In this section : Rheumatology
Osteoarthritis of the Hand/Thumb
High Dose Steroid Pre-Treatment Checklist
Septic Arthritis
Back Pain
Osteoporosis
Gout
Giant Cell Arteritis
Polymyalgia Rheumatica
Rheumatoid Arthritis
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Septic Arthritis
Last updated 2nd June 2021
Think Septic Arthritis
- Short history of hot swollen and tender joint(s) with restriction of movement is septic arthritis until proven otherwise – the exception is 1st MTP joint which is almost always due to gout
- Septic arthritis has same mortality as meningococcal meningitis.
Aspirate the Joint
- The essential investigation is to aspirate the joint before starting antibiotics. If you cannot do it, find someone who can. Samples go in plain sterile containers to microbiology for gram stain & culture AND also in lithium heparin to pathology for crystals.
- Note neither the absence of organisms on gram stain nor a negative fluid culture entirely excludes septic arthritis.
- Always refer suspected sepsis of prosthetic joint to orthopaedics
Other Investigations
- Infection is almost always by haematogenous spread so important to look for source
- Routine bloods including FBC, ESR, U&E, Glucose, CRP
- Blood cultures should always be taken
- Vaginal/penile swabs if young patient ?Gonococcus
- Plain xrays are of no benefit in diagnosing septic arthritis but may show chondrocalcinosis and should be done as a baseline test
- In suspected hip sepsis diagnostic aspiration will usually require use of ultrasound
Treatment of Septic Arthritis
- If clinical suspicion high then Rx as septic arthritis even if no fever
- Most cases due to staph aureus but consider gram negatives if elderly, frail, recurrent UTI and recent abdo surgery
- Rx antibiotics IV for up to 2 weeks or until signs improve, then orally for 4 weeks to total of 6 weeks
- The joint will need to be aspirated regularly so involve Rheumatologist or Orthopaedic surgeon
- Remember to give adequate analgesia
Differential Diagnosis
- Crystal arthritis eg gout or pseudo-gout
- Trauma +/- haemarthrosis
- Monoarticular presentation of RA or sero-neg arthropathy
Treatment of Non-Septic Monoarthritis
- Rest, NSAIDs, analgesics
- Intra-articular steroids in some cases
- Colchicine can be used instead of NSAIDs for acute gout