Medical term:

arthritides

arthritis

[ahr-thri´tis] (pl. arthri´tides)

inflammation of a joint. adj., adj arthrit´ic. The term is often used by the public to indicate any disease involving pain or stiffness of the musculoskeletal system. Arthritis is not a single disease, but a group of over 100 diseases that cause pain and limit movement. The most common types are osteoarthritis and rheumatoid arthritis.

Arthritis of the fingers. Left, normal hand and finger. Right, arthritic hand and finger, with ankylosis, or “locking” of the joint by bone and scar tissue. Courtesy of Bergman Associates.

acute arthritis arthritis marked by pain, heat, redness, and swelling.

acute rheumatic arthritis swelling, tenderness, and redness of many joints of the body, accompanying rheumatic fever.

hypertrophic arthritis rheumatoid arthritis marked by hypertrophy of the cartilage at the edge of the joints; osteoarthritis.

juvenile rheumatoid arthritis rheumatoid arthritis in children under age 16, characterized by swelling, tenderness, and pain, involving one joint or several joints and lasting more than six weeks. It may lead to impaired growth and development, limitation of movement, and ankylosis and contractures of joints. At times it is accompanied by systemic manifestations such as spiking fever, transient rash on the trunk and limbs, hepatosplenomegaly, generalized lymphadenopathy, and anemia, in which case it is known as Still's disease or systemic onset juvenile rheumatoid arthritis.

Lyme arthritis Lyme disease.

psoriatic arthritis that associated with severe psoriasis, classically affecting the terminal interphalangeal joints.

rheumatoid arthritis a chronic systemic disease characterized by inflammatory changes occurring throughout the body's connective tissues. As such, it is classified as a collagen disease. This form of arthritis strikes during the most productive years of adulthood, with onset in the majority of cases between the ages of 20 and 40. No age is spared, however, and the disease may affect infants as well as the very old. The disease affects men and women about equally in number, but three times as many women as men develop symptoms severe enough to require medical attention.

Etiology. The cause of rheumatoid arthritis is unknown and it is doubtful that there is one specific cause. It is regarded by some researchers as an autoimmune disease, in which the body produces abnormal antibodies against its own cells and tissues. Evidence to support this theory is found in the fact that there is an abnormally high level of certain types of immunoglobulins in the blood of patients suffering from rheumatoid arthritis. Other researchers contend that the disease may be due to infection, perhaps from an undefined virus or some other microorganism (e.g., Mycoplasma). There also is the possibility that rheumatoid arthritis is a genetic disorder in which one inherits a predisposition to the disease. Physical and emotional stress also play some part in the onset of acute attacks; however, psychological stress is implicated as a causative factor in the onset of many illnesses.

Symptoms and Pathology. In about 75 per cent of patients the onset of rheumatoid arthritis is gradual, with only mild symptoms at the beginning. Early symptoms include malaise, fever, weight loss, and morning stiffness of the joints. One or more joints may become swollen, painful, and inflamed. Some patients may experience only mild episodes of acute symptoms with lengthy remissions. The more typical patient, however, experiences increasingly severe and frequent attacks with subsequent joint damage and deformity. The pattern of remissions and exacerbations continues throughout the course of the disease.

If untreated, and sometimes in spite of treatment, the joint pathology goes through four stages: (1) proliferative inflammation of the synovium with increased exudate, which eventually leads to thickening of the synovium; (2) formation of a layer of granulation tissue (pannus) that erodes and destroys the cartilage and eventually spreads to contiguous areas, causing destruction of the bone capsule and parts of the muscles that control the joint; (3) fibrous ankylosis resulting from invasion of the pannus by tough fibrous tissue; and (4) bony ankylosis as the fibrous tissue becomes calcified.

In addition to the joint changes there is atrophy of muscles, bones, and skin adjacent to the affected joint. The most characteristic lesions of rheumatoid arthritis are subcutaneous nodules, which may be present for weeks or months and are most commonly found over bony prominences, especially near the elbow.

