What is Brucellosis Arthritis?
Brucellosis is a chronic infectious disease caused by the microorganisms pucella melitensis, pucella abortus, pucella suis. The source of infection are goats, sheep, cattle, pigs. The disease in humans occurs predominantly by consuming dairy products (cheese, cottage cheese, milk) or in direct contact with sick animals. The microorganism has a tendency to linger in tissues rich in reticuloendothelium (bone marrow, lymph nodes, liver, spleen), where specific granulomatous infiltrates develop. The latter have another favorite localization – loose connective tissue around the joints, the outer layers of the capsule, mucous bags, ligaments, tendons – which leads to the appearance of dense, non-suppurative formations – fibrositis. Metastatic lesions of the osteochondral skeleton of the joint and true brucellosis synovitis are extremely rare – only in 2-7% of patients. Most often, apparently, arthritis of the reactive type.
The musculoskeletal system is involved in the process mainly in people older than 50 years.
Symptoms of Brucellosis Arthritis
Brucellosis occurs acutely, subacutely, chronically, and in recent years the number of chronic cases has increased significantly, they make up 51-69% among hospital patients. There are also primary chronic forms of the process (14% of cases), which often present significant diagnostic difficulties. The disease is manifested by wave-like fever, chills, torrential sweats, swollen lymph nodes, liver, spleen, changes in the nervous system (headache, mental disorders, neuritis, etc.) and other organs and systems. Clinical X-ray signs of lesions of the osteo-articular apparatus appear either in the initial period of brucellosis infection (already in the first 3 weeks), or throughout the year from the onset of the disease and more often (in 45% of cases) in chronic forms of the disease.
Generalized arthralgia in the peripheral joints, the sacrum, and the spine (more often in men) is noted. Brucellosis spondylitis is characterized by a primary lesion of the III-IV lumbar vertebrae, then the thoracic region, and least of all the process involves the cervical region; Often develops sacroiliitis.
In the foreground are severe back pain, especially pronounced with pressure on the spinous processes of the affected vertebrae and ileosacral articulations, and the restriction of the function of the spine. In the subcutaneous tissue of the lumbar region often sharply painful nodules (fibrositis) are palpated. Periarthritis, bursitis, tendovaginitis, ligamentitis are also frequent. Periarthritis usually occurs in the shoulder and hip joints, heel bones and can lead to focal calcification of tissues.
Small peripheral joints are practically not affected. Effusion in the articular cavity and the destruction of the bone skeleton of the joint can be observed only occasionally and mainly in the knee and elbow joints. When puncturing these joints, it is possible to obtain serofibrous liquid, which sometimes contains brucella.
Diagnosis of Brucellosis Arthritis
From laboratory parameters should be noted leukopenia with lymphocytosis. Patients usually have a positive skin test with a brucella antigen (Byrne reaction), an opsonophagocytic reaction, and also serological tests (Wright and Headdleson reactions) in high titer (at least 1: 200). Sometimes it is possible to get a culture of a microbe from the blood or bone marrow.
X-ray picture with brucellosis either does not provide any information or is nonspecific (osteoporosis is detected). Of the characteristic radiological findings, sacroiliitis is the most frequent, according to many radiologists. There may be an isolated, unilateral, but more often bilateral lesion. One or several rounded small destructive foci appear along the articular fissure in the bone tissue, merging with each other; the joint space becomes corroded, then narrows, and complete ankylosis occurs. The destructive specific process can cover 1-4 vertebrae and intervertebral discs, but unlike tuberculous lesion does not cause a complete collapse of the vertebral bodies, destruction of the intervertebral discs and bone merger of adjacent affected vertebrae. In limited areas of the vertebral column, brucellosis spondyloarthritis can occur with the formation of coarse asymmetric adhesions between the affected vertebrae, which distinguishes them from the common symmetric process in ankylosing spondylitis. Destructive changes in the hip, knee, elbow joints can result in ankylosis. It is characteristic of brucellosis to develop heel spurs, bone growth in the elbow joints, at the upper pole of the patella.
Diagnosis. The diagnosis of brucellosis lesions is made on the basis of the described clinical x-ray picture, especially with back pain, fever in people who have contact with animals or using animal products, lymphadenopathy, splenomegaly, the isolation of microbes from blood or synovial fluid, and the results of serological tests.
Treatment of Brucellosis Arthritis
Fighting animal disease; canning, boiling all dairy products. To suppress the infection, tetracycline (up to 2 g/day), streptomycin (1 g/day) for 3 weeks, analgesic and anti-inflammatory drugs – indomethacin, reopyrinin and others, and in chronic cases – vaccine therapy are prescribed, although its effectiveness is low. For severe back pain, a corset is recommended.