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{{Septic arthritis}}
{{Septic arthritis}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
{{CMG}}; {{AE}}{{VSKP}}
==Overview==
[[Septic arthritis]] can lead to the development of [[bacteremia]] and [[sepsis]].Prompt diagnosis, rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis.Prognosis of septic arthritis depends on various factors such host [[immune response]], pre-existing [[joint]] disease, presence of risk factors, [[virulence]] of the pathogen and the duration between onset of symptoms and diagnosis.Poly-articluar septic arthritis in particular, carries a poor prognosis because of bacteremia and sepsis which is associated with increased [[mortality]].Close attention has to be paid to identify and rule out common and chronic joint disorder such as [[rheumatoid arthritis]] co-existing with septic arthritis.


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==Natural History==
Septic arthritis commonly presents with either mono-articular involvement associated with [[tenosynovitis]] and [[dermatitis]] (gonococcal) or polyarticular involvement (non gonococcal).<ref name="pmid3883171">Goldenberg DL, Reed JI (1985) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883171 Bacterial arthritis.] ''N Engl J Med'' 312 (12):764-71. [http://dx.doi.org/10.1056/NEJM198503213121206 DOI:10.1056/NEJM198503213121206] PMID: [https://pubmed.gov/3883171 3883171]</ref> It is most commonly observed in patients of extreme age groups with pre existing joint disorders such as [[rheumatoid arthritis]] or predisposing conditions such as skin infection.<ref name="pmid1852426">Esterhai JL, Gelb I (1991) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1852426 Adult septic arthritis.] ''Orthop Clin North Am'' 22 (3):503-14. PMID: [https://pubmed.gov/1852426 1852426]</ref> Prompt diagnosis, rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis. Diagnostic delay is an important contributer for the poor outcome of septic arthritis, which carries a 30–50% case-fatality rate.<ref name="pmid9449882">Goldenberg DL (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9449882 Septic arthritis.] ''Lancet'' 351 (9097):197-202. [http://dx.doi.org/10.1016/S0140-6736(97)09522-6 DOI:10.1016/S0140-6736(97)09522-6] PMID: [https://pubmed.gov/9449882 9449882]</ref> If septic arthritis involving multiple joints, case fatality rate will be >50%.<ref name="pmid11157138">{{cite journal| author=Gupta MN, Sturrock RD, Field M| title=A prospective 2-year study of 75 patients with adult-onset septic arthritis. | journal=Rheumatology (Oxford) | year= 2001 | volume= 40 | issue= 1 | pages= 24-30 | pmid=11157138 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11157138  }} </ref>


==Complications==
==Complications==
*Joint degeneration ([[arthritis]])
Complications of septic arthritis mainly depends on the pre existing joint disease and treatment of current infection. Major complications of septic arthritis includes:<ref name="pmid8059468">Andersen K, Bennedbaek FN, Hansen BL (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8059468 [Septic arthritis].] ''Ugeskr Laeger'' 156 (26):3871-5. PMID: [https://pubmed.gov/8059468 8059468]</ref><ref name="pmid8412643">Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8412643 Polyarticular septic arthritis.] ''Medicine (Baltimore)'' 72 (5):296-310. PMID: [https://pubmed.gov/8412643 8412643]</ref><ref name="pmid9306869">Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9306869 Incidence and sources of native and prosthetic joint infection: a community based prospective survey.] ''Ann Rheum Dis'' 56 (8):470-5. PMID: [https://pubmed.gov/9306869 9306869]</ref><ref name="pmid9153550">Kaandorp CJ, Krijnen P, Moens HJ, Habbema JD, van Schaardenburg D (1997) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9153550 The outcome of bacterial arthritis: a prospective community-based study.] ''Arthritis Rheum'' 40 (5):884-92. [http://dx.doi.org/10.1002/1529-0131(199705)40:5<884::AID-ART15>3.0.CO;2-6 DOI:10.1002/1529-0131(199705)40:5<884::AID-ART15>3.0.CO;2-6] PMID: [https://pubmed.gov/9153550 9153550]</ref><ref name="pmid8849354">Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849354 Risk factors for septic arthritis in patients with joint disease. A prospective study.] ''Arthritis Rheum'' 38 (12):1819-25. PMID: [https://pubmed.gov/8849354 8849354]</ref><ref name="pmid3288326">Klein RS (1988) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3288326 Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection.] ''Clin Geriatr Med'' 4 (2):375-94. PMID: [https://pubmed.gov/3288326 3288326]</ref>
 
