Orthopedics - Oleksa A.P. 2006

Joint Diseases
Infectious Arthritides of Known Etiology
Gonococcal Arthritis

Gonococcal Arthritis is rarely seen in clinical practice today thanks to well-established treatments for Gonorrhea. The condition most frequently affects the knee joint, less commonly the ankle and wrist joints, and occasionally the small JOINTS OF THE hand.

Gonococcal arthritis may develop 2 to 3 weeks, or even several months, after urogenital gonorrhea and can follow either a toxic or a bacterial course.

The toxic form of arthritis, regarded as infectious-allergic in nature, is accompanied by severe pain, pronounced serous or serofibrinous synovitis, fever, elevated ESR, and leukocytosis. The Bordet-Gengou test is often positive.

The course of this arthritis is torpid with infrequent remissions, yet it is characterized by involvement of the bursae, tendon sheaths, and tendons adjacent to the joint (such as achillodynia). Joint aspiration yields no gonococci, and radiographic changes are likewise absent.

Sometimes this toxic form resembles rheumatic arthritis, but rheumatic arthritis typically presents with acute attacks followed by remissions. Following antibiotic therapy, toxic gonococcal arthritis resolves completely without a trace.

The bacterial form of arthritis is metastatic, manifesting with an acute, fulminant purulent-phlegmonous course. Joint pain is excruciating, characteristic of suppurative arthritis, and the joint swells dramatically. Aspiration yields pus in which gonococci, neutrophils, lymphocytes, and macrophages can be detected. The joint is lavaged with an antiseptic solution, and Antibiotics are administered intra-articularly. In purulent gonococcal arthritis, Osteoporosis (Fig. 320) and articular Cartilage destruction develop quite rapidly around the affected joint. Radiographic examination reveals narrowing of the joint space.

As a rule, Purulent Arthritis results in ankylosis. Treatment consists of antibiotic therapy and immobilization of the limb in a functionally advantageous position.

Serofibrinous polyarthritis occasionally occurs, following an acute course with a tendency to become chronic. Such cases must be differentiated from rheumatoid arthritis, which typically involves symmetrical joints (often the small joints of the hands), sterile synovial fluid, a positive Waaler-Rose test, and unresponsiveness to penicillin treatment, among other features.

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Fig. 320. Pronounced osteoporosis in gonococcal arthritis of the wrist joint.

Staphylococcal and streptococcal arthritis, and even acute articular rheumatism, may mimic gonococcal arthritis. However, a carefully taken history, physical examination, and laboratory Analysis of the joint aspirate allow for an accurate Diagnosis.