Arthritis of the TMJ (temporomandibular joint): causes, symptoms and treatment

Every 3rd patient who comes to a rheumatologist with a complaint of joint inflammation, according to statistics, suffers from infectious arthritis. This disease requires immediate consultation with a doctor, because it can completely and irreversibly destroy a joint in a couple of days, and every 12th of those who are unlucky enough to get the disease die every year from its complications. But if you go to the hospital in a timely manner, 70% of patients get off with a “mild fright” - modern medicine allows you to save joints from deformation in most cases.

Let's look at the symptoms and treatment of infectious arthritis.

Definition

Purulent arthritis is a serious disease that is an inflammation of all joint structures. The peculiarity of this type of arthritis is that the joint is a closed cavity. This anatomical structure of the joint creates “favorable” conditions for the accumulation of purulent contents. The joint cavity is equipped with lymphatic and blood vessels, which can lead to the spread of infection throughout the body.

This form of arthritis requires timely diagnosis and treatment, since the purulent process affects all components of the joint.

The danger of purulent arthritis lies in its consequences. A negligent attitude towards one's health can lead to the development of sepsis, ankylosis (complete immobility of the joint), arthrosis, and joint deformation. To avoid serious complications, you should listen carefully to your body.

Purulent arthritis - inflammation of all joint structures caused by pyogenic microflora

General description of the disease

Bacterial or purulent arthritis is an inflammation of the joint caused by pyogenic bacteria. The disease begins acutely and progresses quickly, threatening the patient's life, and therefore requires emergency care.

Purulent (pyogenic) arthritis is a widespread phenomenon, the incidence ranges from 2 to 10 cases per 100 thousand population. According to statistics, from a quarter to a half of patients after such a purulent inflammatory process become disabled. About 5% of patients cannot be saved.

ICD 10 code(s) for pyogenic arthritis M00-M99. When an infectious pathogen of a certain type is identified, the ICD code is specified:

staphylococcal - M00.0;
pneumococcal - M00.1;
caused by other specified bacterial pathogens - M00.8;
unspecified purulent arthritis has an ICD 10 code - M00.9.

Purulent arthritis - main symptoms

The clinical picture of purulent arthritis may vary depending on the form of the disease itself. The acute form begins suddenly, with a sharp deterioration in the patient’s condition.

Added to the symptoms:

high body temperature;
fast fatiguability;
nausea;
vomit;
swelling of the joint;
muscle weakness;
redness of the affected area.

Sometimes there is cyanosis or yellowness of the skin, profuse sweating and headache. When palpating the affected area, the patient experiences sharp pain, and an accumulation of fluid is felt at the site of inflammation. In especially severe cases, the patient experiences tachycardia, fever and intoxication syndrome. If appropriate measures are not taken, the patient may lose consciousness.

Depending on the nature of the ongoing pathological process (serous, purulent or putrefactive), characteristic changes may be observed in the joint.

The disease manifests itself with swelling, sharp pain

The chronic form is more difficult to recognize. Clinical symptoms are less pronounced. Inflammation in the joint makes itself felt in attacks. In the acute stage, the patient experiences nagging pain, mainly at night. Symptoms may include joint stiffness, swelling and redness. With purulent advanced arthritis of the knee or hip joint, joint closure may occur. With timely initiation of therapy, remission occurs. If ankle arthritis is left untreated, you may lose the ability to walk.

If you experience one or more signs of arthritis, you should consult your doctor immediately. Based on the existing symptoms and the results of clinical tests, the doctor decides to prescribe medical or surgical treatment.

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Arthritis of the joint is a disease that causes severe pain, limits mobility and deprives a person of the ability to lead a normal lifestyle. The pathology should not be neglected, since in its chronic form it is more difficult to treat. If you notice swelling, redness or the slightest discomfort, make an appointment with a traumatologist or rheumatologist at the Central Epidemiology Hospital of the Russian Academy of Sciences. If you have already been diagnosed with chronic arthritis of the wrist joint, we will help you get rid of the disease by developing an individual comprehensive program. Call or use the online form to schedule an appointment with a doctor at a time convenient for you.

