Tom Smith arthritis is associated with
(C) Septic arthritis of infancy[?]ACUTE SUPPURATIVE ARTHRITIS IN INFANCY:Pathology:The usual trigger is a haematogenous infection which settles in the synovial membrane; there is an acute inflammatory reaction with a serous or seropurulent exudate and an increase in synovial fluid.As pus appears in the joint, articular cartilage is eroded & destroyed, partly by bacterial enzymes and partly by proteolytic enzymes released from synovial cells, inflammatory cells and pus.In infants the entire epiphysis, which is still largely cartilaginous, may be severely damaged; in older children, vascular occlusion may lead to necrosis of the epiphyseal bone.In adults the effects are usually confined to the articular cartilage, but in late cases there may be extensive erosion due to synovial proliferation and ingrowth.If the infection goes untreated, it will spread to the underlying bone or burst out of the joint to form abscesses and sinuses.With healing there may be: (1) complete resolution and a return to normal; (2) partial loss of articular cartilage and fibrosis of the joint; (3) loss of articular cartilage and bony ankylosis; or (4) bone destruction and permanent deformity of the joint.Clinical features: In new-born infants the emphasis is on septicaemia rather than joint pain. The baby is irritable and refuses to feed; there is a rapid pulse and sometimes a fever.Infection is often suspected, but it could be anywhere!The joints should be carefully felt and moved to elicit the local signs of warmth, tenderness and resistance to movement. The umbilical cord should be examined for a source of infection. An inflamed intravenous infusion site should alwaysexcite suspicion.Baby's chest, spine and abdomen should be carefully examined to exclude other sites of infection.Tom Smith Arthritis:Septic arthritis of hip in infancy.Results in complete destruction of cartilaginous femoral head.Presentation is a child in his preschool age with painless limp. Affected limb is shorter.X-ray shows complete absence of head & neck of femur.Septic Arthritis Pathology:A fibrin-rich exudate.Clotted exudate - a cast in the jointCartilage destruction: lysozymal enzymes dissolve the glycosaminoglycans of the articular cartilage.The femoral head + growth plate destructionOrganisms may vary in their ability to dissolve cartilage: staphylococcus is most damagingHaemophilus influenzae and Gonococcus are the least damaging.Other Options[?]Acute Gonococcal arthritis:Neisseria gonorrhoeae is the commonest cause of septic arthritis in adults.This condition should always be suspected in older age group & patient examined for other signs of genitourinary infections.[?]Smallpox arthritis:Young children with smallpox, virions reach the joints and bone, causing osteomyelitis variolosa.Lesions are symmetrical, most common in the elbows, tibia, and fibula, and characteristically cause separation of an epiphysis and marked periosteal reactions.Swollen joints limit movement, and arthritis may lead to limb deformities, ankylosis, malformed bones, flail joints, and stubby fingers.Now-a-days smallpox arthritits is not seen, because of eradication of smallpox.[?]Chronic pyogenic arthritis:Pyogenic arthritis of the hip is usually seen in children under 2 years of age.The organism (usually a staphylococcus) reaches the joint either directly from a distant focus or by local spread from osteomyelitis of the femur.
Acute gonococcal arthritis
Smallpox arthritis
Septic arthritis of infancy
Chronic pyogenic arthritis
Infection of Bones & Joints