Gonococcal arthritis is an important form of arthritis which involves young adults of either sex who indulge in sexual abuse. About 2-5% of those suffering from gonorrhoea develop this complication.
Clinically patient presents with fever, mild inflammatory asymmetrical polyarthritis with migratory joint paths. There is painful tenosynovitis. The joints mainly affected include knee, shoulder, wrist and inter phalangeal joints.
There are often maculo papular or vesiculo pustular skin lesions often near the affected joints. An untreated case of gonococcal arthritis may end in bony ankylosis of the joint with frank purulent suppuration. Labmen are more liable to suffer from disseminated from of disease especially during menstruation or pregnancy.
In the early stages cultures of blood and skin lesions are positive. Organisms can be recovered from the blood stream and synovial fluid.
Complement fixation test is positive in about 80% of the cases after the first month. In cases where the blood culture is negative, arthritis may be a immunologically mediated reaction to the primary infection.
Diagnosis of the gonococcal arthritis is based on typical clinical features and presence of organisms in blood and synovial fluid.
In early stages it may resemble an acute attack of rheumatoid arthritis. A recent history of gonococcal infection or urethritis and onset ofjoint symptoms within 3 weeks of infection as well as presence of conjunctivitis and iridocyclitis shall be a pointer to gonococcal aetiology.
Treatment is with penicillin (sodium penicillin 0.5-5 mu/JIM or I/V 6 hrly for 2 days followed by procaine penicillin 2.4 to 4.8 mega units daily for 10 days). Alternative is ceftriaxone 1-2 gm daily intravenously for 7-10 days. It can be followed by oral ciprofloxacin 500 mg twice a day for 7 days.
Response to the above regime is good and chances of emergence of drug resistant strains are less.
Meningococcal arthritis
It usually occurs as a part of generalized meningococcal septicemia and is common in the second week of illness. It may be monoarticular or poly articular and is in the form of migratory arthritis. There is intermittent low grade fever and a purpuric rash.
Blood culture is positive though organisms can not be recovered from the joint fluid. When the effusion becomes purulent, the organism may be recovered. Blood generally shows leucopenia. Treatment is with antibiotics, mainly penicillin of amoxycillin.
