Gonorrheal arthritis treatment and symptoms. Gonorrheal arthritis - symptoms and treatment

Inflammation of the joints that develops with a chronic or acute form of a sexually transmitted disease is known to medicine as gonorrheal arthritis. This is a fairly rare disease. In rheumatology, the disease is referred to as specific infectious arthritis, which occurs in 3% of those infected with gonorrhea. Mostly young sexually ill active people. The disease is more common in women than in men.

What is this disease?

Gonococcal arthritis is called bacterial disease which is a complication of chronic or acute infection urinary tract.

Illness caused venereal disease called gonorrhea, which is caused by the bacterium Neisseria gonorrhoeae and is transmitted sexually. Painful gonococcal arthritis occurs when bacteria enter the joint fluid. The disease causes acute inflammatory processes in the ankles, knees, elbows, wrists, and, less commonly, in the axial skeletal bones of the head and trunk. Arthritis is usually accompanied by severe pain, swelling, and redness.

Etiology, pathogenesis and forms of the disease

With gonorrhea, gonococcal bacteria enter the body and multiply on the mucous surface. urethra, cervix, rectum, causing a localized infection. The immune system protects the body from the spread of bacteria beyond the primary infectious focus. But gonococci are able to spread through the bloodstream, and changes in the strain only increase the chances of further advancement through the body. When untimely detected, the bacteria migrate to the tendons and then to the joints, causing inflammation.

The course of gonorrheal arthritis is acute and chronic. There are two forms of this disease:

• Localized gonorrheal septic arthritis that affects one or two large joints such as the knee, elbow, wrist, and ankle. The site of the lesion is very swollen, and upper layer the skin turns red and becomes warm.
• Syndrome of arthritis-dermatitis, which causes migratory pain, (polyarthritis), skin lesions in the form of pustules. IN synovial fluid surrounding the tendon, reveal microorganisms.

Symptoms of the disease

Most men who get gonorrhea have severe symptoms, including severe pain when urinating, so they see a doctor right away. Some women also have signs of infection, however, most often the disease is asymptomatic and takes a chronic form. Therefore, gonococcal arthritis occurs more often in women.

Exacerbation of gonorrheal arthritis can be sudden and painful. Burning pain appears due to massive swelling caused by gonococcal bacteria. Symptoms of the disease are:

• redness and swelling around the affected organs;
• joint pain;
• limited range of motion;
• a sharp increase in temperature;
• fever;
• chills;
• skin lesions;
• leukocytosis.

The course of the disease in a child

Gonococcal arthritis is noted in babies to whom the pathogen came from the mother's body with venereal disease during childbirth. Delay in diagnosis or treatment leads to permanent damage to the limbs. These children are characterized by:

• feeding problems;
• irritability;
• frequent crying;
• fever;
• spontaneous limb movement.

Gonorrheal infection enters the child's body and affects the elbow, knee joints, lower back. Over time, thinning of cartilage, swelling of soft tissues occurs. The knees are affected first hip joints, and then the elbow and ankle joints. The child is assigned complex therapy, medicinal gymnastic exercises And bed rest.

Diagnosis of gonorrheal arthritis

The studies are carried out by dermatovenereologists together with rheumatologists. Testing starts with identifying primary signs and analyses. If you suspect gonorrheal arthritis, you will need to pass tests:

gonorrheal arthritis is rheumatological specific inflammatory disease joints, which appears in acute and chronic. The causative agent of this disease arises from the primary urogenital focus. This type of arthritis is considered bacterial. It is caused by a complication of a gonococcal infection (acute or chronic) of the ureters (the tubes that carry urine to the bladder).

Description

The disease begins to develop unexpectedly quickly and immediately takes on a complex development. It affects the joints in the first months when a person becomes ill, but in the case when the patient has a history of chronic or prostatitis, gonorrheal arthritis may appear after a few years.

Gonorrheal arthritis is considered specific kind infectious arthritis. This disease can be found in two to three percent of people infected with gonorrhea. In most cases, this disease occurs in women. The complex course of the disease occurs due to the fact that the primary urogenital infection passes completely without any symptoms, so specialists make a diagnosis late. This type of arthritis is rare in men.

