbs is gradually impaired: difficulties appear in their flexion or extension.

When to Seek Medical Help

You should consult a doctor if the following symptoms appear:

• persistent or regularly recurring joint pain;
• the appearance of fever, malaise in combination with joint pain;
• swelling, hyperemia of the skin over the joint in combination with fever in patients already suffering from chronic arthritis - perhaps an infection has joined the existing chronic inflammation;
• the appearance of joint pain in pulmonary tuberculosis, gonorrhea, brucellosis and other infectious diseases.

Treatment of the disease

In addition to antibiotics, the patient is prescribed a course of vitamins, which will help strengthen the immune system.
Therapy against fungal diseases is prescribed only after identifying the causative agent of the pathology. Infection of joints with mycosis is treated with large doses of narrow-spectrum antibiotics. Such drugs help destroy beneficial microflora in the body, so you need to take probiotics in combination with them. If the patient has severe joint pain, the doctor prescribes NSAIDs. To strengthen the immune system, it is recommended to take a course of vitamins. The patient needs to reconsider his diet; following a diet will contribute to recovery. It is important to add fresh fruits and vegetables to your diet; they will help remove toxins and waste from the body.

As an auxiliary therapy, doctors recommend exercise therapy, therapeutic massages, and physiotherapy.

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Dangers

The disease is often severe, with complications.

Stages of the disease

The course of the disease is associated with its clinical form, so the stages of development of the pathological process can have significant differences. Let's consider the stages of development of acute purulent arthritis, developed by the Research Institute named after. Vishnevsky:

• Initial
  – purulent process without destruction of intra-articular tissues:
  A.
  - without damage to periarticular tissues;
• V.
  – with the development of purulent processes in adjacent tissues.
• Expanded
  – purulent arthritis with destruction of intra-articular tissues:
  A.
  - without damage to periarticular tissues;
• V.
  – with purulent lesions of the surrounding soft tissues.
• Launched
  – with damage to bone and cartilage tissue:
  A.
  - without damage to surrounding tissues;
• V.
  – with purulent lesions of these tissues;
• S.
  – with the release of pus to the surface of the body (fistulas).
• Final
  :
  in the absence of adequate treatment
  - destruction, joint immobility, disability;
• with proper treatment
  , complete or partial restoration of limb function.

Any form of arthritis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

Possible complications

Infectious arthritis can cause early and late complications. Early complications include mainly complications of purulent arthritis:

• suppuration of periarticular tissues;
• generalization of infection, sepsis.

Long-term consequences include loss of limb function of varying degrees: from mild to complete immobility.

Complications can only be avoided if you consult a doctor in a timely manner.

Timely diagnosis is a chance to prevent consequences

In order for the doctor to prescribe correct and effective treatment, it is necessary to determine what type of fungus has affected the body. The specialist must diagnose the diseased joint, take a sample of the synovial fluid, culture the microflora, and examine it under a microscope. Before starting therapy, it is necessary to exclude other diseases with similar symptoms. For this purpose, radiography is done.

• What to do when your hand joints hurt

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Classification

The origin and symptoms of infectious arthritis of different clinical forms have both similarities and differences. Let's look at the most common forms.

Acute purulent

Acute purulent arthritis of the knee joint

This form of the disease develops when a pyogenic infection (Pseudomonas aeruginosa, staphylococci, streptococci, etc.) gets into the joint. Infection can be primary in wounds and secondary - when infection spreads from surrounding tissues or distant foci of infection. People suffering from rheumatoid arthritis, especially women, are at risk.

The disease begins acutely and progresses severely. Fever, headache, chills appear. The affected joint swells and the skin over it turns red. The pain is so severe that the patient cannot move the limb and tries to give it a position that causes the least pain.

Without timely assistance, the articular surfaces quickly collapse, limiting the mobility of the limb. With adequate treatment, complete recovery occurs.

Septic

It develops against the background of already existing sepsis - a generalized infectious process. The infection enters the joint cavity through the hematogenous route - through the bloodstream. The disease can occur in the form of:

• bacterial-metastatic form with symptoms of acute purulent arthritis
  - the patient’s condition can be extremely severe; the prognosis of the disease depends on timely treatment;
• toxic-allergic form
  - the course is not always acute, often occurs subacutely with multiple lesions of the joints of a migrating (alternating) nature; the process is non-purulent in nature and ends with recovery against the background of cure of sepsis.

