Septic arthritis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]
Overview
Septic arthritis can lead to the development of bacteremia and sepsis.Prompt diagnosis, rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis.Prognosis of septic arthritis depends on various factors such host immune response, pre-existing joint disease, presence of risk factors, virulence of the pathogen and the duration between onset of symptoms and diagnosis.Poly-articluar septic arthritis in particular, carries a poor prognosis because of bacteremia and sepsis which is associated with increased mortality.Close attention has to be paid to identify and rule out common and chronic joint disorder such as rheumatoid arthritis co-existing with septic arthritis.
Natural History
Septic arthritis commonly presents with either mono-articular involvement associated with tenosynovitis and dermatitis (gonococcal) or polyarticular involvement (non gonococcal).[1] It is most commonly observed in patients of extreme age groups with pre existing joint disorders such as rheumatoid arthritis or predisposing conditions such as skin infection.[2] Prompt diagnosis, rapid initiation of treatment, early physical therapy and mobilization are crucial for the outcome of septic arthritis. Diagnostic delay is an important contributer for the poor outcome of septic arthritis, which carries a 30–50% case-fatality rate.[3] If septic arthritis involving multiple joints, case fatality rate will be >50%.[4]
Complications
Complications of septic arthritis mainly depends on the pre existing joint disease and treatment of current infection. Major complications of septic arthritis includes:[5][6][7][8][9][10]
Common Complications
- Joint degeneration (arthritis): common with non gonococcal arthritis (~ 40%)
- Bacteremia (5-20%)
- Osteomyelitis
In children: As the growth plate is in very close to epiphysis, direct extension of a joint infection to the growth plate can lead to reduced bone growth in children.[11][12]
Less Common Complications
Prognosis
Prognosis of septic arthritis depends on various factors such host immune response, pre existing joint disease, presence of risk factors, virulence of the pathogen and the duration between onset of symptoms and diagnosis.[13][1][14]
Indicators of poor prognosis:
- Elderly patient (age > 80 yrs)
- Pre existing medical conditions such as diabetes mellitus or pre existing joint diseases such as rheumatoid arthritis or prosthetic joint
- Presentation with poly articular involvement which increases the risk of bacteremia
- Delayed beginning of antibiotic therapy, especially 7 days after initial presentation
- Unable to sterilize synovium with in 6 days of antimicrobial therapy
- Septic arthritis due to virulent organism that produces super antigens (e.g. Staph. aureus, Gram -ve bacilli)
- Late mobilization and absence of physical therapy
References
- ↑ 1.0 1.1 Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
- ↑ Esterhai JL, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22 (3):503-14. PMID: 1852426
- ↑ Goldenberg DL (1998) Septic arthritis. Lancet 351 (9097):197-202. DOI:10.1016/S0140-6736(97)09522-6 PMID: 9449882
- ↑ Gupta MN, Sturrock RD, Field M (2001). "A prospective 2-year study of 75 patients with adult-onset septic arthritis". Rheumatology (Oxford). 40 (1): 24–30. PMID 11157138.
- ↑ Andersen K, Bennedbaek FN, Hansen BL (1994) [Septic arthritis.] Ugeskr Laeger 156 (26):3871-5. PMID: 8059468
- ↑ Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) Polyarticular septic arthritis. Medicine (Baltimore) 72 (5):296-310. PMID: 8412643
- ↑ Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56 (8):470-5. PMID: 9306869
- ↑ Kaandorp CJ, Krijnen P, Moens HJ, Habbema JD, van Schaardenburg D (1997) The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum 40 (5):884-92. <884::AID-ART15>3.0.CO;2-6 DOI:10.1002/1529-0131(199705)40:5<884::AID-ART15>3.0.CO;2-6 PMID: 9153550
- ↑ Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38 (12):1819-25. PMID: 8849354
- ↑ Klein RS (1988) Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection. Clin Geriatr Med 4 (2):375-94. PMID: 3288326
- ↑ Knights EM (1982) Infectious arthritis. J Foot Surg 21 (3):229-33. PMID: 6749955
- ↑ Nelson JD, Koontz WC (1966) Septic arthritis in infants and children: a review of 117 cases. Pediatrics 38 (6):966-71. PMID: 5297142
- ↑ Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545
- ↑ Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES (1975) Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage. Arthritis Rheum 18 (1):83-90. PMID: 1115748