Causes of development and types of purulent arthritis

The causative agents of purulent arthritis are pathogenic microorganisms. They enter the soft tissues of the joint and begin to actively multiply. Against this background, an inflammatory process occurs. The infection quickly spreads to nearby organs.

In 80% of cases, the causative agent of purulent arthritis is different types of cocci, the remaining 20% are caused by:

E. coli;
Proteus;
salmonella;
Pseudomonas aeruginosa.

Typically, the causative agents of purulent arthritis are streptococci or staphylococci.
The infection enters the body in two ways:

For wounds, operations, injuries, punctures.
Through the blood (with lymphadenitis, osteomyelitis, etc.)

The inflammatory process can develop against the background of infectious diseases (gonorrhea, influenza, pneumonia). Inflammation can begin in any joint. But large joints are more often affected, so arthritis of the hip, knee and elbow joints is not uncommon in medicine. In newborns, purulent inflammation is diagnosed in isolated cases. Young children may become victims as they learn to walk.

The risk group also includes:

athletes;
people suffering from obesity;
people with hereditary diseases;
people with various metabolic disorders;
elderly people.

In medical practice, purulent arthritis is classified according to:

Volume of damage:

bone tissue is not subject to destruction;
ligaments, joints and cartilage are deformed.

Primary ones occur when the pathogen penetrates directly into the joint cavity and can develop with penetrating wounds

Location:

ankle (bone and soft tissues are vulnerable. Inflammation develops quickly and leads to deformation of the foot);
elbow (suppuration of the joints is similar to the development of phlegmon of the joint capsule);
hip (cartilage is damaged first, but without treatment, pathological processes affect the bones. Without treatment, arthritis leads to disability);
knee (develops as a result of fractures, injuries and wounds);
shoulder (inflammation leads to decomposition of cartilage and the formation of abscesses).

Primary

Primary purulent arthritis is a lesion of the joints. Infection is caused by a direct route, that is, pathogens enter the joint cavity through the skin, for example, due to a gunshot wound or severe injury. You can also catch an infection during diagnostic procedures or surgery if the rules of asepsis are not followed.

The disease develops quickly. Pus accumulates in the joint cavity. The inflammatory process manifests itself in the form of skin redness and soreness. If measures are not taken in a timely manner, the capsule, articular ends of the bones and all elements of the joint are involved in the purulent process.

Secondary

Secondary purulent arthritis is diagnosed more often. In this case, the infection enters the joint along with blood or lymph. The source may be internal organs. Purulent damage to the joint can develop against the background of existing infectious diseases (gonorrhea, influenza, erysipelas, sepsis, etc.)

Secondary arthritis develops as a result of infection through surrounding tissue, blood or lymph

Recommendations for infectious arthritis

To maintain the effectiveness of therapy, as well as achieve the most favorable results, it is important to follow a number of recommendations for infectious arthritis, including:

Movement is an integral part of therapy.
Maximum limitation of sudden movements and forces that create additional stress on the affected joints.
Improving power sensations.
Simplifying everyday processes through the use of modern technological solutions.
Increasing personal safety by installing additional handrails in the apartment, using anti-slip mats, etc.

Tests and diagnostic difficulties

Various diagnostic methods are used to make a diagnosis:

Anamnesis collection.
Visual inspection.
Laboratory tests (general blood and urine analysis).
Puncture with removal of synovial fluid.
X-ray.
Ultrasound
MRI.

When collecting anamnesis, the doctor will find out what previous diseases were suffered, whether the patient has allergies and whether he has had surgical operations. An external examination reveals joint mobility, pain and redness. In the blood results, if there is purulent arthritis in the body, the doctor will find an increased ESR, a high concentration of leukocytes and C-reactive protein.

When examining synovial fluid, the doctor examines the level of leukocytes with segmented neutrophils. If their indicator is about 50 thousand per 1 ml, then the diagnosis of “purulent arthritis” is confirmed. X-rays can reveal swelling of soft tissues, narrowing of joint gaps, and erosive destruction. Using ultrasound, the doctor examines the synovium.