Tuberculous

Arthritis in this case also occurs in the form of bacterial-metastatic and toxic-allergic forms. In the first case, the spine and large joints of the limbs are mainly affected, and the disease is called osteoarticular tuberculosis. It initially proceeds chronically with increasing pain during movement and general malaise. The main changes are visible on x-rays in the form of damage to the joint bone tissue from the appearance of a spot with loss of calcium in the bone to bone destruction. If left untreated, it leads to disability.

The toxic-allergic form, first described by Ponce at the beginning of the 20th century, is very similar to rheumatoid arthritis with a chronic onset and damage to the small joints of the hands and feet. Their destruction and disability are also possible. Damage to large joints sometimes occurs without consequences and resolves with anti-tuberculosis therapy.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

Gonorrheal

Damage to joints by gonococcal infection can have bacterial-metastatic and toxic-allergic forms. In both cases, large joints are affected, most often one knee (ankle, wrist). The disease is acute, with high fever, intoxication and severe joint pain. The knee swells, turns red, and is impossible to touch because of the pain.

With timely treatment, the disease has a favorable outcome. If left untreated, complete immobility of the limb quickly sets in.

Borreliosis

Borreliosis or Lyme disease is an infection caused by spiral-shaped bacteria called Borrelia spirochetes. It is transmitted by ticks and occurs in a succession of stages:

1. 1-2 weeks after a tick bite, an increase in body temperature, intoxication, muscle stiffness and the appearance of redness on the body at the site of the tick bite - erythema, surrounded by concentric rings, spreading to large areas of the body. With timely administration of antibacterial therapy, the disease can end at this stage.
2. It develops 1–3 months after the onset of the disease and manifests itself in the form of lesions of the nervous system (meningitis, neuritis with acute pain) and the heart (heart block, myocarditis, etc.).
3. Joint damage begins six months (sometimes 2 years) after the onset of the disease in genetically predisposed people and occurs in the form of severe joint pain, a benign recurrent inflammatory process that occurs as an infectious-allergic arthritis with asymmetric damage to 1 - 2 joints (most often the knee) and ending after a few years with recovery in most patients. But in some patients the disease can become chronic with gradual impairment of limb function.

The initial stage of borreliosis is erythema migrans and stage 3 is chronic arthritis of the knee

Viral

Develops against the background of various viral diseases:

1. Parvovirus infection caused by parvovirus B19
   - the disease occurs with intoxication, fever, skin manifestations in the form of red spots, papules raised above the skin and pinpoint subcutaneous hemorrhages. At the same time, symmetrical damage to the joints occurs. Small joints of the hand, wrist, elbow, knee, and ankle joints may be involved. Symptoms are similar to rheumatoid lesions, but last from 3 months to a year and have a favorable outcome.
2. Rubella
   – arthritis develops more often in adult women against the background of existing symptoms of rubella or before their appearance. Such lesions are rare in children. The periarticular tissues swell, turn red, and severe pain appears, disrupting joint function. The lesion is asymmetrical with the involvement of small joints of the hand, wrist, knee, and elbow joints. Arthritis lasts two to three weeks, after which complete recovery occurs.
3. Viral hepatitis B and C
   - arthritis develops quite often, but has a benign course and ends with complete recovery. Small joints of the hand, elbows, ankles and, less commonly, other joints are affected. Inflammation in the joints usually begins before the appearance of jaundice and ends during its peak.

Causes and types of fungal infection of joints

Pathogenic microorganisms enter the human body with a severe weakening of the immune system and a decrease in protective functions. Patients with drug addiction, cancer, during the postoperative period, and after taking large doses of antibiotics are at risk. The fungus that affects the body enters through damaged epidermal tissue after surgery or prosthetics. Pathological processes reduce the body's resistance to fungal diseases and they easily penetrate into the joint tissue and synovial fluid. There are the following types of fungal infections that affect joints:

• Cryptococcosis. It mainly affects the knee joint, causing osteomyelitis and arthritis.
• Histoplasmosis. It rarely develops into a chronic form and contributes to the appearance of polyarthritis with erythema nodosum.
• Coccidiosis. This type of fungus is based in the lungs; if the disease is not treated, it affects bone tissue and knee joints.
• Candidiasis. Present in the body of almost every person, exacerbation is provoked by prolonged use of antibiotics. It immediately appears on the mucous membranes, then moves to the joints.
• Sporotrichosis. Affects hands and bone tissue.
• Blastomycosis. Foci of infection are based in the spine, feet, skull, legs, and ribs.

