Increased occurrence of native septic arthritis in adult cirrhotic patients: a population-based three-year follow-up study in Taiwan

Hung, Tsung–Hsing; Hsieh, Min-Hong; Lay, Chorng-Jang; Tsai, Chen-Chi; Tsai, Chen–Chi

doi:10.5114/pg.2014.47896

Cited by 5 publications

(6 citation statements)

References 32 publications

(30 reference statements)

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“…Liver disease in musculoskeletal patients is not well-described in the literature. Several case reports and case series describe septic arthritis in patients with liver cirrhosis [ 34 – 37 ]. Liver cirrhosis can lead to neutrophil phagocytic dysfunction and impairment of the innate immune system, which leads to increased risk of infection [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports and case series describe septic arthritis in patients with liver cirrhosis [ 34 – 37 ]. Liver cirrhosis can lead to neutrophil phagocytic dysfunction and impairment of the innate immune system, which leads to increased risk of infection [ 34 ]. In our cohort, three out of five patients had liver cirrhosis; the other two had fatty liver disease, all of which had moderate alcohol consumption.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre

Zhou

Hussain

et al. 2022

Clin Rheumatol

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Background Septic arthritis (SA) is a dangerous condition that requires emergency treatment. Managed by culture-specific antibiotics, irrigation, and debridement (I&D), some patients require repeat surgical treatment. The objectives were to determine the risk factors for SA and risk factors for repeat arthroscopic I&D in SA patients. We hypothesized that variables which directly or indirectly contributed to a larger infection burden would be associated with the development of SA and the need for repeat arthroscopic I&D. Methods All patients ≥ 18 years old presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2018 and January 2020 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma and metalwork in the affected joint, periprosthetic joint infection, previous joint arthroplasty surgery, soft tissue infection, missing data, transferred to another centre, diagnosis not concerning the joint, and < 24-month follow-up were excluded. Two hundred eleven patients were included (SA: 28; pseudogout: 32; gout: 50; others: 101). Variables of interest in the 3-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariable analysis. A multivariable logistic regression model was formed using covariates with corresponding univariable tests of p < 0.200. Similar analyses were performed to compare SA patients with multiple washouts/procedures with those with one washout/procedure. Results Multivariable analysis showed multiple risk factors for SA, namely rheumatoid arthritis (RA) (OR: 3.4; 95% CI: 1.2–10.0; p = 0.023); skin infection (OR: 3.3; 95% CI: 1.2–9.0; p = 0.017), liver disease (OR: 9.9; 95% CI: 2.2–43.9; p = 0.003), knee joint involvement (OR: 3.5; 95% CI: 1.3–9.4; p = 0.014), and use of immunosuppressive medication (OR: 3.5; 95% CI: 1.2–10.6; p = 0.027). Risk factors for multiple washouts included synovial WBC levels > 10.5 × 109 cells/L (OR: 3.0; 95% CI: 2.3–38.8; p = 0.009) and RA (OR: 3.5; 95% CI: 1.9–66.3; p = 0.017). Conclusions These findings suggest that prophylactic actions against septic arthritis should be targeted at patients with liver disease, RA, or skin infection. Repeat arthroscopic I&D of septic joints may be needed, especially in patients with synovial WBC levels > 10.5 × 109 cells/L and RA. Key Points• The risk factors for septic arthritis determined in this study are rheumatoid arthritis, skin infection, liver disease, knee joint involvement, and immunosuppressant usage.• Some septic arthritis patients need multiple rounds of arthroscopic irrigation and debridement. The risk factors for this are a synovial WBC count > 10.5 × 109 cells/L and rheumatoid arthritis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre

Zhou

Hussain

et al. 2022

Clin Rheumatol

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“…Therefore, in patients with CLD and fever and limitation of joint movements, we should have a high suspicion of septic arthritis to diagnose and treat it promptly. [22] In the study conducted by Hung et al [23] 35,106 adult cirrhosis patients without a history of septic arthritis or prosthetic joints and 33,457 non-cirrhotic patients were followed for three years. The incidence of septic arthritis was approximately two-fold higher in patients with cirrhosis than patients without cirrhosis (p=0.001).…”

Section: Infectionsmentioning

confidence: 99%

“…In the study conducted by Hung et al[ 23 ] 35,106 adult cirrhosis patients without a history of septic arthritis or prosthetic joints and 33,457 non-cirrhotic patients were followed for three years. The incidence of septic arthritis was approximately two-fold higher in patients with cirrhosis than patients without cirrhosis (p=0.001).…”

mentioning

confidence: 99%

Common musculoskeletal disorders in chronic liver disease patients

et al. 2021

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Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.

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“…Metabolic derangements and impaired immunity make patients with liver cirrhosis more prone to infections, osteoporosis and osteonecrosis and hence to septic arthritis. [20][21][22][23] Large joints with abundant blood supply to the metaphyses are most prone to bacterial infection, with the most commonly affected joints being the hip, knee and shoulder. Patients usually present with pain and swelling over the affected joint with fever.…”

Section: Septic Arthritismentioning

confidence: 99%

Cirrhosis-related musculoskeletal disease: radiological review

Arora¹,

Rajesh²,

Bansal³

et al. 2016

BJR

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Musculoskeletal problems in patients with liver disease are common; however, they are not so well described in the literature. Therefore, there is a need to collate information on these disorders, as their incidence is on a constant rise and some of these pathologies can severely debilitate the patient's quality of life. These disorders are parietal wall varices with or without bleeding, spontaneous intramuscular haematoma (e.g. rectus sheath), abdominal wall hernia, anasarca, hepatic osteodystrophy, septic arthritis, osteomyelitis, necrotizing fasciitis, osseous metastases from hepatocellular carcinoma etc. While portal hypertension plays a key role in disorders, in others, dysregulation of the coagulation system or a compromised immune system are responsible. Imaging plays an essential role in the assessment of these complications and awareness of these musculoskeletal manifestations is vital for establishing a timely diagnosis and planning of appropriate therapy, as these disorders can significantly impact the morbidity and mortality and also influence candidacy for liver transplantation. We herein comprehensively appraise various musculoskeletal complications associated with chronic liver disease/liver cirrhosis especially from an imaging perspective which, to the best of our knowledge, have not been collectively described in English literature.

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Increased occurrence of native septic arthritis in adult cirrhotic patients: a population-based three-year follow-up study in Taiwan

Cited by 5 publications

References 32 publications

Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre

Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre

Common musculoskeletal disorders in chronic liver disease patients

Cirrhosis-related musculoskeletal disease: radiological review

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