How to treat gonorrheal arthritis? gonorrheal arthritis

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- this is an inflammation of the joints caused by the spread through the bloodstream (hematogenous penetration) of the 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. accumulation of serous or purulent exudate, begins the destruction of the cartilage 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 activity;
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. By clinical picture bursitis and growth combined 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 passed into chronic form, 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 by the 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.

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.

One of the most rare inflammatory diseases of the joints is gonococcal arthritis, treatment for correct definition The reagent is usually not difficult and lasts, depending on the complexity, from 2 weeks to a month.

Causes of gonorrheal arthritis

Infection occurs by the hematogenous route, by metastasis from the urogenital focus to the joint cavity.

According to WHO reports, treatment for gonococcal arthritis is more often required in women than in men. The reasons for this are quite simple and lie in the etiology of the disease and primary focus infections.

Secondary arthritis is manifested due to gonorrhea, usually manifests itself with late recognition of the disease and late treatment of the pathology.

During menstruation and pregnancy in the body of women, favorable conditions are created for increased reproduction of gonococcus. Treatment of gonorrheal arthritis in women tends to be more problematic.

Gonorrheal arthritis - symptoms and treatment

• Fever.
• Chills.
• Temperature increase.
• Often there is polyarthritis - an inflammatory process of several joints at once.
• Skin lesion. In almost 50% of cases, nodular papules filled with pus appear after infection.

In the early stages, it is easy to isolate the cause of gonococcal arthritis using clinical tests. Clinical Tests blood shows the presence of the reagent. In case of inaccurate results, an additional synovial fluid sampling is taken for the study.

Diagnose arthritis on x-ray in case of injury gonococcal infection simple enough. Already on early stages present brightly severe osteoporosis. Other standard measures for determining the disease and the source of inflammation are:

• Dif. diagnostics.
• Bordet-Gangu reaction.
• Clinical analyzes of blood and synovial fluid.

After antibiotics are completed, restorative therapy is prescribed to help cope with the results of inflammation. Joint drainage is often required because infection leads to increased production of synovial fluid.

To relieve swelling and reduce pain syndrome, it is recommended to use drugs of the NSAID group: Indocid, Voltaren, Butadione, etc. In complex and advanced cases promedol and other drugs used for drug blockade can be used.

After the cessation of inflammation, to relieve swelling and restore the functionality of the joints, the patient is shown:

• Physiotherapy.
• Massage.
• Mud therapy and other procedures.

The course of the disease and the prognosis of treatment largely depend on the time of detection of the reagent, as well as on the correct and timely prescribed course of antibiotics. On average, therapy takes at least one month. This is followed by physiotherapy procedures that help restore the functionality of the joints.

Gonorrheal arthritis is a specific inflammatory disease, which develops against the background of the disseminated form of this infectious pathology. A similar complication occurs in about 1% of men and 3% of women suffering from gonorrhea. Mainly large joints are affected.

It is now known that girls who are promiscuous sexual life, suffer from gonorrheal arthritis more often, since it is they who infection often goes without characteristic symptoms, and then, due to the lack of timely treatment, it passes into a disseminated form that destroys the articular surfaces.

Causes and types

The main reason for the development inflammatory process in the tissues that form large joints, there is a gram-positive microbe - gonococcus. Adults are infected sexually. Infection of children can occur in a contact-household way. IN rare cases transmission of bacteria during labor or in utero is possible.

From urinary tract pathogenic microorganisms enter the bloodstream and spread throughout the body. In hard-to-reach knee, hip and ankle joints, they settle in significant quantities, this causes the development of complications. Currently, depending on the nature of the course of the inflammatory process in the synovial membrane, the following types of gonorrheal arthritis are distinguished:

• phlegmous;
• serous fibrous;
• serous;
• purulent.

The accumulation of gonococcus bacteria in the joints is due precisely to the fact that in circulatory system elements of immunity are actively fighting with them. Here they die rather quickly. The disease affects not only the articular bags, but also the ligamentous apparatus.

