Is Arthritis Arthritis Dangerous?

DIAGNOSTIC AND TREATMENT
INFECTIOUS DISEASES
DEFINE
Septic arthritis or pyogenic arthritis is caused by a nonspecific bacterial infection (not caused by tuberculosis, leprosy, fungal, parasitic or viral).
REASON
The most common cause is gram-positive bacteria (85% of cases), especially staphylococcus aureus (50-70%), streptococci, pneumococci, gonorrhea. For gram-positive bacteria, there is usually a way of getting in from the skin through injection, extraction, trauma, acupuncture, joint joint procedures ..

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DIAGNOSE
The diagnosis is based on clinical and subclinical symptoms.
Clinical symptoms: two contagious infections caused by gonorrhea and gonorrhea.
Non-gonococcal septic arthritis:
- Symptoms in the joints: swelling and redness of pain, possible effusion, muscle contraction, limiting movement The number of inflamed joints is usually solitary
- Body: febrile infection syndrome, sometimes chills, dry lips with dirty tongue.
Gonococcal infections:
- Streptococcal septicemia syndrome: fever, chills, erythema and pustular acne, symptoms of arthritis, genital symptoms.



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Arthritis usually in small joints moving nature with bursitis - tendon in the knees, wrists, hands, ankles and ankles.
- True arthritis caused by gonorrhea: often damage a large toxic joint such as groin, knee, wrist, ankles with symptoms of painful redness, swelling, joint effusion.
Subclinical exploration:
- Examination of synovial fluid: suction of blind joint fluid or under the guidance of image diagnosis taking cell count specimens, microscopy, gram stain, culture of synovial fluid to find pathogenic bacteria.
- Image analysation:
+ Conventional X-ray: if the software is swollen soon, joint joints may be wide due to effusion. Late case: narrow joint fissures, destruction of opposite ends of the bone (mirror image), may have adhesion, deformed joints (usually at a very late stage)
+ Joint ultrasound: detect synovial effusion, guide aspiration of synovial fluid
+ Computerized tomography: good value to detect infection of the joints in the deep, the pelvic joints or associated inflammatory lesions in the bone.
+ Magnetic resonance imaging: indicated when software infections are suspected.
- Peripheral blood cell tests usually have a high number of white blood cells; Blood sedimentation, CRP (protein C reaction) usually increases.
- Blood culture to detect pathogenic bacteria, antibiotics for treatment.



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Diagnosis is determined when there is at least 1 of 2 criteria:
- Testing for purulent synovial fluid (degenerated neutrophil or high synovial fluid cells above 100,000 cells / ml with more than 80% being neutrophils) or finding bacteria through fresh examination, staining gram.
- Blood or joint fluid is positive for bacteria.
Combined with at least 1 of 2 standards:
- Clinical typical arthritis.
- Typical radiological signs of arthritis: mirror image
Differential diagnosis
- Acute gouty arthritis.
- Arthritis caused by tuberculosis.
- Arthritis caused by viruses, fungi, parasites.
- Reactive arthritis.
- Infectious osteomyelitis (inflammatory marrow bone).
TREATMENT
The principles of treatment
Early diagnosis, use of intravenous antibiotics, pus drainage when necessary, relative immobility.



. Immediately perform blood culture, joint fluid culture, microscopic examination of gram-staining fluid for bacteria before giving antibiotics. Initial selection of antibiotics is based on the results of gram staining (negative or positive), age and route of infection to predict the pathogenic bacteria
Treatment diagram / regimen
- Medical treatment: starting with intravenous antibiotics at least 1-2 weeks depending on the type of bacteria, sensitivity - drug resistance, severity ... (usually the combination of two antibiotics including at least an intravenous antibiotic), then switch to the appropriate oral antibiotic, the total duration of treatment is usually 2-4 weeks.
- Combination of aspirated drainage (if any), immobilization of joints in severe pain - is in the progression stage, rehabilitation of early joint motor function if pain is low.
- Coordinate surgical treatment when indicated.
Specific treatment:
Antibiotic treatment:
Specific treatment of non-gonococcal arthritis infections:
- When blood and fluid cultures are not available, use intravenous cephalosporin 3rd generation intravenous (TM) antibiotics such as cephotaxim 3g / day in 3 divided doses (every 8 hours), or ceftriaxon 1 - 2g once daily. .




- In case of colonoscopy, gram-positive fluid detects gram-positive bacteria: oxacillin or nafcillin 2g every 6 hours (8g / day), or clindamycin 2.4g TM / day in 4 divided doses. If antibiotic-resistant staphylococcus aureus is suspected: vancomycin 2g / day in divided doses (mixed with 0.9% sodium chloride solution or 5% glucose solution administered intravenously).
- Infections caused by pneumococcal or streptococcal bacteria caused by penicillin-susceptible bacteria: penicllin G 2 million TM units every 4 h for 2 weeks. In case of penicillin resistance: ceftriaxon 1 - 2g once daily, or cefotaxime 1g x 3 times daily for 2 weeks.
- Gram-negative infection: 3rd generation cephalosporin antibiotics for 3-4 weeks, or fluoroquinolones such as levofloxacin 500mg TM / orally every 24 hours.
- Patients suspected of infection with blue-pus bacillus need combination aminoglycoside antibiotics (such as gentamycin 3 mg

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