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Fungal

Most often, fungal infections of the joints develop with actinomycosis, but they also occur with other fungal infections. Pathogenic fungi enter the joint cavity from a nearby bone lesion or from distant lesions (carious teeth) through the bloodstream. The course is chronic, with relapses and the possible addition of a bacterial infection. Very often, fistulas occur - passages through which pus from the joint is released onto the surface of the skin. In the absence of adequate treatment, it leads to a gradual loss of joint function.

Parasitic

The cause of arthritis is usually echinococcosis, which affects the bone tissue of the vertebrae, pelvic bones and long bones of the limbs. A toxic-allergic inflammatory process usually develops in the joints. The joints of the spine, hips, knees and elbows are often involved. The course is benign, but is accompanied by severe joint pain. Recovery occurs when complete treatment of echinococcosis is prescribed.

Infectious-allergic arthritis

Infectious-allergic arthritis occurs when there is an allergy, against the background of which an inflammatory process in the joints develops under unfavorable conditions. The disease occurs in a violent form, accompanied by high fever and severe pain. Redness, swelling, and swelling are observed in the affected area. On different parts of the skin there is a ring-shaped allergic rash. Infectious-allergic arthritis is treated by a rheumatologist and an allergist.

Symptoms of infection

In advanced cases, a person experiences systematic pain.
A fungal disease can develop asymptomatically over a long period of time and appear only in advanced forms of the disease, which complicates the treatment of the infection. First, the fungus attacks bone tissue, then rapidly spreads throughout the body. The affected joints begin to swell and hurt. Advanced mycosis causes serious complications. During an exacerbation, the patient experiences the following symptoms:

• systematic pain;
• redness and severe swelling at the site of the lesion;
• suppuration and ulcers;
• poor mobility of the affected joint;
• increase in temperature.

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Localization of infectious arthritis

In case of infectious joint damage, the localization of the pathological process depends on the characteristics of the infection and its clinical form. In acute purulent arthritis, these are mainly large joints - knee, ankle, elbow. Small joints of the hand and foot are affected in the toxic-allergic form of tuberculosis and some viral arthritis.

Asymmetrical damage to one or two large joints is characteristic of borreliosis; most often with this infection, the knee joints are involved in the process.

Crunching in joints - when to worry

Intra-articular injections of hyaluronic acid

Diagnostics

The main task of diagnosis is to identify the causative agent of infection that is “culpable” in the development of infectious arthritis. The degree of destruction of the joint must also be determined. The following studies are being carried out:

• Laboratory:
  general blood test - signs of inflammation; in toxic-allergic forms of arthritis – increased levels of eosinophils;
• blood biochemistry – general disorders characteristic of a particular infection;
• examination of synovial fluid - the nature of inflammation;
• immunological studies - antibodies to various infectious agents;
• PCR and microbiological studies (inoculation of biological media on nutrient media) – identification of infectious agents;
• histological studies - a piece of synovial membrane tissue taken by biopsy is examined under a microscope - identifying changes characteristic of a specific infection.
• Instrumental:
  Ultrasound – reveals the presence of exudate in the joint cavity and damage to soft tissues;
• radiography - reveals the degree of damage to the bone tissue of the joints;
• computed tomography (CT) – detailing bone destruction;
• diagnostic arthroscopy – examination of the condition of the inner surface of the synovial membrane with the possibility of taking exudate or a piece of tissue for examination.

Diagnostic methods

It is necessary to establish the type of fungal infection.
Before starting treatment, it is important to identify the subtype of fungus. To do this, the affected joints are examined, from which a sample of synovial fluid is taken. The microflora is cultured, after which the most effective antibiotic is selected. It is also necessary to exclude other joint diseases that occur with similar symptoms. For such purposes, radiography is used, which can determine structural changes in osteochondral tissue and the localization of foci of inflammation.

• Arthritis 3 degrees

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Treatment of infectious arthritis

Basic principles of treatment of infectious arthritis:

• suppression of infection that caused joint damage;
• detoxification therapy – removal of toxic inflammatory products from the body;
• prevention of relapse of the disease and further destruction of the joints.

Different clinical forms of infectious arthritis require different approaches to treatment. Thus, acute purulent and other severe arthritis are treated only inpatiently. In case of chronic course, outpatient treatment or its combination with inpatient treatment during an exacerbation is possible. At this stage, the main methods of treating infectious arthritis are surgery and medication in combination with immobilization (creating immobility) of the affected joints.

Later, at the recovery stage, non-drug methods are added: therapeutic exercises, massage, physiotherapeutic procedures, reflexology courses.

