What is Purulent Arthritis & How is it Treated?|Causes, Symptoms of Purulent Arthritis

What Is Purulent Arthritis?

Purulent Arthritis is a pathological condition in which the joints of the body get inflamed as a result of bacterial infection. Purulent Arthritis is a potentially dangerous condition to have as it may lead to various complications like joint arthrosis, contractures and in some cases more serious infections, which may spread to other parts of the body to include abscess and even sepsis which is a potentially life threatening condition. Thus, it is prudent to treat it as soon as the condition is diagnosed to prevent such complications.

In majority of the cases of Purulent Arthritis, Staphylococcus is the offending agent, although pneumococci and streptococci can also cause it even though the occurrence is rather few and far between. Both children and adults are be affected by Purulent Arthritis.

What Is Purulent Arthritis?

What Causes Purulent Arthritis?

As stated above, the bacteria responsible for the development of Purulent Arthritis are staphylococci, pneumococci, and streptococci. These bacteria can enter the joint cavity basically by two ways of which one is direct and the other is lymphogenous. The direct way through which an individual can get affected by Purulent Arthritis is by way of any direct trauma or injury to a joint, an open wound, or during a surgical procedure. The lymphogenous way of the bacteria entering the joint cavity is when the microorganisms are spread all over the body such as with lymphadenitis, osteomyelitis, or other infections. These pathogens mix in the bloodstream and infiltrate into the synovial fluid resulting in inflammation, which progresses to infection in the joint cavity causing Purulent Arthritis.

If an individual has pneumonia, influenza, or gonorrhea then there is more likelihood of that individual having purulent arthritis. The joints most affected by Purulent Arthritis are the knee, hip, and ankle joints. Spread of infection is rarely seen in children or newborns with Purulent Arthritis.
Some of the risk factors for developing Purulent Arthritis are:

  • Deficiency of essential elements in the body.
  • Obesity.
  • Old age.
  • Young athletes who are more prone to injuries.
  • Genetic makeup also plays a role in an individual being predisposed to Purulent Arthritis.
  • Individuals with various metabolic disorders are also prone to having Purulent Arthritis.

What Are The Symptoms Of Purulent Arthritis?

Purulent Arthritis can be acute or chronic with varying symptoms. The symptoms of acute form of Purulent Arthritis have a sudden onset and include:

  • Swelling at the area of the affected joint.
  • Feeling of warmth at the area of the affected joint.
  • Severe pain in the affected joint.
  • Decreased range of motion of the joint.
  • Feeling of weakness and lethargy.
  • Muscle weakness.
  • Nausea with or without vomiting.
  • Hyperemia at the affected site.

Chronic Purulent Arthritis develops usually after an injury to the joint as a result of which the offending bacteria infiltrates the joint causing the infection. Once the infection has set in, there is visible swelling of the area of the affected joint with inflammation. There is also erythema noted around the area of the affected joint. The individual perceives pain with any kind of movement or activity with the joint. These symptoms may wax and wane until the infection clears up.

How is Purulent Arthritis Diagnosed?

As stated above, it is extremely prudent to diagnose Purulent Arthritis early as a delay in diagnosis leads to delay in treatment which may result in severe complications like spread of infection in the bloodstream leading to complications like sepsis which may be life threatening or development of conditions like osteomyelitis.

It should also be noted here that the symptoms displayed by the patient with Purulent Arthritis are quite similar to other arthritic conditions as well which makes the diagnosis that much more difficult.

In order to confirmatively diagnose purulent arthritis, the physician may order different laboratory tests to rule out other conditions which may have similar symptoms. Additionally, an arthroscopy may be performed to look at the status of the joints and to evaluate the extent of damage done to the joint.

Radiographic studies may also be done in the form of x-rays, MRI and CT scans to look at the affected joint. All these tests together confirm the presence of an infection within the joint cavity confirming the diagnosis of purulent arthritis.

How Is Purulent Arthritis Treated?

The main aim of treating Purulent Arthritis is to eliminate the bacteria causing the infection, reducing the swelling and inflammation and reduction of pain, and preservation and restoration of the functionality of the limb. The treatment of Purulent Arthritis is two fold.

During the first stage of treatment of it, antibiotics are used for eliminating the offending bacteria causing the infection. If the infection gets too deep within the joint cavity then the antibiotic may be injected directly into the joint. Normally, this treatment begins after the results of the blood tests are known so that there is information as to the kind of bacteria and to what antibiotic is the bacterium sensitive to. Ampicillin and methicillin are the drugs of choice for the treatment of Purulent Arthritis. Additionally for pain control, pain medications in the form of NSAIDs may be given, and if unsuccessful, steroid therapy may be tried to get the pain under control and also calm down the inflammation.

Once the pain and inflammation comes down and the infection is under control, the second stage of treatment of Purulent Arthritis begins. In this stage, the exudate that gets accumulated in the joint cavity is removed from the body.

Once the infection starts to clear up, the patient is referred to physical therapy to begin exercises to regain strength and mobility of the affected extremity. Some of the exercises that are done are massage, electrophoresis and phonophoresis, mobility exercises to improve range of motion once the individual is treated for Purulent Arthritis.

If there is no improvement after the above measures, then surgery may be required as a last resort. The preferred surgery for treating Purulent Arthritis is arthrotomy, in which all the pus which has been accumulated in the joint is removed, the cavity is cleaned with antiseptics, and antibiotics are injected so that the infection is completely cleared and the individual is considered to be completely treated from Purulent Arthritis.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:January 22, 2018

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