How to treat brucellotic arthritis?

Author: Zhang Qiang, Chief Physician, Beijing Ditan Hospital, Capital Medical University

Reviewer: Ren Dajiang, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

Brucellosis (brucellosis) is a zoonotic infectious disease caused by Brucella.

If the bacterial concentration is relatively high, it will stay around the joints through blood circulation, grow and multiply, causing some joint damage.

The incidence of joint damage caused by brucellosis is very high. The most common damage is to large joints, including the knee, hip, ankle, elbow, and shoulder joints. Small joints are relatively rare.

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1. Who is prone to joint damage after contracting brucellosis?

Generally speaking, it is more common for people with low resistance, such as the elderly and children, to suffer joint damage after contracting brucellosis.

After joint damage, patients will experience some discomfort symptoms, such as joint pain, swelling, and some walking difficulties, but most of them are transient, and may only invade the synovial membrane of the joint without causing joint bone lesions. However, some patients may develop joints, bone infections, joint damage, and even joint abscesses.

If a joint abscess occurs, the entire joint will swell. If it is more serious, the entire joint may be destroyed, losing function, and causing joint stiffness. Damage to the lower limb joints can cause difficulty in walking or squatting, or even limping. This is a more serious form of arthritis.

2. How to diagnose brucellotic arthritis?

Various tests are required to diagnose brucellotic arthritis, including blood tests, agglutination tests, and joint fluid or blood cultures to determine whether Brucella is present.

Then some imaging examinations are done, especially MRI and CT 3D reconstruction, which can show signal changes or whether there is fluid accumulation in the joints, which are early changes. In addition, CT can find whether there is bone damage. The above examinations can make a clear diagnosis.

Once the diagnosis is confirmed, treatment should be initiated actively.

If it is not treated, it may initially be some inflammation of the synovium, including effusion and excessive secretion, but then it will invade the cartilage. After the cartilage is destroyed, the joint will become stiff and deformed. In addition, some patients will develop joint abscesses, and eventually the joints may become useless or even disabled.

3. How to treat brucellotic arthritis?

Most cases of brucellotic arthritis can be treated with medication. Medication treatment emphasizes adequate dosage and adequate course of treatment. Generally, we emphasize the use of quadruple drugs for bone and joint lesions, including oral doxycycline and rifampicin, and intravenous ofloxacin and third-generation cephalosporin.

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The quadruple drug has a course of two weeks, and generally 2-3 courses are needed. Then, based on the changes in inflammatory indicators, it is determined whether to switch to simple oral medications. However, for this type of bone and joint lesions, it is emphasized that the medication should be taken for at least half a year.

However, in some individual cases, if an abscess occurs, or there is excessive hyperplasia or effusion of the synovial membrane in the joint, minimally invasive arthroscopy can be used for treatment.

Arthroscopic surgery is now quite common. Generally, a few small incisions are made and a tube like a ballpoint pen is inserted into the joint cavity. The lesions inside the joint are observed through a mirror. Any lesions of the cartilage and synovium can be seen clearly and corresponding treatment can also be performed.

For some serious patients, if the cartilage and bones of the joints are damaged, the patients' joints will be stiff and deformed, and they will have difficulty walking. In order to restore their walking function, joint replacement surgery may be necessary.

4. Can brucellotic arthritis be completely cured?

Most cases of brucellotic arthritis can be completely cured by taking medication, especially mild and transient ones, which are easy to cure.

However, for this kind of serious bone and cartilage destruction, joint stiffness, deformity, difficulty in movement, and serious impact on work and life, joint replacement surgery may be necessary. After surgery, the recurrence rate is relatively low. If combined with regular drug treatment and ensuring sufficient treatment and a sufficient course of treatment, most of the time the effect is very good.