Purulent arthritis is an inflammation of all joint structures caused by pathogenic bacteria. As a rule, the “culprits of the triumph” are streptococcus and staphylococcus, but sometimes anaerobic flora joins them. The causative agent can penetrate the joint through a wound, an injection from a needle, with 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 borders of the joint can threaten the appearance of phlegmon and abscesses. In advanced cases, sepsis and osteomyelitis are possible.
As a rule, surgeons or traumatologists are involved in the treatment of this pathology. 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, but most often affects the shoulder, knee, ankle and femoral, as they are most susceptible to trauma and experience great stress. The structural features of the capsule provide a long accumulation of pus without any manifestations. Because of this, infected fluids infiltrate all joint tissues, including cartilage and bones. This subsequently leads to serious complications.
Good blood supply and lymphatic drainage contribute to the spread of inflammation to neighboring areas, which in the future threatens the development of sepsis and purulent osteomyelitis. The culprits of the disease in most cases are streptococci and staphylococci, gonococcus, Escherichia coli, Salmonella, Klebsiella and Proteus are slightly less common.
Among the risk factors, one can single out a strong 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.
Kinds
Purulent arthritis is of two types, depending on what exactly caused the inflammatory reaction:
- Non-traumatic.
- Traumatic.
In addition, arthritis is distinguished by the time of onset:
- Primary arthritis, when the infectious process began directly in the joint cavity. This may be the result of a fracture, dislocation, injury or injury.
- Secondary arthritis. Possible if the infection entered the joint from another place in the body.
Purulent arthritis of the shoulder joint
Omarthritis occurs in the case of penetrating injuries or infection through the hematogenous or lymphogenous route. The very first sign of a disease is pain when moving, touching and pulling the joint.
Over time, purulent brachial arthritis becomes noticeable to the naked eye, as fluid accumulates in the joint bag and deforms it. Under the fingers, the doctor feels a pus transfusion. If enough fluid accumulates, it can melt the capsule and leak into the muscle cases, under the fascia. In this case, it will be necessary to treat the phlegmon of the shoulder and neck.
The presence of pathology can be given out by the characteristic pose of the victim. He protects 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 joints of the lower limb
Purulent arthritis of the knee joint develops after infection of tissues with pathogenic bacteria. Eighty percent of all infections are caused by staphylococcus, 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 are formed in places of thinning of tissues.
Purulent arthritis of the ankle joint, as a rule, develops against a background of systemic inflammatory diseases such as lupus, gout, or ankylosing spondylitis. This pathology is characterized by an increase in local and general temperature, joint swelling, and redness of the skin. Sometimes fistulous passages may also appear. In advanced cases, edema spreads to the foot, and breakouts of pus 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, as well 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 suppurative arthritis begins abruptly. The affected joint swells, becomes hot to the touch, the skin above it is hyperemic, stretched and shiny. At the same moment, the patient begins to experience pain during movement, which intensifies over time and acquire a "shooting" character. Any touch becomes painful; a person cannot put on clothing 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. The heartbeat is frequent, breathing is deep and heavy.
Diagnostics
To establish a diagnosis, in addition to examining and collecting an anamnesis, it is necessary to conduct laboratory and instrumental studies. In the general blood test, a typical inflammatory picture is noted: 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 make a joint puncture and give the resulting fluid to a microbiological examination. Pus is microscopic, stained with aniline dyes and sown on a nutrient medium. Five days later, the doctor receives a report indicating the pathogen and its sensitivity to antibiotic therapy.
Of instrumental studies, radiography is prescribed. The swelling of the tissues, the width of the joint space, the presence of erosion and osteoporosis are clearly visible in the picture. If arthritis has just begun, then radiography 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 appoint a consultation with an infectious disease specialist to exclude a generalized infection.
Purulent arthritis: treatment
Even with suspected purulent arthritis, the patient must always go to the hospital. Immediately, without waiting for the results of laboratory tests, empirical antimicrobial therapy of a wide spectrum of action is prescribed to cover all possible pathogens. This approach avoids severe complications.
At first it is suggested to try conservative treatment. If the amount of pus is small or not at all, gypsum is applied to the limb to fix it in one position, then antibiotics are administered intraarticularly.
If empyema of the capsule is observed or with the naked eye it can be seen that a lot of fluid has accumulated in the joint, in this case immediate arthrotomy and placement of drains is indicated. Upon admission of a patient with penetrating wounds of the joints, primary surgical treatment of the damaged area, removal of dirt and foreign bodies, an inspection of all pockets and possible sagging is carried out first, and only then a drainage tube is placed.
Prevention
As a prophylaxis of purulent arthritis, it is recommended to timely conduct operations for osteomyelitis, in time to open the abscess and phlegmon that appear at the site of injuries. In addition, it is imperative to comply with the deadlines for the treatment of infectious diseases and in no case do not cancel the medication yourself. This can cause microorganism resistance and complicate further therapy.
If you still get hurt, you need to thoroughly rinse the wound, treat the edges with iodine or brilliant green and apply a clean dressing. The limb needs to be well fixed and already in this form to go for medical help. This will facilitate the work of the doctor and help delay the onset of inflammation.
Complications
The most formidable complication of purulent arthritis is rightfully sepsis. This condition, which 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 sagging inflammatory exudate. In addition, not only soft tissues, but also bones can melt, and the result of such arthritis will be deformations and configurations of limbs. Contractures that form 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 using folk methods. This can only aggravate the situation. No matter how awe you feel when you see a person with a needle or a scalpel, in case of acute inflammatory diseases it is better not to interfere with the treatment.