| Infectious arthritis is an inflammation of one or more joints (principally the wrists, knees, or hips) that is brought on by infection. Bacterial, viral, or fungal infections usually cause infectious arthritis.
The bloodstream typically carries infection from diseases into the joints. Infection can also result from a wound, surgery, or injection involving the affected joint.
Infectious arthritis occurs in individuals of all ages, but in adults, there may also be a history of osteoarthritis or rheumatoid arthritis. Infectious arthritis is linked to bacterial sources, including gonorrhea, Staphylococcus, tuberculosis, and Lyme disease. Viral sources of the condition include German measles, mononucleosis, mumps, hepatitis B and C, and HIV. Fungi are the least common sources of infectious arthritis, but they can be found in soil, certain plants, and bird droppings. Farmers have a greater risk than urban residents of acquiring fungal sources of infectious arthritis.
Gonococcal and nongonococcal bacterial arthritis are the two principal types of the disease. Infectious arthritis in one joint affects fewer than 50% of gonorrhea sufferers. Individuals who obtain prompt treatment for gonococcal arthritis have a much better chance of full recovery than those affected by other forms of infectious arthritis (nongonococcal).Risk: Children under 3 have a higher prevalence of infectious arthritis. Teenagers have a higher incidence of septic arthritis because of sexually transmitted diseases (STDs). Studies report the same frequency in men and women and men may have a minimally increased risk of developing septic arthritis (Studley). Incidence and Prevalence: Infectious arthritis has an annual incidence that varies from roughly 2 to 10 individuals out of 100,000 (Munoz). Africa, Latin America, and Asia report much higher rates of infectious arthritis than the US. In Australia, 9.2 people out of 100,000 had septic arthritis annually (Studley). |
Source: Medical Disability Advisor
| History: Depending on the underlying cause, individuals may complain of chills and fever, pain, heat, weakness, and swelling in the joint. After several days, other joints may also be involved. The individual may also report red sores on the palms and soles, a rash, and pain in the wrists and ankles. The individual may have had an injury or undergone surgery prior to experiencing the condition. Physical exam: Swelling in the joint may be noted, along with evidence of inflamed tendons. Fever and significantly reduced range of motion in the involved joint are usually present. Tests: Blood tests (serology) will be ordered, including complete blood count, erythrocyte sedimentation rate (ESR, or sed rate), and C-reactive protein. A needle may be inserted to extract fluid from the joint (needle aspiration test). The joint fluid (synovial fluid) will be placed in a special medium (culture), and some of the fluid will be fixed on a slide, stained, and then examined under a microscope for signs of possible infection. In addition to blood tests, cultures of the throat, urethral, cervix, and rectum may also be needed to detect the presence of gonorrhea. X-rays may also be needed to detect possible presence of joint damage from infection. Joint tissue may be removed (biopsy) for examination if tuberculosis or fungi are suspected to be the cause of the inflammation. Imaging studies such as MRI and nuclear scanning help to demonstrate the severity of the infection. |
Source: Medical Disability Advisor
| Prompt treatment of the condition is essential to prevent permanent joint damage. Gonococcal infectious arthritis usually responds well to oral antibiotic therapy. The initial treatment usually must begin in the hospital since some strains of gonococci are resistant to penicillin. Infectious arthritis caused by viral sources usually resolves on its own or has no specific treatment. For nongonococcal arthritis related to bacterial and fungal infections, hospitalization may be necessary (up to a week), during which time the individual is given bed rest, intravenous fluids, and oral or intravenous antibiotics. Needles may be used repetitively to drain fluids from the affected joint (arthrocentesis). In some cases, the joint may be drained surgically (arthrotomy, arthroscopy). Splints may be used to limit movement of the joints and promote healing. Following discharge, most individuals are given oral antibiotics, which must be taken for 1 to 4 weeks. In some cases, antibiotic therapy may be needed for several months. Individuals who have septic arthritis with a total joint prosthesis need to be treated with antibiotic medication, and surgical debridement may be necessary. Treatment for a septic joint prosthesis varies from 1 to 2 weeks of IV antibiotics followed by 2 to 4 weeks of oral antibiotics for mild infections, to surgical removal of the prosthesis and 6 to 8 weeks of IV antibiotics followed by eventual re-implantation of a new prosthesis.
