Swollen and hot joints

The term "arthritis" means an inflammatory lesion of one or more joints. Signs of inflammation are pain, swelling, redness of the skin over the inflamed joint, its stiffness; The inflamed joint is hot to the touch (+ overall body temperature increase). When diagnosing a diagnosis, the following key questions need to be resolved.

• Is only one joint affected (ie, monoarthritis)?
• Otherwise, the patient is healthy or suffering from any other disease that causes arthritis (eg, ulcerative colitis), or are there risk factors for the occurrence of an infectious process (diabetes mellitus, kidney failure, immunosuppression, parenteral drug use)?
• Why is the joint swollen? What is in the joint cavity: blood, crystals, pus?

In such situations it is always necessary to make a diagnostic aspiration puncture of the joint cavity.

The presence of a rheumatoid factor in the blood divides all arthritis into seropositive (SP) and seronegative.

[1], [2], [3], [4]

Causes of swollen and hot joints

Monoarthritis

• Bacterial infection, eg tuberculosis, gonorrhea, septicemia
• Gout or pseudogout
• Reiter's disease
• Traumatic hemarthrosis
• Psoriasis
• Rheumatoid arthritis
• The proliferation of leukemic cells within the joint

Polyarthritis

• Many viruses - measles rubella, mumps, hepatitis A, the  Epstein-Barr virus
• Rheumatoid arthritis
• Syndrome Sherpin
• Acute rheumatism
• Systemic lupus erythematosus
• Nonspecific ulcerative colitis, Crohn's disease
• Manifestation of drug disease

[5], [6], [7]

Examination of the patient

• The liquid, aspirated from the joint cavity, is microscopized, seeded, prepared from it for Gram stains, examined for crystal content in compensated polarized light. The synovial fluid is colored with blood at pseudogout, after a joint injury, but with septic arthritis this happens rarely.
• It is necessary to make a roentgenogram of the affected joint. It is important to find out whether there are signs of trauma (fractures) or signs of rheumatoid arthritis. Calcification of cartilage indicates pseudogout. In some patients, the X-ray of the affected joint is normal.
• The clinical analysis of blood, ESR, blood uric acid, rheumatoid factor (RF), C-reactive protein (normally less than 20 mg / l) - all these parameters can be pathologically changed both in seropositive and in seronegative arthritis and, of course, are not a screening test for sepsis.

[8], [9], [10]

Healing measures

Until the data of the microbiological study of the synovial fluid are obtained, all persons with acute monoarthritis should be referred to a hospital, so in this case it is absolutely necessary to exclude the infectious passage of the disease or to prescribe an antibiotic adequate for a specific infection. 

Treatment is determined individually in each case. If septic arthritis is diagnosed, it is advisable to make the joint lavage (it is good in such cases to find a specialist, since if a hip is affected, surgical intervention may be necessary), the patient is prescribed flucloxacillin (he is active against staphylococci), until the microflora sensitivity is established antibiotics. The drug is administered 500 mg after 6 hours intravenously slowly. Patients aged 2 to 10 years are given 1/2 of this dose. In infants, the infectious onset is often Haemophilus. Treatment is continued for 6 weeks.