Osteoarticular complications of brucellosis

Article Abstract:

Brucellosis is a bacterial infection which affects humans and domesticated animals. The infection is particularly prevalent in Mediterranean and Middle Eastern countries and is often associated with exposure to animals or unpasteurized dairy products. The infection is characterized by a fever usually accompanied by chills, sweating, and malaise, and arthritis is a frequent complication. However, brucellosis-related arthritic problems have not been clearly classified. To better characterize this type of arthritis, 65 patients with joint disease (16 female) of 263 patients with brucellosis were evaluated. The proportion of women affected with arthritis was similar to the total infected. Among patients with arthritis, those with spondylitis (inflammation of the vertebrae) were significantly older, with an average age of 44 years, compared to 28 years in the whole group. Diagnosis was delayed significantly longer (by 30 days, on average) in patients with joint involvement. Spondylitis occurred in 58 percent of patients, sacroiliitis in 45 percent, while arthritis in other single joints occurred in 10 percent. Fourteen patients had multiple joint involvement. Joint abnormalities were present on X-ray at the time of diagnosis in 72 percent of patients. Twenty-six percent of patients with normal X-rays had abnormalities detectable by bone scan. Eight patients had abscesses of the vertebrae, one of whom died, while another sustained severe neurological problems. Blood cultures to identify brucella bacteria were useful for diagnosis in 60 percent of tested arthritis patients, but those with spondylitis had positive cultures less often. Drug therapy was effective in 89 percent of patients, while eight patients with spondylitis required surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of

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Brucella arthritis: a study of 96 cases in Kuwait

Article Abstract:

Brucellosis, a bacterial disease, is usually transmitted to humans through the ingestion of unpasteurized milk or by contact with infected animals. It is still widespread in developing countries, including Central America and the Middle East. Brucellosis primarily causes fever, but can affect many body tissues, and arthritis is a common symptom. This article reviews the clinical characteristics of 96 of 104 patients with arthritis out of a group of 400 patients with brucellosis. Twice as many males were affected by arthritis, and patients were aged 13 to 75 years, most being under 40 years of age. Of the arthritic patients, 54 had acute brucellosis, 24 had subacute infection, and 18 had chronic disease. Patients with acute disease were sicker, while those with chronic disease tended to experience headache, depression, and insomnia. Most patients, regardless of disease type, had joint pain, fever, sweats, and were easily fatigued. Up to 32 percent of patients had abnormal liver function tests. However, this finding and the results of other laboratory tests were not specific enough to aid in the diagnosis of brucellosis. Instead, the diagnosis could be made reliably with the ELISA (enzyme-linked immunosorbent assay) test, in which antibodies specifically recognize Brucella bacteria. Arthritis affected the sacroiliac joint in 26 percent of cases; the knee and hip were affected slightly less often. Joint effusion (fluid accumulation) occurred in 30 percent of patients, primarily in knee, ankle, and wrist joints. Patients responded well to antibiotic therapy, as few relapses occurred. Relapsing patients were effectively treated with new drug regimens. No serious complications or deaths occurred in these 96 cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kuwait

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Small intestinal mucosal protection mechanisms and their importance in rheumatology

Article Abstract:

Many physiological features of the intestinal tract provide the body with protection against infection. Disturbances of intestinal immune mechanisms or other factors may underlie the development of some inflammatory joint diseases, including reactive arthritis, ankylosing spondylitis, and rheumatoid arthritis. Nonimmune intestinal mechanisms include stomach acid, normal bowel bacteria, protein-destroying enzymes, and mucus production. Epithelial cells, which line the intestinal tract, exclude large molecules while allowing absorption of nutrients, salts, and water. The most important protective immune mechanism is the production of antibodies by cells within the intestine. The physiology of this immunity is described. It is possible that penetration of bacterial products through the intestinal barrier, made possible by defects in the mucosal barrier or alteration in intestinal immune function, may underlie development of certain types of arthritis. More study is needed before this issue can be resolved. Many patients with arthritis take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, and these medications alter intestinal permeability, thus confounding studies on whether intestinal permeability is altered before the development of arthritis. However, there is fairly strong evidence that patients with ankylosing spondylitis have altered intestinal permeability, independent of NSAID use. The medical literature on these issues is reviewed. More research that focuses on immune function in the intestines, rather than blood, is needed before this issue can be better understood. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intestines, Gastrointestinal mucosa

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