INFECTIONS IN ARTHRITIS
Professor,Medicine and Consultant Rheumatologist,Dr.DY Patil Medical college and hospital ,Pune
Arthritis is basically a swelling, pain, stiffness and loss of function of a joint, and there are many causes for the same. It may be autoimmune arthritis, where the self fights self, that is, our body immunity attacks our joint tissues. Such diseases occur in the young to middle aged and more women are affected, although no age or gender is a barrier to this scourge. Some examples of these disorders are : rheumatoid arthritis, systemic lupus erythematosus,Sjogren syndrome, scleroderma, myositis, mixed connective tissue disease, spondyloarthropathies.
Another type of arthritis is osteoarthritis which basically is a destruction of joint with age. Weight bearing joints like knees and hip bear the brunt of this.
People suffering from arthritis may be prone to several infections, or the arthritis can be due to an infection.
INFECTIONS WHICH CAN OCCUR IN PATIENTS WITH ARTHRITIS:
The reason why infections may be seen more often in patients suffering from arthritis could be the decrease in protective immunity of the body due to the medications used to treat arthritis (immunosuppressants) or it could be due to the immunosuppressive effect of the disease itself, such as in systemic lupus erythematosus.
Several infections can occur such as chest infections (pneumonias), tuberculosis which affects entire body, urinary tract infections, reproductive tract infections (pelvic inflammatory diseases), skin infections etc.
These may be due to various bacteria, viruses, fungi and parasites.
Lets discuss each infection now in detail.
Pneumonias: common lung infection. It has many causes.
Bacterial : Streptococcus pneumoniae, staphylococcus, klebsiella , pseudomonas, mycoplasma, chlamydia
Viral : SARS COV 2, Influenza A and B, parainfluenza, H1NI etc
Fungal : aspergillus, mucor, candida etc
Common symptoms are high fever, cough, breathlessness, chest pain, altered consciousness etc. As these patients are often on steroids and other disease modifying agents, they can develop serious disease and land up in septicemia which can cause death.
Tuberculosis: TB is rampant in India, widespread in both rural and urban areas. TB spreads from person to person, often in crowded living areas and is definitely more common in patients with arthritis, due to immunosuppressive effect of both disease and medications. Common symptoms of TB are fever, weight loss and loss of appetite, and of course symptoms pertaining to the body organ involved.
It can cause lung infection leading to cough, blood in sputum, chest pain, fluid accumulation in lung linings. Abdominal infection of the intestines and peritoneal cavity can lead to diarrhea, vomiting, pain in abdomen, blood in stools. Infection of brain, spinal cord and meninges can cause headache, vomiting, epileptic fits, paralysis of limbs and eye muscles, etc. This infection is dangerous and can cause rise in intracranial pressures leading to disability and death.
Bone and joints also are affected by TB and this sometimes mimics inflammatory arthritis. So we as rheumatologists always keep an eagle eye on the symptoms patient is suffering from! Many a time we have been surprised with the diagnoses!
Our country also has a high incidence of drug resistant TB and its fast becoming common in immunocompromised patients like those having rheumatic diseases.
Urinary Tract Infections: bacterial, fungal
Urinary infections are very common in women. They can be a main cause of morbidity in women suffering from arthritis. Common symptoms are burning while passing urine, loin pain, pain in lower abdomen etc.
Reproductive infections: These are so often neglected in our patients! Per vaginal discharge, itching, pelvic pain are the common symptoms.
Skin and mucocutaneous infections : Skin infections in patients with arthritis can be very disfiguring and irritating. Common ones are herpes zoster which causes small fluid filled vesicles to appear on the skin , very painful and healing within a week to 10 days, often with persistent pain. Fungal infections over underside of breast,chest, groin, thighs, foot are also common. Sometimes bacterial infections may occur and that may take a dangerous turn, leading to spread of infection into the bloodstream.
Meningeal and brain infections : meningitis, encephalitis and brain abscesses: these are rare but life threatening and occur due to bacteria, viruses, fungi and TB.
Intraabdominal infections: Acute gastroenteritis, leading to severe dehydration is also quite common in patients with arthritis. Hepatitis A and E can occur as well,leading to jaundice. Patients should be screened for Hepatitis B and C before starting them on immunosuppressive medication and this should be kept in mind.
INFECTIONS CAUSING ARTHRITIS:
Some infections like tuberculosis can cause arthritis. This usually occurs in only one joint, mostly knee, causing long standing pain and swelling. Fever, weight loss may accompany these symptoms. This requires at least one year of treatment.
Septic arthritis is a dangerous condition where bacteria seed into the synovial fluid and cause joint destruction. The joint is red,hot and swollen. This is considered an emergency where the fluid must be removed for testing immediately. Antibiotics are needed for a longer duration, mostly 4 weeks.
Some infections like leprosy also can affect the joints for a chronic duration.
Very common in today’s time is viral arthritis such as dengue, chikungunya and Covid-19. The symptoms are an acute onset of fever and often debilitating joint pains which may last from a few days to weeks to even months. Various studies have been conducted where a link between viral arthritis and occurrence of rheumatoid arthritis or persistent RA like arthritis has been found.
So it can be seen that infections and arthritis are inextricably linked. Patients and their physicians have to be aware of this so that prompt diagnosis and treatment can be started.