Summary
Definition
History and exam
Key diagnostic factors
- articulação quente, edemaciada, sensível e com mobilidade restrita
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
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
Diagnostic investigations
1st investigations 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
Investigations to consider
- procalcitonina
- RNM
Treatment algorithm
suspeita de infecção por organismos Gram-positivos ou coloração de Gram negativa
suspeita de infecção por Gram-negativos
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
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
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
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.
Differentials
- Osteoartrite
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