Treatments for Infectious arthritis
Infectious arthritis: Is the Diagnosis Correct?
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Book Excerpts: Treatment of Infectious arthritis
Treatments of Infectious arthritis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
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Arthritis – Multiple Joints:
Treatment
(In A Page: Pediatric Signs and Symptoms)
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Even though unlikely, if septic arthritis (such as with Neisseria gonorrhoeae) is a possibility, antibiotic treatment should be started immediately
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Appropriate treatment of malignancy
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NSAIDs for JRA and spondyloarthropathies as an initial therapy; disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate, and biologics (e.g., TNF blockers) are added depending on clinical response
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Specific treatments of other mixed connective tissue diseases depending on their severity
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Corrective and/or supportive medical/surgical interventions
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Supportive therapy such as PT and OT to increase range of motion and strength; insoles to correct leg length discrepancy
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Psychosocial support especially with chronic diseases
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Arthritis – Single Joint:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
If septic arthritis is a possibility, broad-spectrum antibiotic treatment should be started immediately
-
Fractures and most internal derangements require orthopedics involvement
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Appropriate referral and treatment for malignancy
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JRA and SpA are usually treated with NSAIDs initially, DMARDs (e.g., sulfasalazine and methotrexate) and biologics (e.g., TNF blockers) are added depending on the degree of inflammation and the response of individual patient
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Supportive therapy such as PT and OT to increase range of motion and strength; insoles to correct leg length discrepancy
-
Psychosocial support, especially with chronic arthritis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Psoriatic arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
In mild psoriatic arthritis, treatment is supportive and consists of immobilization through bed rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other nonsteroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. Gold salts and, most commonly, methotrexate therapy are effective in treating both the articular and cutaneous effects of psoriatic arthritis. Antimalarials are contraindicated because they can provoke exfoliative dermatitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Septic arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Antibiotic therapy should begin as soon as a Gram stain has been done; it may be modified when drug sensitivity of the infecting organism is known. Bioassays or bactericidal assays of synovial fluid and bioassays of blood may confirm clearing of the infection.
Rest, immobilization, elevation, and warm compresses help with pain relief. Analgesics are given for pain, if needed. The affected joint can be immobilized with a splint or put into traction until the patient can tolerate movement.
In severe cases, needle aspiration (arthrocentesis) or surgery may be done under sterile conditions to remove grossly purulent or infected joint fluid. Late reconstructive surgery is warranted only for severe joint damage and only after all signs of active infection have disappeared, which usually takes several months. Recommended procedures include arthroplasty and joint fusion. Prosthetic replacement remains controversial because it may exacerbate the infection, but it has helped patients with damaged femoral heads or acetabula.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Juvenile rheumatoid arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Successful management of JRA usually involves administration of anti-inflammatory drugs, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. Both child and parents must be involved in therapy.
Aspirin is the initial drug of choice, with dosage based on the child’s weight. However, other nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. If these prove ineffective, gold salts, hydroxychloroquine, and penicillamine may be tried. Because of adverse effects, steroids are generally reserved for treatment of systemic complications, such as pericarditis or iritis, that are resistant to NSAIDs. Corticosteroids and mydriatic drugs are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated. (See Drug therapy for arthritis, pages 367 and 368.)
Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.
Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation. (See When arthritis requires surgery, page 369.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rheumatoid arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Salicylates, particularly aspirin, are the mainstay of RA therapy because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatory drugs (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), gold salts, penicillamine, and corticosteroids (prednisone). Immunosuppressants, such as cyclophosphamide, methotrexate, and azathioprine, are also therapeutic and are being used more commonly in early disease. (See Drug therapy for arthritis.)
Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program including range-of-motion exercises and carefully individualized therapeutic exercises forestalls joint function loss; application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.
Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty.
Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between the metacarpophalangeal and proximal interphalangeal joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and pain relief. Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of this disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses. Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. (See When arthritis requires surgery.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Psoriatic arthritis:
Treatment
(Handbook of Diseases)
In mild psoriatic arthritis, treatment is supportive and consists of immobilization through joint rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other non-steroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Septic arthritis:
Treatment
(Handbook of Diseases)
The goals of treatment are to provide oxygen and to treat respiratory distress, if present; to monitor and reverse shock through volume expansion; to treat underlying infections with antibiotic therapy; and to support poorly functioning organs.