Because rheumatoid arthritis is a systemic disease, there is involvement of connective tissues other than those in the musculoskeletal system. Degenerative lesions may be found in the collagen in the lungs, heart, blood vessels, and pleura.

Patients with rheumatoid arthritis appear undernourished and chronically ill. Most are anemic because of the effect of the disease on blood-forming organs. The erythrocyte sedimentation rate is elevated and the WBC may be slightly elevated.

Treatment and Patient Care. Management of rheumatoid arthritis is aimed at providing rest and freedom from pain, minimizing emotional stress, preventing or correcting deformities, and maintaining or restoring function so that the patient can enjoy as much independence and mobility as possible. Occupational therapy is needed to teach patients effective ways to carry out such activities of daily living as grooming and self-care, preparing meals, and light housekeeping. This often involves using specially designed utensils and tools that allow deformed joints to perform these tasks.

Rest and Exercise. It is recommended that the patient with rheumatoid arthritis plan for 10 to 12 hours of sleep out of each 24. The patient should be careful to maintain good posture while lying in bed and avoid pillows or other devices that support the joints in a flexed position. A firm mattress is recommended, with only one pillow under the head. During periods of severe attacks, the patient may require continuous bed rest.

The purpose of rest is to allow the body's natural defenses against inflammation to work at optimal level. It is necessary, however, even in the acute phase to balance rest with prescribed exercises which take into account the severity of the case, the joints affected, and the patient's individual needs and tolerance.

Physical Therapy. The goals of physical therapy for the patient with rheumatoid arthritis are to prevent and correct deformities, control pain, strengthen weakened muscles, and improve function.

Therapeutic exercise is of major importance in the physical therapy program established for the patient. It is necessary to enlist the patient's cooperation, and this can be done most effectively by explaining the purposes of the exercises and teaching ways to exercise that will not increase pain. In many instances proper exercise can actually diminish pain. The patient's tolerance for exercise must be carefully monitored. While it is expected that some discomfort may be present during exercise, there should not be persistent pain that continues for hours after the exercises have been done. If such pain and fatigue do occur, the exercise program should be reviewed and revised so that a good balance of rest and exercise is obtained. It should be remembered that overactivity can contribute to the inflammatory process.

Applications of heat or cold may be used in the management of rheumatoid arthritis. Heat applications improve circulation, promote relaxation, and relieve pain. When used in conjunction with exercise, heat can allow more freedom of joint movement. Various forms of heat therapy may be used, including dry heat, moist heat, diathermy, and ultrasound. For dry heat a therapeutic infrared heat lamp may be most convenient during home care. Hot water bottles or electric heating pads also may be used. For treatment of the hands, paraffin baths are effective. Wet heat can be applied by hot tub baths with the water temperature not exceeding 39°C (102°F) or by means of a towel dipped in hot water, wrung out, and applied to the joint. Whirlpool baths are effective, especially when prolonged treatment is indicated. Relief from pain and stiffness can be provided for some patients by applications of cold packs to the affected joints. This can be done by placing ice packs directly over the joint. When either heat or cold is used, care must be taken to protect the patient's skin. It should be remembered that rheumatoid arthritis affects the skin as well as other tissues.

Whenever it is necessary to handle the joints and limbs of a patient with rheumatoid arthritis, it is extremely important to move slowly and gently, avoiding sudden, jarring movements which stimulate muscle contraction and produce pain. The affected joints should be supported so that there is no excessive motion.

Medication. There is no drug that will cure arthritis. The health care provider does have a variety of medications that may be prescribed, depending on the needs and tolerance of the patient. It is important that the patient be advised of the expected results and possible undesirable side effects that may accompany ingestion of certain drugs. He or she should also be advised that therapeutic trials of several different drugs may be necessary. With this information at hand, he or she can work cooperatively with the physician in determining which drug or drugs can be most beneficial for treatment of the condition.

