arthritis

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Classification according to ICD-10
M00-M03 Infectious arthropathies
M05-M14 Inflammatory polyarthropathies
ICD-10 online (WHO version 2019)

The arthritis ( Greek ἀρθρῖτις arthritis , plural arthritis ; of Arthron "joint member" and ending - itis to designate an inflammation) or arthritis is an inflammatory joint disease.

This term must be clearly distinguished from degenerative changes ( osteoarthritis ). While osteoarthritis is a “cold” event caused by “joint wear”, the inflammation is typically associated with overheating, joint effusion, swelling and reddening.

Note: The term arthritis is used differently in English-language literature . There it also generally refers to joint pain regardless of its cause.

Inflammation of the parts surrounding a joint is known as periarthritis (formerly also periarticular fibrositis and fibrositis of the joint envelopes ).

Classification

In principle, arthritis is divided according to the cause. An acute and threatening infectious disease is purulent, bacterial arthritis (also called septic arthritis ), in which germs in the joint are responsible for the development and z. T. are also detectable. The terms pyarthrosis and joint empyema are also used synonymously with purulent arthritis .

A distinction is made from purulent arthritis to (non-bacterial) arthritis in rheumatic diseases, post-infectious arthritis (e.g. in coxitis fugax ), and arthritis in metabolic diseases (e.g. gout ). "Activated osteoarthritis ", in which joint inflammation also occurs as a result of immunological reactions to mechanical abrasion in wearing joints, also belongs to this category - the English term "osteoarthritis" also fits here. There are also other rarer causes of arthritis.

According to the distribution over the body, a distinction is made between monarthritis (only one joint is inflamed), “oligoarthritis” (some / a few joints are diseased) and “ polyarthritis ” (many joints are diseased).

An inflammation of the joint that occurs as part of a disease that originally did not affect the musculoskeletal system is known as symptomatic arthritis .

Bacterial arthritis

There are two causes of purulent bacterial arthritis. The germs enter the joint either through injuries (post-traumatic) that open up the interior of the joint, or via the bloodstream (" hematogenous "). In addition to injuries, one of the more frequent causes of the direct entry of germs is medical interventions (“ iatrogenic ”). Bacteria can be introduced during operations , but also with injections into a joint. Even near-joint, mostly hematogenous osteomyelitis can break into a joint and lead to purulent arthritis.

In adult immunocompetent patients, the pathogen is Staphylococcus aureus in half of the cases , Staphylococcus epidermidis in around 25% and Streptococcus pyogenes in just under 15% . In children and immunocompromised patients, rarer germs and also Shigella can be detected more frequently, so antibiotic therapy must then be designed differently. Arthritis or reactive arthritis (mostly men) can also be caused by Mycoplasma genitalium .

Symptoms and Diagnosis

Sonography of a normal (left) and inflamed (right) hip of a child. Colored blue below: bone boundaries (each on the left shaft, on the right head nucleus, separated by growth zone); colored red: capsule.

With purulent arthritis, there is a pronounced inflammatory reaction with redness, swelling and overheating if the joints are superficial (knee, elbow, ankle). There is also considerable pain that is intensified by movement. Load and movement in the affected joint are restricted. Children are reluctant to play. The affected joint is no longer loaded or moved spontaneously. Usually there are also general symptoms of the disease. A joint effusion is diagnosed . B. palpable on the knees and elbows, on the other joints, z. B. on the hip , can be displayed sonographically . The blood test reveals increased inflammation levels ( C-reactive protein , white blood cell count , sedimentation rate). If purulent arthritis is clinically suspected, an immediate joint puncture should be performed. The appearance of the joint effusion serves for further differentiation. A smear can also be taken and a pathogen detection can be made from it.

treatment

Purulent arthritis is very serious damage to a joint. On the one hand, the joint cartilage is destroyed within hours to days, on the other hand, the germs can spread and lead to a general inflammatory reaction up to sepsis , acute kidney failure and death. The treatment required usually includes immediate surgical intervention, first and foremost joint opening ( arthrotomy ), and for almost all large joints ( knee , hip , ankle , elbow , shoulder ), also an arthroscopy . This is done with extensive irrigation and careful debridement , partial or complete removal of the infected material, and complete or partial resection of the mucous membrane . A previously performed suction-irrigation drainage is now rarely used, instead a so-called interval arthroscopy is carried out: Regular arthroscopic irrigation on every other day until the signs of inflammation disappear and until there is no evidence of bacteria . In parallel, antibiotic therapy must be carried out, which must initially have a broad, undirected effect and can be changed in a targeted manner after the pathogen has been detected. Antibiosis should initially be administered intravenously, after a few days it is possible to switch to oral therapy. Because of the risk of relapse, it is important to regularly check the local findings and the inflammation parameters in the blood.

