Gonorrheal arthritis
Gonorrheal arthritis is a specific inflammatory lesion of the joints that develops with a disseminated form of gonorrhea. Gonorrheal arthritis is accompanied by chills and fever; edema, hyperemia and rashes in the affected joints, limited movement, arthralgia. The diagnosis of gonorrheal arthritis is based on anamnesis, joint radiography, serological and microbiological studies. In the acute period of gonorrhea arthritis, rest and immobilization of the joint, antibiotic therapy, NSAIDs, analgesics, glucocorticosteroids are prescribed; in the recovery period – massage, physiotherapy, physical therapy.
General information
Gonorrheal arthritis is bacterial arthritis that occurs as a complication of acute or chronic gonococcal infection of the genitourinary tract. In rheumatology, gonorrheal arthritis belongs to a group of specific infectious arthritis. Gonorrheal arthritis develops in 2-3% of patients with gonorrhea and usually occurs in sexually active young people (15-40 years old). Articular syndrome affects women more often, it can occur in young girls. In women, the severe course of gonorrheal arthritis is often caused by asymptomatic forms of primary urogenital infection and its late diagnosis. In men, due to the rapid cure of urethritis, gonorrheal arthritis is rare.
The course of gonorrheal arthritis can be acute and chronic. According to the pathogenesis, the infectious-metastatic form prevails, the toxic-allergic form of the disease is less common, their combination is possible. In most cases (85%) gonorrheal arthritis is oligoarthritis, sometimes monoarthritis; in this case, knee, ankle, elbow joints, small joints of the hands and feet can be affected. In the metastatic form of gonorrheal arthritis, one joint is usually affected, in the case of toxic-allergic – several. By the nature of the inflammatory process, serous synovitis is distinguished without the interest of periarticular tissues; serous-fibrinous synovitis, purulent synovitis with periarticular edema; phlegmonous arthritis with predominant inflammation of periarticular tissues. As a rule, the inflammatory process extends both to the tendon-ligamentous apparatus and to the joint bags.
Causes of gonorrheal arthritis
Gonorrheal arthritis is a manifestation of a disseminated form of genitourinary infection – gonorrhea. The causative agent of gonorrheal arthritis is a gram-negative diplococcus (gonococcus) – Neisseria gonorrhoeae. The path of infection with gonorrhea in adults is sexual; in children, it is contact–household, vertical (intranatal, very rarely – transplacental). The entrance gates of gonorrhea infection in children are the mucous membranes of the urogenital tract and conjunctiva.
From the primary (usually urogenital) focus, gonococci can enter the blood and, spreading hematogenically to other organs, cause generalization of infection. This can occur at any period of the gonorrheal process and lead to damage to the joints (gonorrheal arthritis), meningitis (gonorrheal meningitis), eyes (gonorrheal blepharitis). The provoking factors for the development of gonorrheal arthritis in women are menstruation and pregnancy.
Symptoms of gonorrheal arthritis
Gonorrheal arthritis usually develops during the first month of acute gonococcal infection or after several months / years, with the exacerbation of chronic latent forms of gonorrhea. True gonorrheal arthritis is manifested by symptoms of a septic articular process with a pronounced acute onset. It is characterized by chills, hectic fever, the development of severe edema and hyperemia in the area of one or 2-3 joints, rather intense, sharp arthralgias. Sexual differentiation is characteristic of joint damage: in women, inflammation more often covers the elbow and wrist joints, in men – the knee, ankle and metatarsophalangeal joints.
There are pain points in the places of attachment of joint bags and tendons to the bones. Intense soreness with active and somewhat less – with passive movements of the joints is associated with damage to the tendon-ligamentous apparatus. With gonorrheal arthritis, atrophy of the muscles around the joints, osteoporosis develops rapidly. Movements in the affected joints become limited, their configuration changes; due to the proliferation of fibrous tissue, stiffness develops. In half of cases of gonorrheal arthritis, papular (nodules), pustular (pustules) and bullous (blisters) rashes form on the skin near the affected joints, as well as on the back and distal parts of the extremities.
Most cases of gonorrheal arthritis are characterized by the formation of a “flat gonorrheal foot”, which is a combination of achillobursitis, subcutaneous bursitis, “heel spurs” and secondary flat feet. Gonorrheal arthritis has a long course (up to several months and years) with periodic remissions and exacerbations. The chronic form of gonorrheal arthritis in its clinical picture resembles rheumatoid arthritis or Bekhterev’s disease.
Gonorrheal arthritis in newborns occurs as a manifestation of gonococcal sepsis, has a particularly severe course with multiple joint lesions and an intense inflammatory process. Complications of gonorrheal arthritis can be ankylosis and contractures, destruction of joints, melting of cartilage, erosion of the articular ends of bones, osteomyelitis, phlegmon.
Diagnosis of gonorrheal arthritis
Diagnosis of gonorrheal arthritis is carried out on the basis of anamnesis data, the results of laboratory and instrumental studies with the participation of rheumatologists and dermatovenerologists. Gonorrheal arthritis must be differentiated from other infectious arthritis, arthritis with collagenoses.
A general blood test for gonorrheal arthritis shows an increase in the number of leukocytes, ESR, characteristic of the inflammatory process; a biochemical blood test shows an increase in the level of sialic acids, fibrin. The main evidence of the gonorrheic nature of arthritis is the detection of gonococcus by smear microscopy, PCR and bacteriological examination of synovial fluid, blood, secretions from the genitourinary organs (urethra, cervix), rectum, pharynx, eyes.
The Borde-Zhangu serological reaction is an auxiliary diagnostic study for unclear forms of articular pathology, for example, in women with chronic inflammation of the genitourinary organs. Radiography of joints in the early stages of gonorrheal arthritis reveals pronounced epiphyseal osteoporosis; in the chronic stage – obvious signs of destruction of cartilage and bone matter, narrowing of the articular gap, joint deformation.
Treatment of gonorrheal arthritis
Gonorrheal arthritis therapy is carried out in a hospital; it is aimed at eliminating the infectious and inflammatory process in the genitourinary organs and joints. In the acute period of gonorrheal arthritis, rest is indicated, giving the affected limb the most comfortable position with the help of rollers and pillows, immobilization of joints, local dry heat. To eliminate the pathogen, antibiotic therapy is prescribed, which mainly includes penicillin preparations, cephalosporins, and sometimes macrolides.
With severe pain syndrome, NSAIDs, analgesics are recommended, transcranial electroanalgesia is possible. With the development of a concomitant allergic reaction, glucocorticosteroids are used. With a pronounced exudative process, a puncture of the joint is performed with aspiration of the contents and the introduction of antibiotics into its cavity. If decompression is necessary, especially due to the risk of dislocation in the hip joint, arthrotomy and drainage of the joint are performed.
As acute phenomena subside, physiotherapy (UHF therapy, electrophoresis, DMV therapy, paraffin treatment, phototherapy, diathermy), physical therapy, massage are shown. To consolidate the results of treatment of gonorrheal arthritis, balneotherapy is recommended: mud therapy, radon and hydrogen sulfide therapeutic baths. In order to prevent relapses of the disease, patients who have suffered from gonorrheal arthritis need repeated courses of therapy.
In most patients with gonorrheal arthritis, with timely treatment, the prognosis is favorable. Prevention of gonorrheal arthritis consists in preventing infection with gonorrhea, its early diagnosis and adequate therapy.
