Infectious Arthritis

Basic Information

What is Infectious Arthritis?

Infectious arthritis is an inflammation of one or more joints (principally the wrists, knee or hip) that is caused by infection. The disease can occur in individuals of all ages, including children, but in adults there is usually a history of osteoarthritis or rheumatoid arthritis as well.

There are two principle types of infectious arthritis: gonococcal and non-gonococcal. Gonococcal arthritis is the most common form of the disease, especially in urban areas. It is usually found in otherwise healthy individuals aged 40 or under. Women have the disease twice as often as men, and frequently during the menstrual cycle or pregnancy; homosexual males commonly develop the disease as a complication of gonococcal pharyngitis and proctitis. Non-gonococcal arthritis, also known as septic arthritis, has a sudden onset, usually affecting wrists and large joints. It is usually traced to Staphylococcus, Streptococcus, E. coli and Pseudomonas aeruginosa bacteria and is found most frequently in drug abusers and in individuals with damaged or artificial joints.

Infectious Arthritis signs and symptoms

• Chills and fever (sometimes high).
• Redness, swelling, tenderness and pain (often throbbing) in the affected joint. Pain sometimes spreads to other joints. It worsens with movement.
• Pain in the buttocks, thighs or groin (sometimes).

Causes

• Entry into a joint by germs, usually bacteria (streptococci, staphylococci, gonococci, haemophilus or tubercle bacillus) or fungi. Germs gain entry from:
  • Infection elsewhere in the body, as with gonorrhea or tuberculosis.
  • Infection next to the joint, as with skin boils, cellulitis or bone infection.
  • Injury to the joint, including puncture wounds and skin abrasions.

Risk increases with

• Adults over 60.
• Illness that has lowered resistance.
• Sexually transmitted infections.
• Diabetes mellitus.
• Rheumatoid arthritis.
• Use of immunosuppressive drugs.
• Joint surgery.
• Injections into joints.
• Excess alcohol consumption.
• Use of mind-altering drugs, especially those that are injected.
• Poor hygiene.
• Prosthetic joint.
• The use of aspirin and other non-steroidal anti-inflammatory drugs for other disorders may suppress signs of joint inflammation, delaying diagnosis.

Preventive measures

• Protect exposed joints, such as the knee, during activities involving injury risks.
• Obtain prompt medical treatment for infections elsewhere in the body.

Expected outcomes

Treatment for gonococcal arthritis is usually a complete success. The outlook for individuals with septic arthritis is less favorable, with a mortality rate of up to 30% when individuals develop respiratory problems or have the infection in several joints. Non-gonococcal arthritis may permanently damage the involved joint.

Possible complications

Acute respiratory distress is a complication of septic arthritis. Both treated and untreated septic arthritis can result in permanent damage of the affected joint. Spread of the infection to a heart valve may require six weeks of intravenous antibiotics.

Alternatives

Septic arthritis may initially be mistaken for gout, acute rheumatic fever, rheumatoid arthritis and Still's disease (juvenile rheumatoid arthritis). Gonococcal arthritis may be mistaken for Reiter's syndrome, Lyme disease, rheumatic fever and infective endocarditis.

Infectious Arthritis Treatment

General measures

• Diagnostic tests may include laboratory studies, such as blood counts, blood culture and culture of fluid from the infected joint and X-rays of affected joints.
• Treatment involves antibiotic therapy with close medical monitoring of your progress through frequent cultures of joint fluid.
• Hospitalization for complete rest and intravenous antibiotics.
• Surgery to drain fluid or remove foreign material introduced by an injury.
• Physical therapy after recovery to regain full use of the joint.
• Additional information available from the Arthritis Foundation.

Medications

• Antibiotics (often intravenous). Don't discontinue antibiotics until told to do so. Infection may return after symptoms disappear.
• Narcotic pain medicine for a short time to relieve pain.

Information	Brand	Generic	Label	Rating
	Principen	Ampicillin
	Noroxin	Norfloxacin
	Motrin	Ibuprofen

Activity

• Splints or casts may be necessary to rest the affected joint completely. Movement delays healing.
• Range-of-motion exercises may be started following treatment.
• After cure, physical therapy is often necessary to restore joint function. Resume normal activities gradually as symptoms improve.

Diet

No special diet.

Appropriate specialists

Internist, osteopath, rheumatologist, infectious disease specialist, and orthopedic surgeon.

Last updated 27 November 2015