In chronic arthritis , antibiotic treatment takes place over six to twelve months according to the antibiogram.

Special forms

  • In the case of joint tuberculosis , the joint that is surgically opened for flushing-suction-drainage represents a high risk of infection for the nursing staff and doctors who take care of the patient's care. The necessary tuberculostatic treatment takes much longer than with other invading germs.
  • Tabular arthropathy : It is a late sequela of syphilis and occurs in the third, "tertiary" stage of syphilis. It is assumed that syphilis has an effect on the nerves supplying the joint. There is no direct connection with the local effects of the infectious agents.
  • PAPA syndrome : combination of pyogenic arthritis, pyoderma gangrenosum and acne

Arthritis not related to infection

They are counted among the rheumatic diseases. These are autoimmune processes in which the body's own substances are falsely classified as "foreign" and attacked by the body's defense system.

The result is swelling and overgrowth of the synovium, the layer of mucous membrane that is responsible for nourishing the articular cartilage and producing synovial fluid. This overgrown mucous membrane gradually overgrows and destroys the cartilage, starting from the edges. The name for this aggressive, no longer properly functioning synovium is "pannus". Depending on the type and course of the arthritis, this can go as far as the complete exposure of the bony joint surface, then bone rubs on bone. This abrasion causes the bones that make up the joint to shorten. The joint becomes very unstable , the ligamentous apparatus loses its function due to the severe bone abrasion. This very severe form is called "mutilating" (eating away).

  • The rheumatoid arthritis (syn. Rheumatoid arthritis, cP, or (obsolete primary) chronic polyarthritis, pcP) can occur at a young age. The diagnosis is first made with blood tests; the laboratory results then show what are known as "rheumatoid factors". However, it may be that the laboratory findings do not allow a clear statement even in the case of severe clinical pictures. Laboratory tests of the synovial fluid may provide additional information. The histological examination of the synovia can also provide information. The x-ray shows characteristic changes in the bones near the joint, which are called "arthritic marginal seams". Another diagnostic aid is skeletal scintigraphy , which provides an overview of the inflammatory activities and shows which joints, which can often be unremarkable from the outside, are involved in the disease process. If the laboratory test of “rheumatoid factors” remains negative over the course of the disease, one speaks of “seronegative arthritis”.
  • The psoriatic arthritis occurs in the context of psoriasis on (psoriasis). The diagnosis can be made difficult by the fact that the joint involvement occurs in some cases months or years before the typical skin symptoms of psoriasis. Asymmetrical distribution of the affected joints on both halves of the body is typical here. Also radiation attack, e.g. B. all joints of a finger, distal involvement of all finger end joints or dactylitis (inflammation of all structures of the finger) speak for this form of arthritis.
  • The gout -Arthritis is a result of a disorder of uric acid metabolism. Characteristic in the X-ray are round, so-called "punch defects" in the parts of the bone near the joint.

literature

Web links

Wiktionary: Arthritis  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Ludwig Heilmeyer , Wolfgang Müller: The rheumatic diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 309–351, here: pp. 342–346: The soft tissue rheumatism (fibrositis, muscular rheumatism, myalgia, panniculitis).
  2. ↑ H.-J. Hettenkofer: Rheumatology: Diagnostics, Clinic, Therapy. 5th edition. Thieme Verlag, 2003, ISBN 3-13-657805-8 , p. 146 ff.
  3. ↑ Wolfgang Miehle: Joint and spinal rheumatism. Eular Verlag, Basel 1987, ISBN 3-7177-0133-9 , p. 175.
  4. ↑ lexikon-orthopaedie.com
  5. ↑ D. Taylor-Robinson, CB Gilroy, S. Horowitz, J. Horowitz: Mycoplasma genitalium in the joints of two patients with arthritis. In: European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology. Volume 13, Number 12, December 1994, pp. 1066-1069, PMID 7889971 .
  6. ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 170-173, here: p. 173 ( chronic arthritis ).