TOXIC SYNOVITIS Vs. SEPTIC ARTHRITIS
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Acute Osteomyelitis and Septic Arthritis in Children: a Systematic Review of Systematic Reviews
European Review for Medical and Pharmacological Sciences 2019; 23(2 Suppl.): 145-158 Acute osteomyelitis and septic arthritis in children: a systematic review of systematic reviews A. GIGANTE1, V. COPPA2, M. MARINELLI3, N. GIAMPAOLINI3, D. FALCIONI3, N. SPECCHIA3 1Orthopaedics and Traumatology, Polytechnic University of Marche, Ancona, Italy 2Clinical Orthopaedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Ancona, Italy 3Clinic of Adult and Paediatric Orthopaedics, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy Abstract. – OBJECTIVE: Septic arthritis and Osteomyelitis (OM) is an inflammation of osteomyelitis are rare in children, but they are bone, usually due to infection with bacteria or difficult to treat and are associated with a high other micro-organisms (e.g., fungi), that is asso- rate of sequelae. This paper addresses the main ciated with bone destruction. Septic arthritis (SA) clinical issues related to septic arthritis and os- teomyelitis by means of a systematic review of is an infection of the synovial space that involves systematic reviews. the synovial membrane, the joint space, and joint 2 MATERIALS AND METHODS: The major elec- structures . tronic databases were searched for systematic SA and OM are commonly divided into three reviews/meta-analyses septic arthritis and os- types based on aetiology: haematogenous, sec- teomyelitis. The papers that fulfilled the inclu- ondary to contiguous infection, and secondary sion/exclusion criteria were selected. to direct inoculation. The distinctive anatomical RESULTS: There were four systematic re- views on septic arthritis and four on osteomy- characteristics of younger children, especial- elitis. Independent assessment of their meth- ly the presence of vessels between metaphysis odological quality by two reviewers using and epiphysis and of intracapsular metaphyses, AMSTAR 2 indicated that its criteria were not involve that a bone infection may lead to SA sec- consistently followed. -
Arthritis in Dogs
ANIMAL HOSPITAL Arthritis in Dogs Arthritis is a complex condition involving inflammation of one or more joints. Arthritis is derived from the Greek word "arthro", meaning "joint", and "itis", meaning inflammation. There are many causes of arthritis in pets. In most cases, the arthritis is a progressive degenerative disease that worsens with age. What causes arthritis? Arthritis can be classified as primary arthritis such as rheumatoid arthritis or secondary arthritis which occurs as a result of joint instability. "The most common type of secondary arthritis is osteoarthritis..." Secondary arthritis is the most common form diagnosed in veterinary patients. The most common type of secondary arthritis is osteoarthritis (OA) which is also known as degenerative joint disease (DJD). Some common causes of secondary arthritis include obesity, hip dysplasia, cranial cruciate ligament rupture, and so forth. Other causes include joint infection, often as the result of bites (septic arthritis), or traumatic injury such as a car accident. Infective or septic arthritis can be caused by a variety of microorganisms, such as bacteria, viruses and fungi. Septic arthritis normally only affects a single joint and the condition results in swelling, fever, heat and pain in the joint. With septic arthritis, your pet is likely to stop eating and become depressed. Rheumatoid arthritis is an immune mediated, erosive, inflammatory condition. Cartilage and bone are eroded within affected joints and the condition can progress to complete joint fixation (ankylosis). It may affect single joints or multiple joints may be involved 6032 Northwest Highway Chicago, IL 60631 773 631 6727 www.abellanimalhosp.com ANIMAL HOSPITAL (polyarthritis). -
Septic Arthritis of the Sternoclavicular Joint
