All joints are assessed for inflammation, deformities, and contractures. The patient's ability to perform activities of daily living (ADLs) is evaluated. The patient is assessed for fatigue. Vital signs are monitored, and weight changes, pain (location, quality, severity, inciting and relieving factors), and morning stiffness (esp. duration) are documented. Use of moist heat is encouraged to relieve stiffness and pain. Prescribed anti-inflammatory and analgesic drugs are administered and evaluated; the patient is taught about the use of these medications. Patient response to all medications is evaluated, esp. after a change in drug regimen, and the patient and family are taught to recognize the purpose, schedule, and side effects of each. Over-the-counter drugs and herbal remedies may interact with prescribed drugs and should not be taken unless approved by physicians or pharmacists. Inflamed joints are occasionally splinted in extension to prevent contractures. Pressure areas are noted, and range of motion is maintained with gentle, passive exercise if the patient cannot comfortably perform active movement. Once inflammation has subsided, the patient is instructed in active range-of-motion exercise for specific joints. Warm baths or soaks are encouraged before or during exercise. Cleansing lotions or oils should be used for dry skin. The patient is encouraged to perform ADLs, if possible, allowing extra time as needed. Assistive and safety devices may be recommended for some patients. The patient should pace activities, alternate sitting and standing, and take short rest periods. Referral to an occupational or physical therapist helps keep joints in optimal condition as well as teaching the patient methods for simplifying activities and protecting joints. The importance of keeping PT/OT appointments and following home-care instructions should be stressed to both the patient and the family. A well-balanced diet that controls weight is recommended (obesity further stresses joints). Both patient and family should be referred to local and national support and information groups. Desired outcomes include cooperation with prescribed medication and exercise regimens, ability to perform ADLs, slowed progression of debilitating effects, pain control, and proper use of assistive devices. For more information and support, patient and family should contact the Arthritis Foundation (404-872-7100) ().
Patients with disseminated Neisseria gonorrhoeae infection are usually young, healthy, and sexually active. 30 Disseminated gonococcal infection may have various clinical musculoskeletal presentations, with or without associated dermatitis. Patients typically display a migratory pattern of arthralgias, tenosynovial inflammation, or nonerosive arthritis. 6 , 23 , 30 Blood cultures are seldom positive, and synovial fluid cultures are variable, with a positive result in only 25 to 70 percent of patients with gonococcal arthritis. 19 , 23 When a disseminated gonococcal infection is suspected, cultures should be taken from potentially infected mucosal sites (., urethra, rectum, pharynx, cervix). 30 , 41 PCR testing has a sensitivity of 76 percent and a specificity of 96 percent for N. gonorrhoeae , and may be useful in patients with culture-negative disease if the clinical scenario is unclear or similar to a reactive arthritis. 26
In a different form of arthritis, called reactive arthritis , an infection in another party of the body – usually the intestines, genitals or urinary tract – triggers an inflammatory response in the joints. Unlike septic arthritis, however, the infection itself is not present in the joint. Several types of systemic infections – including Lyme disease , infectious hepatitis, fifth disease , mumps, German measles and rheumatic fever – can also have joint symptoms or can trigger arthritis, but as with reactive arthritis the joint itself is not infected.