Symptomatic manifestations

The first manifestations of this pathological condition are observed after the entry of microorganisms into the blood. A person's temperature rises significantly, symptoms characteristic of a feverish state appear. Often people complain about headache and violent chills. Severe edema and hyperemia develop in the area of ​​one or more affected joints. Patients begin to complain of severe pain in the area of ​​the affected joints.

With any movement, discomfort in the joint can increase significantly. The skin in the affected area may be covered with a distinct rash and pustules. Due to growth fibrous tissue stiffness of the joints develops in the affected area, which in the future may require long-term rehabilitation or even surgical intervention. Often, arthritis causes atrophy of the muscles surrounding the affected joints.

In most cases of development of this complication, the formation of a flat gonorrheal foot is observed. This pathological condition is a combination of:

• achilobursitis;
• heel spurs;
• secondary flatfoot.

Without targeted treatment, gonorrheal arthritis can have a very long course, often taking several years.

The transition of the disease to a chronic form resembles rheumatoid arthritis or Bechterew's disease. Dangerous complications of the development of this infectious lesion of the joint include:

• destruction of its surfaces;
• purulent fusion of cartilage;
• erosion of the ends of the bones;
• phlegmon;
• osteomyelitis;
• ankylosis;
• contractures.

Such a course is considered extremely unfavorable, as it often leads to severe damage to the joints, which in the future will be extremely difficult to restore.

Identification of the disease

For staging accurate diagnosis the clinical picture is usually not enough. To accurately identify a disease such as gonorrheal arthritis knee joint or other joints, the physician must carefully evaluate the patient's symptoms. It is advisable to study the medical history, to identify cases of unprotected sexual intercourse, which could cause gonococci to enter the patient's body.

If a person has previously had gonorrhea and is not completely gone necessary treatment, the specialist may suspect the development of this dangerous complication. This is followed by a thorough examination of the affected knee or other joints and palpation of the affected areas. To clarify the diagnosis and identify the causative agent of the inflammatory process, the following laboratory tests are carried out:

• smear microscopy;
• general and biochemical analysis blood;
• polymerase chain reaction;
• bakposev on the microflora of the mucous membranes;
• joint fluid biopsy.

An x-ray of the affected joints should be taken. This allows you to assess the degree of damage to the joints. After the complex therapy appropriate treatment can be given.

Treatment Methods

Wherein pathological condition indicated therapy in a hospital setting. During acute course disease, the patient is provided with complete rest and immobilization of the affected joints in a comfortable position with the help of rollers. To reduce the intensity discomfort dry heat is recommended. To eliminate the infection that caused the development of the inflammatory process, antibiotics are prescribed. Macrolides, cephalosporins and penicillin preparations are usually used.

With a significant pain syndrome Non-steroidal anti-inflammatory drugs and analgesics may be prescribed. In rare cases, transcranial electroanalgesia is indicated. With the development allergic reactions glucocorticosteroids are prescribed. With the accumulation of exudate in the damaged articular bag, a puncture may be prescribed to remove it. After aspiration of such contents internal cavity washed thoroughly with antibiotic solution. In the presence of decompression and with an increased risk of hip dislocation, a drainage procedure and arthrotomy may be indicated.

After the attenuation of the inflammatory process, procedures are prescribed to restore the mobility of the affected joint. Patients are shown physiotherapy, exercise therapy and massage. In the future, gonorrheal arthritis therapy can be supplemented with mud therapy, procedures using hydrogen sulfide and radon baths, etc. rehabilitation period people who have had this disease are recommended sanatorium treatment.

Gonococcal arthritis occurs in 0.08-0.6% of cases of complicated gonorrhea. Women are more often ill, including girls suffering from gonococcal vulvovaginitis. Men get sick extremely rarely due to the rapid cure of urethritis. The exception is homosexuals suffering from gonococcal proctitis.