Treatment begins with the administration of I.V. fluids and the insertion of a pulmonary artery catheter to check pulmonary circulation and PAWP. Administration of whole blood or plasma may be necessary to help raise the PAWP to a satisfactory level of 14 to 18 mm Hg. A urinary catheter allows accurate measurement of hourly urine output.
The patient may require endotracheal intubation and placement on a ventilator to overcome hypoxia. Adjustments are necessary to promote adequate cellular oxygenation and support hyperdynamic needs.
Antibiotic therapy
Treatment also requires immediate administration of I.V. antibiotics to control the infection. Depending on the organism, an antibiotic combination may be necessary.
Appropriate anti-infectives for causes of septic shock depend on the suspected organism. Other measures to combat infections include surgery to drain and excise abscesses and debridement.
Other drug therapy
If shock persists after fluid infusion, treatment with a vasopressor, such as dopamine, maintains adequate blood perfusion to vital organs. Other treatment includes correction of acidosis and, possibly, I.V. corticosteroids.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Juvenile rheumatoid arthritis:
Treatment
(Handbook of Diseases)
Successful management of JRA usually involves administration of an anti-inflammatory, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. The child and his parents must be involved in therapy.
A nonsteroidal anti-inflammatory drug (NSAID) — such as aspirin, ibuprofen, or naproxen — is used to reduce pain and swelling. If this proves ineffective, a disease-modifying antirheumatic drug (DMARD), such as methotrexate, is a useful second-line agent. In addition, gold salts, hydroxychloroquine, auranofin, aurothioglucose, etanercept, or sulfasalazine may be considered. Responses to individual drugs may differ among the various subtypes of JRA. Because of adverse effects, systemic steroids are generally reserved for treatment of systemic complications that are resistant to NSAIDs and DMARDS, such as pericarditis and iritis. However, an intra-articular steroid can be effective in managing pauciarticular and polyarticular JRA.
CLINICAL TIP: Joint rest (by splinting) used for up to 3 days after joint injections with a corticosteroid may improve anti-inflamma-tory response.
Corticosteroids and mydriatics are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated.
Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.
Generally, the prognosis for JRA is good, although disabilities can occur. Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Rheumatoid arthritis:
Treatment
(Handbook of Diseases)
Salicylates, particularly aspirin, are the mainstay of RA therapy, because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatories (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), sulfasalazine, gold salts, and corticosteroids (prednisone). (See Drug therapy for arthritis.)
Immunosuppressants — such as methotrexate, cyclosporine, and azathioprine — are also therapeutic. They’re being used more commonly early in the disease process. Cox-2 inhibitors, such as rofecoxib and celecoxib, significantly reduce the risk of GI bleeding. Cyclophosphamide, which suppresses the immune system and is associated with toxic adverse effects, may be used in patients who have been unsuccessful with other therapies.
UNDER STUDY: A number of new drugs are becoming popular for RA therapy:
❑ Etanercept, an injectable, and infliximab, given I.V. every 2 months, inhibit the inflammatory protein tumor necrosis factor.
❑ Leflunomide blocks the growth of new cells.
❑ Anakinra, an injectable, blocks another inflammatory protein, interleukin-1.
Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program, including range-of-motion exercises and carefully individualized therapeutic exercises, forestalls loss of joint function.
Application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.
Treatment in advanced disease
Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty. (See When arthritis requires surgery, page 743.)
Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between MCP and PIP joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and relief of pain.
Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of the disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses.
Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. Apheresis may slow down RA or stop it from wor-sening.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Conventional medical treatments for arthritis have come a long way in recent years. But many people suffering from arthritis pain have found...
Conventional medical treatments for arthritis have come a long way in recent years. But many people suffering from arthritis pain have found...
Conventional medical treatments for arthritis have come a long way in recent years. But many people suffering from arthritis pain have found...
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