Septic Arthritis-Causes,Symptoms and Treatment
Septic arthritis, also called infectious arthritis, is caused by a bacterial infection or more rarely by a fungal or viral infection. The condition is typically acute, causing severe joint pain, inflammation, redness, and in some cases fever and chills but may also become chronic. Septic arthritis may affect any joint but is most frequently found in the knee, hip, shoulder, wrist, elbow, and finger joints.
Septic arthritis in the diabetic foot usually arises from contiguous osteomyelitis spreading into the joint. Occasionally septic arthritis may arise from penetrating injury into the joint. Joint space narrowing and destruction ensues, accompanied by joint effusion. The septic joint fluid may communicate with adjacent structures such as tendon sheaths.
Who gets it?
Septic arthritis can strike any age group, including infants and children. In adults, it most commonly affects weight-bearing joints such as the knee, while in children it is more common in the shoulders, hips, and knees. Risk factors include patients diagnosed with chronic rheumatoid arthritis, certain systemic infections, certain types of cancer, diabetes, sickle cell anemia, or systemic lupus erythematosus (SLE), IV drug abusers and alcoholics, and patients with artificial (prosthetic) joints.
What microbes cause septic arthritis?
Septic arthritis can be caused by bacteria, viruses, and fungi. The most common causes of septic arthritis are bacteria, including Staphylococcus aureus and Haemophilus influenzae. In certain “high-risk” individuals, other bacteria may cause septic arthritis, such as E. coli and Pseudomonas spp. in intravenous drug abusers and the elderly, Neisseria gonorrhoeae in sexually active young adults, and Salmonella spp. in young children or in people with sickle cell disease.
Symptoms
The classic picture is a single swollen joint with pain on active or passive movement. Patients with septic arthritis usually present with a single swollen joint with pain on active or passive movement. The knee is involved in about 50% of the cases, but wrists, ankles, and hips are also commonly affected. Septic arthritis may present as polyarticular arthritis in about 10% to 19% of patients.
How is Septic Arthritis treated?
Start immediately on diagnosis to prevent joint destruction.
Empirical Antibiotics - Discuss with microbiologist. Intravenous flucloxacillin and fusidic acid (or erythromycin or clindamycin) for at least a week. In immunosuppressed, gentamicin and flucloxacillin is used. The antibibiotics are continued orally (usually two antibiotics for six weeks and then one for a further six weeks).
Drainage of the joint and arthroscopic washouts are helpful in relieving pain
Infected fluid is drained from the affected joint. This helps to stop damage to the joint while the antibiotics clear the infection. With an infection in a knee, elbow or shoulder joint the drainage may be relatively easy to do with a needle. However, deeper joints such as a hip joint are more difficult and may need a small operation to drain the infected fluid. The joint may need to be drained several times until infected fluid stops building up.
