Ho G
Division of Rheumatology, Miriam Hospital, Brown University School of Medicine, Providence, RI 02906.
Curr Opin Rheumatol. 1992 Aug;4(4):509-15.
The 1991 literature on septic arthritis included a concise review of adult septic arthritis, examples of pseudoseptic arthritis, and two interesting animal studies. One animal study examined the induction of acute synovitis by the intra-articular injection of bacterial endotoxin and the cytokines tumor necrosis factor-alpha, and interleukin-1 beta; and the other studied the effects of early and delayed synovectomy in the management of septic arthritis. The predispositions to septic arthritis can be divided into local joint abnormalities, systemic factors, or both. Examples of the local joint abnormalities include osteoarthritis of the hip and apatite-associated arthropathy. Septic arthritis in a patient with rheumatoid arthritis, in a patient with diabetes mellitus and hip arthropathy associated with hemochromatosis, or in a patient with acquired immunodeficiency syndrome and hemophilic arthropathy are examples of how systemic predisposition is coupled with local joint pathology to increase the vulnerability of the host to joint infection. Other examples of systemic disease that predispose to septic arthritis are systemic lupus erythematosus, hypogammaglobulinemia, and human immunodeficiency virus infection, as well as intravenous drug abuse. Unusual microorganisms causing septic arthritis in the adult include Achromobacter xylosoxidans, Moraxella catarrhalis, meningococci, and diphtheroids. Uncommon pathogenesis is represented by a case of intra-articular inoculation of Mycobacterium gastri into the small joint of the hand and a case of mixed bacterial infection of the hip resulting from an extension of a contiguous pelvic infection associated with trauma. Two cases of immune complex glomerulonephritis illustrate the extra-articular complications of septic arthritis: one due to group G streptococcus and the other due to pneumococcus. Finally, septic bursitis is reviewed from the community practice perspective.
1991年关于化脓性关节炎的文献包括一篇关于成人化脓性关节炎的简明综述、假性化脓性关节炎的实例以及两项有趣的动物研究。一项动物研究检测了关节内注射细菌内毒素、细胞因子肿瘤坏死因子-α和白细胞介素-1β诱导急性滑膜炎的情况；另一项研究了早期和延迟滑膜切除术在化脓性关节炎治疗中的效果。化脓性关节炎的易感因素可分为局部关节异常、全身因素或两者皆有。局部关节异常的例子包括髋关节骨关节炎和磷灰石相关关节病。类风湿关节炎患者、糖尿病患者伴血色素沉着症相关的髋关节病、或获得性免疫缺陷综合征患者伴血友病性关节病发生的化脓性关节炎，均为例证，表明全身易感性与局部关节病理状况相结合如何增加宿主对关节感染的易感性。易引发化脓性关节炎的其他全身性疾病实例包括系统性红斑狼疮、低丙种球蛋白血症、人类免疫缺陷病毒感染以及静脉药物滥用。在成人中引起化脓性关节炎的不常见微生物包括木糖氧化无色杆菌、卡他莫拉菌、脑膜炎球菌和类白喉杆菌。不常见的发病机制表现为胃部结核杆菌关节内接种到手的小关节的病例，以及因与创伤相关的连续性盆腔感染蔓延导致髋关节混合细菌感染的病例。两例免疫复合物肾小球肾炎说明了化脓性关节炎的关节外并发症：一例由G组链球菌引起，另一例由肺炎球菌引起。最后，从社区实践角度对脓性滑囊炎进行了综述。
