Septic arthritis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
==Natural History== | ==Natural History== | ||
Prompt diagnosis. rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis. | |||
==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: | ||
=== Common Complications === | |||
*Joint degeneration ([[arthritis]]): common with non gonococcal arthritis (~ 40%) | |||
*Bacteremaia (5-20%) | |||
*Osteomyelitis | |||
=== Less Common Complications === | |||
* Endocarditis | |||
* Pericarditis | |||
* Pyomyositis | |||
* Perihepatitis | |||
* Meningitis | |||
==Prognosis== | ==Prognosis== | ||
Prognosis 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> | Prognosis 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> | ||
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 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. Staph. aureus, Gram -ve bacilli) | |||
* Late mobilization and absence of physical therapy | |||
Morbidity and mortality due to septic arthritis are varies with host, virulence, diagnostic and treatment factors. | |||
Recovery is good with prompt [[antibiotic]] treatment. If treatment is delayed, permanent joint damage may result. | Recovery is good with prompt [[antibiotic]] treatment. If treatment is delayed, permanent joint damage may result. | ||
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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
Natural History
Prompt diagnosis. rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis.
Complications
Complications of septic arthritis mainly depends on the pre existing joint disease and treatment of current infection. Major complications of septic arthritis includes:
Common Complications
- Joint degeneration (arthritis): common with non gonococcal arthritis (~ 40%)
- Bacteremaia (5-20%)
- Osteomyelitis
Less Common Complications
- Endocarditis
- Pericarditis
- Pyomyositis
- Perihepatitis
- Meningitis
Prognosis
Prognosis 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.[1][2][3]
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 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. Staph. aureus, Gram -ve bacilli)
- Late mobilization and absence of physical therapy
Morbidity and mortality due to septic arthritis are varies with host, virulence, diagnostic and treatment factors.
Recovery is good with prompt antibiotic treatment. If treatment is delayed, permanent joint damage may result.
References
- ↑ 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
- ↑ Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
- ↑ 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