Arthritis can occur as a result of trauma, infection or natural wear and tear, but it can also be the consequence of an autoimmune disease in which the body attacks its own tissues (e.g. rheumatoid arthritis), or the deposition of uric acid crystals in the joints (e.g. gout). Sometimes, there’s no reason to explain the symptoms.
Most arthritic diseases are chronic. Some lead to the deterioration of joint structures. Stiffness reduces joint mobility, and the muscles surrounding the joint atrophy, accelerating the progression of the disease. Over time, cartilage crumbles, bone wears away and the joint may become deformed.
Acute arthritis includes :
- Infectious arthritis. It can occur when an infection directly affects a joint and causes inflammation;
- Reactive arthritis. This form of arthritis also occurs following an infection. But in this case, the infection is not located directly in the joint.
Symptoms vary according to the type of germ causing infectious arthritis.
Septic arthritis is a therapeutic emergency. Treatment must be codified and rapid to avoid irreversible joint damage. Inoculation of a germ into a joint leads initially to an inflammatory reaction of the joint fluid, followed by inflammation and abscessation of the synovium, and ultimately to osteocartilaginous destruction. Diagnosis is based on joint puncture, performed as soon as possible and before any antibiotic treatment. Any delay in diagnosis runs the risk of irreversible osteoarticular damage. Specific surgical treatment is available for each stage of infection.
The mere presence of germs in the joint fluid is sufficient to make the diagnosis of joint infection, whether or not there are clinical or paraclinical manifestations.
Clinical diagnosis
It is based on a combination of general signs of infection and local signs of inflammation. However, the fundamental argument for differentiating these signs from a rheumatic inflammatory crisis is the notion of contagion: notion of a distant portal of entry
with or without signs of bacteremia, notion of direct traumatic or iatrogenic portal of entry.
notion of bone or soft-tissue infection close to a joint. However, the key to diagnosis is isolation.
The key to diagnosis is isolation of the germ from the joint fluid. Any suspected joint infection must be accompanied by a joint fluid sample.
Significant elevation of inflammatory markers (elevated CRP, blood neutrophils and globular sedimentation rate) provides additional but non-specific evidence of infection.
Principles of joint infection treatment
Probabilistic antibiotic therapy should be rapidly corrected by antibiogram data and targeted curative antibiotic therapy according to joint puncture data.
immobilization in functional position for pain relief and faster healing
Just as there are three stages of evolution (liquid stage, synovial stage, osteoarthritis), there are three stages of treatment corresponding to each stage:
- liquid drainage (puncture) for the liquid stage;
- open synovectomy for synovial stage;
- arthrectomy” joint resection (with or without arthrodesis or arthroplasty) for the osteoarthritis stage.
A painful, febrile joint requires diagnostic and evacuation puncture, immobilization and medical treatment. Results are most favourable at this early stage. A joint that has been infected for less than seven days, with significant fluid effusion, requires active treatment of the joint fluid (joint lavage). After evacuation, reproduction of the joint effusion should prompt consideration of the next step.
Your surgeon will suggest the best specific treatment for your arthritis, based on your clinical and biological findings.