Aspirin was among the first drugs used to treat rheumatoid arthritis and remains a low-cost treatment option. It is a potent antiinflammatory agent when given at dosages that achieve a serum level of 20–30 mg/100 ml. For those prone to stomach upset or other gastrointestinal side effects from aspirin, enteric-coated tablets or antacid mixtures of aspirin are available.

Other nonaspirin, nonsteroidal antiinflammatory drugs (NSAIDs) include the indole derivatives indomethacin, sulindac, and tolmetin and the phenylalkanoic acid derivatives fenoprofen, ibuprofen, and naproxen. Nowadays NSAIDs are the most used group of medications for treatment of arthritis. They may provide more relief than aspirin for certain patients, but they also may have side effects related to the gastrointestinal and nervous systems. COX-2 (cyclooxygenase-2) inhibitors are the latest class of NSAIDs. They have fewer gastrointestinal side effects than other NSAIDs.

Cytotoxic agents may also be used; these drugs act as immunosuppressants and block the inflammatory process of the disease. methotrexate is the most common of these. The dosage for the management of rheumatoid arthritis is much lower than the dosages for malignancies; thus the associated side effects are fewer. gold compounds or penicillamine may be prescribed for selected patients who cannot tolerate or are not responding well to more conservative methods of treatment.

The corticosteroids may be used in treating rheumatoid arthritis, but they are not a substitute for other forms of treatment. In some cases these drugs produce side effects that are more difficult to treat than arthritis. They also may worsen certain features of the disease rather than relieve them. Drugs included in this group are cortisone, hydrocortisone, prednisone, prednisolone, and dexamethasone.

Another group of medications that reduce inflammation are the biological response modifiers. Members of this group used to treat arthritis include etanercept and infliximab.

Surgical Intervention and Orthopedic Devices. In the past, surgical intervention was reserved for patients who had already suffered severe joint deformity. There is presently a trend toward the use of surgery in the early stages of the disease so that deformities and serious mechanical abnormalities can be prevented or at least modified.

One surgical procedure employed is synovectomy (excision of the synovial membrane of a joint). The goal of this treatment is to interrupt the destructive inflammatory processes that eventually lead to ankylosis and invasion of surrounding cartilage and bone tissues.

Surgical repair of a hip joint (arthroplasty) may be performed when there is extensive damage and ambulation is not possible. The purpose of this procedure is to restore, improve, or maintain joint function. In cases in which it is not possible to restore the damaged hip joint there is a surgical procedure in which the diseased joint is completely replaced with a total hip prosthesis. The procedure is called a total hip replacement. A similar procedure involving total replacement of the knee can be done when there is extensive damage to the knee joint.

Braces, casts, or splints are sometimes used to immobilize the affected part so that it can rest during an active stage of the disease. Devices that immobilize the affected joint also may allow for motion of adjacent muscle, thereby improving muscle strength and permitting more independence on the part of the patient. Braces also may be used to prevent deformities by maintaining good position of the joints.

Patient Education. Unfortunately, arthritis is so widespread and such a crippling disease that its victims may be easy prey for charlatans and promoters of “miraculous cures.” The nature of the disease, with its unexplained remissions and relief of symptoms, makes it easy for unscrupulous individuals to convince the arthritic patient that some bizarre treatment they have used has indeed “cured” the arthritis. It is important that members of the health team recognize the need for patient education and work diligently with the patient and family so that they can cooperatively participate in a program of care that is most effective for the individual patient.

Home care is an essential part of the management of arthritis. To help in education of the public The Arthritis Foundation provides a number of pamphlets and other educational materials, supports a broad program of research and education, and helps finance improvement of local facilities for treatment of arthritis. The address of the foundation is The Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309, telephone 404-872-7100.

suppurative arthritis inflammation of a joint with a purulent effusion into the joint, due chiefly to bacterial infection.

systemic onset juvenile rheumatoid arthritis Still's disease.

ar·thrit·i·des

(ar-thrit'i-dēz),

Plural of arthritis.