J Am Board Fam Med: first published as 10.3122/jabfm.2012.06.110196 on 7 November 2012. Downloaded from BRIEF REPORT Septic Arthritis of the Sternoclavicular Joint Jason Womack, MD Septic arthritis is a medical emergency that requires immediate action to prevent significant morbidity and mortality. The sternoclavicular joint may have a more insidious onset than septic arthritis at other sites. A high index of suspicion and judicious use of laboratory and radiologic evaluation can help so- lidify this diagnosis. The sternoclavicular joint is likely to become infected in the immunocompromised patient or the patient who uses intravenous drugs, but sternoclavicular joint arthritis in the former is uncommon. This case series describes the course of 2 immunocompetent patients who were treated conservatively for septic arthritis of the sternoclavicular joint. (J Am Board Fam Med 2012;25: 908–912.) Keywords: Case Reports, Septic Arthritis, Sternoclavicular Joint Case 1 of admission, he continued to complain of left cla- A 50-year-old man presented to his primary care vicular pain, and the course of prednisone failed to physician with a 1-week history of nausea, vomit- provide any pain relief. The patient denied any ing, and diarrhea. His medical history was signifi- current fevers or chills. He was afebrile, and exam- cant for 1 episode of pseudo-gout. He had no ination revealed a swollen and tender left sterno- chronic medical illnesses. He was noted to have a clavicular (SC) joint. The prostate was normal in heart rate of 60 beats per minute and a blood size and texture and was not tender during palpa- pressure of 94/58 mm Hg. -
Septic Arthritis Caused by Burkholderia Pseudomallei Anil Malhotra1 & Sujit K
G.J.B.A.H.S.,Vol.4(2):108-109 (April-June, 2015) ISSN: 2319 – 5584 Septic arthritis caused by Burkholderia pseudomallei Anil Malhotra1 & Sujit K. Bhattacharya*2 Kothari Medical Centre, 8/3, Alipore Road, Kolkata, India *Corresponding Author Abstract Introduction: Melioidosis is caused by Burkholderia pseudomallei. Septic arthritis is rare but well-recognized manifestation of this disease. Case presentation: We report a case of Melioidosis presenting with septic arthritis. The patient responded well to prolonged treatment with intravenous/oral antibiotic and recovered. Conclusion: It is important to keep in mind Melioidosis as a rare, but curable cause of septic arthritis. Key words: Melioidosis, Burkholderia pseudomallei, Septic arthritis, Diabetes, Pneumonia, Antibiotic Introduction: Melioidosis is an infection caused by Burkholderia pseudomallei1. The disease is known as a remarkable imitator due to the wide and variable clinical spectrum of its manifestations2-4. Septic arthritis5 is rare but well-recognized manifestation of this disease. Case Report: We report a case of Melioidosis in a 38 year old male presenting with septic arthritis of the right knee and leg for 3 weeks and fever for 4 weeks. This was preceded by injury to right thigh in June 2013 and pnemonitis in June 2014. Investigations: Physical examination showed swelling and tenderness of the right knee joint, right tibia and ankle. Left knee and other big joints were normal. It was also revealed the absence of anemia, cyanosis, clubbing, jaundice; fever (99 degree F), Pulse rate 118/min, and B.P. 130/70 mmHg. Complete blood count showed neutrophilic leukocytosis, raised ESR (100 mm/1st hour), normal blood sugar, urea, creatinine, lipid profile, liver function tests and negative HbsAg and HIV testing. -
Journal of Arthritis DOI: 10.4172/2167-7921.1000102 ISSN: 2167-7921
al of Arth rn ri u ti o s J García-Arias et al., J Arthritis 2012, 1:1 Journal of Arthritis DOI: 10.4172/2167-7921.1000102 ISSN: 2167-7921 Research Article Open Access Septic Arthritis and Tuberculosis Arthritis Miriam García-Arias, Silvia Pérez-Esteban and Santos Castañeda* Rheumatology Unit, La Princesa Universitary Hospital, Madrid, Spain Abstract Septic arthritis is an important medical emergency, with high morbidity and mortality. We review the changing epidemiology of infectious arthritis, which incidence seems to be increasing due to several factors. We discuss various different risk factors for development of septic arthritis and examine host factors, bacterial proteins and enzymes described to be essential for the pathogenesis of septic arthritis. Diagnosis of disease should be making by an experienced clinician and it is almost based on clinical symptoms, a detailed history, a careful examination and test results. Treatment of septic arthritis should include prompt removal of purulent synovial fluid and needle aspiration. There is little evidence on which to base the choice and duration of antibiotic therapy, but