Septic arthritis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Septic arthritis presents with a joint that is painful, hot, swollen, and restricted.
Diagnosis is based on the opinion of the clinician experienced in the management of musculoskeletal disease.
In all cases of suspected native joint sepsis, the joint should be aspirated.
In all cases of suspected septic arthritis, empirical antibiotic therapy should be commenced once appropriate cultures have been taken.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18.[Abstract]
Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.[Abstract][Full Text]
Coakley G, Mathews C, Field M, et al. BSR and BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford). 2006 Aug;45(8):1039-41.[Abstract][Full Text]
Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].[Full Text]
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].[Full Text]

Referenced Articles

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5. Gupta MN, Sturrock RD, Field M. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis. 2003 Apr;62(4):327-31.[Abstract][Full Text]
6. Dubost JJ, Soubrier M, De Champs C, et al. No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis. 2002 Mar;61(3):267-9.[Abstract][Full Text]
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10. Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18.[Abstract]
11. Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.[Abstract][Full Text]
12. Coakley G, Mathews C, Field M, et al. BSR and BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford). 2006 Aug;45(8):1039-41.[Abstract][Full Text]
13. National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management. Sep 2017 [internet publication].[Full Text]
14. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.[Abstract][Full Text]
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21. Karchevsky M, Schweitzer ME, Morrison WB, et al. MRI findings of septic arthritis and associated osteomyelitis in adults. Am J Roentgenol. 2004 Jan;182(1):119-22.[Abstract][Full Text]
22. American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].[Full Text]
23. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38.[Abstract]
24. Brennan-Olsen SL, Cook S, Leech MT, et al. Prevalence of arthritis according to age, sex and socioeconomic status in six low and middle income countries: analysis of data from the World Health Organization study on global AGEing and adult health (SAGE) wave 1. BMC Musculoskelet Disord. 2017 Jun 21;18(1):271.[Abstract][Full Text]
25. Yagupsky P, Press J. Use of the isolator 1.5 microbial tube for culture of synovial fluid from patients with septic arthritis. J Clin Microbiol. 1997 Sep;35(9):2410-2.[Abstract][Full Text]
26. von Essen R. Culture of joint specimens in bacterial arthritis. Impact of blood culture bottle utilization. Scand J Rheumatol. 1997;26(4):293-300.[Abstract]
27. Ahmed I, Gertner E. Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med. 2012 Mar;125(3):265-9.[Abstract][Full Text]
28. Bashir MA, Ray R, Sarda P, et al. Determination of a safe INR for joint injections in patients taking warfarin. Ann R Coll Surg Engl. 2015 Nov;97(8):589-91.[Abstract][Full Text]
29. The Primary Care Rheumatology and Musculoskeletal Medicine Society. Joint and Soft Tissue Injection Recommendations. 2021 [internet publication].[Full Text]
30. Margaretten ME, Kohlwes J, Moore D, et al. Does this adult patient have septic arthritis? JAMA. 2007 Apr 4;297(13):1478-88.[Abstract]
31. Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med. 2019 Jan 31;380(5):425-36.[Abstract][Full Text]
32. Gjika E, Beaulieu JY, Vakalopoulos K, et al. Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial. Ann Rheum Dis. 2019 Aug;78(8):1114-21.[Abstract][Full Text]
33. Mushtaq S, Choudhary R, Scanzello CR. Non-surgical treatment of osteoarthritis-related pain in the elderly. Curr Rev Musculoskelet Med. 2011 Sep;4(3):113-22.[Abstract][Full Text]
34. Bashir MA, Ray R, Sarda P, et al. Determination of a safe INR for joint injections in patients taking warfarin. Ann R Coll Surg Engl. 2015 Nov;97(8):589-91.[Abstract][Full Text]
35. Mushtaq S, Choudhary R, Scanzello CR. Non-surgical treatment of osteoarthritis-related pain in the elderly. Curr Rev Musculoskelet Med. 2011 Sep;4(3):113-22.[Abstract][Full Text]
36. Ding T, Ledingham J, Luqmani R, et al; Standards, Audit and Guidelines Working Group of BSR Clinical Affairs Committee and BHPR. BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies. Rheumatology (Oxford). 2010 Nov;49(11):2217-9.[Abstract][Full Text]
37. Delgado-Noguera MF, Forero Delgadillo JM, Franco AA, et al. Corticosteroids for septic arthritis in children. Cochrane Database Syst Rev. 2018 Nov 21;11:CD012125.[Abstract][Full Text]
38. Abram SGF, Alvand A, Judge A, et al. Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout. Lancet Infect Dis. 2020 Mar;20(3):341-9.[Abstract]
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