Surgical treatment of acute purulent arthritis

When there is a suppurative process in the joints, the following surgical procedures and operations are performed:

• arthrocentesis
  - joint puncture (puncture with a needle and syringe) followed by removal of purulent exudate, washing (lavage) of the joint cavity with a disinfectant solution and administration of antibiotics;
• therapeutic arthroscopy
  – the same procedure, but performed using endoscopic equipment (arthroscope); during arthroscopy, it is possible to remove not only pus, but also pieces of necrotic tissue and bone sequestration;
• arthrotomy with flow-aspiration drainage
  – performed when there is a large accumulation of pus and destruction of the joint; The joint cavity is opened in a traditional surgical way, after which the pus is removed and the joint cavity is regularly washed with disinfectant solutions and antibiotics are introduced into it.

Immobilization

To reduce the pain of acute arthritis, the affected joints must be kept motionless. Immobilization is carried out using splints, orthoses and other special devices for a short period until the acute period of inflammation passes. Prolonged immobilization may interfere with the recovery of joint function.

Immobilization for infectious arthritis

Drug treatment

This is the main type of treatment. Even acute purulent arthritis in the initial stages is treated conservatively.

Infection suppression:

1. When viral, fungal or parasitic arthritis is complicated by a laboratory-confirmed bacterial infection, courses of antibacterial therapy are also prescribed.
2. Viral arthritis is one of the symptoms of an underlying viral infection. Treatment of this infection leads to elimination of inflammation in the joints. Antiviral drugs: Interferon alpha is prescribed for any viral arthritis; for hepatitis B and C, Entecavir and Telbuvidin are used. But all antiviral drugs have many side effects, so they are not always used.
3. Fungal infections of the joints are treated with antifungal drugs with laboratory-confirmed sensitivity of the fungal infection to them.
4. Parasitic arthritis - treatment is carried out after identifying the causative agent of the infection. For echinococcal (ascariasis, trichuriasis) arthritis, Albendazole or Mebendazole is prescribed.

Elimination of intoxication and inflammation:

1. To relieve intoxication, intravenous drip solutions of 5% glucose, 0.9% sodium chloride (saline) with vitamins C, group B are prescribed;
2. Inflammation, swelling and pain in the joints are eliminated by prescribing orally, intramuscularly and externally such medications (ointments, gels) as Diclofenac, Ibuprofen, Ketolac, Nemisulide, etc. Menovazin solution, used for rubbing, relieves pain well. If pain and inflammation are not relieved, short courses of glucocorticoids (GCS) are prescribed - Prednisolone, Dexamethasone, etc. But in infectious processes this is dangerous, since GCS reduce immunity.

If there is a risk of the inflammatory process becoming chronic, treatment of arthritis is carried out by a rheumatologist together with another specialist (surgeon, infectious disease specialist, dermatovenerologist). Basic drugs are prescribed that suppress inflammatory processes that develop during immune failure (Methotrexate, Sulfasalazine).

To restore the cartilage tissue of the joints, chondroprotectors are prescribed: Structum, Donu, Chondroitin.

Antibiotics for infectious arthritis

Antibiotic treatment of infectious arthritis is carried out for all types of bacterial inflammation. But their effectiveness depends on how accurately the pathogen is identified and its sensitivity to antibiotics is established. Only selective use of antibiotics will be beneficial. For tuberculous arthritis, anti-tuberculosis drugs are prescribed - Streptomycin, Rifampicin, etc.

Antibiotics for the treatment of infectious arthritis

Non-drug methods

Used mainly after eliminating acute inflammation:

• physical therapy (physical therapy) - individual exercises with minimal muscle tension are prescribed at the end of the acute period; then the volume of loads is gradually increased; Exercise therapy helps improve blood circulation, strengthen muscles and quickly restore limb function;
• acupressure – the principle of purpose and mechanism of action is the same as for exercise therapy;
• physiotherapeutic procedures - sometimes prescribed in the acute period, for example, electrophoresis with painkillers and anti-inflammatory drugs; during the rehabilitation period, thermal procedures (paraffin, ozokerite), magneto- and laser therapy are prescribed; during the period of stable remission - mud applications.

Traditional methods

Traditional methods are also often included in complex treatment:

• warming compress: take half a glass of turpentine and vodka, 3 tablespoons of vegetable oil; mix the ingredients, moisten a napkin, apply to the sore joint, cover with plastic, wrap and leave overnight; repeat three times a week for a month;
• tincture of elecampane roots: 2 tablespoons of crushed dry raw material, pour 200 ml of vodka, leave for a week, strain and use as a rub at night.