By origin, these are considered infectious-allergic. Pathological fluid accumulates in the joint cavity, after which swelling of the surrounding tissues develops. In places of attachment to the bones, ligaments and tendons become inflamed.

Symptoms

Gonorrhea can lead to the development of a disease such as gonorrheal arthritis. The main symptom of the onset of the disease is a sudden increase in body temperature (up to or above 40 degrees). The patient develops a feverish state, he is shivering, he has migrating pains in the joints, swelling and rashes appear in the area of ​​​​inflammation foci, human movements become limited. Most often, the disease affects the knee and ankle joints, small elbow and radial joints are less susceptible to inflammation. The disease proceeds as monoarthritis and is characterized by inflammation of the large knee or ankle joint.

In infected places, the appearance of sharp and strong pain. At the site of the pain focus, the skin begins to redden, swell and becomes warmer to the touch.

Inflammation of the tendons provokes stiffness of movements, the joint stops moving freely, due to the process of scarring inside, and in the end, the joint changes its configuration.

If the disease has seized ankle joint, then the patient develops a "flat gonorrheal foot". With this diagnosis, the patient's tarsal and metatarsal joints become inflamed. After that, the muscles of the foot atrophy, flat feet begin to form. If treatment is not started in time, then fibrous tissue begins to grow in the joint, which can make the joint completely immobile.

Diagnostics

Most importantly, at the first symptoms, immediately contact a specialist. For staging accurate diagnosis, the patient is sent for delivery laboratory analysis blood. In the blood, you can see an increased number of leukocytes and ESR. When passing a blood test for biochemistry, an increased amount of fibrin, haptoglobin, sialic acids, seromucoid is determined.

The patient is asked to take an x-ray. It helps to see the expansion of the joint space on the diseased joint (characteristic of this disease), to identify. Gonorrheal arthritis can cause the development of deforming osteoarthritis.

When taking synovial fluid for analysis (microscopy), it can be seen a large number of leukocytes, with neutrophils predominating, and a smear taken from it indicates the presence of gonococci. For microscopy, a puncture of the diseased joint is made.

For more accurate diagnosis, you can conduct a serological (in the blood you can see the presence of antibodies to pathogens) and microbiological examination.

Treatment

The course of therapy for gonorrheal arthritis is recommended to be carried out in a hospital setting. If the disease is just beginning, then the patient is trying to get rid of infectious and inflammatory process in organs genitourinary system and joints. The patient at this time must be kept calm, the affected joints are trying to give the most comfortable position(using pillows). Apply to the affected joint dry heat trying to keep it still.

• To neutralize the pathogen (gonococci), the patient is prescribed antibacterial drugs. Usually antibiotics are penicillin series, cephalosporins, macrolides. If a person is worried about severe pain, then analgesics are used, and an allergy occurs in the course of treatment, then in some cases glucocorticosteroids are prescribed.
• For complex treatment , together with medications, physiotherapeutic procedures are prescribed: electrophoresis with the use of medication, ultra-high-frequency therapy, ultraphonophoresis, mercury-quartz lamps, massage, physiotherapy exercises.
• At severe cases , accompanied by severe pain, the patient can do a local blockade of the joint - chipping the joint with antibiotics and anesthetics.
• If fluid has accumulated inside the cavity , then a puncture is made to remove it, and antibiotics are injected into the cavity.
• After completing the entire course of treatment , for recovery and rehabilitation, the patient is offered spa treatment where the patient undergoes balneotherapy: mud therapy, radon and hydrogen sulfide baths.

Prevention

Prevention of the disease is the same as all prevention infectious diseases urinary system. The main thing is to detect gonorrhea infection in time, to carry out correct diagnosis on initial stage disease progression and appropriate treatment. With the timely passage of a course of therapy, the disease can be cured. Be healthy!

Gonococcal arthritis is a pathology that develops with a complicated course of gonorrhea. Most often, the disease affects girls and women suffering from gonococcal vulvovaginitis. In men, this disease is detected in homosexuals suffering from gonococcal proctitis.