What provokes / Causes of Gonococcal arthritis:

The causative agent of the disease is gonococcus, which penetrates into the joint cavity by the hematogenous route, metastasizing from the primary urogenital focus. This possibility is created with disseminated (generalized) gonorrhea, which occurs in approximately 1% of men and 4% of women. The high frequency and severity of the disease in women is due to the often asymptomatic course of the primary infection, its late recognition and too late treatment. Predisposing factors in women are also pregnancy and menstruation, during which favorable conditions are created in the genitals for the reproduction of gonococcus. The possibility of developing reactive arthritis in patients with gonorrhea is taken into question by many authors, since it turned out that in the past the venereal form of Reiter's disease was taken for arthritis of this genesis.

Symptoms of Gonococcal Arthritis:

True gonococcal arthritis is characterized the same symptoms as any other septic articular process: high fever, chills, damage to one or more joints, leukocytosis. The usual localization of the process is knee, ankle, wrist joints, which show signs of local inflammation and rapidly developing atrophy of the periarticular muscle groups. It is extremely rare that the development of gonococcal mono or oligoarthritis is not accompanied by common symptoms sepsis. In 25-50% of patients, gonococcal skin lesions are simultaneously detected in the form of nodular papules on a red base, sometimes vesicles and pustules filled with purulent or hemorrhagic contents with a dark necrotic center, which are usually localized on the back, distal parts limbs, around the joints.

In the initial acute period diseases, bacteremia is observed, which can be proved by the isolation of gonococcus from the blood, and in 50% of patients it is possible to identify the microorganism from the synovial fluid. In the synovial membrane, examined at the height of the disease, a picture is determined acute inflammation with abundant tissue infiltration by neutrophilic leukocytes up to the formation of microabscesses.

Diagnosis of gonococcal arthritis:

Radiological signs: pronounced epiphyseal osteoporosis from the very early stages diseases. Cartilage destruction and erosion of the articular ends of the bones develop only with late and inadequate treatment.

Diagnosis: The diagnosis of gonococcal arthritis is considered absolutely proven when the microbe is isolated from the blood or found in smears and cultures of the synovial fluid. Gonococcal etiology of the articular process can be considered as probable if the microorganism is found only in anogenital foci, but adequate penicillin therapy brings a quick and complete effect.

Bordet-Jangu reaction has only an auxiliary diagnostic value, since in acute gonorrhea it becomes positive only at the 2-4th week of the disease. However, in chronic complicated gonorrhea (epididymitis, salpingo-oophoritis, prostatitis, etc.), it is positive in 40-90% of cases. The results of the reaction can be taken into account in unclear forms. articular pathology especially in women with chronic inflammatory foci urinary tract.

differential diagnosis. Acute gonococcal arthritis, especially in the absence of conclusive evidence of its association with gonorrhea, should be differentiated from other infectious arthritis. It should be taken into account that gonococcal arthritis occurs, as a rule, in practically healthy people, while other infectious arthritis - more often in debilitated patients, against the background of severe common diseases. Reiter's disease, unlike gonococcal arthritis, is predominantly diagnosed in men who are carriers of HLA B27; its development is in chronological relationship with non-gonococcal (most often chlamydial) urethritis or prostatitis, and clinical symptoms, in addition to arthritis, includes such signs as conjunctivitis, balanitis, damage to the mucous membranes of the oral cavity, keratoderma of the soles and palms.

Treatment for gonococcal arthritis:

In the acute period - peace, creation comfortable position for the affected limb with pillows, rollers, splints, dry heat on the joint. Be sure to prescribe penicillin 6000000-10000000 IU / day 4 times. If the diagnosis is established in a timely manner and treatment is started early, after 1-3 days there can be a surprisingly rapid regression of all clinical manifestations diseases, which is recommended to be taken into account as an additional diagnostic sign gonococcal arthritis.

Treatment with penicillin is continued for 7-14 days, sometimes replacing it as the condition improves with ampicillin at a dose of 2 g / day. You can also use erythromycin 1.5-2 g / day for 1-2 weeks. With true gonococcal arthritis, short-term antibiotic therapy is quite effective. In addition to penicillin, NSAIDs are prescribed (indocide, reopyrin, butadione, voltaren, etc.). It is extremely rare for severe pain in the acute period to use more powerful analgesics (promedol, etc.). When subsiding inflammatory phenomena prescribe a massage therapeutic gymnastics, physiotherapeutic procedures (sollux, diathermy, paraffin applications).

