Acute Arthritis

• Reactive arthritis is sometimes a problem in tourists, because of the frequency of intestinal infections (Campylobacter, Yersinia, Salmonella, Shigella). The lesions appear several days to weeks after an acute infection. Presence of HLA-B27 increases the risk of post-infectious arthritis 50-fold. Reactive arthritis can also occur in inflammatory intestinal diseases and in genital Chlamydia trachomatis infections. The ankles and knees are more often affected than other joints.

• Rat bite fever (Haverhill fever) is accompanied by skin rash, fever and a migratory artritis. The patient might not spontaneously tell the doctor that a bite from a rodent (rat or other) occurred. When transmissions occurs via contaminated milk, there will be no skin ulcer.

• Filariosis. Arthritis secondary to infection with Wuchereria bancrofti usually affects the knee or an ankle joint. Inflammation of the joint can be secondary to rupture of dilated lymph vessels. Microfilariae can be detected in the blood. Mansonella perstans filariosis occasionally causes articular problems.

• Dracunculiasis (Guinea worm) can be accompanied by severe inflammation of joints, with eosinophilia. Detection of the adult worm in a concomitant skin ulcer orientates the diagnosis. There are no microfilariae in the blood or tissues.

• Coccidiomycosis can be accompanied by severe joint pain (desert rheumatism). Culture of the fungus is usually necessary for the diagnosis.

• Acute bacterial infection of a joint is occasionally seen. Septic arthritis can result in permanent damage to the joints. Staphylococcus aureus is notorious for this. Infection with Neisseria meningitidis or Neisseria gonorrhoeae can be accompanied by acute septic arthritis or by development of an immue complex arthritis that may exhibit a migratory character.

• Viral. Many acute articular inflammations are secondary to a viral infection (rubella, rubeola, mumps, hepatitis B, Chikungunya, parvovirus B19 [erythema infectiosum], lymphocytic choriomeningitis virus). The arthritis is usually self-limiting. Ross River Virus is an arbovirosis confined to Australia. Chronic arthralgia may follow acute infection. Similar symptoms can follow infection with Barmah Forest virus. There are a number of other (rare) arboviruses which cause arthralgia (see chapter arboviruses).

• In the trauma group, it is important to check if their might be any foreign body, such as a broken off sea urchin spine near a joint.

Category: Medicine Notes