Inflammatory damage to the joints, which is a consequence of acute and chronic gonorrhea, formed in connection with the spread of infection from the primary urogenital focus, is diagnosed as gonococcal arthritis.

By origin, gonorrheal arthritis is classified as an infectious-allergic pathology. However, sometimes there is a metastatic path of damage to the joints. In this case, in the presence of gonococci in the joint effusion, acute gonococcal arthritis is diagnosed.

When defeated synovial bag pathological fluid accumulates in the joint cavity, causing inflammatory edema surrounding tissues. At the same time, damage to the ligaments and tendons is noted in the places of their attachment to the bones.

Note: The osteocartilaginous articular skeleton in this case is affected much less frequently.

Causes

Pathogen this disease is a gonococcus penetrating into the articular cavity by the hematogenous route from the primary infectious focus. As a rule, this occurs with generalized gonorrhea, which develops in 4% of women and 1% of men.

Due to the fact that gonorrhea is often asymptomatic in the fairer sex, it is early stages very difficult to recognize and assign proper treatment. The most favorable conditions for the reproduction of gonococcus are menstruation and pregnancy, so these factors are considered to be predisposing to the occurrence of gonorrheal arthritis.

Symptoms of Arthritis Caused by Gonococcal Infection

Gonococcal arthritis has the same symptoms as other septic arthritis. articular pathologies. At the same time, there is a feverish state, fever, chills, leukocytosis. All these signs occur against the background of damage to one or more joints.

A favorite place for the localization of the pathogen are the ankles, knees and wrist joints. There are clear signs here local inflammation, and also quickly occurs atrophy of the muscles located in close proximity to them.

IN rare cases gonococcal arthritis can provoke the development of general septic symptoms.

Almost half of the patients have skin lesions. At the same time, on the skin of the back and distal departments extremities around the inflamed joint, nodular papules, vesicles or pustules appear, filled with hemorrhagic or purulent contents with an area of ​​necrosis in the center.

Diagnostics

1. X-ray examination. Already on the most early stages pathological process pronounced epiphyseal osteoporosis is noted.
2. Blood test to detect bacteremia.
3. Biochemical blood test (to determine the amount of sialic acids, seromucoid, fibrin and haptoglobin).
4. Synovial fluid analysis.
5. Bordet-Gangu reaction.

Treatment and prevention of the disease

Treatment of this disease involves the use of antibiotics and anti-inflammatory drugs to reduce the activity inflammatory process in joints and relieve pain. With the help of immunosuppressors, immune dysfunction is corrected, and the functional properties of the affected joint are also increased.

For the purpose of prevention, casual sexual contact should be avoided, and, in case of infection with gonorrhea, treatment should be started without delay.

Features of gonorrheal arthritis and causes of development. Is it possible to determine the onset by symptoms specific infection? Diagnosis and methods of treatment.

The content of the article:

Gonorrheal arthritis is an inflammation of the joints caused by the spread through the bloodstream (hematogenous penetration) of gonococcus. Occurs in 2-3% of cases as a complication of acute or chronic specific infection of the urethra. Women are more likely to get sick, because their infection can be asymptomatic for a long time. And at this time pathogenic bacteria settle in the cartilage of the joint and are embedded in the bone tissue.

What is gonorrheal arthritis?

The spread is quite fast due to anatomical features urinary organs. They have a dense network blood vessels And lymphatic ducts. During menstruation, favorable conditions due to severe hyperemia (blood flow to the genitals).

Accumulating in the joint bag, bacteria begin to actively multiply, the concentration in the synovial fluid increases, its structure changes. Serous or purulent exudate accumulates, destruction of cartilage begins, adjacent bone tissue, tendons, ligaments and mucous membranes lining the articular cavities.

The most common form is bacteremic, toxic-allergic arthritis.

Allocate:

• Serous synovitis- the amount of synovial fluid increases due to the accumulation of serous exudate;
• Serous fibrinous synovitis- significant effusion, periarticular tissues, ligaments and joints surrounding the joint capsule are affected;
• Purulent synovitis- fragments of pus are found in the synovial fluid, which causes significant external edema;
• Phlegmonous arthritis- an advanced form of the disease.