It should be remembered: traditional methods of treatment should only be prescribed by a doctor. Self-treatment of infectious arthritis can cause irreparable harm to the body.

Bacterial (septic) arthritis

About the article

6020

0

Regular issues of "RMZh" No. 20 dated October 25, 2004 p. 1137

Category: Rheumatology

Author: Belov B.S.

For quotation:

Belov B.S. Bacterial (septic) arthritis. RMJ. 2004;20:1137.

Bacterial (septic) arthritis (BA) is a rapidly progressive pathology caused by direct invasion of the joint by pyogenic microorganisms 1 . The disease occurs everywhere. Mostly children and people over 60 years of age are affected. The annual incidence of asthma is 2–10 cases per 100,000 population, and among patients with rheumatoid arthritis (RA) and recipients of valve prostheses, these values ​​reach 30–70 per 100,000. Despite the extensive arsenal of antimicrobial agents developed and introduced into clinical practice and intensive development surgical technology, irreversible loss of joint function develops in 25–50% of patients. The incidence of deaths from asthma has not changed significantly over the past 25 years and is 5–15% [1]. Etiology Theoretically, all known bacteria can cause AD (Table 1). The most common etiological agent of asthma is S. aureus, which accounts for up to 80% of cases of joint infections in patients with RA and diabetes mellitus. This pathogen is also the main one in infectious coxitis and polyarticular variants of asthma. In second place in the frequency of isolation in patients with asthma are streptococci (primarily β-hemolytic streptococcus of group A), which, as a rule, are associated with underlying autoimmune diseases, chronic skin infection and previous trauma. The occurrence of S. pneumoniae as a causative agent of asthma has decreased significantly in recent years. Streptococci of other groups (B, G, C and F - in descending order) are isolated from asthma in patients with immune deficiency, malignant neoplasms, as well as infectious pathologies of the digestive and urogenital tract. Gram-negative bacilli are the cause of asthma in elderly patients, drug addicts who inject drugs intravenously, as well as in patients with immunodeficiency. Anaerobes as causative agents of asthma are more often found in recipients of joint prostheses, people with deep infections of soft tissues and patients with diabetes mellitus. The most significant etiological agents of asthma among children are S. aureus and Str. pyogenes. The role of H. influenzae, previously quite common in asthma in children, has significantly decreased in recent years due to the widespread introduction of a specific vaccine. At the same time, a number of researchers have noted an increase in the incidence of the gram-negative bacillus K. kingae in asthma, which is a normal inhabitant of the oral cavity in children under 2 years of age [6]. Table 2 summarizes data on the most common pathogens of asthma depending on the categories of patients. Pathogenesis Normally, articular tissues are sterile, which is ensured by the successful functioning of phagocytes of the synovial membrane and synovial fluid (SF). For the development of asthma, the presence of a number of “risk factors” is necessary, depending both on the state of the macroorganism (primarily anti-infective immunity and joint status) and the pathogenic microbe (virulence, exposure, inoculum volume, etc.). The main factors predisposing to the development of asthma are presented in Table 3. One of the most significant aspects of the occurrence of asthma is the weakening of the natural defenses of the macroorganism, due to concomitant diseases, immunosuppression, and the age of the patients. Of no small importance is the background articular pathology, the therapy performed, as well as possible complications of the latter. In particular, in RA, the likelihood of asthma increases due to the prescription of glucocorticosteroids (including intra-articular), cytotoxic immunosuppressants, as well as monoclonal antibodies to tumor necrosis factor - ? (infliximab). Penetration of the pathogen into the joint can occur in several ways. 1. Hematogenous dissemination with transient or persistent bacteremia, as a consequence of distant primary foci of infection (pneumonia, pyelonephritis, pyoderma, etc.). 2. Lymphogenic spread from foci of infection close to the joint. 3. Iatrogenic route during arthrocentesis or arthroscopy. 4. Penetrating injuries caused by plant thorns and other contaminated objects. Invasion of the bacterium into the joint is accompanied by an active inflammatory cellular response and the release of cells involved in inflammation into the joint cavity. Subsequently, under the influence of bacterial waste products, the immune response is stimulated and various inflammatory mediators are released. The accumulation of pro-inflammatory cytokines and phagocyte autolysis products – proteases – entails inhibition of cartilage synthesis and its degradation, followed by destruction of cartilage and bone tissue and the formation of bone ankylosis. Clinical picture As a rule, asthma is characterized by an acute onset with intense pain, swelling, skin hyperemia and hyperthermia of the affected joint. In most cases (60–80%) there is fever. However, body temperature can be low-grade and even normal, which is more common with damage to the hip and sacroiliac joints, against the background of active anti-inflammatory therapy for the underlying disease, as well as in elderly patients. In 80–90% of cases, a single joint is affected (usually the knee or hip) (Fig. 1). The development of an infectious process in the joints of the hands is mainly of traumatic origin (penetrating puncture wounds or bites). The oligo- or polyarticular type of lesion is more often observed with the development of asthma in patients with RA, systemic lesions of connective tissue, as well as in drug addicts who inject drugs intravenously. In addition, in “intravenous” drug addicts, asthma is characterized by a slower onset, a long course and frequent damage to the syndesmosis of the body (sacroiliac and sternoclavicular joints, pubic fusion). In young children, the only manifestation of bacterial coxitis may be sharp pain when moving with fixation of the hip joint in a position of flexion and external rotation. Unlike gonococcal arthritis, BA is not characterized by damage to periarticular soft tissues. Diagnostics When analyzing peripheral blood in patients with asthma, leukocytosis is detected with a shift in the leukocyte formula to the left and a significant increase in ESR. The basis for diagnosing BA is a detailed analysis of the fluid obtained by puncture aspiration from the affected joint (in this case, it is necessary to remove the effusion to the maximum extent possible). A definite diagnosis of AD requires identification of bacteria in the SF. It is inoculated on media for aerobic and anaerobic microbes and should be performed immediately after collection (at the patient’s bedside). In order to obtain preliminary information about the pathogen and prescribe empirical antibacterial therapy, Gram staining of smears is necessary, and the effectiveness of the study is increased by preliminary centrifugation of the fluid. The diagnostic efficiency of this technique is 75% and 50% for infection with gram-positive cocci and gram-negative bacilli, respectively. Visually, SF in BA is purulent in nature, grayish-yellow or bloody in color, intensely turbid, thick, with a large amorphous sediment. When counting leukocytes, the level of cytosis often exceeds that in other