musculoskeletal and connective tissue disorders
Acute Infectious Arthritis
Symptoms and Signs of Acute Infectious Arthritis
Over a few hours to a few days, patients with an acute joint infection develop moderate to severe joint pain, warmth, tenderness, effusion, restricted active and passive motion, and sometimes redness. Systemic symptoms may be minimal or absent, although signs of sepsis may be present in patients who have bacteremia, particularly with a virulent pathogen such asS. aureus,beta-hemolytic streptococci, or gram negative bacilli.. Infants and children may present with limited spontaneous movement of a limb (pseudoparalysis), irritability, feeding disturbances, and a high, low-grade, or no fever. Gonococcal arthritis can cause a distinctive dermatitis-polyarthritis-tenosynovitis syndrome. Classic manifestations are Fever (for 5 to 7 days) Multiple skin lesions (petechiae, papules, pustules, hemorrhagic vesicles or bullae, necrotic lesions) on mucosal surfaces and on the skin of the trunk, hands, or lower extremities Migratory arthralgias, arthritis, and tenosynovitis (often involves multiple tendons), most often the small joints of the hands, wrists, elbows, knees, and ankles, and rarely the axial skeletal joints Symptoms of the original mucosal infection (eg, urethritis, cervicitis) may not be present. Nongonococcal bacterial arthritis causes progressive moderate to severe joint pain that is markedly worsened by movement or palpation. Most infected joints are swollen, red, and warm. Fever is absent or low grade in up to 50% of patients; only 20% of patients report a shaking chill. Virulent organisms (eg,S. aureus,Pseudomonas aeruginosa) generally cause a more fulminant arthritis, whereas less virulent organisms (eg, coagulase-negative staphylococci,Propionibacterium acnes) cause a less fulminant arthritis. In 80% ofadults,nongonococcal bacterial arthritis is monarticular and usually occurs in a peripheral joint: knee, hip, shoulder, wrist, ankle, or elbow. Inchildren,≥90% is monarticular: knee (39%), hip (26%), and ankle (13%). Polyarticular involvement is somewhat more common among patients who are immunosuppressed, who have an underlying chronic arthritis (eg, rheumatoid arthritis, osteoarthritis), or who have a streptococcal or staphylococcal infection (especially beta-hemolytic streptococcus orS. aureus). In injection drug users and patients with indwelling vascular catheters, axial joints (eg, sternoclavicular, costochondral, hip, shoulder, vertebral, symphysis pubis, sacroiliac) are often involved.H. influenzamay cause a dermatitis-arthritis syndrome similar to gonococcal infection. Infection due to human, dog, or cat bites (see Human and Mammal Bites ) usually develops within 48 hours. Rat-Bite Fever cause systemic symptoms such as fever, rash, and joint pain or true arthritis with regional adenopathy within about 2 to 10 days. Viral infectious arthritis sometimes causes symptoms similar to acute nongonococcal bacterial arthritis and is more likely to be polyarticular than bacterial arthritis. arthritis may have other Symptoms and Signs or present only with acute monarthritis or oligoarthritis, which, if untreated, may be recurrent. Chronic pain that remains after appropriate therapy is likely to be of noninfectious etiology. A polyarticular rheumatoid arthritis–like syndrome is distinctly unusual and more likely to be from another diagnosis. 