To confirm the diagnosis, you may need to consult a rheumatologist, infectious disease specialist, gastroenterologist, pulmonologist and therapist.

The diagnosis is made on the basis of a characteristic history, clinical manifestations, and blood tests confirming the presence of acute inflammation

How dangerous is the disease?

The course of the pyogenic inflammatory process in the joints depends on the virulence (ability to cause harm to the patient’s body) of the infectious agent, the state of the patient’s immunity, and the presence of chronic diseases. Without treatment, the disease progresses in any case, moving from stage to stage with joint destruction and severe complications.

Stages

Stages of pyogenic arthritis according to the Research Institute named after. Vishnevsky:

Early
– pus accumulates in the joint cavity without destroying its tissues (on x-rays, an expansion of the joint space appears due to the accumulation of purulent exudate):
1b
– purulent inflammation around the joint.
Explicit
– intra-articular tissues (synovium, cartilage, ligaments) are destroyed (on x-ray - destruction of the articular surfaces of bones):
2b
– suppuration spreads to surrounding tissues.
Progressive
– cartilage and subchondral bone are destroyed (on x-ray – focal bone destruction, narrowing of the joint space), joint mobility is impaired:
3b
– ulcers around the joint;
3c
– fistulas (pus breakthrough) on the surface of the skin.
Ultimate
:
If treatment is carried out in a timely manner
, a complete recovery is possible.

Possible complications

Any form of arthritis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

If left untreated, suppurative processes lead to severe complications:

complete destruction and immobility of the joint;
spread of suppuration to the skin, subcutaneous tissue, ligaments and tendons with the formation of fistulas, abscesses and phlegmons that are difficult to treat;
osteomyelitis – purulent inflammation of the bone;
compression of nerves by swollen tissues, accompanied by severe pain; for example, ankle arthritis may be complicated by tarsal syndrome due to compression of the tibial nerve;
sepsis – multiple pyogenic lesions of organs and systems.

Pyogenic arthritis is a disease that cannot be cured with home remedies. The sooner the patient sees a doctor, the greater his chances of recovery.

What to do if you suspect purulent arthritis

Algorithm of actions:

call a doctor at home; if you have a high temperature, call an ambulance;
take any medicine with anti-inflammatory and antipyretic effects: Analgin, Pentalgin, Paracetamol, Diclofenac; Apply an external agent with similar properties to the affected joint: Diclofenac ointment, Menovazin solution;
lie down and take a position that minimizes pain.

Do not refuse hospitalization under any circumstances!

Treatment

Treatment of purulent arthritis is carried out taking into account the localization of the purulent lesion. To avoid serious complications, treatment should be carried out only in medical institutions. Taking medications without permission can only make the situation worse. Therapy is aimed at restoring the limb, relieving pain and restoring mobility to the joint.

The following methods are used in the treatment process:

rest of the injured limb;
drug treatment;
surgical intervention;
physiotherapy;
physiotherapy.

The treatment regimen depends on the stage and form of the disease. If medical recommendations are followed, the prognosis for the patient is favorable. Without treatment, acute purulent inflammation leads to sepsis and death.

First stage

Before prescribing medications to a patient, doctors perform an antibiogram. It helps to understand which drugs are combined with each other and what analogs they can be replaced with, since pathogenic microorganisms can develop resistance to the active ingredients of the drug.

Antibiotic therapy is prescribed

At this stage, the patient is prescribed antibiotics in the form of intravenous or intramuscular injections. In severe cases, the antibiotic is injected directly into the joint cavity. Semi-synthetic penicillin antibiotics have performed well in the fight against infection.

The following are considered effective:

"Oxacillin."
"Ceftriaxone".
"Clindamycin."
Vancomycin.

To reduce pain, corticosteroid hormones are used to help reduce the source of inflammation. They eliminate the symptoms, but do not eradicate the cause of the disease. The complex also uses non-steroidal anti-inflammatory drugs (Ketorolac, Ketoprofen).

Second phase

At this stage, doctors perform a puncture to remove accumulated pus in the joint cavity. If no significant improvements are observed after the procedure, the puncture is repeated. It will take time for the patient to recover the damaged joint.