Pain relievers (analgesics) and anti-inflammatory drugs may also be prescribed. Antifungal medication may be required for infectious arthritis caused by fungi. After the condition is resolved, exercises that emphasize strength building and range of motion may be recommended. |
Source: Medical Disability Advisor
| Treatment for gonococcal arthritis almost always succeeds, particularly if the condition is addressed promptly. Improvement usually takes place by 72 hours, and recovery is typically complete in 10 days (Studley). Permanent joint damage may result when medical intervention is delayed, but significant damage to the joint cartilage (articular cartilage) is uncommon in gonococcal septic arthritis.
A mortality rate of 2% to 14% was observed in one study of patients with nongonococcal arthritis (Munoz). According to another source, fewer than 10% of individuals with septic arthritis die from it, and roughly 60% make a full recovery (Studley). The mortality rate is higher when individuals develop respiratory problems (pneumonia or ARDS), or have the infection in several joints. In 21% of cases, the individual died, or the joint was destroyed; in 33% of cases, the individual experienced poor results such as amputation, joint dysfunction, or surgery to drain the joint (Munoz).
When this condition results from Lyme disease, symptoms may recur. |
Source: Medical Disability Advisor
| Complications primarily involving nongonococcal infectious arthritis may include acute respiratory distress. Permanent damage to the affected joint may also occur. Osteomyelitis (bone infection) adjacent to the joint infection may occur. Multiple joints are more likely to be involved if a pre-existing joint disease is present, such as rheumatoid arthritis, or if the individual has diabetes mellitus. Some types of infectious arthritis may produce red, tender bumps, primarily on the lower legs (erythema nodosum). Viruses such as HIV and hepatitis B and C may cause infectious arthritis to be ongoing (chronic). |
Source: Medical Disability Advisor
| Depending on the infection's source, the individual may require several weeks or longer time off from work to recover from infectious arthritis. If the individual has had surgery for the condition, accommodations may be needed, such as temporary assignment to tasks that require only mild physical activity. If significant damage has occurred in a weight-bearing joint, certain tasks requiring extensive physical activity or heavy lifting may no longer be appropriate. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual recently had an injury, surgery, or injection in the affected joint?
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Does individual have osteoarthritis or rheumatoid arthritis?
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Was there recent exposure to bacteria, viruses, or fungi?
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Does individual complain of fever, chills, pain, heat, weakness, or swelling in the joint?
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Were joints involved?
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Does individual also report red sores on the palms and soles, a rash, and pain in the wrists and ankles?
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On physical exam, did individual have swelling in the joint with inflamed tendons?
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Does individual have fever and reduced range of motion in the joint?
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Was serology testing done? Was a needle aspiration performed for culture and microscopic examination? Were throat, urethral, or rectal cultures done?
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Was x-ray or biopsy performed?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Is individual being treated with antibiotics or antifungal medications? If "yes," are the antibiotics being administered by IV or IM routes?
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Was hospitalization necessary?
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Was individual's joint drained by arthrocentesis, arthrotomy, or arthroscopy?
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Is individual continuing drug therapy for up to 4 weeks?
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Is individual also being treated with analgesics and/or NSAIDs? Splints?
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Was physical therapy recommended?
Regarding prognosis:
- Is individual active in physical therapy? Is a home exercise program in place?
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Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Have any complications developed, such as acute respiratory distress, permanent damage of the affected joint, multiple joint involvement, erythema nodosum, or chronic infectious arthritis?
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Is individual draining pus from a hole in the skin from osteomyelitis?
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Source: Medical Disability Advisor
| Munoz, Gabriel, and Edmund W. Raycraft. "Septic Arthritis." eMedicine. Eds. Jegan Krishnan, et al. 20 Dec. 2004. Medscape. 14 Sep. 2004 <http://emedicine.com/orthoped/topic437.htm>.Studley, Matthew, and Larry Holder. "Septic Arthritis." eMedicine. Eds. Guiseppe Guglielmi, et al. 12 Jun. 2003. Medscape. 15 Sep. 2004 <http://emedicine.com/radio/topic629.htm>. |
Source: Medical Disability Advisor
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