Gonococcal arthritis is a specific inflammatory lesion of the joints that develops with a disseminated form of gonorrhea. Disease is accompanied by chills and fever; edema, hyperemia and rashes in the affected joints, limited movement, arthralgia. The diagnosis is based on the data of anamnesis, joint radiography, serological and microbiological studies. In the acute period of gonococcal arthritis, rest and immobilization of the joint, antibiotic therapy, NSAIDs, analgesics, glucocorticosteroids are prescribed; in the recovery period – massage, physiotherapy, physical therapy.
Meaning
Gonococcal arthritis is bacterial arthritis that occurs as a complication of acute or chronic gonococcal infection of the genitourinary tract. In rheumatology, disease belongs to a group of specific infectious arthritis. Pathology develops in 2-3% of patients with gonorrhea and usually occurs in sexually active young people (15-40 years old). Articular syndrome affects women more often, it can occur in young girls. In women, the severe course is often caused by asymptomatic forms of primary urogenital infection and its late diagnosis. In men, due to the rapid cure of urethritis, disease is rare.
The course of gonococcal arthritis can be acute and chronic. According to the pathogenesis, the infectious-metastatic form prevails, the toxic-allergic form of the disease is less common, their combination is possible. In most cases (85%) gonococcal arthritis is oligoarthritis, sometimes monoarthritis; in this case, knee, ankle, elbow joints, small joints of the hands and feet can be affected. In the metastatic form of gonococcal arthritis, one joint is usually affected, in the case of toxic-allergic – several. By the nature of the inflammatory process, serous synovitis is distinguished without the interest of periarticular tissues; serous-fibrinous synovitis, purulent synovitis with periarticular edema; phlegmonous arthritis with predominant inflammation of periarticular tissues. As a rule, the inflammatory process extends both to the tendon-ligamentous apparatus and to the joint bags.
Causes
Gonococcal arthritis is a manifestation of a disseminated form of genitourinary infection – gonorrhea. The causative agent of gonococcal arthritis is a gram-negative diplococcus (gonococcus) – Neisseria gonorrhoeae. The path of infection with gonorrhea in adults is sexual; in children, it is contact–household, vertical (intranatal, very rarely – transplacental). The entrance gates of gonorrhea infection in children are the mucous membranes of the urogenital tract and conjunctiva.
From the primary (usually urogenital) focus, gonococci can enter the blood and, spreading hematogenically to other organs, cause generalization of infection. This can occur at any period of the gonorrheal process and lead to damage to the joints, meningitis (gonorrheal meningitis), eyes (gonorrheal blepharitis). The provoking factors for the development of gonococcal arthritis in women are menstruation and pregnancy.
Symptoms
Gonococcal arthritis usually develops during the first month of acute gonococcal infection or after several months / years, with the exacerbation of chronic latent forms of gonorrhea. True gonococcal arthritis is manifested by symptoms of a septic articular process with a pronounced acute onset. It is characterized by chills, hectic fever, the development of severe edema and hyperemia in the area of one or 2-3 joints, rather intense, sharp arthralgias. Sexual differentiation is characteristic of joint damage: in women, inflammation more often covers the elbow and wrist joints, in men – the knee, ankle and metatarsophalangeal joints.
There are pain points in the places of attachment of joint bags and tendons to the bones. Intense soreness with active and somewhat less – with passive movements of the joints is associated with damage to the tendon-ligamentous apparatus. With this disease, atrophy of the muscles around the joints, osteoporosis develops rapidly. Movements in the affected joints become limited, their configuration changes; due to the proliferation of fibrous tissue, stiffness develops. In half of the cases of this disease, papular (nodules), pustular (pustules) and bullous (blisters) rashes form on the skin near the affected joints, as well as on the back and distal parts of the extremities.
Most cases of gonococcal arthritis are characterized by the formation of a “flat gonorrheal foot”, which is a combination of achillobursitis, subcutaneous bursitis, “heel spurs” and secondary flat feet. Disease has a long course (up to several months and years) with periodic remissions and exacerbations. The chronic form in its clinical picture resembles rheumatoid arthritis or Bekhterev’s disease.
Disease in newborns occurs as a manifestation of gonococcal sepsis, has a particularly severe course with multiple joint lesions and an intense inflammatory process. Complications of gonococcal arthritis can be ankylosis and contractures, destruction of joints, melting of cartilage, erosion of the articular ends of bones, osteomyelitis, phlegmon.
Diagnostics
Diagnosis of gonococcal arthritis is carried out on the basis of anamnesis data, the results of laboratory and instrumental studies with the participation of rheumatologists and dermatovenerologists. Gonococcal arthritis must be differentiated from other infectious arthritis, arthritis with collagenoses.
Blood test shows an increase in the number of leukocytes, ESR, characteristic of the inflammatory process; a biochemical blood test shows an increase in the level of sialic acids, fibrin. The main evidence of the gonorrheic nature of arthritis is the detection of gonococcus by smear microscopy, PCR and bacteriological examination of synovial fluid, blood, secretions from the genitourinary organs (urethra, cervix), rectum, pharynx, eyes.
The Borde-Zhangu serological reaction is an auxiliary diagnostic study for unclear forms of articular pathology, for example, in women with chronic inflammation of the genitourinary organs. Radiography of joints in the early stages of gonococcal arthritis reveals pronounced epiphyseal osteoporosis; in the chronic stage – obvious signs of destruction of cartilage and bone matter, narrowing of the articular gap, joint deformation.
Treatment
Gonococcal arthritis therapy is carried out in a hospital; it is aimed at eliminating the infectious and inflammatory process in the genitourinary organs and joints. In the acute period of gonococcal arthritis, rest is indicated, giving the affected limb the most comfortable position with the help of rollers and pillows, immobilization of joints, local dry heat. To eliminate the pathogen, antibiotic therapy is prescribed, which mainly includes penicillin-type drugs, cephalosporins, and sometimes macrolides.
With severe pain syndrome, NSAIDs, analgesics are recommended, transcranial electroanalgesia is possible. With the development of a concomitant allergic reaction, glucocorticosteroids are used. With a pronounced exudative process, a puncture of the joint is performed with aspiration of the contents and the introduction of antibiotics into its cavity. If decompression is necessary, especially due to the risk of dislocation in the hip joint, arthrotomy and drainage of the joint are performed.
As acute phenomena subside, physiotherapy (UVI therapy, electrophoresis, DMV therapy, paraffin treatment, phototherapy, diathermy), physical therapy, massage are shown. To consolidate the results of treatment of gonococcal arthritis, balneotherapy is recommended: mud therapy, radon and hydrogen sulfide therapeutic baths. In order to prevent relapses of the disease, patients who have suffered from gonococcal arthritis need repeated courses of therapy.
In most patients with gonococcal arthritis, with timely treatment, the prognosis is favorable. Prevention consists in preventing infection with gonorrhea, its early diagnosis and adequate therapy.