Septic arthritis occurs when a joint is infected by one of the groups of pus-forming bacteria. There is usually a severe infection of the joint, which may be subacute or even chronic. It is called pyogenic arthritis when pus forms inside the joint. Staphylococci, streptococci or pneumococci are usually responsible, and sometimes gonococci or other organisms. The organisms may reach the joint by three routes: blood-borne infection, through puncture wounds, or from an adjacent focus of osteomyelitis, particularly when the affected metaphysis lies wholly or partly inside the joint cavity (as is the case with the upper end of the humerus, the metaphyses at the elbow, the upper and lower ends of the forearm bones, and all the metaphyses of the femur). The infection causes an acute or subacute inflammatory reaction within the joint tissues; fluid is exuded into the joint, and the fluid is cloudy or frankly purulent, depending on the severity of the infection. The outcome varies from complete resolution with normal function, to complete destruction of the joint and its replacement by fibrous or bony tissue. The infection begins acutely or subacutely, with pain and swelling in the joint. There is also a systemic illness accompanied by fever.
The joint swells partly from fluid effusion and partly from thickening of the synovial membrane. When the affected joint is superficial, the overlying skin is warmer than usual and often reddened. All movements are restricted: in severe cases movement is almost completely impossible because of protective muscle spasm. Attempted or forced movement increases the pain. A boil or another primary focus of infection is often found elsewhere in the body.
There are polymorphonuclear white blood cells, and the erythrocyte sedimentation rate is raised. Bacteriological examination of the joint fluid usually identifies the causative organism. Rheumatoid arthritis is a chronic, non-bacterial inflammation of the joints, often associated with mild systemic symptoms. It usually affects several joints at the same time. Joint changes of a similar nature also occur in a number of other conditions, such as juvenile rheumatoid arthritis (Still's disease), Reiter's syndrome, psoriasis, systemic lupus erythematosus, and other connective tissue (collagen) diseases.
Some cases of the disease result from autoimmunity or from infection. The autoimmune hypothesis is based mainly on the observation that the serum of many patients with rheumatoid arthritis contains antibodies to gamma globulin protein: when the antibody is present, the disease is called "seropositive," in contrast to seronegative arthritis when the antibody is absent.
The synovial membrane enlarges as a result of chronic inflammatory changes. After further time, the articular cartilage weakens and wears away, and in long-established cases the bone beneath the cartilage may also erode. The lining of the tendon sheaths may become inflamed and thickened. The tendons within them may weaken and may even rupture, aggravating any existing deformity. Inflammatory nodules may form in the soft tissues.
Any joint may be affected, but involvement is more common in the more peripheral joints, such as those of the hands, wrists, feet, knees and elbows, than in the lumbar or thoracic spine, the shoulders or the hips. The onset is gradual, with increasing pain and swelling of the joints; before long a number of other joints are affected in the same way. Pain and stiffness are often worse when activity is resumed after a period of rest. There is often a systemic disturbance with fatigue and anemia.
The affected joints swell because of synovial thickening. The overlying skin is warmer than usual. The range of joint movement is restricted, and movement causes pain, especially in the limbs. These clinical features are often more severe in seropositive disease than when rheumatoid factor is absent from the serum.
The presence of rheumatoid factor in the blood is highly suggestive, although the tests for rheumatoid arthritis are not conclusive. Rheumatoid factor may be absent even in well-established rheumatoid arthritis.
Rheumatoid arthritis tends to become quiescent after remaining active for months or years. In most cases there is a permanent reduction in joint function. Diagnosis is based on the medical history and on laboratory tests (which may include a blood or synovial fluid sample) ordered by the doctor, together with X-rays or other imaging tests that help confirm the diagnosis.
Treatments for joint and rheumatic diseases differ depending on the type of disease or the patient's condition. In general, treatment in Ayurveda includes the following: Rookshswedam, Dhanyamladhara, Patrapotala swedam, Jambeerapindaswedam, Upanaham, Avagaham and others.