=== Common Complications ===
*[[Degenerative Arthritis|Joint degeneration]] ([[arthritis]]): common with non gonococcal arthritis (~ 40%)
*[[Bacteremia]] (5-20%)
*[[Osteomyelitis]]
'''In children:''' As the growth plate is in very close to [[epiphysis]], direct extension of a joint infection to the growth plate can lead to reduced bone growth in children.<ref name="pmid6749955">Knights EM (1982) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6749955 Infectious arthritis.] ''J Foot Surg'' 21 (3):229-33. PMID: [https://pubmed.gov/6749955 6749955]</ref><ref name="pmid5297142">Nelson JD, Koontz WC (1966) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=5297142 Septic arthritis in infants and children: a review of 117 cases.] ''Pediatrics'' 38 (6):966-71. PMID: [https://pubmed.gov/5297142 5297142]</ref>
 
=== Less Common Complications ===
* [[Endocarditis]]
* [[Pericarditis]]
* [[Pyomyositis]]
* [[Perihepatitis]]
* [[Meningitis]]


==Prognosis==
==Prognosis==
Recovery is good with prompt [[antibiotic]] treatment. If treatment is delayed, permanent joint damage may result.
Prognosis of septic arthritis depends on various factors such host immune response, pre existing joint disease, presence of risk factors, [[virulence]] of the pathogen and the duration between onset of symptoms and diagnosis.<ref name="pmid769545">Goldenberg DL, Cohen AS (1976) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=769545 Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis).] ''Am J Med'' 60 (3):369-77. PMID: [https://pubmed.gov/769545 769545]</ref><ref name="pmid3883171">Goldenberg DL, Reed JI (1985) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883171 Bacterial arthritis.] ''N Engl J Med'' 312 (12):764-71. [http://dx.doi.org/10.1056/NEJM198503213121206 DOI:10.1056/NEJM198503213121206] PMID: [https://pubmed.gov/3883171 3883171]</ref><ref name="pmid1115748">Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES (1975) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1115748 Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage.] ''Arthritis Rheum'' 18 (1):83-90. PMID: [https://pubmed.gov/1115748 1115748]</ref>
==References==
 
Indicators of poor prognosis:
* Elderly patient (age > 80 yrs)
* Pre existing medical conditions such as [[diabetes mellitus]] or pre existing joint diseases such as [[rheumatoid arthritis]] or [[Prosthetic|prosthetic joint]]
* Presentation with poly articular involvement which increases the risk of [[bacteremia]]
 
* Delayed beginning of antibiotic therapy, especially 7 days after initial presentation
* Unable to sterilize synovium with in 6 days of antimicrobial therapy
* Septic arthritis due to virulent organism that produces super antigens (e.g. [[Staphylococcus aureus|Staph. aureus]], [[Gram negative bacteremia|Gram -ve bacilli]])
* Late mobilization and absence of physical therapy 
 
== References ==
{{reflist|2}}
{{reflist|2}}
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Arthritis]]
[[Category:Arthritis]]
[[Category:Needs content]]
[[Category:Medical emergencies]]
[[Category:Medical emergencies]]
[[Category:Signs and symptoms]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]
[[Category:Infectious disease]]
 
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]


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Latest revision as of 18:46, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Septic arthritis can lead to the development of bacteremia and sepsis.Prompt diagnosis, rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis.Prognosis of septic arthritis depends on various factors such host immune response, pre-existing joint disease, presence of risk factors, virulence of the pathogen and the duration between onset of symptoms and diagnosis.Poly-articluar septic arthritis in particular, carries a poor prognosis because of bacteremia and sepsis which is associated with increased mortality.Close attention has to be paid to identify and rule out common and chronic joint disorder such as rheumatoid arthritis co-existing with septic arthritis.