treatment should be based on the presence of risk factors and the likelihood of the organism involved, patient’s age and results of Gram’s stain. Furthermore, we revised joint and bone infections due to tuberculosis and atypical mycobacteria, with a special mention of tuberculosis associated with anti-TNFα and biologic agents. Keywords: Septic arthritis; Tuberculosis arthritis; Antibiotic therapy; Several factors have contributed to the increase in the incidence Anti-TNFα; Immunosuppression of septic arthritis in recent years, such as increased orthopedic- related infections, an aging population and an increase in the use of Joint and bone infections are uncommon, but are true rheumatologic immunosuppressive therapy [4]. -
Gout and Monoarthritis
Gout and Monoarthritis Acute monoarthritis has numerous causes, but most commonly is related to crystals (gout and pseudogout), trauma and infection. Early diagnosis is critical in order to identify and treat septic arthritis, which can lead to rapid joint destruction. Joint aspiration is the gold standard method of diagnosis. For many reasons, managing gout, both acutely and as a chronic disease, is challenging. Registrars need to develop a systematic approach to assessing monoarthritis, and be familiar with the management of gout and other crystal arthropathies. TEACHING AND • Aetiology of acute monoarthritis LEARNING AREAS • Risk factors for gout and septic arthritis • Clinical features and stages of gout • Investigation of monoarthritis (bloods, imaging, synovial fluid analysis) • Joint aspiration techniques • Interpretation of synovial fluid analysis • Management of hyperuricaemia and gout (acute and chronic), including indications and targets for urate-lowering therapy • Adverse effects of medications for gout, including Steven-Johnson syndrome • Indications and pathway for referral PRE- SESSION • Read the AAFP article - Diagnosing Acute Monoarthritis in Adults: A Practical Approach for the Family ACTIVITIES Physician TEACHING TIPS • Monoarthritis may be the first symptom of an inflammatory polyarthritis AND TRAPS • Consider gonococcal infection in younger patients with monoarthritis • Fever may be absent in patients with septic arthritis, and present in gout • Fleeting monoarthritis suggests gonococcal arthritis or rheumatic fever -
Differential Diagnosis of Juvenile Idiopathic Arthritis
pISSN: 2093-940X, eISSN: 2233-4718 Journal of Rheumatic Diseases Vol. 24, No. 3, June, 2017 https://doi.org/10.4078/jrd.2017.24.3.131 Review Article Differential Diagnosis of Juvenile Idiopathic Arthritis Young Dae Kim1, Alan V Job2, Woojin Cho2,3 1Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea, 2Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 3Department of Orthopaedic Surgery, Montefiore Medical Center, New York, USA Juvenile idiopathic arthritis (JIA) is a broad spectrum of disease defined by the presence of arthritis of unknown etiology, lasting more than six weeks duration, and occurring in children less than 16 years of age. JIA encompasses several disease categories, each with distinct clinical manifestations, laboratory findings, genetic backgrounds, and pathogenesis. JIA is classified into sev- en subtypes by the International League of Associations for Rheumatology: systemic, oligoarticular, polyarticular with and with- out rheumatoid factor, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Diagnosis of the precise sub- type is an important requirement for management and research. JIA is a common chronic rheumatic disease in children and is an important cause of acute and chronic disability. Arthritis or arthritis-like symptoms may be present in many other conditions. Therefore, it is important to consider differential diagnoses for JIA that include infections, other connective tissue diseases, and malignancies. Leukemia and septic arthritis are the most important diseases that can be mistaken for JIA. The aim of this review is to provide a summary of the subtypes and differential diagnoses of JIA. (J Rheum Dis 2017;24:131-137) Key Words. -
Evaluation of the Limping Child
