Gonococcal and Meningococcal Arthritides

Rheumatoid arthritis: new approaches for its evaluation and management

Rheumatoid arthritis is a chronic, progressive disease with a long-term outcome characterized by significant morbidity, loss of functional capacity, and increased mortality. The cornerstone of therapy includes the appropriate melding of pharmacological, rehabilitative, and surgical treatments. New developments in the care of patients with rheumatoid arthritis have focused on aggressive pharmacological therapy early in the course of the illness, ongoing assessment of disease activity and patient function, and a better understanding of the role of rehabilitative techniques such as therapeutic exercise and behavioral approaches to education. This article synthesizes information from studies on recent advances in the management of rheumatoid arthritis outlining diagnosis and assessment, disability issues, outcome studies, current status of traditional and experimental pharmacological therapies, and new strategies of nonpharmacological treatments aimed at the clinician challenged by this fascinating disorder.

Septic arthritis. Clinical approach to the 'hot joint'

Joint space infections continue to be among the most common forms of arthritis. Diagnosis can be difficult, particularly in the presence of underlying joint disease. Septic arthritis should be suspected in all patients who present with an acutely swollen joint. Immediate joint aspiration with Gram's stain and culture of the synovial fluid is essential. Intensive, long-term antibiotic therapy is necessary to prevent a high rate of morbidity and, possibly, death.

Hemophilus influenzae septic arthritis in adults

Hemophilus influenzae is an important but uncommon cause of adult septic arthritis. We report two cases and review 23 previously published cases. Two-thirds of the patients had systemic diseases, local factors, or both which predisposed them to septic arthritis. The acute disease was monarticular in 48%, polyarticular in 24%, and accompanied by tenosynovitis and/or bursitis in 28% of cases. Extraarticular sites of H. influenzae infection were found in 60% of cases. These sites represented either likely portals of bacterial entry or foci of infection resulting from hematogenous dissemination of H. influenzae. The most characteristic synovial fluid finding was the presence of Gram-negative pleomorphic microorganism. However, misinterpretation of the Gram-stained smear was common and led to an erroneous initial diagnosis in several instances. Prompt sterilization of the infected synovial fluid was the rule once an appropriate antimicrobial agent was administered. A favorable outcome was reported in 88% of cases.