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See Latest ArticlesGonococcal and nongonococcal arthritis
Rheumatic Disease Clinics of North America, 06/02/09
García-De La Torre I et al. - Article reviews the risk factors, pathogenesis, clinical manifestations, diagnosis, and treatment of nongonococcal and gonococcal arthritis.
- Risk factors: RA, diabetes, liver disease, alcoholism, chronic renal failure, malignancies, intravenous drug use, hemodialysis, AIDS, hemophilia, organ transplantation, hypogammaglobulinemia, immunosuppressive drugs and glucocorticosteroids, biologic agents etc.
- Pathogenesis: Bacterial invasion, host inflammation, and tissue ischemia. Bacterial enzymes and toxins are directly injurious to cartilage.
- Clinical features: Gonococcal vs nongonococcal arthritis –
- Patient profile: Sexually active young adults, mainly women vs Newborns or adults with chronic disease (diabetes, RA, OA)
- Presentation: Migratory polyarthritis dermatitis, tenosynovitis vs Single joint involvement
- Pattern of joint involvement: Polyarticular ~50% vs Oligoarticular ~90%
- Culture positivity: Less than 50% vs Nearly 90%
- Prognosis: Good with adequate antibiotic therapy vs Usually bad prognosis, requiring joint drainage in most cases
- Diagnosis: Recent onset of fever, general malaise, arthralgia and synovitis (mono/polyarticular)
- Prognosis:
- Gram-positive cocci: Cefazolin 2 g IV q 8 h Cefotaxime 1 g IV q 8 h
- Gram-negative cocci: Ceftriaxone 1 g IV q 24 h
- Gram-negative rods:Cefepime 2 g IV q 8 h Piperacillin-tazobactam 4.5 g IV q 6 h
- MRSA suspicion or risk factorsVancomycin 1 g IV q 12 h
IGNACIO GARCIA-DE LA TORRE, 06/04/09
| In this article we tried to update the current concepts regarding the Gonococcal and nongonococcal arthritis. This is a relatively common problem that we face in our daily practice as rheumatologists. We reviewed the risk factors, pathogenesis, clinical manifestations, diagnosis and treatment of this type of arthritis. If we can make an early diagnosis and give an adequate treatment the prognosis will improve in these patients. |
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