Pyogenic arthritis – Causes, symptoms and treatment

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Arthritis is a very common problem but pyogenic arthritis can cost you your joint. Read on to know more.

Pyogenic arthritisAnother name for pyogenic arthritis is septic arthritis. In this condition, there is inflammation and pus formation in a joint. It requires prompt diagnosis and treatment or the person may lose the joint.

Causes of pyogenic arthritis

  1. Spread of infection from a nearby focus of infection like a penetrating wound or from a distant site like a lung infection is a strong possibility. Osteomyelitis (infection of the bone) if untreated may spread to a nearby joint.
  2. This problem is seen more often in people with weakened immune systems such as infants, elderly people and those having compromised immune systems due to AIDS or cancer. Other people affected include intravenous drug users as there is a higher chance of contracting an infection through a needle.
  3. The infection is commonly due to bacteria but could even be viral in origin but the latter resolve on their own. Bacteria like Staphylococcus aureus, Hemophilus influenzae, E.coli and Neisseria are possible culprits. Viruses that may be responsible include Hepatitis A and B, HI and herpes viruses.
  4. Commonly joints of the arms and legs are involved with the knee joint being the commonest one.
  5. People having multisystem illnesses like diabetes, systemic lupus or rheumatoid arthritis are at increased risk of developing septic arthritis. Also people with chronic skin infections like psoriasis and eczema or those having skin wounds area high risk group.

Symptoms and signs of pyogenic arthritis

  • Inflammatory signs in the affected joint are noticed.
  • Pain, swelling, redness, warmth and difficulty in using the joint are commonly seen. Pain increases on movement and decreases on rest.
  • One or multiple joints may be affected.
  • Sometimes pain is seen at a different site; for example if the hip joint is affected the pain is noticed in the knee joint and vice versa.

Diagnosis of pyogenic arthritis

An orthopaedic surgeon can confirm what the problem is after taking a complete history and conducting a local and general examination. Previous injury or surgery to that joint is a strong indicator for pyogenic arthritis.

Investigations for pyogenic arthritis

A needle is inserted in the joint and the fluid removed is given for laboratory investigations. Based on the culture report, the correct antibiotic can be given. In severe cases, the person may need hospital admission and antibiotics to be given intravenously for faster effect.

If the doctor is unable to withdraw fluid through a needle, an arthroscopy may be done. In this procedure a small instrument is inserted into the joint space, the joint is visualised by means of a camera and pus can be removed.

If pus cannot be drained using arthroscopy, open surgery may be required to remove the pus formed inside. Joints which are located deep in the body like the hip joint may require open surgery.

Treatment of pyogenic arthritis

Prompt medical care is essential to save the joint. If the joint is irreversibly damaged, joint replacement is the only option.

The principle of treatment is prompt use of antibiotics or anti-viral drugs to take care of the infection and drainage of the pus to eliminate chances of re-infection.

Drugs: A broad spectrum antibiotic is started till the culture results are obtained then the antibiotic can be changed depending on the infectious agent.

Drainage of pus: If the septic arthritis is diagnosed early, the pus can be drained either by aspiration through a needle done daily till no more fluid comes out or through arthroscopy or by open surgery.

Complications in pyogenic arthritis

If the joint is irreversibly damaged, joint replacement is the only option. The infection if untreated leads to damage to the structures of the joint like cartilage, ligaments and the lining in which the joint is enclosed. So the common complications are osteoarthritis or joint deformity.

Written by Dr Nisreen Nakhoda, General Physician

Photograph by mDhil

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