Infectious Arthritis

 

What Is It?

Infectious arthritis is joint pain, soreness, stiffness and swelling caused by an infection by bacteria, viruses or fungi. These infections can affect a joint after spreading through the bloodstream from another part of the body, such as the lungs during pneumonia. An infection also can enter a joint through a nearby wound. Sometimes, tissue around the joint becomes infected after surgery, an injection or trauma, such as an insect bite. Once the infectious agent reaches the joint, it can cause symptoms of joint inflammation and, at times, fever and chills. Depending on the type of infection, one or more joints may be affected.

The most common joint affected by infection is the knee. Small joints, such as those in fingers and toes, are more likely to become infected after a viral infection or direct injury, such as a bite. Among intravenous drug users, joints such as those in the spine or sternum (breastbone) may be involved. People who already have rheumatoid arthritis or other joint disease are more likely to develop infectious arthritis.

Certain infectious agents can cause a form of infectious arthritis called reactive arthritis or Reiter’s disease, which appears to be caused by the immune system reacting to bacteria, rather than by a direct infection of the joint. In this condition, arthritis develops weeks, months or even years after the infection. By the time the arthritis develops, the infection is gone. Infections of the genital and gastrointestinal tracts are the most common triggers of reactive arthritis.

Symptoms

Symptoms of infectious arthritis include:

  • Joint pain and stiffness, typically in the knee, shoulder, ankle, finger, wrist or hip
  • Warmth and redness in surrounding tissue
  • Fever and shaking chills
  • Skin rash

Other symptoms vary, depending on the cause. Some of the more common causes of infectious arthritis include:

Lyme disease
Lyme disease is caused by bacteria that live in deer ticks and are transmitted through a tick bite into a person’s bloodstream. Arthritis can develop in the later stages of Lyme disease.

After an infected tick bites a person, a large, round, red rash (called erythema migrans) usually develops around the bite, often with an area of skin in the center that appears normal. Flulike symptoms sometimes develop, including fever, headaches, chills, body aches, stiffness, nausea, fatigue and sore throat. The symptoms of Lyme disease often mimic those of other diseases, and considerable time can pass between the appearance of the rash and the next wave of symptoms.

Because the tick bite often goes unnoticed and the rash may be overlooked, Lyme disease is not always diagnosed immediately. When the infection is not treated, further symptoms may develop, including joint inflammation (most commonly in the knee), neurologic symptoms (confusion, convulsions, muscle weakness), and an abnormally slow heart rate that may lead to fainting. Antibiotic treatment usually cures the illness.

Gonorrhea
Gonorrhea is a sexually transmitted bacterial infection that can cause pain in one or more joints and/or tendons and sometimes a rash and fever. About a third of people with gonorrhea report joint pain.

Staphylococcus infection
Staphylococcus bacteria are common bacteria that can cause infections through cuts or other breaks in the skin, or through contaminated food. The bacteria can be released in the bloodstream and spread to the knee or other joints, causing intense and sudden pain, swelling and immobility of the joint. This is a serious condition because joint damage can develop in a matter of days if the infection is not detected and treated promptly.

Tuberculosis
Tuberculosis is an infection caused by the Mycobacterium tuberculosis bacterium. It usually affects the lungs, but it can affect other parts of the body, including the gastrointestinal tract, the nerves, lymph system and skin, as well as bones and joints. Arthritis caused by tuberculosis usually affects either the spine or large joints, such as the hips or knees. The joint inflammation caused by tuberculosis tends to be less dramatic than inflammation caused by some other bacterial infections, and it develops slowly.

Viruses
Arthritis can arise from infection from many viruses, including those that cause colds, upper respiratory infections, HIV, hepatitis, parvovirus, rubella and mumps. Many joints can be affected at the same time, and the symptoms of viral infectious arthritis can mimic those of rheumatoid arthritis. However, viral arthritis symptoms usually disappear within days or weeks if the disease causing the problem is eliminated. HIV and some forms of viral hepatitis may cause chronic (long-lasting) infection and longer-lasting joint symptoms.

Diagnosis

If your doctor suspects that your joint symptoms are related to a bacterial infection, he or she probably will draw fluid from the affected joint with a needle after numbing the area, and will have it analyzed in a lab. Blood and urine tests also may be done. If your doctor thinks a sexually transmitted disease may be causing the problem, he or she will perform a pelvic examination if you are a woman, and a swab of the penis and urine test if you are a man. The urine and swabbed material are sent to be tested in a laboratory. Tests are not available to diagnose most viral diseases. However, the more chronic and/or serious viral diseases, such as parvovirus, hepatitis B, hepatitis C and HIV, can be diagnosed with blood tests that measure antibodies against these viruses.

Expected Duration

How long symptoms last depends on the cause, and how soon treatment is started. Symptoms can improve in as little as 24 hours after treatment is begun. However, they may continue for weeks or months when related to Lyme disease, many bacterial strains or tuberculosis. If infection damages joints, symptoms may be lifelong.

Prevention

The best way to prevent infectious arthritis varies depending on the type of infection:

  • Staphylococcal arthritis — If you have a staphylococcal infection, antibiotics can be used to prevent this type of arthritis. However, for many people, joint pain and swelling are the first signs of the infection.


  • Gonococcal arthritis — Practicing safe sex or abstinence can prevent gonorrhea, which will prevent this type of arthritis.


  • Lyme disease arthritis — The best way to prevent arthritis from a Lyme infection is to avoid Lyme disease. Wear long pants and long-sleeved shirts, use tick repellent, and avoid woods, brush and other areas where ticks are found.


  • Tuberculosis-related arthritis — A tuberculosis vaccine may help to prevent tuberculosis and any associated arthritis. However, vaccination for tuberculosis is not routine in many parts of the world, including the United States, and the vaccine is only moderately effective. If you have tuberculous, antibiotics may prevent joint infection and arthritis. If a skin test shows recent exposure to tuberculosis or if a chest X-ray suggests active tuberculosis, antibiotics may avoid the spread of infection, including infectious arthritis.


  • Viral arthritis — The best way to avoid arthritis caused by a viral infection is to avoid getting the infection. The best way to do this is to wash your hands after you have been around sick children or other people with a viral infection.

Treatment

Because many bacterial infections can permanently destroy cartilage around joints, a joint infection needs to be treated immediately with antibiotics.

Viral infections do not respond to antibiotics. However, antiviral therapies are available for some viral infections, such as HIV. Aspirin or ibuprofen (Advil, Motrin and other brand names) can be taken to alleviate pain and swelling during the time it takes for the infection to run its course. Viral infections usually do not cause joint damage.

For most bacterial infections, hospitalization will be recommended in order to drain the infected joint, to allow the joint to be rested, and to give antibiotics intravenously (into a vein).

In some cases, surgery may be performed to remove damaged tissue from the joint. Surgery is rarely necessary for arthritis associated with gonorrhea infection. If serious damage already has occurred, surgery may be needed to reconstruct the joint.

Reactive arthritis (or Reiter’s disease) may be treated with other medicines, but only after the infection has been cured. These medicines include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, methotrexate (Folex, Methotrexate LPF, Rheumatrex) and sulfasalazine (Azulfidine).

While the joint is recovering from the infection, it may need to be immobilized briefly. As soon as possible, however, exercise and physical therapy are recommended to restore strength and mobility.

When To Call A Professional

If you experience any of the symptoms listed above for more than a few days, contact your doctor.

Prognosis

If infectious arthritis is detected and treated promptly, joint damage is unlikely. However, joint damage is possible with many types of infections, especially when a bacterial infection is not detected promptly and treated.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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