Farlex Partner Medical Dictionary © Farlex 2012

arthritis

(ar-thri'tis ) plural.arthritides [ arthro- + -itis]

Joint inflammation, often accompanied by pain, swelling, stiffness, and deformity. Arthritis is very common, affecting millions. The most prevalent type, osteoarthritis or degenerative arthritis, increases in incidence with age but is not considered a part of normal aging. Other forms of arthritis include rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Arthritis differs from rheumatic disease in that arthritis is a disease of joints whereas rheumatic disease may also affect other tissues and organs. arthritic (-thrit'ik), adjective

Etiology

Arthritis may result from infections (e.g., rheumatic fever, staphylococcal infections, gonorrhea, tuberculosis), metabolic disturbances (e.g., gout, calcium pyrophosphate crystal disease), multisystem autoimmune diseases (e.g., psoriasis, rheumatoid arthritis, systemic lupus erythematosus), neuropathies (e.g., Charcot's joint), joint trauma, or endocrine diseases (e.g., acromegaly). See: bursitis; monoarthritis; osteoarthritis; polyarthritis; rheumatism

Treatment

Anti-inflammatory drugs, corticosteroids, monoclonal antibodies, antibiotics, joint aspiration, surgery, and occupational or physical therapies may play a role in the treating arthritis, depending on the cause and severity of the illness.

acne-associated arthritis

Abbreviation: AAA

Joint inflammation accompanying acne fulminans, typically in adolescent boys. It is a rare type of spondyloarthropathy. The joint disease in AAA commonly involves the acromioclavicular and sacroiliac joints. Painful hyperostosis of the sternum and clavicles are typical findings. The syndrome is also known as SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteomyelitis). Affected boys are HLA-B27 negative. Synonym: synovitis acne pustulosis hyperostosis and osteomyelitis syndrome

acute suppurative arthritis

Septic arthritis.

adjuvant arthritis

Abbreviation: AA

An experimental model of arthritis in rodents induced by injection of foreign substance, such as Freund's adjuvant, into the tail vein or paw. This model can be used to study new agents for human arthritis treatment. See: Rheumatoid arthritis

allergic arthritis

Arthritis occurring in serum sickness or, occasionally, as a result of food allergies.

See: serum sickness

bacterial arthritis

Infection of joints associated with fever and other systemic symptoms. Joint destruction occurs if the infection is not treated expeditiously. Removal of pus from the joint is necessary. In older or immunosuppressed patients, the most common causative organism is Staphylococcus aureus. Staphylococci, anaerobes, or gram-negative bacteria are found in prosthetic joint infections. Gonococci and Borrelia burgdorferi, the spirochete that causes Lyme disease, differ from other forms of bacteria that cause joint infection in that they tend to affect younger and more active people. Synonym: acute suppurative arthritis; septic arthritis

cricoarytenoid arthritis

One of the causes of dysphonia and vocal fold immobility that does not involve laryngeal nerve damage. It is caused by degenerative changes of the cricoarytenoid joints.

degenerative arthritis

Osteoarthritis.

enteropathic arthritis

Joint disease associated with inflammatory bowel disease.

epidemic arthritis

Infectious arthritis, often accompanied by a rash, caused by the Ross River virus.

experimental arthritis

Any form of arthritis induced in laboratory animals, used to study pathophysiology, or to foster improvements in diagnosis or treatment of the disease.

gonococcal arthritis

Arthritis, often with tenosynovitis and/or rash, caused by gonococcal infection. The joints of the knees, wrists, and hands are most commonly affected. The disease may affect any sexually active person and may follow infection of a mucous membrane by gonorrhea. This presentation of gonorrhea is usually called “disseminated gonococcal infection” (DGI).

