Arthritis Details

Arthritis is an inflammatory joint disease. In English literature the term which is used is fundamentally different. The degenerative changes of arthritis are known in English as “osteoarthritis”.

The joints acts are basically inflamed with warmth, swelling and redness. In principle, arthritis is divided into the cause. An acute and dangerous disease is purulent, bacterial arthritis, detectable in the nuclei in the joint. Synonymous with suppurative arthritis.

Distinguishable from suppurative arthritis is rheumatic diseases, post-infectious arthritis (e.g. in the late Lyme disease). The arthritis in metabolic disorders (e.g. gout), and the “active osteoarthritis” due to mechanical overload is also identified as an arthritis – here it fits the English term “osteoarthritis”.

In addition, there are other rarer causes of arthritis. After the distribution over the body between “monoarthritis” (only one joint is diseased), “oligoarthritis” (some/a few joints are affected) and “polyarthritis” (many different joints are affected).

Bacterial arthritis

The germs enter either through injury, the interior of the joint opening, or through the blood (“haematogenous”) into the joint. It is one of the most frequent causes of injuries in addition to the direct Keimeintritts medical interventions (iatrogenic). In operations, injections can be introduced.

Even a periarticular osteomyelitis can break into a joint and lead to purulent arthritis. In adults immune-competent patients the following can be found as the causative agent in half the cases: Staphylococcus aureus; Staphylococcus epidermidis in about 25% and streptococci in about 15% of cases. In children and immune-compromised patients, there can be frequently detected, less common germs. If this is the case, antibiotic therapy should then be designed differently.

Symptoms and Diagnosis

Sonography of normal (left) and inflamed (right) hip of a child. Under Blue colored borders is each bone (left shank, right head core, separated by a growth zone) red colored capsule.

In purulent arthritis, there is a pronounced inflammatory reaction with redness, swelling and heat, if the joints are shallow (knee, elbow, ankle).

In addition, there is often significant pain that is intensified by movement. Loading and movement in the affected joints are limited. In children, the affected joint will be charged no more spontaneously, or moved.

Usually there are also common disease symptoms. Diagnostic shows a joint effusion, the example is palpable at the knee and elbow, on the other joints, such as is at the hip, they are sonographically representable.

Blood tests find elevated inflammatory markers (C) reactive protein, leukocytes, erythrocyte sedimentation rate. If there is a clinical suspicion of purulent arthritis, there should be an immediate arthrocentesis. The appearance of the joint effusion is in further differentiation; a swab can also be removed and carried into a pathogen.

Treatment

Suppurative arthritis is a very grave and serious injury of a joint. It occurs within hours or days of the destruction of joint cartilage. The germs can spread and lead to a general inflammatory response to sepsis, acute renal failure and death. The treatment required usually includes a prompt surgical intervention, (primarily the joint opening) and arthroscopy at selected joints.

It is important to complete the flushing of the joint and subsequent drainage. The suction-irrigation drainage is now rarely used. In parallel an antibiotic needs to be carried out, the first act must be broad-directional, and can be selectively altered after receipt of the pathogen detection.

The intravenous antibiotic therapy should be performed first, after a few weeks and a switch to oral therapy is possible. It is important to regularly check the local findings and inflammatory parameters in the blood because of the risk of recurrence.

Special

The necessary tuberculosis treatment takes much longer than for other invading pathogens. Tabes arthropathy: It is a late consequence of syphilis and occurs in the “third” stage of syphilis. There is an effect of syphilis on the nerves supplying the joint. A direct relationship with the local effects of the infectious agent does not exist. Without timely and proper treatment this can lead to the complete destruction of one or more joints.

Non-infection related arthritis

They are counted among the rheumatic disorders. It is an autoimmune process, in which the body’s own substances are misrepresented as “foreign” and attacked by the immune system defenses.

The result is a swelling and proliferation of the synovial membrane, the mucous layer, which is responsible for the nutrition of articular cartilage and the production of synovial fluid. These proliferating mucosa grows over gradually, starting from the edges of the cartilage and destroying it.

The term for this aggressive, working synovium is “pannus”. Depending on the type and progressive form of arthritis, it can range up to complete denudation of the bony articular surface, then the bone rubs on bone. This abrasion causes the joint-forming bone to shorten. The joint becomes very unstable.

Rheumatoid arthritis (syn. primary chronic polyarthritis, PCP, chronic arthritis, CP) can occur even at a young age. The diagnosis is initially made with blood tests; the laboratory findings are so-called “rheumatoid factors”. Laboratory studies of the synovial fluid may bring additional information.

The histological examination of synovium may also help identify it. The x-ray shows characteristic changes of the bone joints. Another bone scan is the diagnostic tool that provides an overview of the inflammatory activities and shows which joints (which from the outside can often be norma), are involved in the disease process.

Psoriatic arthritis occurs in the context of psoriasis. The diagnosis can be made difficult by the joint involvement in some cases months or years before experiencing the typical skin manifestations of psoriasis.

Typically all the asymmetric distributions are affected joints on both sides of the body. Gout arthritis is caused by a disorder of the uric acid metabolism, characteristically radiographic round, so-called “punching defects” in the interests of the bone joints.