Current Concept Review Evaluation of the Limping Child Jessica Burns, MD, MPH; Scott Mubarak, MD Rady Children’s Hospital, San Diego, CA Abstract: Prompt evaluation of a younger child (age <5) with gait disturbance or refusal to walk is necessary to distinguish orthopedic urgency (trauma or infection) from relatively benign processes and chronic problems such as arthritis. Physical examination should include evaluation of gait, supine and simulated prone hip examination (on the parent’s lap to keep the child comfortable), and the crawl test. There are six radiographic views of the lower extremities that can assist in the diagnosis. In conjunction with the detailed history, a thorough physical exam, and radiographs from the orthopedic provider can determine the need for laboratory tests and other imaging. Key Concepts: • Evaluation of the limping child begins with a thorough history. • Physical examination of the limping child can be optimized by utilizing the parent to hold the child while the examiner moves the extremities and checks the back. • Six screening radiographs can be obtained to assist in making the correct diagnosis. • Laboratory analysis and magnetic resonance imaging can be obtained if the diagnosis remains elusive. Introduction Evaluation of gait disturbance in the younger child is an symptoms. Utilizing the parent in the physical important skill for the pediatric orthopedic surgeon. examination can help elicit a more detailed examination Although the true incidence is unknown, it is estimated of the child. Focused radiographs can then be utilized to that there are 1.8 per thousand children that will present support a suspected diagnosis. From there, the need for to the pediatric emergency department with complaint of laboratory analysis and further advanced imaging can be gait disturbance. -
Joint Pains UHL Childrens Hospital Guideline
LRI Children’s Hospital Joint Pains in Children Staff relevant to: Children’s Medical and Nursing Staff working within UHL Children’s Hospital Team approval date: March 2019 Version: 2 Revision due: March 2022 Written by: Dr A Sridhar, Consultant Paediatrician/Paediatric Rheumatology Trust Ref: C89/2016 1. Introduction and Who Guideline applies to THIS IS AN AREA WHERE CLINICAL ASSESSMENT IS USUALLY MUCH MORE IMPORTANT THAN “ROUTINE INVESTIGATIONS” SINGLE PAINFUL JOINT The most important diagnosis to consider is SEPTIC ARTHRITIS Can occur: In Any Joint All Age Groups May be co-existing osteomyelitis (particularly in very young) Related documents: Management of the limping child UHL - C13/2016 Septic Arthritis UHL – B47/2017 Differential diagnosis: 1. History of Injury: Traumatic, Acute Joint bleed (May be the first presentation of Haemophilia or other bleeding disorder) - Haemarthroses 2. Significant Fever and Pain: Septic arthritis or Osteomyelitis 3. Recent Viral illness, diarrhoea, Tonsillitis: Reactive Arthritis- 7-14 days after the illness, Fever may not be present 4. History of IBD: Usually monoarthritis of large joints reflects activity 5. Vascultic Rash: HSP or other forms of vasculitis Page 1 of 6 Title: Joint Pains in Children V:2 Approved by Children’s Clinical Practice Group: March 2019 Trust Ref: C89/2016 Next Review: March 2022 NB: Paper copies of this document may not be most recent version. The definitive version is held in the Trust Policy and Guideline Library. 6. Recent Drug ingestion: Serum sickness often associated with Urticarial rash 7. Bone pain, Lymphadenopathy, Hepato-splenomegaly: Leukemia, Lymphoma, Neuroblastoma, bone tumour (h/o nocturnal bone pain) 8. -
Hip Osteoarthritis Information
Bòrd SSN nan Eilean Siar NHS Western Isles Physiotherapy Department Hip Osteoarthritis An Information Guide for Patients and Carers Page 1 Contents Section 1: What is osteoarthritis? 3 Contributing factors to osteoarthritis Section 2: Diagnosis and symptoms 5 Symptoms Diagnosis Flare up of symptoms Section 3: Gentle hip exercises for flare ups 7 Section 4: Living with osteoarthritis 8 How with osteoarthritis affect me? What you can do to help yourself Section 5: Range of movement exercises 9 Section 6: Strengthening exercises 10 Other forms of exercise Section 7: Other treatments 13 Living with osteoarthritis Surgery Section 8: Local groups and activities 14 Page 2 What is osteoarthritis? This booklet is designed to give you some useful information following your diagnosis of osteoarthritis. Osteoarthritis is a very common condition which can affect any joint causing pain, and stiffness. It’s most likely to affect the joints that bear most of our weight, such