Natural History

Septic arthritis commonly presents with either mono-articular involvement associated with tenosynovitis and dermatitis (gonococcal) or polyarticular involvement (non gonococcal).[1] It is most commonly observed in patients of extreme age groups with pre existing joint disorders such as rheumatoid arthritis or predisposing conditions such as skin infection.[2] Prompt diagnosis, rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis. Diagnostic delay is an important contributer for the poor outcome of septic arthritis, which carries a 30–50% case-fatality rate.[3] If septic arthritis involving multiple joints, case fatality rate will be >50%.[4]

Complications

Complications of septic arthritis mainly depends on the pre existing joint disease and treatment of current infection. Major complications of septic arthritis includes:[5][6][7][8][9][10]

Common Complications

In children: As the growth plate is in very close to epiphysis, direct extension of a joint infection to the growth plate can lead to reduced bone growth in children.[11][12]

Less Common Complications

Prognosis

Prognosis of septic arthritis depends on various factors such host immune response, pre existing joint disease, presence of risk factors, virulence of the pathogen and the duration between onset of symptoms and diagnosis.[13][1][14]

Indicators of poor prognosis:

  • Delayed beginning of antibiotic therapy, especially 7 days after initial presentation
  • Unable to sterilize synovium with in 6 days of antimicrobial therapy
  • Septic arthritis due to virulent organism that produces super antigens (e.g. Staph. aureus, Gram -ve bacilli)
  • Late mobilization and absence of physical therapy

References

  1. ↑ 1.0 1.1 Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
  2. ↑ Esterhai JL, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22 (3):503-14. PMID: 1852426
  3. ↑ Goldenberg DL (1998) Septic arthritis. Lancet 351 (9097):197-202. DOI:10.1016/S0140-6736(97)09522-6 PMID: 9449882
  4. ↑ Gupta MN, Sturrock RD, Field M (2001). "A prospective 2-year study of 75 patients with adult-onset septic arthritis". Rheumatology (Oxford). 40 (1): 24–30. PMID 11157138.
  5. ↑ Andersen K, Bennedbaek FN, Hansen BL (1994) [Septic arthritis.] Ugeskr Laeger 156 (26):3871-5. PMID: 8059468
  6. ↑ Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) Polyarticular septic arthritis. Medicine (Baltimore) 72 (5):296-310. PMID: 8412643
  7. ↑ Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56 (8):470-5. PMID: 9306869
  8. ↑ Kaandorp CJ, Krijnen P, Moens HJ, Habbema JD, van Schaardenburg D (1997) The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum 40 (5):884-92. <884::AID-ART15>3.0.CO;2-6 DOI:10.1002/1529-0131(199705)40:5<884::AID-ART15>3.0.CO;2-6 PMID: 9153550
  9. ↑ Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38 (12):1819-25. PMID: 8849354
  10. ↑ Klein RS (1988) Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection. Clin Geriatr Med 4 (2):375-94. PMID: 3288326
  11. ↑ Knights EM (1982) Infectious arthritis. J Foot Surg 21 (3):229-33. PMID: 6749955
  12. ↑ Nelson JD, Koontz WC (1966) Septic arthritis in infants and children: a review of 117 cases. Pediatrics 38 (6):966-71. PMID: 5297142
  13. ↑ Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545
  14. ↑ Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES (1975) Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage. Arthritis Rheum 18 (1):83-90. PMID: 1115748


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