Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- hot, swollen, tender, restricted joint
Otros factores de diagnóstico
- history of intravenous drug use
- history of diabetes
- history of cutaneous lesions
- prosthetic joint
- history of rheumatoid arthritis or osteoarthritis
- acute onset of symptoms
- fever
- low socioeconomic status
- history of alcohol use disorder
- history of previous corticosteroid injection
Factores de riesgo
- underlying joint disease
- joint prostheses
- immunosuppression
- intravenous drug use
- diabetes
- alcohol use disorder
- skin lesions
- previous intra-articular corticosteroid injection
- recent joint surgery
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- synovial fluid Gram stain and culture
- synovial fluid white cell count
- blood culture
- serum white cell count
- erythrocyte sedimentation rate
- CRP
- plain radiograph
- ultrasound
- synovium biopsy for Mycobacterium tuberculosis
Pruebas diagnósticas que deben considerarse
- synovial glucose, LDH, lactate, procalcitonin
- synovial polymerase chain reaction (PCR)
- serum procalcitonin
- Neisseria gonorrhea culture and nucleic acid amplification testing
- MRI
- cardiac ultrasound
Algoritmo de tratamiento
prosthetic joint: suspected infection
native joint: suspected infection with negative Gram stain (or Gram stain not available)
native joint: suspected infection with Gram-positive stain and no risk factors for resistant microorganisms
native joint: suspected infection with Gram-positive stain and risk factors for resistant microorganisms
native joint: suspected infection with Gram-negative stain
native joint: confirmed MSSA infection
native joint: confirmed MRSA infection
native joint: confirmed streptococcal infection
native joint: confirmed gram-negative rods infection
native joint: confirmed gonococcal or meningococcal infection
native joint: infection with fungi/tuberculosis/other organisms
Colaboradores
Autores
Blerta Green, MD
Fellow in Rheumatology
Section of Rheumatology, Allergy, and Immunology
Yale University School of Medicine
New Haven
CT
Declarações
RTS declares that he has no competing interests.
Robert T. Schoen, MD, MBA
Clinical Professor of Medicine
Section of Rheumatology, Allergy, and Immunology
Yale University School of Medicine
New Haven
CT
Declarações
RTS declares that he has no competing interests.
Francine Touzard Romo, MD
Associate Professor of Medicine
Division of Infectious Diseases
Warren Alpert Medical School
Brown University
Providence
Rhode Island
Declarações
FTR declares that she has no competing interests.
Revisores
Andrew Keat, MBBS
Consultant Physician and Rheumatologist
Northwick Park Hospital
Harrow
UK
Declarações
AK declares that he has no competing interests.
Cheryl Main, MD, FRCPC
Medical Microbiologist
Infectious Disease Consultant
Hamilton Regional Laboratory Medicine Program
Hamilton Health Sciences
Hamilton
Canada
Declarações
CM declares that she has no competing interests.
John Ross, MD
Brigham and Women’s Hospital
Hospitalist Section
Boston
MA
Declarações
JR declares that he has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18. Resumo
Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.Texto completo Resumo
Ravn C, Neyt J, Benito N, et al. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect. 2023;8(1):29-37.Texto completo Resumo
Benito N, Martínez-Pastor JC, Lora-Tamayo J, et al. Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed). 2024 Apr;42(4):208-14.Texto completo Resumo
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].Texto completo
Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].Texto completo
Le Vavasseur B, Zeller V. Antibiotic therapy for prosthetic joint infections: an overview. Antibiotics (Basel). 2022 Apr 5;11(4):486.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Osteoarthritis
- Psoriatic arthritis
- Rheumatoid arthritis
Mais Diagnósticos diferenciaisDiretrizes
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT
Mais DiretrizesFolhetos informativos para os pacientes
Septic arthritis
Mais Folhetos informativos para os pacientesVideos
Aspiration and injection of the knee: animated demonstration
Aspiration and injection of the shoulder animated demonstration
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