Nongonococcal infectious arthritis refers to arthritis that results from bacterial or other infections apart from N. gonorrhoeae. It commonly presents severe joint inflammation and pain which is usually followed by joint warmth and swelling; the patient may also present fever. These include Staphylococcus aureus and Streptococcus species are some of the common bacterial species found in infections. For example, factors that increase your risk for developing arthritis include underlying medical conditions, joint diseases, age and injury or surgery to the joints. The diagnosis of the condition is done by joint aspiration, radiographic examination, and blood tests. The management is with the use of antibiotics, surgical drainage of the joint in case of help and other supportive therapies. It is important to start treatment as early as possible to avoid joint deterioration and have a good prognosis. 

Non-Gonococcal infectious arthritis mostly affects children, adults and the elderly and the causative agents and the risk factors differ from one age group to the other. In the children it is usually caused by Staphylococcus aureus and Hemophilus influenzae bacteria. In adults it is usually caused by Staphylococcus aureus including MRSA and Streptococcus species and is more frequent in patients with chronic diseases, joint disease or trauma. It is the elderly that are most vulnerable since they are more likely to have chronic illnesses and are more likely to have developed arthritis and thus joint pains. Epidemiology shows that the incidence ranges between 2 to 10 cases per 100,000 population per year, although these numbers are thought to be even higher in hospitalized patients or those with prosthetic joints. 

Non gonococcal infectious arthritis involves bacterial invasion of the joint including via the hematogenous route, direct trauma, or local infection. These bacteria attach themselves to the lining of the joint called the synovial membrane and reproduce actively, causing a highly inflammatory process. Some of the manifestations of this response are the secretion of inflammatory mediators, increase in synovial fluid production accompanied by pus formation and presence of neutrophils. It causes cartilage to breakdown, the bones to be destroyed and the joint becomes affected leading to pain, swelling and alteration of joint mobility. 

Nongonococcal infectious arthritis is mostly due to bacteria with Staphylococcus aureus (including MRSA) being the dominant pathogen. Other bacteria include Streptococcus species and Gram-negative bacteria such as Escherichia coli. It may also be caused by fungal pathogens such as Candida and mycobacterial pathogens such as Mycobacterium tuberculosis more common in immunocompromised patients. 

Early Diagnosis and Intervention: Early utilization of antibiotics along with joint aspiration enhances the patients’ prognosis and decreases joint deterioration. 

Virulence of the Pathogen: Specific strains of bacteria such as Staphylococcus aureus or Methicillin Resistant Staphylococcus aureus or MRSA, for instance, are more aggressive and difficult to deal with than other bacteria. 

Comorbidities: Such diseases as diabetes, rheumatoid arthritis, or immunosuppressive diseases can be a contributing factor to the progress of the sickness and its treatment. 

Affected Joint: For instance, larger joints such as the hip or the shoulder may be more difficult to manage and may be expected to yield a poorer outcome as compared to smaller joint involvement. 

Prosthetic Joint Infection: In some cases, among the patients who develop infection the bacteria are not so easy to manage and might need more surgery. 

Age Group 

Children: Often begins with a sudden onset of symptoms such as pain, swelling in the joints and high fever. These pathogens are common: Staphylococcus aureus and Haemophilus influenzae. 

Adults: Usually characterized by severe joint achings, swelling, redness, and increased temperature of the joint which tends to occur suddenly. The knee, hip and shoulder joints are the common site affected to a very large extent. Some of the pathogens involved are Staphylococcus aureus and Streptococcus in nature. 

Elderly: It is often diagnosed when it is already in the advanced stages, with or without more subtle symptoms or different presentations. Risk for the development of one or more comorbidities and prosthetic joint infections. 

Inspection: Particularly to look for signs of inflammation such as redness, swelling and warmth over the affected joint. 

Palpation: palpate for swelling, heat, and for fullness or fluid in the pocket; look for markings of pus. 

Range of Motion: Assess both the active and the passive range of motion for pain and disability. 

Systemic Symptoms: Check for temperature for fever and look at other signs of infection such as rashes. 

Functional Impact: Concerning joint involvement, it is pertinent to find out how it interferes with the everyday tasks and even bearing the weight of the body. 

• Recent trauma 
• Immunosuppression 
• Joint abnormalities 
• Diabetes 
• Rheumatoid arthritis 

Acute: Most of the cases occur as acute conditions with sudden increase in pain, stiffness, joint swelling, erythema and warmth. General signs and symptoms which may be evident include fever. 

Subacute/Chronic: In some cases, especially in immuno-compromised patients; the disease is less severe and may last longer before diagnosis is made. 

Treatment Paradigm 

Antibiotic Therapy: 

Empiric Antibiotics: It is necessary to begin with the broad-spectrum IV antibiotics including vancomycin and ceftriaxone to target potential pathogens. 

Targeted Therapy: For example, change antibiotics according to the bacterial culture, where a specific agent will be effective. 

Duration: It usually requires a course of intravenous antibiotics that lasts between 2-4 weeks and then oral antibiotics that last between 1-2 weeks. 