Treatment

It is treated with intravenous ceftriaxone. A tetracycline antibiotic is usually given at the same time to treat possible co-infection with Chlamydia species.

gouty arthritis

Arthritis caused by gout.

hypertrophic arthritis

Osteoarthritis.

juvenile idiopathic arthritis

Abbreviation: JIA
The preferred name for juvenile rheumatoid arthritis.

juvenile rheumatoid arthritis

Abbreviation: JRA

Any of a group of chronic, inflammatory diseases involving the joints and other organs in children under 16. The age of onset is variable, as are the extra-articular manifestations. JRA affects about 1 in 1000 children (150,000 to 250,000 in the US alone) with overall incidence twice as high in females and is the most common form of arthritis in childhood. At least five subgroups are recognized. Synonym: Still's disease; juvenile idiopathic arthritis

Symptoms

Signs and symptoms depend on the type of JRA that is present.

Treatment

Anti-inflammatory agents are the mainstay of palliation but have little effect on the outcome of the disease. Corticosteroids may have adverse effects on bone growth; therefore most rheumatologists try to minimize their use. Disease-modifying drugs, such as methotrexate or leflunomide are current mainstays of treatment. Hematopoietic stem cell transplantation may be used in specialized treatment centers. Surgery is used to release ankylosed joints once the child reaches physical maturity and is able to carry out vigorous rehabilitation. Physical and occupational therapy are needed to maintain muscle strength and joint range of motion to prevent contractures, deformities, and disability. Gait training and joint protection also are helpful. Splinting joints in correct alignment reduces pain and prevents contractures. Regularly scheduled slit-lamp examinations help in the early diagnosis of iridocyclitis, which should be managed by an ophthalmologist, usually with corticosteroids and mydriatics. Other extra-articular manifestations should be referred to medical and surgical specialists.

Patient care

The child and family are instructed about the disease, treatment, and coping strategies, and are encouraged to express concerns. A well-balanced diet, regular exercise and rest periods, and avoidance of overexertion are encouraged. The child should be encouraged to be independent and involved in education and have an active social life. Moist heat helps relieve pain and stiffness. Placing the child in a warm bath, immersing painful hands and feet in pans of warm water for 10 min two to three times daily, or using daily whirlpool baths, a paraffin bath, or hot packs provide temporary relief of acute swelling and pain. Swimming and aerobic exercise in warm water are recommended to strengthen muscles and maintain mobility. Good posture and body mechanics are important; sleeping on a firm mattress without a pillow or with only a thin pillow is recommended to maintain proper body alignment. The patient should lie prone to straighten the hips and knees when resting or watching television. When braces or splints are required, their use is explained and demonstrated. Activities of daily living and playing provide opportunities to maintain mobility and incorporate therapeutic exercises using assistive and safety devices. The child with photophobia due to iridocyclitis should wear sunglasses. The child and family are referred to local and national support and information groups like the Arthritis Foundation (404-872-7100) (www.arthritis.org). Desired outcomes include the child's ability to achieve and maintain optimal health with joints that are movable, flexible, and free of deformity; to move with minimal or no discomfort; to engage in activities suitable to his or her interests, capabilities, and developmental level; and to perform self-care activities to maximum capabilities.

Lyme arthritis

The large-joint arthritis that develops in approx. 35% to 80% of patients with Lyme disease, caused by the spirochete Borrelia burgdorferi. It appears 2 weeks to 2 years after infection and is marked by periodic episodes of pain that move among different joints; the shoulders, knees, elbows, and ankles are involved most commonly. Approx. 10% of patients develop permanent deformities. The likelihood of chronic arthritic complaints is markedly diminished if patients are treated with amoxicillin or other appropriate antibiotics. See: Lyme disease

arthritis mutilans

Severe joint destruction, a characteristic of several inflammatory joint diseases, including some instances of psoriatic arthritis.

neuropathic arthritis

Arthritis associated with diseases of the nervous system. It occurs most commonly as a result of diabetes but can occur in tabes dorsalis, syphilis, and syringomyelia.

