What is Septic Arthritis

Infective arthritis may represent a direct invasion of joint space by a variety of microorganisms, including a variety of bacteria, viruses, mycobacteria, and fungi. Reactive arthritis, a sterile inflammatory process, may be the consequence of an infectious process located somewhere else in the body. Although any infectious agent may cause arthritis, bacterial pathogens are the most rapidly destructive.

Acute septic arthritis tends to be caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae and group B streptococcus while chronic septic arthritis (which occurs less frequently) is caused by organisms such as Mycobacterium tuberculosis and Candida albicans. In most instances only a single joint is affected, and the knee and the hip are the most commonly infected joints.

Statistics on Septic Arthritis

Septic arthritis can occur at any age. When considering children, it occurs at a higher rate in those under 3 years of age, with the hip, knee and ankle being the most common joints affected.

From age 3 to adolescence, Septic arthritis is uncommon, at which point incidence will increase again. This is due partly to the incidence of STI based Septic arthritis (such as gonococcal arthritis in females with cervical Gonorrhoea).

Septic arthritis is often seen in the elderly, immunosuppressed and those with chronic inflammatory arthritides (such as rheumatoid arthritis), as these are predisposing conditions.

Risk Factors for Septic Arthritis

Risk factors for Septic arthritis include a simultaneous bacterial infection, chronic illness, diseases or medications that operate on suppression of the immune system, intravenous drug abuse, rheumatoid arthritis, sickle cell disease, artificial joints, recent damage to a joint leading to bruising/inflammation, or recent joint arthroscopy or other invasive surgery.

Progression of Septic Arthritis

The individual will feel that the joint is hot, red, swollen, painful, with loss of range of movement. You may have a fever.

How is Septic Arthritis Diagnosed?

The health professional examining you will take blood to perform a test called a full blood count. If you have septic arthritis, this will generally show an increased number of white cells in your blood.

X-ray have no value in diagnosis.

Prognosis of Septic Arthritis

Recovery is positive with quick diagnosis and prompt antibiotic treatment. If treatment is delayed however, permanent joint damage may result.

How is Septic Arthritis Treated?

Start immediately on diagnosis to prevent joint destruction.

  • Empirical Antibiotics – Discuss with microbiologist. Intravenous flucloxacillin and fusidic acid (or erythromycin or clindamycin) for at least a week. In immunosuppressed, gentamicin and flucloxacillin is used. The antibibiotics are continued orally (usually two antibiotics for six weeks and then one for a further six weeks).
  • Drainage of the joint and arthroscopic washouts are helpful in relieving pain
  • Analgesia
  • Immobilize joint and then physiotherapy started earlyu to prevent stiffness and muscle wasting.

Septic Arthritis References

  1. Division of Rheumatology, Johns Hopkins Hospital, Baltimore
  2. Goldenberg DL, Cohen AS: Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 1976 Mar; 60(3): 369-77
  3. Rosenthal J, Bole GG, Robinson WD: Acute nongonococcal infectious arthritis. Evaluation of risk factors, therapy, and outcome. Arthritis Rheum 1980 Aug; 23(8): 889-97
  4. Zimmermann B, Mikolich DJ, Ho G: Septic bursitis. Semin Arthritis Rheum 1995 Jun; 24(6): 391-410

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