Septic arthritis
Summary
Definition
History and exam
Key diagnostic factors
- hot, swollen, tender, restricted joint
Other diagnostic factors
- low socioeconomic status
- history of intravenous drug abuse
- history of diabetes
- history of cutaneous ulcers
- prosthetic joint
- history of rheumatoid arthritis or osteoarthritis
- short history of symptoms
- fever
- history of alcohol use disorder
- history of previous corticosteroid injection
Risk factors
- underlying joint disease
- joint prostheses
- immunosuppression
- contiguous spread (presence of cutaneous ulcers or skin infection)
- previous intra-articular corticosteroid injection
- recent joint surgery
Diagnostic investigations
1st investigations to order
- synovial fluid Gram stain and culture
- synovial fluid white cell count
- blood culture
- white cell count
- erythrocyte sedimentation rate
- CRP
- plain radiograph
- ultrasound
Investigations to consider
- procalcitonin
- MRI
Treatment algorithm
suspected gram-positive infection or negative Gram stain
suspected gram-negative infection
confirmed MSSA or streptococcal infection
confirmed MRSA infection
confirmed gram-negative rods infection
confirmed gonococcal or meningococcal infection
infection with fungi/tuberculosis/other organisms
Contributors
Authors
Gerald Coakley, PhD, FRCP
Consultant Rheumatologist
Queen Elizabeth Hospital
London
UK
Disclosures
GC is an author of a reference cited in this topic.
Catherine J. Mathews, MSc, FRCP
Consultant Rheumatologist
Queen Elizabeth Hospital
London
UK
Disclosures
CJM is an author of a reference cited in this topic.
Peer reviewers
Andrew Keat, MBBS
Consultant Physician and Rheumatologist
Northwick Park Hospital
Harrow
UK
Disclosures
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.
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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
Coakley G, Mathews C, Field M, et al. BSR and BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford). 2006 Aug;45(8):1039-41.Texto completo Resumo
Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].Texto completo
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
Artigos de referência
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Diagnósticos diferenciais
- Osteoarthritis
- Psoriatic arthritis
- Rheumatoid arthritis
Mais Diagnósticos diferenciaisDiretrizes
- ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot)
- Hot joint guideline update
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