Purulent arthritis is an inflammation of all joint structures caused by pathogenic bacteria. As a rule, the "heroes of the occasion" are strepto- and staphylococci, but sometimes anaerobic flora joins them. The pathogen can enter the joint through a wound, a needle prick, through the flow of blood and lymph.
Definition
Purulent arthritis is a limited acute inflammatory process of microbial etiology that develops in the joint cavity. With untimely or poor-quality treatment, it can cause severe long-term consequences, such as arthrosis and contractures. In addition, the spread of infection beyond the boundaries of the joint can threaten the appearance of phlegmon and abscesses. In advanced cases, sepsis and osteomyelitis are possible.
The treatment of this pathology, as a rule, is done by surgeons or traumatologists. Their main task is to open the joint cavity and ensure the outflow of infected fluid, as well as prescribe adequate antibiotic therapy.
Etiology
Purulent arthritis can develop in absolutely any joint, butmost often affected are the shoulder, knee, ankle and femoral, as they are most susceptible to injury and experience heavy loads. The structural features of the capsule provide a long-term accumulation of pus without any manifestations. In view of this, infected fluids permeate all tissues of the joint, including cartilage and bones. This subsequently leads to severe complications.
Good blood supply and lymphatic drainage contribute to the spread of inflammation to neighboring areas, which in the future threatens to develop sepsis and purulent osteomyelitis. The culprits of the disease in most cases are streptococci and staphylococci, a little less common are gonococcus, E. coli, Salmonella, Klebsiella and Proteus.
Among the risk factors are severe contamination of penetrating wounds of the joints, a history of open fractures, a decrease in local and general immunity, and exhaustion of the body as a whole.
Views
Purulent arthritis is of two types, depending on what exactly caused the inflammatory reaction:
- Nontraumatic.
- Traumatic.
In addition, arthritis is distinguished by the time of occurrence:
- Primary arthritis, when the infectious process began directly in the joint cavity. This may be the result of a fracture, dislocation, trauma or injury.
- Secondary arthritis. Possible if the infection has entered the joint from another place in the body.
Purulent arthritis of the shoulder joint
Omarthritis occurs in case of penetrating injuries or infection by the hematogenous or lymphogenous route. The very first sign of the disease is pain when moving, touching and sloshing the joint.
Over time, purulent shoulder arthritis becomes visible to the naked eye, as fluid accumulates in the joint bag and deforms it. Under the fingers, the doctor feels a transfusion of pus. If enough fluid accumulates, it can melt the capsule and flow into the muscle sheaths, under the fascia. In this case, you will have to treat the phlegmon of the shoulder and neck.
The characteristic posture of the victim can give out the presence of pathology. He saves the limb, practically does not use it, the shoulder is lowered, and the arm itself is laid aside and bent at the elbow.
Arthritis of the lower limb joints
Purulent arthritis of the knee joint develops after tissue infection with pathogenic bacteria. Eighty percent of all infections are caused by staphylococcus aureus, meningococcus, or Pseudomonas aeruginosa. The disease begins acutely, with a rise in temperature and severe intoxication. The knee swells, all physiological depressions and protrusions are smoothed out, sometimes purulent fistulas form in places of tissue thinning.
Purulent arthritis of the ankle usually develops against the background of systemic inflammatory diseases such as lupus, gout or Bechterew's disease. This pathology is characterized by an increase in local and general temperature, swelling of the joint,redness of the skin. Sometimes fistulous passages may also appear. In advanced cases, swelling spreads to the foot, and pus breaks form streaks.
Purulent arthritis of the hip joint, or coxitis, occurs with autoimmune diseases, impaired uric acid metabolism, the presence of a chronic inflammatory process in the body, and also as a result of joint overload. The strongest intoxication, fever, nausea and vomiting, as well as pain when moving in the joint and touching it, redness of the skin over the joint comes to the fore.
Symptoms
Acute purulent arthritis begins abruptly. The affected joint swells, becomes hot to the touch, the skin over it is hyperemic, stretched and shiny. At the same moment, the patient begins to experience pain during movement, which intensify over time and acquire a “shooting” character. Any touch becomes painful, a person cannot put clothes on the affected limb. If nothing is done, then in a few days the swelling will spread above and below the joint.
In addition to local, there are general symptoms. Among them, intoxication, high fever, chills, nausea and vomiting prevail. Possible loss of consciousness, headaches. Heartbeat is fast, breathing is deep and heavy.
Diagnosis
To establish a diagnosis, in addition to examination and history taking, it is necessary to conduct laboratory and instrumental studies. In the general blood test, a typicalinflammatory picture: an increase in the erythrocyte sedimentation rate, a shift in the leukocyte formula to reticulocytes, a huge number of neutrophils. It is also recommended to puncture the joint and give the resulting liquid for microbiological examination. Pus is microscoped, stained with aniline dyes and sown on a nutrient medium. Five days later, the doctor receives a conclusion indicating the pathogen and its sensitivity to antibiotic therapy.
Of instrumental studies, radiography is prescribed. The picture clearly shows swelling of the tissues, the width of the joint space, the presence of erosion and osteoporosis. If arthritis has just begun, then x-rays may not be informative. In such cases, the patient is sent for an ultrasound or CT scan. In addition to all of the above, it is necessary to schedule a consultation with an infectious disease specialist to rule out a generalized infection.
Purulent arthritis: treatment
Even if purulent arthritis is suspected, the patient must go to the hospital. Immediately, without waiting for the results of laboratory tests, broad-spectrum empiric antimicrobial therapy is prescribed to cover all possible pathogens. This approach avoids serious complications.
First, it is proposed to try conservative treatment. If there is little or no pus, a cast is applied to the limb to fix it in one position, then antibiotics are injected intra-articularly.
If there is an empyema of the capsule or visible to the naked eye,that a lot of fluid has accumulated in the joint, in which case immediate arthrotomy and drainage are indicated. Upon admission of a patient with penetrating wounds of the joints, the primary surgical treatment of the damaged area is first carried out, the removal of dirt and foreign bodies, the revision of all pockets and possible leaks, and only after that a drainage tube is placed.
Prevention
As a prevention of purulent arthritis, it is recommended to perform operations for osteomyelitis in a timely manner, to open abscesses and phlegmons that appear at the sites of injuries in time. In addition, it is imperative to observe the terms of treatment of infectious diseases and in no case cancel the medication on your own. This can cause microorganism resistance and make further therapy difficult.
If you are still injured, you must thoroughly wash the wound, treat the edges with iodine or brilliant green and apply a clean bandage. The limb must be well fixed and already in this form go for medical help. This will make the doctor's job easier and help delay the onset of inflammation.
Complications
The most formidable complication of purulent arthritis is rightfully sepsis. This is a condition that literally threatens a person's life, as it can end fatally. But, in addition to a generalized infection, there are a number of diseases associated with this pathology.
The accumulation of pus in the joint bag can lead to its melting and the formation of phlegmon, fistulas and inflammationexudate. In addition, not only soft tissues, but also bones can melt, and the result of such arthritis will be deformities and defigurations of the limbs. Contractures, which are formed due to the forced position of the joint, in the most severe cases can lead to loss of function and disability.
Therefore, it is extremely important to seek medical help in a timely manner. Do not try to endure pain or help yourself with folk methods. This can only make the situation worse. No matter how awe you feel at the sight of a person with a needle or a scalpel, in the case of acute inflammatory diseases, it is better not to delay treatment.