During the rehabilitation period, physiotherapy is carried out; it has a beneficial effect on the joint. For purulent arthritis the following is prescribed:

After the acute stage has passed, it is necessary to begin physical procedures

UHF;
manual therapy;
electrophoresis;
magnetic therapy;
massage;
medicinal baths.

Physiotherapy relieves pain and improves joint mobility. The set of procedures is selected by the attending physician based on the severity of the disease. Physiotherapy can be used in combination with folk remedies. Only a doctor can select the most effective recipes. Self-medication in this case is not acceptable.

A decoction based on celandine has proven itself well. Pour 1 tsp. celandine 200 ml of boiling water. Drink 1/3 cup of the decoction three times a day. The course of treatment is 1-1.5 months.

As an external remedy, you can use an ointment made from bee honey (100 g), salt (10 g), radish juice (150 g) and vodka (100 g). Mix all ingredients until smooth. Apply the product to the affected area morning and evening.

Features of nutrition during treatment and prevention of infectious arthritis

Therapeutic nutrition for arthritis of various types is aimed primarily at normalizing the immune response, as well as weakening inflammatory processes, in order to restore the range of motion of the affected joint.

Nutritional features depend on:

stages of disease development;
presence of concomitant diseases;
severity of clinical manifestations.

Based on this, we can come to the conclusion that there is no single diet. However, there are a number of general principles for creating a diet, including:

fractional meals;
preference for certain types of culinary food processing (boiling/baking/steaming/stewing);
food intake temperature – no more than 60°C;
limiting salt and liquid intake;
giving up bad habits;
saturating the diet with vitamins.

Surgery

If conservative therapy does not bring results, then doctors are forced to resort to a radical method of treatment. In this case, purulent arthritis is treated surgically.

For extensive purulent wounds and open fractures, secondary surgical treatment is performed

In medical practice, there are several types of operations:

Arthrotomy. During surgery, the doctor opens the joint and drains it. Pus is pumped out of the joint cavity along with dead tissue. The cavity is washed with an antiseptic. To avoid infection, the patient is prescribed antibiotic therapy.
Resection. Damaged ends of bones and cartilage are excised. The surgeon places tissue between them to prevent fusion. These manipulations help stop the inflammatory process and maintain limb mobility. Upon completion of the operation, the patient is given a plaster cast.
Installation of an articulating cement spacer. This operation is performed when large joints are affected. An articulating cement spacer is a special form that is temporarily installed in the bone tissue.

If the disease progresses rapidly, then a solution to remove the affected joint is used to save the patient's life. In rare cases, doctors are forced to amputate a limb.

Infectious arthritis - what is it?

Infectious arthritis is characterized by an inflammatory process occurring inside the joint. This may be caused by bacteria, viruses, parasites or fungi.

This type of arthritis can affect absolutely any joint.

. A characteristic feature of the disease is that in addition to local manifestations (swelling, pain and joint immobility), there are also general symptoms (fever, chills, signs of intoxication).

Infectious arthritis refers to a group of diseases caused by various types of infectious agents that penetrate specifically into the structure of the tissues that form the joint.

According to existing statistics in the field of rheumatology and traumatology, arthritis of this type is diagnosed in every third patient.

The most common site of infectious arthritis is the joints of the upper and lower extremities

Prevention

It is easier to prevent a disease than to treat it. By following simple preventive measures, you can avoid many diseases, including purulent arthritis.

To do this you need:

protect joints from injuries, bruises, fractures;
for open wounds, carry out primary treatment correctly;
promptly treat inflammatory and infectious diseases;
to live an active lifestyle;
follow a diet;
avoid hypothermia;
strengthen immunity;
be examined by a doctor annually.

Particularly useful preventive measures for persons at risk. Purulent arthritis is not a death sentence. Timely treatment will help avoid negative consequences and maintain health.

Possible localizations

Pyogenic arthritis most often develops in one joint. But people suffering from rheumatoid arthritis may develop purulent polyarthritis.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

Inflammation of the joints of the lower extremities

In large joints of the legs, suppuration is most often the result of open injuries. Sometimes small ones are also affected, especially if the patient already has chronic arthritis.

