Medical Blog

Nongonococcal Infectious Arthritis

Introduction
Background

Nongonococcal infectious arthritis is an acute or subacute illness with potentially significant morbidity and mortality. Bacteria, mycobacteria, and fungi can cause the disease. Both healthy individuals and individuals with predisposing conditions can be infected. Nongonococcal infectious arthritis is typically a monoarticular disease, but, in approximately 10% of patients, it affects multiple joints. Without treatment, the condition results in joint destruction.
Pathophysiology
Read more…

Lyme Disease

Introduction
Background

Lyme disease is due to infection with the spirochete Borrelia burgdorferi and the body’s immune response to the infection. In Europe, the rash (then called erythema chronicum migrans [ECM]) was first described at the beginning of the 20th century. The neurologic manifestations and the association with Ixodes ticks (also known as deer ticks; see Image 1) were recognized by the mid 1930s and were known as tick-borne meningoencephalitis. In the United States, Lyme disease was not recognized until the early 1970s, when an outbreak of pediatric arthritis occurred in the region around Lyme, Connecticut. This was investigated by Allen Steere, MD, and others from Yale. The recognition that the patients in the United States had ECM led to the recognition that Lyme arthritis was one manifestation of the same tick-borne condition known in Europe. Read more…

Gonococcal Arthritis

Introduction
Background

Gonococcal arthritis is the most common acute septic arthritis in young adults. It is caused by the gram-negative diplococcus Neisseria gonorrhoeae. Although the pathogenesis of articular involvement is controversial, it is ultimately a consequence of disseminated gonococcal infection (DGI). Gonococcal arthritis manifests as either a bacteremic infection (arthritis-dermatitis syndrome) in 60% of cases or as a localized septic arthritis in the other 40%. Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. Patients with gonococcal arthritis who develop joint destruction (rare) usually require hospitalization for antibiotic therapy to avoid other potentially serious complications of DGI. Read more…

Gout

Introduction
Background

Gout is a common disorder of uric acid metabolism that can lead to deposition of monosodium urate (MSU) crystals in soft tissue, recurrent episodes of debilitating joint inflammation, and, if untreated, joint destruction and renal damage. Gout is definitively diagnosed based on the demonstration of urate crystals in aspirated synovial fluid.
Read more…

Calcium Pyrophosphate Deposition Disease

Introduction
Background

Calcium pyrophosphate deposition disease (CPDD) is a metabolic arthropathy resulting from the deposition of calcium pyrophosphate dihydrate (CPPD) in and around joints, especially in articular and fibrocartilage. Although CPDD often is asymptomatic, with only radiographic changes (ie, chondrocalcinosis), various clinical manifestations may occur, including acute (pseudogout) and chronic arthritis. Although almost any joint may be involved, the knees, wrists, and hips are most commonly affected. This condition is the most common cause of secondary metabolic osteoarthritis. Read more…