Septic arthritis natural history, complications and prognosis: Difference between revisions

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==Complications==
==Complications==
Complications of septic arthritis mainly depends on the pre existing joint disease and treatment of current infection. Major complications of septic arthritis includes:
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 ===
=== Common Complications ===

Revision as of 20:32, 24 January 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

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:[1][2][3][4][5][6]

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.[7][8][9]

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

  1. ↑ Andersen K, Bennedbaek FN, Hansen BL (1994) [Septic arthritis.] Ugeskr Laeger 156 (26):3871-5. PMID: 8059468
  2. ↑ 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
  3. ↑ 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
  4. ↑ 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
  5. ↑ 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
  6. ↑ 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
  7. ↑ 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
  8. ↑ Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
  9. ↑ 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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