The Arthritis (Greek ἀρθρῖτις arthritis, arthritis Pl, Arthron " joint element " and suffix -itis to refer to a disease) is an inflammatory joint disease.
Clearly delineate this notion of degenerative changes (arthritis ). While it is a "cold" Done by " degenerative joint disease " is at the arthritis, the inflammation typically associated with overheating, Gelenkergußbildung, swelling and redness.
Note: In the English literature, the term arthritis is used differently. He referred to there general joint pain regardless of its cause.
The arthritis is subdivided principle for the cause. An acute and threatening disease is purulent, bacterial arthritis, responsible for the germs in the joint for the emergence and sometimes are also detectable. Synonymous with purulent arthritis, the terms Pyarthros and Gelenkempyem are needed.
Is distinguished from the purulent arthritis ( non-bacterial ) arthritis in rheumatic diseases, post- infectious arthritis ( eg, in the late disease, in which coxitis fugax ), the arthritis in metabolic diseases (eg gout). The "activated osteoarthritis ", when it also comes as a result of immunological responses to mechanical abrasion wear at joints to arthritis, falls into this category - here then fits the English term " osteoarthritis " again. In addition, there are other less common causes of arthritis.
After the distribution over the body is between a " monarthritis " ( only one joint is ill ), a " oligoarthritis " (some / few joints are ill ) and a " polyarthritis " (many of the joints are diseased ) differed.
Distinguish Roughly speaking, in the purulent bacterial arthritis two causes. The germs either by injury ( trauma ), which open up the interior of joint, or in the bloodstream ( " hematogenous " ) into the joint. One of the more common causes of direct Keimeintritts addition to the injuries medical interventions ( " iatrogenic "). During surgery, but also for injections into a joint bacteria can be introduced. Also, near the joint, usually hematogenous osteomyelitis can break into a joint and cause a purulent arthritis.
In adult immunocompetent patients is found as a pathogen in half the cases, Staphylococcus aureus, Staphylococcus epidermidis, in about 25 % and almost 15% streptococci. In children and immunocompromised patients may be more likely rarer germs and also Shigella prove, according to the antibiotic therapy must then be designed differently. Arthritis or reactive arthritis ( mostly men) but can also be caused by Mycoplasma genitalium.
Symptoms and diagnosis
In the purulent arthritis, there is a pronounced inflammatory reaction with redness, swelling and warmth when the joints are superficial (knee, elbow, ankle). In addition, considerable pain, which are intensified by movement. Load and movement in the affected joint are restricted. In children there is a play displeasure. The affected joint is spontaneously not loaded or moved. Mostly it is a general disease symptoms. Diagnostic shows a joint effusion, the palpable, for example, on the knees and elbows, is sonographically represented at the other joints, such as at the hip. In the blood test, there are increased inflammatory markers (C- reactive protein, leukocyte count, erythrocyte sedimentation rate ). If there is clinical suspicion of a purulent arthritis an immediate joint puncture should be performed. The appearance of the joint effusion serves to further differentiation. A swab taken and from a pathogen detection.
A purulent arthritis is a very serious injury to a joint dar. one hand, occurs within hours to days to destruction of the articular cartilage, on the other hand, the germs can spread and lead to a general inflammatory response including sepsis, the acute renal failure and death. The required treatment usually includes an immediate surgical intervention, primarily the joint opening ( arthrotomy ), in almost all large joints ( knee, hip, ankle, elbow, shoulder) and the Arthroscopy ( arthroscopic ). This is carried out with a detailed and thorough rinsing debridement, the partial or complete removal of the infected material and partial or total resection of the mucosa. A previously recognized Suction-Irrigation Drainage is now rarely used, a so-called interval arthroscopy is performed instead: Regular arthroscopic lavage every second day until disappearance of the signs of inflammation and to the lack of evidence of bacteria. Parallel antibiotic treatment must be carried out, the first act must be non-directional wide, and can be selectively altered after receipt of pathogen detection. The antibiotics should initially be administered intravenously, after a few days, a switch to oral therapy is possible. It is important because of the risk of recurrence, the regular, the local findings and inflammatory markers in the blood.
- In the joint tuberculosis is for the irrigation-suction drainage surgically opened joint is a high risk of infection for the nurses and doctors who care for the care of the patient. The necessary anti-tuberculosis treatment lasts much longer than other invading germs.
- Tabetic arthropathy: it is a late consequence of syphilis and occurs in the third, " tertiary " syphilis on. Suspected an effect of syphilis is made here to the nerves supplying the joint. A direct relationship with the local effects of the causative agent is not there.
This Infektarthropathien can lead to the complete destruction of one or more joints without timely and proper treatment.
Non- infection-related arthritis
They are counted among the diseases of the rheumatic type. It is to autoimmune processes where the body's own substances are falsely classified as "foreign" and attacked by the immune system of the body.
The result is first a swelling and proliferation of the synovium, the lining layer, which is responsible for the nutrition of articular cartilage and the production of synovial fluid. These proliferating mucous gradually increases, starting from the edges to the cartilage and destroys it. The term for this aggressive, not really functioning synovium is " pannus ." Depending on the type and form of arthritis can be enough to complete denudation of the bony joint surface, then rubbing bone on bone. This abrasion causes the bones forming the joint shorten. The joint is very unstable, the ligaments lose by the strong bone abrasion its function. This very severe form is called " mutilierend " ( eroding ).
- Rheumatoid arthritis ( syn. rheumatoid arthritis, PCP, chronic polyarthritis, CP) can occur even at a young age. The diagnosis is made first with blood tests in the laboratory findings can be found then the so-called " rheumatoid factor ". However, it may be that the laboratory findings do not permit unambiguous statement even with heavy diseases. Laboratory studies of synovial fluid may provide additional information. The histological (histological ) examination of the synovial fluid may also shed light. The radiograph shows characteristic changes of the bone near the joints, which are called " arthritic Randsaumbildung ". Another diagnostic tool is a bone scan, which provides an overview of the inflammatory activity and shows which joints which often can be inconspicuous from the outside, are involved in the disease process. If over the course of the disease of chemical laboratory detection of " rheumatoid factor " is negative, it is called a " seronegative arthritis ".
- Psoriatic arthritis occurs in a psoriasis (psoriasis). The diagnosis can be difficult because the joint involvement in some cases months or years to occur before the typical skin symptoms of psoriasis. Is typical in this asymmetric distribution of the affected joints on both sides of the body. Also beam attack, such as all the joints of a finger, distal involvement of all Fingerendgelenke or dactylitis (inflammation of all structures of the finger ) in favor of this form of arthritis.
- Gout arthritis is a result of a disturbance of uric acid metabolism. Characteristic are the radiograph round, so-called " punch defects" in the periarticular shares of the bone.