Causes of gonorrheal arthritis

Ways of infection of young children:

1. Transplacental- through the placenta from a sick mother to the fetus, is extremely rare;
2. Vertical or intranatal- infection occurs during labor;
3. Contact household- associated with low immune status kids.

Main symptoms of gonorrheal arthritis

Symptoms:

• Acute burning pain, which increases with passive bends and unbends;
• Hyperemia and edema in the affected area;
• Decreased range of motion;
• Acute intoxication against the background of fever;
• Chill and feverish condition.

The clinical picture largely depends on gender. Joints are more commonly affected in women upper limbs- wrist and elbow, and in men - lower, namely ankle, knee, metatarsophalangeal.

At untimely treatment begin pathological changes the affected limb. The foot changes shape, flat feet develop. The clinical picture combines bursitis and growth heel spurs. Symptoms resemble ankylosing spondylitis or rheumatoid arthritis.

In newborns, the disease is much more severe. Gonococcal sepsis may develop, against which ankylosis (fusion of articulating bones), cartilage melting, phlegmon (unlimited acute purulent inflammation fiber), osteomyelitis (purulent necrosis of the bone marrow).

Diagnosis of gonococcal arthritis

The diagnosis is made with the help of such studies:

1. General blood test for leukocytosis.
2. Serological examination of blood according to the Borde-Gangu reaction. Detect antibodies to the pathogen.
3. Microscopic examination biological materials. Smears are taken from the conjunctiva of the eyes, nasopharynx, pelvic organs - the vulva and cervical canal in women and the urethra in men. Be sure to make a puncture: using a long needle, synovial fluid is pumped out of the affected joints for examination.
4. Radiography. If the disease has already managed to become chronic, then the picture shows degenerative changes bone tissue, deformation of cartilaginous surfaces, narrowing of the joint space.

Important! The diagnosis is considered proven when a gonococcus (or diplococcus) is isolated in the synovial fluid.

Features of the treatment of gonorrheal arthritis

To restore the condition, complex therapeutic measures are needed - antibiotic therapy and the elimination of arthritis. How to treat gonorrheal arthritis and what methods to use, is determined clinical picture. In the acute process of the affected limb, immobilization is required.

Medications for gonorrheal arthritis

Are used:

• Facilities NSAID groups for removal acute pain. Recommend Butadion, Reopirin and analogues - Indocide, Nimesulide and the like.
• Antibacterial drugs. Penicillin for 1-2 weeks or Tetracycline for 8-10 days. Can be replaced by analogues: Ampicillin and modern macrolide drugs - Erythromycin, Clarithromycin, Azithromycin, Midecamycin. Despite the instructions in the instructions for brief application, the decision on the duration of use is made by the doctor.
• In acute pain, it is possible to prescribe stronger analgesics - for example, Promedol.
• as an anti-inflammatory therapeutic regimen salicylates, such as Aspirin, may be administered.

Often, antibiotics are injected directly into the affected joint. Efficiency is assessed on the 3rd day after the start of treatment. If improvement is not noticeable, the drugs are changed.

Physiotherapy for gonorrheal arthritis

Physiotherapy does not affect autogenous microorganisms and is used to eliminate pain and restore mobility of affected joints. Can be prescribed: UHF, magnetotherapy, electrophoresis with means of NSAIDs or analgesics, laser irradiation, transcranial electroanalgesia. Radiation is directed to the inflamed area by a pulsed current of different frequencies.

To alleviate the condition after the end of treatment with antibiotics, iodine-bromine, radon or hydrogen sulfide baths, heating with ozocerite or paraffin are prescribed.

Gymnastics in the treatment of gonorrheal arthritis

To the complex physiotherapy exercises stretching and rotational exercises are included. The duration of the first classes is from 10-15 minutes, gradually adjusted to 30 minutes.

First, the joint is thoroughly kneaded - you can do light massage, vigorous rubbing. Muscles need to be toned. With damage to the lower extremities the best preparation to exercises to restore mobility - walking. It is advisable to conduct classes in the morning and in the evening.

Surgery for gonorrheal arthritis

Most often, children are operated on, because due to an untimely diagnosis during the period active growth joints are deformed.

