Ask the Doctors December 2004 Issue

Ask Dr. Marks: 12/04

I’ve been told that septic, or infectious, arthritis can damage cartilage quickly. What causes it, how is it treated, and is there any way I can prevent it?

Septic (infectious) arthritis is a true orthopaedic emergency. Delayed diagnosis and treatment can lead to a destroyed joint, or even death. Although there is no way to prevent most cases of septic arthritis, quick diagnosis and treatment are essential.

Septic arthritis results from bacterial invasion of a joint space. Bacteria gain access to the joint by spreading through the bloodstream, from inoculation during trauma, inoculation at the time of surgery, or by spreading from a nearby bone infection. Patients with septic arthritis experience symptoms such as fever, extreme joint pain, or swelling and redness over the joint. It is more common in the elderly or in patients whose immune system has been compromised.

The most common type of infecting bacteria in adults is Staphylococcus aureus, which stimulates the release of destructive enzymes within the joint fluid. These enzymes attack the collagen within the cartilage, leading to its destruction.

Treatment is aimed at killing the infecting organisms and washing away the destructive enzymes. The patient is taken to the operating room to have his joint washed out and drained. Multiple trips to the operating room are often necessary to save the joint. Antibiotics are also given in large amounts over a prolonged period of time.

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After a painful bout of carpal tunnel syndrome, I’ve been diagnosed with rheuma-toid arthritis. Could my carpal tunnel problem have caused the onset of RA?

Your carpal tunnel syndrome did not cause the onset of RA. However, the reverse is often true. People with RA are at increased risk of developing carpal tunnel syndrome. In fact, any condition that crowds or reduces the size of the carpal tunnel may bring on symptoms.

Running through the wrist’s carpal tunnel is the median nerve as well as tendons and their surrounding synovial membrane. It is this synovial membrane that can become inflamed and swollen in patients with rheumatoid arthritis. The swelling of the synovium in the non-expandable carpal tunnel crowds and compresses the median nerve, causing pain and numbness of the hand. The standard treatment is to increase the size of the carpal tunnel by surgically incising the ligament that forms the roof of the tunnel.

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I’ve heard that some of the traditional factors that are believed to cause gout—excessive consumption of meat and seafood—are now being called into question. What’s the latest on this?

For many years, doctors have recommended that patients with gout avoid foods high in purine, such as alcoholic beverages, fish, seafood, shellfish, and meats such as bacon, turkey, and veal. Dietary management, however, can be very restrictive and of limited benefit. As a result, most patients do not comply with dietary management of their gout. For this reason, the focus of treatment today has shifted to the control of hyperuricemia (excessive uric acid in the blood) by medications and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during gout attacks.