ARTHRITIS, INFECTIOUS

Infectious arthritis (sometimes called septic arthritis) is an infection inside of a joint. It is usually caused by bacteria. Normally, the inside of joints are free of germs (sterile). When bacteria get into the sterile joint they cause inflammation, resulting in pain and swelling. Usually only one joint becomes infected at a time such as the knee, hip, wrist, shoulder, elbow, or ankle.

Anyone can develop a joint infection, but it is most common in young children and older adults. There are several reasons why joint infections develop in individuals. Most of the time it is because of abnormal changes in the joint from other forms of arthritis, a poorly working immune system (possibly caused by certain medicines or other conditions such as diabetes or kidney disease), or an artificial joint (joint replacement).

Joint infections are diagnosed by removing the infected fluid from the joint with a needle and testing it in the laboratory. With antibiotic treatment and drainage of the infected fluid from the joint, the infection can usually be cured.

Infected joints swell quickly and are very painful and difficult to bend. They cause high fevers, chills, shakes, muscle aches, and fatigue. Depending on the joint involved, individuals with joint infections may not be able to walk or use their arms. Patients usually receive initial intravenous (IV) antibiotic treatment in the hospital before continuing treatment at home. After treatment is started the symptoms slowly improve over the next 1—2 weeks. However, even after the infection is treated joint pain may persist. In addition to antibiotic treatment, it is necessary to receive physical therapy to help maintain motion in the joint. This requires dedication to performing the exercises on a regular basis. Because of possible permanent damage from the infection, some individuals never recover full motion in the affected joint even with the therapy.

Joint infections require three stages of therapy: antibiotics, drainage of the joint, and therapy to restore normal motion in the joint.

Antibiotics are usually given through a vein for the first 2 weeks and then by mouth for an additional 2—4 weeks. Sometimes longer treatment is needed. The most common side effects from antibiotics are allergic reactions, rashes, and diarrhea. Women sometimes have yeast infections develop while taking antibiotics.

During the first week of treatment the infected joint fluid must be drained regularly. This is performed in one of two ways depending on the affected joint. Most joints can be drained by sticking a needle into the joint and drawing the fluid off usually once a day. Other joints are more difficult to drain this way and instead require drainage by an operation.

After the first few days of treatment, individuals with joint infections should begin therapy to restore normal motion in the joint. Therapists teach and assist with this part of the treatment. Therapy should continue until after the pain is gone and the joint is working normally again.

• Take your medicines as prescribed.
• Ask your doctor which over-the-counter medications you may take with your prescription medications.
• Perform exercises to maintain joint motion and preserve strength.

• Don't wait to see whether side effects from medications will go away.
• Don't continue an exercise program that causes pain. If pain after exercise continues, it usually means the exercise program needs to be modified specifically for you.

• If you have any medication side effects.
• If the medication and treatments are not decreasing the pain.
• If a new fever, chills, or worsening pain or swelling develop.
• If you believe you need a referral to a physical or occupational therapist.

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