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Septic arthritis causes, risk, diagnosis and treatment

Here is a discussion of Septic arthritis regarding its aetiology, Risk factors, symptoms, signs, diagnostic investigations and treatment approach .
This can accompany bacteraemia or septicemia, the most common organism is staphylococcus aureus. It is a medical emergency as it leads to severe joint destruction within short time.
Causative organisms
• Staph aureus.
• Streptococci, gonococci.
Septic-arthritis• Haemophilus influenza and other Gram negative bacilli.
Risk factors
• Increasing age.
• Pre-existing joint disease e.g. rheumatoid disease.
• DM and immunosuppression.
• Artificial joints (prostheses).
Clinical picture 
1- Fever, malaise.
 2- Painful swelling usually in one large joint.
3- Signs of inflammation (redness, hotness, tenderness ± effusion).
Investigations

• ++ TLC ,, ++  ESR -blood culture.
• X ray showing soft tissue swelling then articular erosions.
• Synovial fluid examination showing ++ PNL, positive culture.

Treatment of Septic arthritis 

• Rest of joint, analgesics.
• Drainage of the joint and arthroscopic joint washouts are helpful in relievil!g pain, initially the joint should be aspirated daily to keep the effusion at a minimum.
• Intravenous antibiotic for 3 week e.g I.V f1ucloxacillin 2 gm/6hrs followed by oral treatment for 6 weeks in total.
• The joint should be immobilized initially and then physiotherapy should be started to prevent stiffness and muscle wasting.

Viral arthritis.

Viral. arthritis are usually self limiting.
- The usual presentation is with acute polyarthritis, fever or viral prodrome and rash.
- Parvovirus is the most common.
- Polyarthritis may also rarely occur with hepatitis B, C and HIV.
- Diagnosis is confirmed by viral serology.
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Tamer Mobarak

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