Joint Drainage and Surgical Intervention: 

Joint Aspiration: Multiple attempts might be required in cases where there is need to remove infected fluid. 

Surgical Drainage: Department of Appeals at the Post Office – use of arthroscopic or open drainage depending on severity or joint aspiration. 

Supportive Care: 

Pain Management: Medical treatment includes giving pain relievers such as analgesics and Anti-inflammatories. 

Immobilization and Physical Therapy: For the first couple of days, apply skeletal fixation and, when the infection has begun to recede, rebalancing the limb. 

Monitoring and Follow-up: This means that there is a need to monitor the response of the patient to the treatment plan and make changes if there is an indication.  

Infectious Disease

Joint Drainage: Suctioning or surgical evacuation of infected pleural fluid and thus decreasing the inflammation. 

Immobilization: Stabilizing the joint during the inflammatory phase in a bid to reduce pains and the level of inflammation. 

Physical Therapy: Activities to be carried out to improve joint mobility, tone and efficiency after the infection has been contained. 

Supportive Measures: A process of applying heat and cold on painful areas, using aids as means to lessen the pressure of the stressed joint. 

Infectious Disease

Nafcillin: It is frequently employed as the drug of first choice for infections that may be associated with penicillin G–resistant strains of streptococci or staphylococci. In the case of more serious conditions, the drug should be administered intravenously in the first days of the therapy, and then switched to oral use. This is the reason that intravenous use should be limited to a period of 1-2 days due to the danger of thrombophlebitis especially in patients with elderly age. 

Ceftriaxone: It belongs to the class of third-generation cephalosporins and has a high efficacy against gram-negative bacteria but lesser activity against gram-positive bacteria. 

Ciprofloxacin: It is an antibiotic that stops the bacteria from synthesizing DNA thus putting a halt to bacterial replication. It is most active against the gram-negative ones and can be combined with the aforementioned drug nafcillin. 

Vancomycin: It is effective against Staphylococcus epidermidis which is Gram-positive and facultatively anaerobic organism. To reduce the chance of toxicity when using vancomycin, the trough concentrations are recommended to be determined at least after 3rd dose and before the subsequent dose that is at about 30 minutes. The dosage adjustment for the patients with the compromised renal function should be based on the creatinine clearance. 

Infectious Disease

Isoniazid: The medication is quite effective, relatively cheap and most of the time the side effects associated with the drug are mild. If peripheral neuropathy develops as a side effect, then pyridoxine should be administered. It is recommended that a prophylactic dose of 6-50mg/day of pyridoxine should be administered to reduce the development of neuropathy. 

Rifampin: It is administered with other antituberculosis drugs, such as isoniazid, for effective treatment of tuberculosis. This agent functions by binding selectively to bacterial RNA polymerase rather than mammalian RNA polymerase, although cross-resistance is possible. Duration of therapy ranges from 6 to 9 months or until six months from the time the sputum culture converts to negative. 

Infectious Disease

Amphotericin B Lipid Complex: Amphotericin B which can be isolated from Streptomyces nodosus is both fungistatic and fungicidal. The mechanism of action involves the formation of a complex with the sterols present in the fungal cell membrane like ergosterol that finally results in the alteration of the cell membrane permeability and cell death. 

Fluconazole: It is a synthetic, broad spectrum antifungal agent which acts by interfering with fungal cytochrome P-450 and competitive inhibition of sterol C-14alpha demethylase. This is usually advised for use in conjunction with amphotericin B. 

Infectious Disease

Joint Aspiration and Drainage: This procedure is essential in the diagnosing and managing of the disease. It entails as a process of evacuation of the purulent material (pus) and synovial fluid in the infected joint to provide relief of pressure, pain and improve penetration of antibiotics. 

Antibiotic Therapy: Following the act of aspiration, intravenous antibiotics that are broad-spectrum are normally given and may later be redirected according to culture and sensitivity reports. The antibiotics used depend on the likely organism and the patient characteristics. 

Surgical Intervention: If joint aspiration is not sufficient or infection persists after administration of antibiotics then surgical procedure is required to clean the joint. This is a more elaborate process in order to ensure that affected tissue is gotten out and may at times include replacement of the joint, if it has been affected by the infection. 

Supportive Care: This includes pain management, joint immobilization, and physical therapy when the acute stage of the infection is managed. These measures assist in regaining joint movements and avoiding undesirable consequences. 

Infectious Disease

Acute Phase: They emphasise early operative intervention with joint aspiration to achieve reduction of pressure and for sampling of synovial fluid for analysis. To treat the infection, broad-spectrum intravenous antibiotics are commenced; pain relief and joint immobilisation are applied. 

Subacute Phase: Once a pathogen has been isolated, and its sensitivities are known, the antibiotics are adjusted to address the infection. Further joint care including follow up with physical therapy is beneficial in the region in dealing with stiffness of the joints. 

Recovery Phase: After the infection has been cleared, treatment focuses on regaining mobility of the affected joint entirely. This may include constant physical therapy and examination of the whole body for any abnormalities that may have resulted from the incident. The management of those antecedent factors that culminated into the formation of the infection is also of importance in this stage.