as the hips, as they have to take extreme stresses, twists and turns, therefore osteoarthritis of the hip is very common and can affect either one or both hips. A normal joint A joint with mild osteoarthritis In a healthy joint, a coating of smooth and slippery tissue, called cartilage, covers the surface of the bones and helps the bones to move freely against each other. When a joint develops osteoarthritis, the bones lose their smooth surfaces and they become rougher and the cartilage thins. The repair process of the cartilage is sometimes not sufficient as we age. Almost all of us will develop osteoarthritis in some of our joints as we get older, though we may not even be aware of it. -
Arthrofibrosis-Ebook-Small.Pdf
Table of Contents About the Authors 3 Introduction 4 Basic Knee Anatomy 6 What is Knee Arthrofibrosis? 10 Basic Definition and Classification Systems 10 Structures Involved With Loss of Knee Flexion 12 Structures Involved With Loss of Knee Extension 13 Effects of Loss of Knee Motion 13 How Does Knee Arthrofibrosis Happen? 15 How the Body Normally Heals After an Injury or Surgery 15 Abnormal Healing Response in Arthrofibrosis 16 Risk Factors Associated with Secondary Arthrofibrosis 16 How is Knee Arthrofibrosis Diagnosed? 19 Early Detection 19 Established Arthrofibrosis 20 Other Reasons for Limitations of Knee Motion 22 Prevention of Knee Arthrofibrosis 23 Physical Therapy: Setting Goals Before Surgery 23 Exercises to Regain Knee Motion 24 Exercises to Regain Strength and Knee Function 25 Treatment of Inflammation, Pain, Hemarthrosis, Infection 32 First-Line Treatment 32 Medications 32 Overpressure Exercises 33 Gentle Ranging of the Knee Under Anesthesia 36 In-Patient Physical Therapy Program 37 Operative Options 38 Arthroscopic Lysis of Adhesions and Removal of Scar Tissues 38 Open Z-Plasty Release Medial and Lateral Retinacular Tissues 41 Open Posterior Capsulotomy 44 Important Comments Regarding These Operations 47 Questionable Treatment Options 47 Ultrasound 47 Extracorporeal Shockwave Therapy 48 Inflammatory Diet 48 Patellar Infera: Recognition, Prevention, Treatment 48 Recognition 48 Prevention 49 Treating Early Patella Infera 49 Treating Chronic Patella Infera 50 Complex Regional Pain Syndrome (CRPS) 51 What is it? 51 The Human Nervous System 51 CRPS Types I and II 52 Potential Causes of CRPS 52 Diagnosis 53 Treatment 54 Acronyms and References 56 3 About the Authors Dr. Frank Noyes is an internationally recognized orthopaedic surgeon and researcher who has specialized in the treatment of knee injuries and disorders for nearly 4 decades. -
Letters to the Editor
Letters to the Editor Peritonitis and cervical arthritis early stages of the disease or as the single as presenting manifestations of joint implicated (6-9). In our patient, who presented with fever, neck stiffness and systemic juvenile idiopathic signs of peritoneal infl ammation, meningi- arthritis tis and peritonitis secondary to appendicitis were excluded. The associated evanescent Sirs, macular salmon-pink rash and cervical Early involvement of the cervical spine is spine involvement suggested sJIA. Diag- uncommon and peritonitis is a rare extra- nosis was confi rmed by the outcome with articular presentation in systemic-onset juv- a relapse. enile idiopathic arthritis (sJIA) (1-3). Over 21 years we observed 264 cases of We describe a previously healthy 4-year- JIA, of whom 3 had monoarticular C1-C2 old boy with C1-C2 arthritis and peritonitis involvement lasting for several months (2 presenting as the initial manifestations of oligoarthritis previous to this case). sJIA. He was admitted following 2 days of We are not aware of any other published fever, lethargy, vomiting, abdominal pain cases of sJIA who presented with C1-C2 and neck stiffness. A blood count showed arthritis and peritonitis simultaneously . 20100 leucocytes/ml (74% neutrophils), the C-reactive protein was 2.8 mg/dl. Cerebral A. VAZ, MD spinal fl uid analysis excluded meningitis. C. VEIGA, MD Twelve hours post admission he appeared P. ESTANQUEIRO, MD clinically septic, developed abdominal M. SALGADO, MD signs suggestive of peritonitis and C-reac- Department of Pediatric Rheumatology, tive protein increased to 10 mg/dl. Antibiot- Fig. 1. Cervical MRI: arrows showing bilateral effu- Hospital Pediátrico de Coimbra, Portugal.