INFECTION IN ARTHRITIS

Dr.Hardik Rathod

•Rheumatoid arthritis, other inflammatory arthritis and autoimmune disease are chronic immune system disorders.

•They ultimately lead to damage and deformities of joints and other extra articular sites like eyes, skin, lungs and other internal organs.

•As patients have their immune system altered, they are somewhat more prone to infection than general population.

•Also because of the treatment  with some immune suppressive function, patients with arthritis are more prone to infection.

•In this article we will talk about some common infection of skin, respiratory system and gut and other systems. 

•Skin and mucosa:

o Common infections of skin like boils due to staphylococcus and cellulitis due to streptococcus and other bacteria are common especially in patients with arthritis with other metabolic disease like diabetes.

o Fungal infection in groin, axillae and intertriginous area due to tinea is also very common, especially in patients with sweating tendency and patients who are on long term steroids treatment.

o Patients with long standing arthritis with deformities can also developed traction ulcers which can get secondary infected and cause trouble.

o Rheumatoid vasculitis though very rare can cause ulcers mainly in legs and these ulcers can get infected causing pus discharge and leads to morbidity.

o Treatment of these infection are generally antibiotics, oral and topical and they respond generally well.

o Generally, there is no need of current arthritis treatment but patients should consult their primary care doctors and rheumatologist as soon as possible for evaluation and treatment.

o Infection of oral mucosa with fungi like candida is also common in patients with arthritis on treatment, patients having diabetes. 

Boil lesion

Cellulitis

Tinea Infection

Oral Candidiasis

• Infection of upper and lower respiratory tracts

o Upper respiratory tract involves nose, upper part of pharynx and larynx.

o Common viral infection like cold, influenza and bacterial infection like pharyngitis and tonsilitis as common with general population.

o Lower respiratory tract includes trachea, bronchi and lungs.

o Bronchitis and pneumonia in lungs can occur in patients with long standing disease on treatment.

o Patients with interstitial lung disease as a complication of RA and other autoimmune conditions are more prone to infection.

o In this pandemic times due to covid 19, patients with arthritis were thought to be more prone for severe infection but lots of data now show that patients with arthritis are not at more risk than general population and they should continue treatment with consultation with their doctor. 

• Infection of gut:

o Loose motions and diarrhoea due to viruses and bacteria and parasites like amoeba can occur but not more than in general population.

o Gastritis due to H Pylori bacteria is also common, it can cause troublesome acidity. Treatment is simple and may need to consult gastroenterologist.

o Other infections like colitis, hepatitis is not so common and can occur along with arthritis and other autoimmune conditions.

o Eating hygienic food and maintaining good health is necessary to avoid such infections.

• Infection of genitourinary system

o Infection in urine generally due to E coli and other bacteria, and candida infection is very common, specially in female patients.

o General symptoms are burning micturition, fever and white discharge. Urine report may show pus cells and culture helps identifying the causative organism and guiding treatment.

o Patients with diabetes, renal stones are more prone than other patients.

o Generally, treatment with antibiotics and drinking lots of water is enough.

o Infection in upper part like in bladder (cystitis) and kidney (pyelonephritis) is not very common but when occur patient may need urgent treatment. 

• Infection in other systems

• EYES:

•  Infection in eyes like conjunctivitis, keratitis is common specially in patients having dry eyes also known as sicca or Sjogren’s syndrome which can occur along with RA.
•  Infection in vitreous and retina (Cytomegalovirus retinitis) is very rare but can be dangerous if not treated properly.
•  Urgent consultation with ophthalmologist and proper treatment can prevent eye damage.

Cardiovascular system

Infective endocarditis, not very common but can occur in patients with very weak immune system. 

Other infections are very rare in cardiovascular system.

• What if you get any one of these?

o No need to panic
o Maintain good health, hygiene
o Regular exercise, Weight control
o Consult your primary care doctor immediately and get treated
o Inform your rheumatologist

THANK YOU, STAY SAFE AND STAY ACTIVE