Arthritis is an inflammation caused by bacteria (septic arthritis), viruses, fungi, or parasites present in the synovium, joint cavity or periarticular tissues. Depending on the course of the disease, we can distinguish acute or chronic inflammation.
Symptoms of infection are primarily pain, swelling, redness and limited mobility of the joint. In infectious arthritis, a single joint is usually involved, most often the knee joint, but the disease can also affect other joints, such as:
Among adults, the annual incidence of IA is about 2 to 5 people per 100,000 (twice as often among children). However, among people suffering from rheumatoid arthritis, the incidence is 28 to 38 people per 100,000, and among patients after endoprosthesis, it is 40 to 68 people per 100,000.
It should be remembered that if the patient is taking medications for another inflammatory disease of the joints, the symptoms may be minor (the medications then mask the symptoms of IA). In adults, IS most often affects the knee joints, and in children, the hip.
In this case, in children, it is characteristic that they keep the hip still in one position and defend themselves against any movement in that joint. Don’t forget about rheumatoid arthritis symptoms.
Infective arthritis – visit to the doctor
If you experience symptoms such as those listed at the beginning of this section, contact your GP immediately. Quickly implemented treatment will minimize the risk of permanent damage to the joint and the spread of infection.
In 95% of cases, infectious or arthritis in hands develops as a result of infection:
- Bacterial (Staphylococcus aureus, Neisseria gonorrhoeae, Pseudomonas aeruginosa);
- Viral (parvovirus B19, HIV, HBV, HCV).
The remaining 5% of infections are caused by fungi or parasites.
Microbes can enter the pond:
- Through the bloodstream (90%) – e.g. from elsewhere in the body where an infection is taking place (e.g. from the upper respiratory tract or the genitourinary system) or by intravenous administration of non-sterile agents (e.g. drugs);
- By breaking the continuity of the skin and articular capsule (10%) – e.g. as a result of a wound or accidental surgery.
When bacteria enter a joint, they begin multiplication within the synovium and release endotoxins that damage the joint. This leads to an inflammatory process in a given area of the body. They destroy bacteria (among others by producing the so-called “free radicals”), but at the same time, using the same mechanism, they damage the joint and intensify the inflammatory process again.
You should prepare the following situations:
- A list of symptoms that are bothering you (when they occurred, how long do they last, whether something is causing them to worsen or go away).
- List of drugs taken on a regular basis.
- List of diseases for which the patient is treated chronically.
A list of bothering questions about the disease. Don’t be afraid and don’t be shy to ask your doctor questions. During the visit, he serves you with his knowledge as best he can.
Infective arthritis – researchInfective arthritis – research
During the first visit to a specialist, the doctor will conduct a medical history with the patient and a full physical examination. In the diagnosis of infective arthritis, you may also need:
Synovial fluid analysis – the doctor collects the fluid from the joint cavity (using a syringe with a needle), which then makes it possible to identify what specific bacteria caused the infection in the patient. Normally, the synovial fluid is clear and the infection changes its color, smell, and texture. The synovial fluid can either be smeared on a slide and viewed under a microscope (looking for microorganisms) or placed on a culture medium and, after receiving the culture, determine what pathogen we are dealing with.
Laboratory tests – performed on the patient’s blood, may show an increase in inflammatory markers (ESR or CRP), an increase in the number of white blood cells and a slight anemia.
The diagnosis is made on the basis of an interview, the results of a physical examination and additional tests. The immediate evidence of a joint infection is the presence of microorganisms within it (although this is not always possible).
Infective arthritis – treatment
The goals of treating infectious arthritis are:
- Joint sterilization (removal of microorganisms);
- Joint decompression (removal of excess necrotic fluid);
- Restoration of the correct range of motion.
The mainstay of therapy in IZ is antibiotic therapy and removal of fluid and necrotic tissues from the joint.
As treatment should be started as soon as possible, the patient will first receive a broad-spectrum antibiotic (which destroys many microorganisms, used when I do not know yet what bacteria caused the disease). It will be changed to a targeted antibiotic (destroying a specific microorganism) as soon as the causative agent is identified.
At the start of treatment, antibiotics are usually given intravenously. Then, in the event of improvement, patients switch to oral antibiotic therapy. Standard treatment lasts from two to six weeks, although it depends largely on the patient’s health and the factor that caused the infection. Taking antibiotics can have a wide range of side effects, so you should discuss them with your doctor.
In the case of viral infections, pharmacotherapy is limited to the administration of non-steroidal anti-inflammatory drugs (inhibiting inflammation in the joint), and in the case of fungal infections, antifungal drugs are administered (for up to six to twelve months).
It is performed daily (until the number of leukocytes in the fluid is normalized) and the synovial fluid and necrotic tissues are completely removed. This serves:
- Reducing the pressure in the joint,
- Removal of any microorganisms,
- Provides material for research and monitoring the effectiveness of the treatment.
The fluid from the joint is removed during arthroscopy or during an arthrocentesis procedure.
As soon as the infection is under control, it is recommended to start the joint (perform passive movements as soon as possible – the physical therapist will help with this). This ensures proper nutrition and hydration of the healing articular cartilage and prevents the formation of adhesions in the joint. Early implementation of physiotherapy also prevents the formation of muscle atrophy and the development of contractures.
It should be remembered that all forms of home treatment should be consulted with a doctor first. First of all, follow your doctor’s instructions carefully.
Joint pain can be reduced by taking non-steroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen). Although these medications are available without a prescription, consult your doctor before using them.
Rapid implementation of antibiotic treatment and joint decompression usually resolves the infection process and prevents permanent changes. Unfortunately, delaying treatment may result in permanent joint deformities. The prognosis of IA is worsened by comorbidities such as RA or diabetes. Unfortunately, about 50% of patients still report joint pain and limited range of motion after treatment.