oligoarticular type I juvenile idiopathic arthritis

A form of JIA that accounts for about 33% of all cases; 80% of cases occur in girls, usually presenting in early childhood. Only a few joints are involved, typically the large joints of the knee, ankle, or elbow. One third of cases develop chronic iridocyclitis. Results of rheumatoid factor evaluation are usually negative. Ultimately, 10% of these children develop ocular damage, and 20% go on to develop polyarthritis.

oligoarticular type II juvenile idiopathic arthritis

A form of JIA that 90% of the time occurs in boys. As with type I, few joints are involved in this form of JIA; the hip girdle is usually involved. Sacroiliitis and acute iridocyclitis are the important extra-articular manifestations; an unknown percentage of children develop chronic spondyloarthropathy.

palindromic arthritis

Transient recurrent arthritis, of unknown cause, usually affecting large joints, such as the knees and elbows.

polyarticular juvenile idiopathic arthritis, rheumatoid factor–negative

A form of JIA that accounts for about 25% of all cases; 90% of cases occur in girls. It may involve multiple joints. Iridocyclitis, its most severe extra-articular manifestation, is rare. Severe arthritis develops in 10% to 15% of these children.

polyarticular juvenile idiopathic arthritis, rheumatoid factor–positive

A form of JIA that accounts for 5% to 10% of all cases; 80% of cases occur in girls. Typically presenting later in childhood, this arthritis may affect multiple joints. There are few extra-articular manifestations but 50% or more of these children develop severe arthritis.

psoriatic arthritis

Arthritis associated with psoriasis. The exacerbations and remissions of arthritic symptoms do not always parallel those of psoriasis. “Sausage-shaped” deformities of the fingers and toes are often present.

reactive arthritis

Arthritis that occurs shortly after an infection of the urinary or gastrointestinal tract. It often affects large joints in the lower extremities, usually in people under 50. Reiter's syndrome may be a form of reactive arthritis.

RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS

rheumatoid arthritis

A chronic systemic disease marked by inflammation of multiple synovial joints. The disease usually affects similar groups of joints on both sides of the body and can create bony erosions that can be seen radiographically. Subcutaneous nodule formation and elevated serum rheumatoid factor levels are common. Patients typically complain of joint stiffness in the morning rather than after activities. Women are affected three times more often than men. Members of some ethnic groups, such as certain Native Americans, have higher rates of this disease than the general population. The illness usually begins in mid-life, but any age group can be affected. See: illustration See: Gripping with Rheumatoid Arthritis

Etiology

Factors implicated in the development and the severity of this disease include genetics (e.g., HLA haplotypes), autoimmune phenomena, and environmental influences.

Symptoms

Joint pains, morning stiffness, gelling, malaise, and fatigue are often present. Systemic disease marked by pleural effusions, pericarditis, pulmonary fibrosis, neuropathies, and ocular disorders may occu. Symptoms usually develop gradually over the course of several months but may begin abruptly in some patients.

Treatment

Most rheumatologists recommend aggressive therapy with disease-modifying antirheumatic drugs (DMARDs) early in the course of the illness to prevent bony erosions and loss of joint function. Drugs in this class include agents like methotrexate. Nonsteroidal anti-inflammatory drugs, e.g., ibuprofen or corticosteroids are often prescribed for palliation. Many patients may continue to take low-dose corticosteroids for years, but the benefits of long-term steroid use must be weighed against the risks, such as diabetes, osteoporosis, and adrenal suppression. Gold compounds can be used, but they are weaker than DMARDs and newer agents. Newer agents include antibodies to tumor necrosis factor and other immunomodulatory drugs. Powerful immunosuppressive agents like cyclosporine, azathioprine, and mycophenolate may also be used. Combination therapies involving several agents from different classes can be used. Joint replacement surgery can be helpful for some patients. Homeopathic substances such as black currant (gamma linolenic acid) and fish oil have demonstrated efficacy in rheumatoid arthritis