inflammatory diseases (RA, gouty arthritis, reactive arthritis) and is >50,000/mm 3 , often more than 100,000/mm 3 with a predominance of neutrophils (>85%). SF also has low glucose levels, less than half of serum concentrations, and high levels of lactic acid. Blood cultures for blood culture give positive results in 50% of cases. X-ray of the joint is one of the first-priority diagnostic measures, since it allows one to exclude concomitant osteomyelitis and determine further tactics for examining and treating the patient. However, it should be noted that distinct changes on radiographs in BA (osteoporosis, narrowing of the joint space, marginal erosions) appear approximately 2 weeks from the onset of the disease. The use of radioisotope scanning techniques with technetium, gallium or indium is especially important in cases where the joint under study is located deep in the tissue or is difficult to reach for palpation (hip, sacroiliac). These methods also help to identify changes inherent in AD at early stages of the process, i.e. during the first two days, when there are still no radiological changes. On computed tomograms, destructive changes in bone tissue are detected much earlier than on plain radiographs. This method is most informative for lesions of the sacroiliac and sternoclavicular joints. Magnetic resonance imaging can detect soft tissue swelling and effusion into the joint cavity, as well as osteomyelitis, in the early stages of the disease. Differential diagnosis Differential diagnosis of BA should be carried out with the following diseases manifested by acute monoarthritis: – acute gouty arthritis; – pseudogout; - rheumatoid arthritis; – viral arthritis; – seronegative spondyloarthritis; – Lyme borreliosis. It should be noted that joint infection is one of the few emergency situations in rheumatology that requires rapid diagnosis and intensive treatment, which avoids irreversible structural changes. Therefore, there is a rule - to regard every acute monoarthritis as infectious until proven otherwise. Prosthetic joint infections The incidence of infection of prosthetic joints is 0.5–2%. Among the pathogens, staphylococci (primarily coagulase-negative), streptococci, gram-negative aerobes and anaerobes predominate (Table 4). Early forms of joint prosthesis infections (up to 3 months after implantation) are caused mainly by epidermal staphylococci and develop due to postoperative contamination or due to contact spread from infected skin, subcutaneous tissues, muscles or postoperative hematoma. Late forms occur during infection with other microbes presented in Table 4 and are caused by hematogenous dissemination. The main risk factors for damage to prosthetic joints include: immunodeficiency states, RA, repeated operations on the joint, long-term surgical intervention, prosthetics of superficial joints (elbow, shoulder, ankle). The onset of the disease can be acute or subacute depending on the virulence of the pathogen. Pain appears (95%), fever (43%), swelling of the joint (38%), outflow of purulent discharge through the drainage (32%). This symptomatology, combined with radiographic signs of destruction of bone tissue near the prosthesis, always indicates infection. Distinguishing a surgical skin infection from a purulent lesion of a joint prosthesis often causes great difficulties. The final diagnosis is made by blood tests, examination of aspirate from the cavity of the artificial joint and/or bone biopsy taken near the area where the cement joins the prosthesis. Treatment Treatment of asthma is complex, including antimicrobial and symptomatic therapy, drainage of infected fluid and physical therapy. Antimicrobial therapy is carried out empirically during the first 1–2 days, taking into account the patient’s age, the clinical picture of the disease and the results of a Gram smear study of the liver, and subsequently, taking into account the isolated pathogen and its sensitivity to antibiotics (Tables 5, 6). Antibiotics should be administered predominantly parenterally; their intra-articular use is inappropriate. The lack of positive dynamics after 2 days dictates the need to change the antibiotic. Continued accelerated ESR is an indication for prolongation of treatment, which averages 3–4 weeks. (sometimes up to 6 weeks), but not less than 2 weeks. after the elimination of all signs of the disease. In addition to antimicrobial therapy, analgesics and non-steroidal anti-inflammatory drugs (diclofenac, ketoprofen, etc.) are prescribed. Drainage of the infected joint is carried out (sometimes several times a day) by closed aspiration through a needle. In order to assess the effectiveness of treatment, leukocyte counts, Gram staining and SG cultures are performed each time. Open surgical drainage of the infected joint is carried out in the presence of the following indications [7]: – infection of the hip and, possibly, shoulder joint; – vertebral osteomyelitis, accompanied by compression of the spinal cord; – anatomical features that make drainage of the joint difficult (for example, the sternoclavicular joint); – impossibility of removing pus with closed drainage through a needle due to increased viscosity of the contents or adhesions in the joint cavity; – ineffectiveness of closed aspiration (persistence of the pathogen or lack of reduction in leukocytosis in the synovial fluid); – prosthetic joints; – concomitant osteomyelitis requiring surgical drainage; – arthritis that develops as a result of a foreign body entering the joint cavity; – late start of therapy (more than 7 days). During the first two days, the joint is immobilized. Starting from the 3rd day of illness, passive movements in the joint are performed. Loads and/or active movements in the joint are started after the arthralgia disappears. Treatment of an infected prosthetic joint is carried out as follows: 1. Simultaneous arthroplasty with excision of infected tissue, installation of a new prosthesis and a subsequent 6-week course of antibiotic therapy (vancomycin + amikacin; vancomycin + cefepime/ceftazidime; oxacillin + rifampicin). 2. Excision of prosthetic components, contaminated areas of skin and soft tissue, followed by parenteral antimicrobial therapy for 6 weeks. After this, the joint is reimplanted with continued antibiotic therapy for 5 days. Prevention The likelihood of infection of a prosthetic joint increases significantly during bacteremia that occurs during dental and urological procedures. In this regard, experts from the American Academy of Orthopedic Surgery, the American Dental Association and the American Urological Association have developed antibiotic prophylaxis regimens for individuals at high risk of developing joint prosthetic infection [11,12]. All recipients of joint prostheses are subject to prophylaxis during the first two years after surgery, patients with immunosuppression due to the underlying disease (RA, systemic lupus erythematosus) or drug/radiation therapy, as well as patients with aggravating concomitant pathology (previous infection of the joint prosthesis, hemophilia, HIV -infection, insulin-dependent diabetes type I, malignant neoplasms) when they undergo a number of dental interventions, including tooth extraction, periodontal manipulation, installation of implants, etc. The above categories of patients should also receive prophylaxis for various manipulations associated with a possible violation of the integrity of the mucous membrane of the urinary tract (lithotripsy, endoscopy, transrectal prostate biopsy, etc.) Antimicrobial prophylaxis regimens are presented in Table 7.