Purulent arthritis of the hip joint

The hip joint is often involved in the process, but the course is smoothed, without pronounced symptoms of inflammation. This localization is especially dangerous for elderly people with osteoporosis (fragile bones), as it is complicated by long-term non-healing femoral neck fractures. Suppurative arthritis of the hip joint is common in children and is often diagnosed based on x-ray findings, but usually results in complete recovery.

Suppurative arthritis of the knee joint

This is a very common location, since the knee bears the highest load and is often injured. The general condition suffers, redness and swelling of the knee are visible to the eye, and there is severe pain. If it develops against the background of pre-existing chronic arthritis, several joints may be affected at once;

Suppurative arthritis of the ankle joint

The ankle is also often affected after injuries - bruises, bites, etc. Suppuration can spread to the foot, affecting the tendons and ligaments (enthesitis). This complication is associated with severe heel pain. Swelling of the ankle can also lead to the development of tarsal tunnel syndrome, a narrow space behind the inner malleolus where the tibial nerve passes through. Tarsal syndrome is manifested by pain along the foot, flat feet and atrophy of the foot muscles.

Purulent arthritis of the foot

When the small joints of the foot are inflamed, suppuration often joins existing skin (fungal, bacterial) or joint (rheumatoid, gouty arthritis) lesions. It proceeds smoothly, so it is sometimes detected at later stages.

Inflammation of the joints of the upper extremities

Both large and small joints can be affected.

Purulent arthritis of the shoulder joint

The disease often develops after injury or against the background of an existing inflammatory process. It lasts a long time, especially when the glenohumeral joint is affected. The main symptom is severe aching pain. If not treated in time, the pain will bother you for the rest of your life.

Purulent arthritis of the shoulder complicated by osteomyelitis

Suppurative arthritis of the elbow joint

Inflammation of the elbow joint often develops against the background of chronic injury (tennis players) or with psoriatic arthritis.

Purulent arthritis of the hand

The small joints of the hand become suppurated mainly due to rheumatoid arthritis. Against the background of anti-inflammatory treatment, it goes unnoticed, so it is important to pay attention to the slightest changes in your health and consult a doctor in a timely manner.

Purulent arthritis of fingers

This type of arthritis develops against the background of household injuries (cuts, wounds), as well as with psoriatic and gouty arthritis.

Cervical purulent arthritis

Pyogenic arthritis of the cervical spine is rare. This is a very dangerous disease, since pus can enter the brain, swollen periarticular tissues can compress the blood vessels and nerve roots that supply the brain. Therefore, such patients require emergency hospitalization.

General clinical recommendations

People with arthritis should:

to refuse from bad habits;
lead a healthy lifestyle, regularly take walks in the fresh air, toughen up;
do therapeutic exercises, swimming;
exclude heavy physical activity, injuries, stress;
eat right, watch your weight;
promptly treat all acute and chronic diseases;
continue to be observed by your doctor, undergo prescribed examinations and, if necessary, anti-relapse treatment.

These recommendations are also relevant for people suffering from chronic arthritis, especially rheumatoid arthritis.

Prevention

To prevent the development of purulent arthritis, it is worth following all the recommendations for a healthy lifestyle, hardening and doing sports as much as possible.

Approach to treating the disease in our clinic

In medical (Moscow) purulent arthritis is treated with special attention. Severe patients with high fever and pain are admitted without waiting lists and, if a purulent inflammatory process is suspected, they are sent to a surgical hospital. The patient is recommended to visit the clinic again after the inflammation has been eliminated to carry out rehabilitation measures.

Comprehensive rehabilitation includes:

modern methods of joint restoration developed in leading clinics around the world;
Traditional oriental methods - ancient Chinese and Tibetan doctors have used them for centuries to restore the health of the body as a whole.

After a course of rehabilitation in our center, most patients experience a complete recovery. And patients with chronic arthritis of various origins forget about joint pain for a long time and lead a healthy lifestyle. Medical specialists in Moscow are waiting for you!

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