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Artrite séptica

Last reviewed: 14 Aug 2025
Last updated: 15 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • articulação quente, edemaciada, sensível e com mobilidade restrita
Full details

Other diagnostic factors

  • condição socioeconômica baixa
  • história de abuso de substâncias por via intravenosa.
  • história de diabetes
  • história de úlceras cutâneas
  • prótese articular
  • história de artrite reumatoide ou de osteoartrite
  • história curta dos sintomas
  • febre
  • transtornos decorrentes do uso de bebidas alcoólicas
  • história de injeção de corticosteroide prévia
Full details

Risk factors

  • doença articular subjacente
  • próteses das articulações
  • imunossupressão
  • disseminação contígua (presença de úlceras cutâneas ou infecção cutânea)
  • injeção intra-articular de corticosteroides prévia
  • cirurgia articular recente
Full details

Diagnostic tests

1st tests to order

  • coloração de Gram e cultura do líquido sinovial
  • contagem de leucócitos no líquido sinovial
  • hemocultura
  • contagem de leucócitos
  • velocidade de hemossedimentação
  • proteína C-reativa
  • radiografia simples
  • ultrassonografia
Full details

Tests to consider

  • procalcitonina
  • RNM
Full details

Treatment algorithm

INITIAL

suspeita de infecção por organismos Gram-positivos ou coloração de Gram negativa

suspeita de infecção por Gram-negativos

ACUTE

infecção confirmada por Staphylococcus aureus sensível à meticilina (SASM) ou infecção por estreptococos

infecção por Staphylococcus aureus resistente à meticilina (MRSA) confirmada

infecção confirmada por bastonetes Gram-negativos

infecção gonocócica ou meningocócica confirmada

infecção por fungos/tuberculose/outros organismos

Contributors

Authors

Gerald Coakley, PhD, FRCP
Gerald Coakley

Consultant Rheumatologist

Queen Elizabeth Hospital

London

UK

Disclosures

GC is an author of a reference cited in this topic.

Catherine J. Mathews, MSc, FRCP
Catherine J. Mathews

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

Disclosures

CM declares that she has no competing interests.

John Ross, MD

Brigham and Women’s Hospital

Hospitalist Section

Boston

MA

Disclosures

JR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.Full text  Abstract

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.Full text  Abstract

Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].Full text

Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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