Arthritis For Dummies. Barry Fox
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from staphylococci to HIV to tuberculosis, can infect a joint or trigger an autoimmune inflammatory response in a joint.
Summarizing the symptoms
With infectious arthrtitis, symptoms include joint pain to the touch or with movement, as well as swelling and stiffness. The skin around the joint may be red and puffy. If the infection spreads beyond the joint, a fever or other symptoms may accompany it (although fever can occur for other reasons). Some forms of infectious arthritis hit hard and fast, so it’s important that you see your doctor immediately if you have any symptoms. If left untreated, infectious arthritis may seriously damage joints within just a few days or weeks.
Diagnosing and treating infectious arthritis
If your doctor suspects infectious arthritis, they will call for various tests to firm up the diagnosis. Blood, urine, and joint fluid samples will be analyzed for infectious organisms. But even before the lab results come back, your doctor may begin giving you antibiotics, starting with those that kill the “usual suspects.” Other medicines may follow once the doctor is sure what’s ailing you, including additional or other antibiotics, antifungal medicines, or antiviral medications.
In addition, your doctor may drain pus from the joint, splint the joint, if necessary, and arrange for you to get physical therapy. Certain infections may also require surgery to clean out the joint.
Getting a Grip On Gonococcal Arthritis
Caused by the gonococci bacterium — the same culprit responsible for gonorrhea — gonococcal arthritis is the most widespread form of infectious arthritis.
Summarizing the symptoms
Gonococcal arthritis typically strikes hard and fast, and the pain seems to move from one joint to another. Small blisters can appear on the skin in some or many parts of the body, and the tendons may swell and ache.
Diagnosing and treating gonococcal arthritis
Both men and women can develop gonococcal arthritis. Men are much more likely to know that something is wrong because of the penile discharge and painful urination experienced with gonorrhea. Thus, they’re more likely to receive treatment for the disease before it progresses to gonococcal arthritis. Women, who don’t have such obvious symptoms, are less likely to receive early treatment for gonorrhea and more likely to develop gonococcal arthritis, and to suffer from pain in the abdomen and fever related to the disease.
The typical patient with is a young, sexually active person with the signs and symptoms of venereal disease, so the doctor can often zero in on a possible diagnosis of gonococcal arthritis during the medical history and physical examination. The doctor will then check for skin blisters and wait for lab reports on samples of various body fluids before making a definitive diagnosis.
Treatment with standard antibiotics used to be successful, although in recent years certain strains of gonorrhea have become resistant to many drugs. Today, gonococcal arthritis is treated with an injection or infusion of ceftriaxone, a broad spectrum antibiotic that will stop the infection, possibly together with another antimicrobial agent. These medications should knock out the infection but they won’t be able to repair any permanent damage caused by the disease.
Surveying Psoriatic Arthritis
Psoriatic arthritis (PsA) adds insult to the injury of psoriasis because it strikes those who are already suffering from this inflammatory disease of the skin. According to the National Psoriasis Foundation, about 30 percent of psoriasis sufferers go on to develop psoriatic arthritis.
Summarizing the symptoms
In PsA, the joints of the fingers and toes become inflamed, swollen, stiff and, in more severe cases, deformed. There can be pitting of the nails or separation from the nail bed, as well as eye pain and redness. Psoriatic arthritis can also affect the spine, shoulders, or hips.
Diagnosing and treating psoriatic arthritis
A specific test for PsA doesn’t exist, so the diagnosis is based on patient history and a physical exam. Typical signs of PsA (besides joint pain) include skin psoriasis, a family history of psoriasis, nail psoriasis, swelling of the fingers or toes (dactylitis), and inflammation of the areas where tendons insert on bone (enthesitis). Psoriatic arthritis is also particularly likely to occur in the joints at the end of the fingers near the fingernails.
Treatment is important, because psoriatic arthritis can cause severe damage to the joints. Unfortunately, it has no cure, but just like RA there are many medicines that have revolutionized its treatment. Standard treatment for PsA includes DMARDs such as methotrexate or biologics such as Humira to slow the progression of the disease and protect the joints from permanent damage.
Though many of the treatments for PsA and RA overlap, they are very different diseases. During the past few years, the FDA has approved several new drugs to treat psoriatic arthritis that don’t work for RA, like secukinumab (Cosentyx) and guselkumab (Tremfya). Chapter 8 tells you more about these medications.
Anlalyzing Ankylosing Spondylitis
Ankylosing spondylitis (AS) attacks and inflames the cartilage, ligaments, and tendons of the spine. The back becomes stiff and sore and as the disease progresses, its ligaments and tendons can become more like bone tissue, forming bony bridges between the vertebrae and locking them into place. In more severe cases, AS can turn the spine into an unbending rod, although the disease usually doesn’t advance to that point. Figure 4-2 shows the difference between a normal spine and one with AS.
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FIGURE 4-2: Normal vertebrae compared to those with ankylosing spondylitis.
AS currently affects some 300,000 Americans, with its favorite targets being Caucasian men between the ages of 16 and 35. The disease often runs in families and has been linked to a certain genetic marker (HLA-B27), although 80 percent of those with this gene never develop the disease. Something else (perhaps an infection) is undoubtedly triggering it.
Summarizing the symptoms
AS generally comes on gradually, as pain or stiffness settles into the lower back or hips, and the places where tendons and ligaments attach to the spine. Problems can also develop with the neck, shoulders, hips, knees, and back of the heel. The pain may be worse at night or upon arising, then recede once the person begins to move around. AS symptoms can be fairly constant or come and go.
A systemic disease, AS can cause compression fractures to the vertebrae, eye problems, loss of appetite, fatigue, and fever. There may also be difficulty in taking a deep breath, damage to the aorta (the body’s largest artery), and problems caused by pressure on the nerves.
Diagnosing and treating ankylosing spondylitis
No one, single test can detect AS, so diagnosis is usually made from a combination of symptoms and family history, a physical examination, blood tests showing inflammatory markers and/or the HLA-B27 gene, and MRIs or X-rays, which can reveal characteristic joint damage or extra bone in the spine or sacroiliac joints of the pelvis.
Treatment is aimed at relieving pain and inflammation and preventing or correcting deformities of the