Specific monoarthritis is an infectious disease characterized by inflammation of the joints and periarticular tissues of the fingers. People working in the marine industry are more likely to suffer from this pathology. Clinically manifested by severe swelling, pain and severe restriction of movement in one of the joints of the fingers. The diagnosis is made on the basis of symptoms, anamnestic data and radiographic picture. Treatment is carried out by dissection of edematous tissues, the use of antibacterial agents and nonsteroidal anti-inflammatory drugs. In severe cases, arthrotomy is performed.
M13.1 Monoarthritis, not classified elsewhere
The causative agents of specific monoarthritis are gram-positive diplococci. Infection occurs through small wounds in the skin during cutting or processing of marine commercial animals – sea hares, seals, seals, in which bacteria live on the skin and mucous membrane of the internal organs of the digestive system. At the same time, the animals themselves do not get sick with specific monoarthritis. The high-risk group includes workers of the marine St. John’s wort fishery in the northern seas, who are constantly in contact with animals and do not comply with safety regulations. Various pathologies that reduce the reactivity of the immune system predispose to the development of infection ‒ diabetes mellitus, chronic alcoholism, blood diseases (anemia, hemoblastosis).
When bacteria enter the damaged skin, inflammatory infiltrates form in it, spreading to the subcutaneous tissue, joint and periarticular tissues (muscles, ligaments, tendons). Diplococci produce exotoxin, which leads to the gradual destruction of the cartilaginous surfaces of joints and metaepiphyseal ends of bones. Pathoanatomic examination shows signs of a productive inflammatory process – a large number of lymphocytes, plasma cells and fibroblasts located around the vessels. Bone trabeculae are thinned, replaced by less durable osteoid tissue and inflammatory infiltrates.
According to the clinical course, severity and probability of complications in clinical rheumatology, the following forms of specific monoarthritis are distinguished:
- Paraarticular. The most benign option. The course of the disease is gradual and very mild, bone destruction does not occur. In most cases, recovery occurs.
- Articular. Pronounced swelling and joint pain are characteristic. There is a tendency to a chronic course with constant exacerbations. It almost always ends with ankylosis and deforming osteoarthritis, significantly impeding movement in the joint.
- Mixed. The most severe form. Acute purulent arthritis joins due to the layering of secondary bacterial infection (staphylococci, streptococci).
The incubation period (the time from direct infection to the onset of symptoms) can range from 2 to 20 days. The earliest sign is a slight dull pain at the site of the injury. After 1-2 days, the joint begins to ache (most often – the proximal interphalangeal). At the same time, there is swelling of the joint, which almost immediately restricts movement in it. With an increase in swelling, joint pain also increases, which becomes aching and throbbing. The site of the lesion is hard, tense, the skin above the joint becomes pale, then bluish.
Any movement causes severe pain. Skin sensitivity is lost. The swelling engulfs the entire finger, can spread to the hand and forearm. Dislocations and subluxations of the joint are possible. After about 2 weeks, the inflammatory process subsides, which somewhat facilitates the patient’s condition. The reverse development is slow, usually about 2-3 months. The transition to the chronic phase is typical. Exacerbation is promoted by cooling, physical activity, alcohol consumption. In the acute period, general well–being worsens – weakness, loss of appetite, sleep disturbance. The temperature remains normal at the same time.
Disease is considered a relatively benign disease with a high recovery rate. Serious consequences that pose a threat to the patient’s life are extremely rare. The most frequent adverse outcome is ankylosis and osteoarthritis, which occur due to the destruction of the metaepiphyseal plates of the joints and lead to deformity of the fingers and flexor contractures. Severe complications are possible with the layering of secondary bacterial coccal flora. Mainly, these include purulent arthritis and panarthritis. With the further spread of infection, osteomyelitis and a septic condition may develop, requiring immediate medical intervention.
Patients in specific monoarthritis are led by rheumatologists. Diagnosis is assisted by a rather specific clinical picture and anamnestic data – profession, butchering of marine animals (seals, seals). Upon examination, crepitation (crunch) is noted during pressure on the joint area. Sometimes large regional lymph nodes are palpated. Additional methods of examination of patients with specific monoarthritis include:
- Laboratory tests. Blood test is informative only in the acute stage (the first 2 weeks). Markers of inflammation are revealed – an increased level of leukocytes, a shift of the leukocyte formula to the left, an accelerated rate of erythrocyte sedimentation. There may be a high C-reactive protein in the biochemical analysis of the blood. To isolate the pathogen, bacterial seeding is carried out from the affected tissues.
- X-ray examinations. Radiography of the hands and affected joints is the most reliable method of diagnosing specific monoarthritis. At the beginning of the disease, there is a narrowing of the articular gap and foci of rarefaction of bone tissue. With the further progression of specific monoarthritis, thinning of the suprachondria and destruction of the cartilaginous surface of the joint are detected on radiographs.
Disease should be differentiated from rheumatic pathologies accompanied by acute monoarthritis – gout and other microcrystalline arthritis (pyrophosphate and hydroxyappatite arthropathies). It is also necessary to distinguish specific monoarthritis from other infectious diseases that can cause pain and swelling in the joints of the hand – brucellosis, tuberculosis arthritis.
Depending on the severity of the patient’s condition, treatment can take place both on an outpatient basis and in a hospital. Surgical operation is considered the main method of treatment. After preliminary local anesthesia, multiple soft tissue dissections are performed from different sides. Gauze turunds are inserted into surgical wounds for the outflow of the discharge, a bandage is applied on top. When the joint is destroyed, arthrotomy (opening of the joint cavity) is performed.
Tetracycline antibiotics (doxycycline, tetracycline) are used to combat the infectious pathogen. With the development of purulent arthritis, a combination of 2 antibacterial drugs of different groups is used. Nonsteroidal anti-inflammatory drugs (diclofenac, analgin) are prescribed to relieve pain. Antidiplococcal serum helps to suppress a strong inflammatory process and relieve intoxication.
Prognosis and prevention
In most patients, specific monoarthritis has a benign course. Complete recovery often occurs. With untimely treatment, in some cases (with an articular form), flexion contracture and joint deformation may occur. Fatal outcomes are extremely rare and possible only with the development of secondary purulent arthritis. Prevention consists in observing the hygienic rules of hand care. It is mandatory to wash your hands after contact with marine animals. In case of wounds or scratches, it is necessary to immediately treat the damage site with alcohol or iodine solution.