Chronic Arthritis

• Caisson disease (the bends) due to rapid decompression after scuba diving can initially result in itching and a marbled or mottled appearance of the skin. These symptoms can precede more serious problems (abdominal pain, transverse myelitis, lung embolism due to nitrogen gas). Aseptic bone necrosis is a later complication.

• Infectious. Chronic arthritis due to tuberculosis is not unusual in the tropics. It is more likely to occur in the hip joint. Brucellosis with bone lesions can resemble tuberculosis. Buruli ulcer disease, leprosy and fungal infections can mutilate joints.

• Lyme disease caused by Borrelia burgdorgeri can follow tick-bite in individuals in Europe or America, but is apparently non-existent in the tropics.

• Whipple’s disease (infection with Tropheryma whipplei) is very rare. Insufficient data are available on its incidence in the tropics. In addition to polyarthritis, it is characterised by fever, chronic diarrhoea due to malabsorption, anaemia and various neurological signs.

• Charcot joints. In neuropathic joints there is a loss of pain perception and of proprioception. One has to exclude diabetes, leprosy and syphilis. Other causes are amyloidosis and syringomyelitis.

Category: Medicine Notes