Infectious Arthritis

What Is It?

Infectious arthritis is joint pain, soreness, stiffness and swelling caused by an infection by bacteria, viruses or fungi.

These infections can enter a joint various ways:

• After spreading through the bloodstream from another part of the body, such as the lungs during pneumonia
• Through a nearby wound
• After surgery, an injection or trauma, such as an insect bite

Once the infection reaches the joint, it can cause symptoms of joint inflammation and, at times, fever and chills. Depending on the type of infection, one or more joints may be affected.

The most common joint affected by infection is the knee. Small joints, such as those in fingers and toes, are more likely to become infected after a viral infection or direct injury, such as a bite. In people who use intravenous drugs, joints in the spine or breastbone (sternum) may be involved. People who already have rheumatoid arthritis or another joint disease are more likely to develop infectious arthritis.

Certain bacteria can cause a form of infectious arthritis called reactive arthritis or Reiter's disease, which appears to be caused by the immune system reacting to bacteria, rather than by the infection itself. In Reiter's disease, arthritis develops weeks, months or even years after the infection. Reiter's disease happens most commonly after infections of the genital and gastrointestinal tracts.

Symptoms

Symptoms of infectious arthritis include:

• Joint pain and stiffness, typically in the knee, shoulder, ankle, finger, wrist or hip
• Warmth and redness in surrounding tissue
• Fever and shaking chills
• Skin rash

Other symptoms vary, depending on the cause. Some of the more common causes of infectious arthritis include:

Lyme Disease

Lyme disease is caused by bacteria that live in deer ticks and are transmitted through a tick bite into a person's bloodstream. Arthritis can develop in the later stages of Lyme disease.

After an infected tick bites a person, a large, round, red rash (called erythema migrans) usually develops around the bite, often with an area of skin in the center that appears normal. Flulike symptoms sometimes develop, including fever, headaches, chills, body aches, stiffness, nausea, fatigue and sore throat. The symptoms of Lyme disease often mimic those of other diseases, and considerable time can pass between the appearance of the rash and the next wave of symptoms.

Because the tick bite often goes unnoticed and the rash may be overlooked, Lyme disease is not always diagnosed immediately. When the infection is not treated, further symptoms may develop, including joint inflammation (most commonly in the knee), neurologic symptoms (confusion, convulsions, muscle weakness), and an abnormally slow heart rate that may lead to fainting. Antibiotic treatment usually cures the illness.

Gonorrhea

Gonorrhea is a sexually transmitted bacterial infection that can cause pain in one or more joints and/or tendons and sometimes a rash and fever. About a third of people with gonorrhea report joint pain.

Staphylococcus Infection

Staphylococcus bacteria are common bacteria that can cause infections through cuts or other breaks in the skin, or through contaminated food. The bacteria can be released in the bloodstream and spread to the knee or other joints, causing intense and sudden pain, swelling and immobility of the joint. This is a serious condition because joint damage can develop in a matter of days if the infection is not detected and treated promptly.

Tuberculosis

Tuberculosis is an infection caused by the Mycobacterium tuberculosis bacterium. It usually affects the lungs, but it can affect other parts of the body, including the gastrointestinal tract, the nerves, lymph system and skin, as well as bones and joints. Arthritis caused by tuberculosis usually affects either the spine or large joints, such as the hips or knees. The joint inflammation caused by tuberculosis tends to be less dramatic than inflammation caused by some other bacterial infections, and it develops slowly.

Viruses

Arthritis can arise from infection from many viruses, including those that cause colds, upper respiratory infections, HIV, hepatitis, parvovirus, rubella and mumps. Many joints can be affected at the same time, and the symptoms of viral infectious arthritis can mimic those of rheumatoid arthritis. However, viral arthritis symptoms usually disappear within days or weeks if the disease causing the problem is eliminated. HIV and some forms of viral hepatitis may cause chronic (long-lasting) infection and longer-lasting joint symptoms.

