Understanding Arthritis – Part 2
Here are several other forms of Arthritis. Gout is more common in the Western world.
Sometimes, crystals of salts get deposited in the joints. This leads to a condition known as gout. The crystals deposited are of monosodium urate and are associated with increased uric acid levels in the body. I will be writing a separate article about Gout and its treatment.
As the name indicates infective arthritis is the inflammation of joints as a result of infection. Infection of the joints is common but nevertheless important because of the damage it can cause.
The most important test in the diagnosis of infective arthritis is Synovial Fluid Culture. Synovial fluid is drawn from the joint space with the help of a long needle and checked for the presence of any microorganisms. Different types of microorganisms may be seen in infective arthritis. Bacteria are the commonest. Others include viruses, algae and some parasites.
Septic arthritis is a non specific type of arthritis which can result from infection of the joints by one of the bacteria from a group of organisms known as ‘pyogenic organisms’. Most common causative bacteria is Staphylococcus aureus. Others are other subtypes of staphylococci, Neisseria or Gram negative bacilli. Organisms reach the joint from another focus of infection in the body, like the ear or a boil by travelling in the blood stream. It occurs mostly in individuals with low immunity like very young and very old people or persons receiving immunosuppressive drugs.
Usually the onset is sudden with only one joint being affected, often the knee. The affected joint is red, warm and swollen and fever is usual. The rule is to test any suddenly painful joint to exclude infection. Treatment is started immediately as cartilage destruction can occur in a few days after the onset of infection. Antibiotics are given for a period of 6 weeks usually in the form of intramuscular and intravenous injections. Infections directly into the joints should be avoided as this may further exacerbate the condition. Drainage of the joints to remove any debris is performed daily until no pus or fluid remains in the joints. Septic arthritis usually resolves completely within days to weeks after start of appropriate antibiotic therapy.
In 1% of the people suffering from tuberculosis there is involvement of bones and joints. In most of the cases only one joint is affected most common being joints of the spine (50%), knee (30%) or the hip joint (20%). Synovial fluid culture or in some cases synovial biopsy may be required to confirm diagnosis. Treatment is the same as for that for tuberculosis elsewhere.
This type of infective arthritis is seen in young females and homosexual males. Usually more than two joints are involved. A clue to diagnosis is the presence of small pustular skin lesions near the affected joints. Treatment is with penicillin given for two weeks.
A number of viruses cause arthritis. The commonest is Rubella which causes arthritis in young adult females. Arthritis may also occur after rubella vaccination. Arthritis may also occur as a complication of mumps. This type of arthritis is usually self limiting. Transient arthritis may also be seen in chicken pox and hepatitis B infection
Fungal infections of the joints are rare. Actinomycosis can affect the temporomandibular joint or the vertebrae. Destructive joint lesions my rarely occur as result of infection by the fungus blastomycosis.