Irregularity of the joint space and narrowing of the joint space

Introduction Arthritic changes caused by a variety of causes are characterized by irregular joint space and narrow joint space. Common in brucellosis arthritis. It can be complicated or form bacteremia and toxemia.

Cause

Common in brucellosis arthritis. Brucellosis arthritis is caused by Brucella infection caused by Brucella after being digested into the body. Most of them are digested in the lymph, bone marrow and spleen. Brucella is negative for Gram-like staining of tiny polymorpha. It is divided into six species of sheep, pigs, rats, sheep, and dogs. In China, sheep are mainly transmitted to humans through sheep, cattle, pigs, and dogs. The pathogens mainly exist in the tissues of the sick animals, urine, milk, and fetuses. Most of them enter the human body through the mouth, and can also invade the body by damaged skin, respiratory mucosa, and the like. Eating milk and cheese that has not been sterilized by Pasteurization is easy to infect Brucella, animals, veterinarians, etc., which are susceptible to people.

an examination

Related inspection

Joint examination blood test

Laboratory inspection:

Brucella requires complex growth conditions, so the positive rate of synovial fluid culture is only 50% to 65%. The total number of white blood cells in the synovial fluid is 10×109/L to 50×109/L, and monocytes are more common. The most commonly used in serological tests is the agglutination test. Newer technology enzyme-linked immunosorbent assays may be more accurate. The complement fixation test and the 2-mercaptoethanol test are commonly used to diagnose chronic brucellosis. Blood cultures in patients with acute brucellosis are generally positive. The positive rate of blood culture in chronic cases is less than 10%, while the positive rate of bone marrow culture is higher. Other ancillary examinations: X-ray examinations have common changes in the scapula and spine. The bones of the tendon ligaments such as the shoulders and condyles are characterized by localized superficial small cystic bone destruction and marginal hardening health search. The calcified joint cavity in the tendon and the bursa is normal without dead bone and sinus. The bone structure of the ankle joint is disordered, the joint space is narrow or blurred, the articular surface is irregularly hardened, the adjacent osteoporosis is loose, the small area is destroyed, and the two sides are fused, and the surrounding area is hardened. When the lumbar vertebra is invaded, calcification or ossification of the ligament and intervertebral cartilage can be seen. The lesion is limited to 1 or 2 intervertebral discs. The intervertebral space is narrowed, and the bone destruction of the upper and lower margins of adjacent vertebral bodies is marked by hyperosteogeny of small bone hyperplasia, irregular joint space, and narrow joint space. >Monocyte>Complement binding reaction clinical manifestations: Brucellosis can be an acute, self-limiting disease, joint pain lasts for several days, arthritis persists after several weeks without sequelae. Healthy search is a chronic, infectious disease. Need to be treated with antibiotics. Chronic or recurrent brucellosis is often caused by a strain of Maltese Brucella that is common in a single joint or asymmetrical few peripheral joints. Knee and hip shoulders are good sites, followed by ankles, wrists, ankles, and elbow joints that can also invade the spine. The ankle joint is common in unilateral. Some patients have both peripheral arthritis and spondyloarthropathy. The patient felt pain in the back and limbs and had symptoms of fever. A few weeks before the onset of arthritis, patients have systemic symptoms such as headache, fatigue, and sweating. The affected joints are characterized by swelling, painful fever and erythema, and exudation in the joints. The heat type is wave heat, sometimes it is relaxation heat or intermittent heat.

Differential diagnosis

Brucellosis arthritis is similar to arthritis caused by Salmonella and Yersinia. Pay attention to identification.

Mainly based on the following aspects of comprehensive analysis and diagnosis:

1. History of pathogen contact: In the affected area, there is a history of contact with sick animals. Or drink dairy products that have not been sterilized by Babbitt.

2. History: A history of acute subacute and chronic Brucella infection.

3. Culture: The acute blood culture rate of acute brucellosis is high. The positive rate of blood culture is only 10%. The positive rate of bone marrow culture is high. The positive rate of joint fluid culture is 50%-65%.

4. Laboratory examination: The total number of white blood cells in the joint fluid is often classified between 10×10 ⁹ and 50×10 ⁹ /L, which is more common in monocytes. Complement binding assays and 2-mercaptoethanol assays are commonly used to diagnose chronic brucellosis. The most commonly used serological test is the agglutination test.

5. X-ray examination: 1 shoulder joint: the humerus nodules, shoulders, condyles and other tendon ligament attachment bones are limited superficial small cystic bone destruction and cystic wall hardening. Calcification occurs at the tendon and bursa. The joint space is normal. 2 Ankle joint: the joint space is narrow or blurred, the articular surface health search is irregularly hardened, adjacent to osteoporosis, small-scale bone destruction, fusion with each other, hardening around the destruction zone 3 lumbar vertebrae: ligament calcification or ossification or manifestation of vertebra Interstitial cartilitis, that is, the lesion is limited to 1 or 2 intervertebral disc space narrowing and bone destruction of the upper and lower margins of adjacent vertebral bodies. Significant bone hyperplasia or small arthritic changes are characterized by irregular joint space and narrow joint space.

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