Patient care

All joints are assessed for inflammation, deformities, and contractures. The patient's ability to perform activities of daily living (ADLs) is evaluated. The patient is assessed for fatigue. Vital signs are monitored, and weight changes, pain (location, quality, severity, inciting and relieving factors), and morning stiffness (esp. duration) are documented. Use of moist heat is encouraged to relieve stiffness and pain. Prescribed anti-inflammatory and analgesic drugs are administered and evaluated; the patient is taught about the use of these medications. Patient response to all medications is evaluated, esp. after a change in drug regimen, and the patient and family are taught to recognize the purpose, schedule, and side effects of each. Over-the-counter drugs and herbal remedies may interact with prescribed drugs and should not be taken unless approved by physicians or pharmacists. Inflamed joints are occasionally splinted in extension to prevent contractures. Pressure areas are noted, and range of motion is maintained with gentle, passive exercise if the patient cannot comfortably perform active movement. Once inflammation has subsided, the patient is instructed in active range-of-motion exercise for specific joints. Warm baths or soaks are encouraged before or during exercise. Cleansing lotions or oils should be used for dry skin. The patient is encouraged to perform ADLs, if possible, allowing extra time as needed. Assistive and safety devices may be recommended for some patients. The patient should pace activities, alternate sitting and standing, and take short rest periods. Referral to an occupational or physical therapist helps keep joints in optimal condition as well as teaching the patient methods for simplifying activities and protecting joints. The importance of keeping PT/OT appointments and following home-care instructions should be stressed to both the patient and the family. A well-balanced diet that controls weight is recommended (obesity further stresses joints). Both patient and family should be referred to local and national support and information groups. Desired outcomes include cooperation with prescribed medication and exercise regimens, ability to perform ADLs, slowed progression of debilitating effects, pain control, and proper use of assistive devices. For more information and support, patient and family should contact the Arthritis Foundation (404-872-7100) (www.arthritis.org).

septic arthritis

Inflammation of the synovial tissues in a joint as the result of a pyogenic bacterial infection. Once infection occurs, cartilage is destroyed and the joint space narrows. Patients at greatest risk are those with pre-existing arthritis, joint trauma, or immune deficiencies and those who use intravenous drugs. Synonym: bacterial arthritis; acute suppurative arthritis

Etiology

The primary site of infection is usually elsewhere, with joint infection occurring as the result of bacteremia or spread from osteomyelitis in an adjacent bone. The most common pathogen for those 16 to 40 years old is Neisseria gonorrhoeae; other common bacteria include Staphylococcus aureus, group B streptococci, and gram-negative bacilli such as Escherichia coli and Salmonella spp.

Symptoms

Suppurative arthritis is marked by an acutely painful, warm, swollen joint with limited range of motion and fever; the white blood cell count and erythrocyte sedimentation rates are increased. Except in gonococcal arthritis, only one joint is affected, most commonly the knee, hip, or shoulder.

Treatment

Prompt treatment is necessary, including drainage of the joint and antimicrobial drug therapy (intravenous penicillinase-resistant penicillins and third-generation cephalosporins). The affected joint is supported with a sling or pillows, and the patient's pain is treated with mild opioids and nonsteroidal anti-inflammatory agents. Without vigorous treatment, significant joint destruction can occur.

syphilitic arthritis

Arthritis occurring in the secondary and tertiary stages of syphilis and marked by tenderness, swelling, and limitation of motion.

systemic juvenile idiopathic arthritis

A form of JIA that accounts for 20% of all cases; boys are affected 60% of the time. Fever and rash may be the presenting symptoms, either with or without joint involvement. Ultimately, 25% of these children develop severe arthritis.

tuberculous arthritis

Chronic, slowly progressive arthritis of hips, knees, ankles, or intervertebral disks caused by Mycobacterium tuberculosis. The organism usually spreads via the blood or from osteomyelitis in an adjacent bone. The macrophage and lymphocyte response to the mycobacterium destroys the bone along the joint margins, resulting in progressive pain, fibrosis, and restricted movement.

See: granuloma

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