1. Synovectomy. To eliminate pain, the affected part of the synovial membrane is removed.
2. Arthroplasty. The method is used when advanced disease. Sand off all excess growths. If the joint is destroyed, part of the joint can be replaced.
3. Resection. With this method, the patient is relieved of pain when walking by removing part of the affected bone tissue.
4. Arthrodesis - fusion of joints. The range of motion cannot be restored, but after the operation, the bones will be able to withstand increased load. During the operation, a layer of affected bone tissue is removed, and the ends of the joints are connected together. Such an operation does not save from disability, but helps to get rid of pain.

Note! If antibiotic therapy is started on time, then surgery will not be needed and the affected joint will fully recover.

Folk remedies for gonorrheal arthritis

Folk recipes:

• Elimination of dysbacteriosis and acceleration of metabolism in the affected joints. In glass warm water dissolve 1 dessert spoon of honey and 1 g of yeast. Let stand 1.5 hours. Take 2 times a day 40 minutes after breakfast and lunch.
• Vitaminization of the body. You need to drink 1/3 cup of cranberry juice or rosehip infusion with honey for 7 days.
• Against intoxication. It is used during therapy with antibiotics and NSAIDs.
• To speed up the recovery of mobility. teaspoon apple cider vinegar diluted in a glass of warm boiled water. Take 2 weeks up to 5 times a day. Long-term use NSAIDs the amount of vinegar is reduced or the method is abandoned.
• Restoration of immunity. Brew tansy or yarrow with boiling water, 1 tablespoon per glass of water, insist wrapped up. 20 minutes before meals, you need to drink 1 tablespoon 3 times a day for 2 weeks.

After gonococcal conjunctivitis will help restore general state and balance of microflora in the genitals Birch juice. It is advisable to drink a glass a day during the period of sap flow.

This disease develops in patients with gonorrhea. Gonorrheal arthritis occurs due to hematogenous dissemination of infection from the primary urogenital focus. The disease develops more often in women and manifests itself in toxic-allergic, metastatic and combined forms.

Symptoms of the development of gonorrheal arthritis

The disease is characterized by a pronounced pain syndrome. Inflammation that has passed to the surrounding soft tissues, leads to a change in the shape of the joints, muscle atrophy, subluxations, vicious positions, and limitation of range of motion. Compression nerve endings gives rise to pain syndrome. Destructive processes in the joint are observed quite rarely.

Most often, with symptoms of gonorrheal arthritis, the synovial membrane of the joints is affected. The acute (exudative) phase of inflammation is manifested by thrombovasculitis and disorders of blood rheology, edema, sweating of fibrin, tissue infiltration by neutrophils and macrophages, accumulation of serous, serous-fibrous, less often purulent exudate With inflammatory reaction periarticular tissues (syndrome inflammatory phenomena). This syndrome is leading in the course of infectious arthritis.

In chronic synovitis (in the productive phase), the main role belongs to immunological disorders, autoimmune and immunocomplex processes (immunopathological allergic syndrome). The reasons for the unusual response of the immunocompetent system cannot be considered unconditionally established.

It is assumed that this is facilitated in some cases by the inherited carriage of the histocompatibility antigen HLA-B27. An antigenic relationship between HLA and bacteria is possible, and a violation of the regulation of antibody synthesis, which may have a different origin, is not excluded.

Diagnosis of gonorrheal arthritis

At the first stages of the development of the articular syndrome in gonorrhea, gonococcus can be sown from the blood. When arthritis develops, gonococci are already shed from the synovial fluid. Gonorrheal infectious-allergic polyarthritis can occur in acute and chronic form.

Acute gonorrheal serous arthritis may begin shortly after intercourse or at a later time: appears strong pain in the joints, swelling, body temperature rises. Emergence acute forms associated with any additional impact (cooling, physical, sexual or mental overstrain, physiotherapy). The possibility of developing chronic gonococcal polyarthritis, which proceeds more sluggishly with subfebrile temperature and very similar to rheumatoid arthritis with lesions of 2-3 large joints or spinal column with symptoms of ankylosing spondylitis.

The main syndromes of the disease:

• inflammatory,
• painful,
• articular (defiguration of the joints).