References 1. Goldenberg DL. Septic arthritis. Lancet. 1998;351(9097):197–202. 2. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis. 1999; 58(4):214–219. 3. Dubost JJ, Soubrier M, De Champs C, Ristori JM, Bussiere JL, Sauvezie B. No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis. 2002; 61(3):267–269. 4. Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997; 56(8): 470–475. 5. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. 2002; 15(4): 527–544. 6. Lahmann JD, Lahmann SJ Etiology of septic arthritis in children: an update for the 1990s. Pediatr. Emerg. Care. 1999; 15:40–42. 7. Gilliard WR Bacterial (septic) arthritis. In the book. West S.D. Secrets of rheumatology. /Trans. from English M., St. Petersburg – “Binom Publishing House” – “Nevsky Dialect”, 1999. 331–341. 8. Urban JA, Garvin KL Prosthetic joint infections. Curr. Treat. Opt. Infect. Dis. 2003; 5:309–321. 9. Rao N. Septic arthritis. Curr. Treat. Opt. Infect. Dis. 2002; 4: 279–287. 10. Trampuz A., Steckelberg JM Septic arthritis. Curr. Treat. Opt. Infect. Dis. 2003; 5:337–344. 11. Antibiotic prophylaxis for dental patients with total joint replacements. JADA. 2003; 134:895–898. 12. Antibiotic prophylaxis for urological patients with total joint replacements. J Urology 2003; 169(5):1796–1797.

