Septic arthritis differential diagnosis

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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

**Differentiating gonococcal arthritis from non-gonococcal arthritis**
Characterestic	Gonococcal arthritis	Non gonococcal arthritis
Patient profile	Mostly sexually active young adult Female > male	Patient with history of rheumatoid arthritis or other systemic arthritis Immunocompromised patient Common in extremes of age such as in newborn or elderly
Initial presentation	Migratory polyarthralgia is common Tenosynovitis in majority of patients Dermatitis in majority of patients	Single hot, swollen and painful joint Polyarthralgia is very rare Tenosynovitis and dermatitis are very rare.
Polyarticular involvement	Common (~40–70% of patients) Usually involves 2-3 joints	Rare (~10–20% of patients). Mostly monoarticular involvement (>85%)
Recovery of bacteria	Positive blood culture <10% Positive synovial fluid culture <50%	Positive blood culture 50% Positive synovial fluid culture >90%
Response to antibiotics	Within a few days outcome excellent	Takes weeks Joint drainage must be adequate Outcome often poor