Clinical Management of Septic Arthritis

Sharff, Katie A.; Richards, Eric P.; Townes, John M.

doi:10.1007/s11926-013-0332-4

Cited by 117 publications

(105 citation statements)

References 83 publications

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“…Previous studies have therefore emphasized the need to evaluate and treat septic arthritis on emergency basis due to the rapid cartilage destruction in non-gonococcal septic arthritis. 19,20 Among the 6 cases of crystal induced arthritis (gout), Four cases presented with 1st metatarsophalangeal (MTP) joint involvement, one with 1st distal interphalangeal (DIP) joint and one with ankle joint involvement. Four cases showed crystals in joint aspirate and remaining 2 were diagnosed on the basis of hyperuricemia, joint pain and risk factors.…”

Section: Discussionmentioning

confidence: 99%

Etiology and outcome of mono-articular arthritis: a follow up study

2018

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Background: Monoarthritis is a common rheumatological complaint. Inspite of investigations, many cases remain undiagnosed. Prompt investigation and treatment is important in acute arthritis especially septic arthritis else joint destruction, permanent disability or even death can result. This study was conducted to etiologically categorise patients as inflammatory, non-inflammatory and infective arthritis and to study the outcome.Methods: This observational prospective study conducted at a tertiary care hospital in Mumbai enrolled 40 patients above the age of 12 yrs presenting with first episode of mono-articular arthritis. They were treated with standard treatment guidelines and followed up every 3 monthly for one year. Outcome was assessed using ESR, CRP values and Health Assessment Questionnaire.Results: Mean age at diagnosis was 38 years with a male to female ratio of 1.4:1. Acute and chronic mono-articular arthritis cases were 16.2% and 83.7% respectively. Knee joint was most commonly involved (38%). Etiologically inflammatory, infectious and non-inflammatory cases were 59.5%, 29.7% and 10.8% respectively. In 21% cases etiology was tuberculosis. 27 % evolved into oligoarthritis over one year. The serial ESR, CRP values and Stanford Health Assessment Questionarre scores decreased significantly across all etiological groups with treatment.Conclusions: Knee is the most commonly affected joint in mono-articular arthritis. Tuberculosis is the most common etiology. Irrespective of the etiology, if patients are treated according to standard guidelines promptly mono-articular arthritis has a good response to therapy as assessed by the health assessment questionnaire (HAQ) and serial measurements of proinflammatory markers like ESR, CRP.

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Section: Discussionmentioning

confidence: 99%

Etiology and outcome of mono-articular arthritis: a follow up study

2018

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“…In the past 20 years, we have been treating an increasing number of MRSA SA, healthcare as well as community acquired, even in patients who do not have traditional risk factors for MRSA acquisition 7 11. Therefore, some authors recommend initial antibiotic treatment with coverage for MRSA in patients at risk or where the local incidence of community-associated infection is greater than 10% 1 2.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors propose an empiric antibiotic regime based on clinical presentation, host risk factors, Gram stain results and knowledge of local prevalence of drug-resistant pathogens 7 8 12. A schema of 2–4 weeks of parental therapy is also suggested for S. aureus joint infection depending on the expert group 7 13. In the case of this patient, a 2-week treatment course with vancomycin and gentamicin was performed with no recurrence.…”

Section: Discussionmentioning

confidence: 99%

Sternoclavicular septic arthritis due to methicillin-resistantStaphylococcus aureusin a patient with a suprapubic catheter

et al. 2015

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We report a case of a 74-year-old man who presented to the emergency department with a 1-week history of fever. He had a meatal stenosis and had a suprapubic catheter for 10 months, and had a recent hospitalisation for urosepsis with bacteraemia due to methicillin-resistant Staphylococcus aureus after manipulation of the catheter. Clinical examinations were performed in the emergency department and the patient was hospitalised with the diagnosis of recurrent urinary tract infection. The following day, we noticed the development of a mass in the left sternoclavicular joint with inflammatory signs and excruciating pain. Ultrasonographic findings led to the diagnosis of left sternoclavicular synovitis, and methicillin-resistant S. aureus grew in blood cultures leading to the diagnosis of sternoclavicular septic arthritis. Treatment with vancomycin and gentamicin was started and maintained for 4 weeks with complete resolution of symptoms and no complications or sequelae.

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“…Hence, even though there is some data suggesting that the inflammatory markers can used to distinguish septic arthritis from flares of inflammatory conditions [133e135], our clinical experience suggests that clinical judgment is the most important factor in making this differentiation. A sudden increase in inflammation in one or two joints out of proportion to disease activity should raise the suspicion of superimposed bacterial arthritis [154].…”

Section: Diagnosismentioning

confidence: 99%

“…The higher the synovial fluid leukocyte count, the greater the likelihood of septic arthritis. In patients who are immunocompromised [4], who have been partially treated with prior antibiotics [154] or who have prosthetic joints [159], the synovial fluid leukocyte count may be lower.…”

Section: Joint Aspirationmentioning

confidence: 99%