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Approach to treating the disease in our clinic

Medical doctors in Moscow have developed their own approach to the treatment of infectious arthritis. It includes:

• thorough identification of the causes (infectious factor) of the disease;
• suppression of infection using modern medicinal methods developed in the most advanced clinics in the world;
• restoration of joint function using modern medicinal and non-medicinal methods, as well as using traditional methods of treatment of ancient Chinese medicine, which considers the human body as a whole.

As a result of the complex treatment, our patients forget about pain and lead their usual lifestyle. To prevent exacerbations, our clinic conducts courses of anti-relapse treatment.

General clinical recommendations

Persons who have had acute infectious arthritis or suffer from chronic infectious arthritis must:

• lead an active healthy lifestyle, quit smoking and alcohol abuse;
• eat properly and fully;
• exclude heavy physical activity and injuries;
• engage in therapeutic exercises, swimming and feasible sports;
• treat infections promptly;
• carry out doctor's orders; in the chronic course of the disease, conduct courses of anti-relapse treatment.

Prevention

Infectious arthritis can be prevented by doing hardening, sports without heavy physical activity, eating right and treating all infections in a timely manner.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthritis

Frequently asked questions about the disease

What is the difference between infectious and reactive arthritis?

An infectious inflammatory process develops when an infection enters a joint, and a reactive inflammatory process develops against the background of some kind of general infection in the absence of a pathogen in the joint cavity. Read more about reactive arthritis in this article.

Which doctor treats you?

Nonspecific infectious processes - a surgeon or traumatologist, specific ones - a surgeon and another specialist - an infectious disease specialist, a dermatovenerologist, a phthisiatrician. When transitioning to a chronic course, a rheumatologist.

What is the prognosis for treatment of infectious arthritis?

Depends on the infection that caused the disease. Most acute arthritis ends in recovery. The outcome of specific infections depends on the course of the underlying disease: viral arthritis ends in complete recovery, while tuberculosis arthritis does not always have a favorable outcome.

Infectious arthritis can be severe with unpredictable consequences. Therefore, it is very important to treat it promptly and correctly. They know how to do this.

Bibliography:

1. Belov B. S. // Bacterial (septic) arthritis and infection of the prosthetic joint: modern aspects. — [b.m.]: Modern rheumatology., 2010.
2. Parvizi J Jacovides C, Antoci V, et all, // Diagnosis of periprosthetic joint infection:. — [b.m.]: J Bone Joint Surg AM, 2012..
3. Isaacs J. Oxford textbook of rheumatology. – Oxford University Press, 2013.
4. Slobodin G. et al. Acute sacroiliitis //Clinical rheumatology. – 2021. – T. 35. – No. 4. – pp. 851-856.

Themes

Arthritis, Joints, Pain, Treatment without surgery Date of publication: 03/04/2021 Date of update: 03/15/2021

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Prevention methods and prognosis

A preventive measure in the fight against mycosis is compliance with the rules of personal hygiene. In public places such as baths, saunas, swimming pools, gyms, you must always have personal replacement shoes and a towel. You cannot use other people's manicure accessories. To improve immunity, it is recommended to periodically take a course of vitamins. Antibiotic treatment should only be prescribed by a qualified specialist, since an incorrectly selected drug can cause fungus. An advanced infection is difficult to cure; the disease becomes chronic and causes irreparable harm to health. With timely treatment and properly selected therapy, the disease is easily treatable.

Bibliography:

• https://osteokeen.ru/zabolevania/gribok-i-sustavy.html
• https://etosustav.ru/zabolevania/problemy/gribok-i-sustavy.html