Which doctors should you contact if you have Gonococcal arthritis:

Rheumatologist

Are you worried about something? Do you want to know more detailed information about Gonococcal arthritis, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors examine you, study external signs and help identify the disease by symptoms, advise you and provide needed help and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.

(+38 044) 206-20-00

If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific symptoms, characteristic external manifestations- so called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent terrible disease but also support healthy mind in the body and the body as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register for medical portal Eurolaboratory to be constantly up to date latest news and updates of information on the site, which will be automatically sent to you by mail.

Other diseases from the group Diseases of the musculoskeletal system and connective tissue:

Gonorrheal arthritis is an infectious rheumatological disease characterized by an inflammatory process that occurs in the joints against the background of chronic or acute gonorrhea. Gonorrheal arthritis is caused by the ability of gonococci to spread through the tissues and organs of the body if they become infected. genitourinary system.

Gonorrheal arthritis is different from purulent form arthritis is not the specificity of inflammation, and this is expressed in the clinical picture of this type of disease.

Symptoms

Gonorrheal arthritis, as the name implies, develops in the body only after the development and transfer of gonorrhea by a person. The first sign of the development of gonorrheal arthritis is fever body. The temperature rises to significant levels - 39-40 degrees. The patient complains of severe chills and short pains migrating from joint to joint. All these are manifestations of the beginning of the development of gonorrheal arthritis.

Most often, with this disease, no more than one or two joints are seriously affected. Usually it is the knee or ankle joint. A little less commonly, gonorrheal arthritis affects the wrist or elbow joints.

Arthritis appears severe pain sharp and acute form in the affected joints. Then swelling and redness appear at the site of pain localization. skin in the area of ​​the diseased joint. If you feel the lesion site, you can feel the temperature difference between it and the rest of the skin.

With the course and development of gonorrheal arthritis, inflammation of the tendons also develops. This manifests itself in stiffness of movements, in articular stiffness (a process of scarring occurs inside), and in a modification of the configuration of the joint.

If the process of development of gonorrheal arthritis is formed in ankle joint, the patient develops a "flat gonorrheal foot", as it is customary to call this symptom in medical circles. In the process, inflammation affects all the tarsal and metatarsal joints. And to this process are added such symptoms as: atrophy of the foot muscles, the obvious formation of flat feet, in running diseases, the joint can be completely immobilized, as fibrous tissue grows in it.

Diagnostics

Diagnosis of gonorrheal arthritis requires a blood test. A general clinical blood test reveals an increased number of leukocytes, an increased ESR (this indicates the course of the inflammatory process in the body). A biochemical blood test reveals an increased content of substances characteristic of this disease in the blood - fibrian, sialic acids, and others.

Also, when diagnosing gonorrheal arthritis, it is necessary to use such a diagnostic method as microscopy of the fluid of the joints. Do microscopy by puncture of the joint. In the presence of the disease in the fluid, an increased number of leukocytes can be detected, and in the smears of the pathogens themselves - gonococci.

A serological study is also mandatory when diagnosing gonorrheal arthritis. In this case, antibodies to pathogens can be detected in the blood.

And X-ray examination is also one of the main methods for diagnosing gonorrheal arthritis. At the same time, characteristic diseases of the expansion of the joint space are visible for this type.

Prevention

All methods of preventing infectious diseases of the human genitourinary system, including the timely detection and treatment of gonorrhea, can be attributed to the prevention of gonorrheal arthritis.

Treatment

Gonorrheal arthritis is treated with conservative methods. Assigned to the patient antibacterial drugs who have strong impact on pathogens (gonococci) and glucocorticosteroids. In parallel with taking medications, physiotherapeutic procedures are necessarily prescribed: mercury-quartz lamps, SUF, UHF therapy, ultraphonophoresis, drug electrophoresis, and others.

In rare cases, local injection of the joint with antibiotics and anesthetics is used.

For the rehabilitation period after the transfer of gonorrheal arthritis, the patient is prescribed spa treatment.