Prospective Clinical Trial for Septic Arthritis: Cartilage Degradation and Inflammation Are Associated with Upregulation of Cartilage Metabolites

Abstract

Background. Intra-articular infections can rapidly lead to osteoarthritic degradation. The aim of this clinical biomarker analysis was to investigate the influence of inflammation on cartilage destruction and metabolism. Methods. Patients with acute joint infections were enrolled in a prospective clinical trial and the cytokine composition of effusions (n = 76) was analyzed. Characteristics of epidemiology and disease severity were correlated with levels of cytokines with known roles in cartilage turnover and degradation. Results. Higher synovial IL-1β concentrations were associated with clinical parameters indicating a higher disease severity (p < 0.03) excluding the incidence of sepsis. Additionally, intra-articular IL-1β levels correlated with inflammatory serum parameters as leucocyte counts (LC) and C-reactive protein concentrations (p < 0.05) but not with age or comorbidity. Both higher LC and synovial IL-1β levels were associated with increased intra-articular collagen type II cleavage products (C2C) indicating cartilage degradation. Joints with preinfectious lesions had higher C2C levels. Intra-articular inflammation led to increased concentrations of typical cartilage metabolites as bFGF, BMP-2, and BMP-7. Infections with Staphylococcus species induced higher IL-1β expression but less cartilage destruction than other bacteria. Conclusion. Articular infections have bacteria-specific implications on cartilage metabolism. Collagen type II cleavage products reliably mark destruction, which is associated with upregulation of typical cartilage turnover cytokines. This trial is registered with DRKS00003536, MISSinG.

Arthroscopic Treatment Yields Lower Reoperation Rates than Open Treatment for Native Knee but Not Native Shoulder Septic Arthritis

“… 18 , 19 This indicates that there is a high risk for recurrent infection, which may lead to subsequent articular cartilage destruction. 20 With the ultimate goal of prevention of joint destruction, neither open nor arthroscopic approaches showed superiority in decreasing eventual arthroplasty at 2 years with ∼7% of each cohort undergoing TKA conversion. These findings are significant, as patients who undergo arthroplasty following septic arthritis have been shown to have strikingly poorer outcomes than those undergoing arthroplasty for osteoarthritis.…”

Why do we not prescribe steroids in acute native septic arthritis?

“…"Intraarticular infections have bacteria-specific implications on cartilage metabolism. Collagen type II cleavage products reliably mark destruction, which is associated with upregulation of typical cartilage-turnover cytokines" [14]. It should be noted that physicians prescribe steroids in the management of an acute bacterial infection, e.g.…”

Concentration of amikacin sulphate in synovial fluid when given in combination with dexamethasone phosphate in intravenous regional limb perfusion in standing horses

“…Septic synovitis is typically accompanied by an inflammatory response creating oedema, heat and pain in the area of the affected synovial structure. Pro‐inflammatory cytokines, such as IL‐1b, TNFa and oncostatin M have been shown to be responsible for cartilage degradation in cases of synovitis and can cause irreversible damage (Hui et al, 2003; Schmal et al, 2016).…”