The incidence of acute arthritis in stroke patients, and its impact on rehabilitation

To investigate the occurrence of acute arthritis after stroke,we prospectively studied 111 patients presenting with theirfirst stroke and no history of previous arthritis. Clinical,biochemical and serological assessment was complemented by brainCT scan; appropriate X-rays were taken of any inflamed jointsand synovial fluid was collected and analysed. Those with asepticarthritis were randomly chosen to receive either intra-articularsteroids or nonsteroidal anti-inflammatory drugs (NSAIDs). Patientswith significant renal impairment were excluded. Acute arthritiswas observed within 8.34 (median) days, on the paretic sidein 19 patients (10 crystal, 4 inflammatory osteoarthritis, 1septic, 4 unexplained) unexplained) and on the non-paretic sidein 4 patients (1 inflammatory osteoarthritis, 1 septic, 2 unexplained).One patient had pseudogout affecting both sides. Thiazide therapyprior to the stroke was associated with gout in 3 patients.Hospital patients with arthritis had a longer median lengthof stay than those without (41 vs. 21 days: p =0.01). Patientsreceiving intra-articular steroids recovered more rapidly thanthose treated with NSAIDs (p<0.05). This prospective studydemonstrates the occurrence of acute arthritis in paretic limbsafter stroke.Physicians should be aware of this complication,and that administration of intra-articular steroids in asepticcases speeds rehabilitation and recovery.