Without adequate treatment gonorrheal arthritis may result in articular ankylosing, periarticular phlegmon, or osteomyelitis.

Features of the treatment of gonorrheal arthritis

Treatment is aimed at reducing proliferative phenomena in the joint and periarticular tissues, relieving pain, weakening muscle contractures and preventing muscle atrophy, weakening allergic inflammation in the tissues of the joint, tendons, mucous bags. Treatment for gonorrheal arthritis includes specific preparations(antibiotics) and anti-inflammatory drugs (Reopyrin, Indomethacin, Butadione).

Physical Methods are prescribed after subsiding of acute inflammatory phenomena and are used to reduce the activity of the inflammatory process in the joints (anti-inflammatory methods), relieve pain (analgesic methods of treatment), correct immune dysfunction (immunosuppressive methods), increase the functional properties of the affected joint (fibromodulatory methods) These tasks help to realize following methods physiotherapy:

Anti-inflammatory methods: low-intensity UHF therapy, UHF therapy on the adrenal region, hydrocortisone ultra-phonophoresis, intraorganic antibiotic electrophoresis, low-frequency magnetotherapy.

Analgesic methods: SUF - irradiation in erythemal doses, transcranial electroanalgesia.

Immunosuppressive treatments for gonorrheal arthritis: medicinal electrophoresis immunosuppressants.

Fibromodulatory methods: infrared laser therapy, pelotherapy, radon baths, hydrogen sulfide baths, bromine-iodine baths.

Anti-inflammatory therapies for gonorrheal arthritis

Medicinal electrophoresis. Apply solutions of antibiotics. Under the influence of constant electric current conduction currents occur in the tissues, which cause polarization cell membranes and improve their permeability. In the tissues of the interpolar zone, the concentration of antibiotics increases by 1.5 times. Due to the ionization of antibiotic solutions in an electric field, their penetrating power increases. Intraorganic electrophoresis is carried out using electrodes that are placed longitudinally or transversely in the projection inflammatory focus. Procedures for the treatment of gonorrheal arthritis are carried out 30 minutes after parenteral or 1-1.5 hours after oral administration of an antibiotic. Current strength up to 30 mA, for 25 minutes, daily; course of treatment of gonorrheal arthritis 10 procedures.

Low frequency magnetotherapy. The spatial inhomogeneity of magnetic fields (most pronounced in traveling fields) in the tissues of the joint forms magnetohydrodynamic forces that cause additional movement of ions in cells. This significantly reduces blood clotting and increases the likelihood of its participation. shaped elements V chemical reactions. Spatial-temporal inhomogeneity of the field leads to the emergence of multidirectional mechanical moments during the first and second phases of the oscillation period magnetic field, resulting in increased convection processes in cells moving biological fluids and their metabolism is activated.

Due to the increase in the oscillatory movements of the uniform elements and proteins of the blood plasma, local blood flow is activated and the blood supply to various organs and tissues is increased. Dosing is carried out according to the magnitude of the magnetic induction (15-30 mT), the duration of the procedure is 15-30 minutes, daily or every other day; course of treatment of gonorrheal arthritis 18-20 procedures.

Contraindications: purulent exudation in the joint, pronounced proliferative phenomena.

Spa treatment for this type of arthritis

Patients with gonorrheal arthritis after subsiding of acute inflammatory phenomena in the joints, with chronic bursitis, achillodynia, with pronounced proliferative changes in articular and periarticular tissues, muscle spasms and by contractures they are sent to balneological and mud treatment resorts with radon waters (Pyatigorsk, Abano-Terme, Bad Brambach, Baden-Baden, Bad Kreuznach, Bankya, Vichy, Vouliagmeni, Dax, Caiafa, Kaldelash, Colorado Springs), hydrogen sulfide waters(Pyatigorsk, Sochi, Argman, Surakhany, Chimion, Baldone, Shikhovo), to mud treatment resorts (Pyatigorsk, Nalchik).

A contraindication to spa treatment is acute gonorrheal arthritis.

Physiotherapy is aimed at

• prevention of muscle atrophy (trophostimulating treatments),
• improvement functional activity affected joint (fibromodulating methods).