Diagnosis

If your doctor suspects that your joint symptoms are related to a bacterial infection, he or she probably will draw fluid from the affected joint with a needle after numbing the area, and will have it analyzed in a lab. Blood and urine tests also may be done. If your doctor thinks a sexually transmitted disease may be causing the problem, he or she will perform a pelvic examination if you are a woman, and a swab of the penis and urine test if you are a man. The urine and swabbed material are sent to be tested in a laboratory. Tests are not available to diagnose most viral diseases. However, the more chronic and/or serious viral diseases, such as parvovirus, hepatitis B, hepatitis C and HIV , can be diagnosed with blood tests that measure antibodies against these viruses.

Expected Duration

How long symptoms last depends on the cause, and how soon treatment is started. Symptoms can improve in as little as 24 hours after treatment is begun. However, they may continue for weeks or months when related to Lyme disease, many bacterial strains or tuberculosis. If infection damages joints, symptoms may be lifelong.

Prevention

The best way to prevent infectious arthritis varies depending on the type of infection:

• Staphylococcal arthritis — If you have a staphylococcal infection, antibiotics can be used to prevent this type of arthritis. However, for many people, joint pain and swelling are the first signs of the infection.
• Gonococcal arthritis — You can prevent this type of arthritis by preventing gonorrhea. Practice safe sex or don't have sex.
• Lyme disease arthritis — The best way to prevent arthritis from a Lyme infection is to avoid Lyme disease. Wear long pants and long-sleeved shirts, use tick repellent and avoid woods, brush and other areas where ticks live.
• Tuberculosis-related arthritis — A tuberculosis vaccine may help to prevent tuberculosis and any associated arthritis. However, vaccination for tuberculosis is not routine in many parts of the world, including the United States, and the vaccine is only moderately effective. If you have tuberculous, antibiotics may prevent joint infection and arthritis. If a skin test shows recent exposure to tuberculosis or if a chest X-ray suggests active tuberculosis, antibiotics may stop the infection from spreading into joints.
• Viral arthritis — The best way to avoid arthritis caused by a viral infection is to avoid getting the infection. Wash your hands after you have been around sick children or other people with a viral infection.

Treatment

Because many bacterial infections can permanently destroy cartilage around joints, a joint infected with bacteria needs to be treated immediately with antibiotics.

Viral infections do not respond to antibiotics and will go away on their own. However, antiviral therapies are available for some viral infections, such as HIV. Aspirin or ibuprofen (Advil, Motrin and other brand names) can be taken to alleviate pain and swelling during the time it takes for the infection to go away. Viral infections usually do not cause joint damage.

If you have a bacterial infection, you probably will be hospitalized so the infected joint can be drained, you can receive antibiotics intravenously (into a vein), and you can rest the joint.

In some cases, surgery may be necessary to remove damaged tissue from the joint. If serious damage already has occurred, surgery may be needed to reconstruct the joint. Surgery is rarely necessary for arthritis associated with gonorrhea or viral infection.

Reactive arthritis (or Reiter's disease) may be treated with other medicines, but only after the infection has been cured. These medicines include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, methotrexate (Folex, Methotrexate LPF, Rheumatrex) and sulfasalazine (Azulfidine).

While the joint is recovering from the infection, it may need to be immobilized briefly. As soon as possible, however, exercise and physical therapy are recommended to restore strength and mobility.

When To Call A Professional

If you experience any of the symptoms listed above for more than a few days, contact your doctor.

Prognosis

If infectious arthritis is detected and treated promptly, joint damage is unlikely. However, joint damage is possible with many types of infections, especially when a bacterial infection is not detected promptly and treated.

Additional Info

American College of Rheumatology

1800 Century Place, Suite 250

Atlanta, GA 30345

Phone: (404) 633-3777

Fax: (404) 633-1870

E-Mail: acr@rheumatology.org

http://www.rheumatology.org/

Arthritis Foundation

P.O. Box 7669

Atlanta, GA 30357-0669

Phone: (404) 872-7100

Toll-Free: (800) 283-7800

http://www.arthritis.org/