Author: Helia Mansouri Dana
Infectious arthritis, commonly known as septic arthritis, refers to the inflammation of the joints due to infection by bacteria, viruses, and fungi (J. W. Smith, Chalupa, and Hasan 2006). This is often found in the larger joints of the body such as the hip and the knee (J. W. Smith, Chalupa, and Hasan 2006). When microbes infect the joint, the body’s immune responses react by causing inflammation to limit the spread of the infection (Shirtliff and Mader 2002). This is what causes the symptoms associated with septic arthritis and can lead to damage of the joint cartilage itself (Shirtliff and Mader 2002).
Septic arthritis occurs in 2 to 5 per 100000 individuals per year, however, those with prosthetics at the joints or with inflammatory conditions of the joints, such as rheumatoid arthritis, are more susceptible to the disease (Kaandorp et al. 1995).
What Causes Septic Arthritis?
Septic arthritis can have a variety of different causes based on the type of microbe that has infected the joint, but they mainly occur due to bacteria entering the bloodstream (Visser and Tupper 2009, J. W. Smith, Chalupa, and Hasan 2006). This allows access to deep tissues within the body, including the joints, and if conditions are suitable for growth, the bacteria will establish an infection (Visser and Tupper 2009).
Viruses can also cause septic arthritis by entering the bloodstream, and many of these viruses are the cause of other diseases, such as mumps, polio, rubella, and hepatitis (J. W. Smith, Chalupa, and Hasan 2006).
- Pain and swelling in a single joint (may be multiple joints)
- Limited range of motion in affected joint
- Lack of coordination
- Walking abnormalities
(Hassan et al. 2017)
- Rheumatoid arthritis
- Old age
- Immune deficiency
- Alcohol and drug abuse
- Prosthetic joints
- Skin infections
- Recent joint surgeries
(Wu et al. 2017; Singh and Yu 2017)
How does my doctor know I have Septic Arthritis?
Individuals with septic arthritis are typically presented with fever, local pain, warmth, swelling, and decreased range of motion in the affected joint (J. W. Smith, Chalupa, and Hasan 2006; Shirtliff and Mader 2002). Typically, only one joint is affected but it must be noted that multiple joints may also be infected (I. D. M. Smith et al. 2018). Many of these features overlap with other diseases of the joint, so consultation with a physician and further testing is required to confirm the diagnosis (Hassan et al. 2017; Shirtliff and Mader 2002).
In order to confirm the diagnosis of septic arthritis, the fluid surrounding the joints is taken using a needle and tested for the presence of bacteria or viruses, and further investigated for a white blood cell count and sugar levels (Hassan et al. 2017). A high level of white blood cells in the fluid is a sign of infection in the joint, but must be taken into account alongside test results for the presence of bacterial as well as reduced sugar levels in the fluid (Tarkowski 2006). Radiographs and ultrasonography may be done for imaging of the joint to gain additional clues (Hassan et al. 2017).
Initial treatment of septic arthritis usually requires drainage of the fluids surrounding the joints using a needle. This may be done via surgery for joints that are not easily accessible (Smith et al. 2006).
Both intravenous and oral treatment with antibiotics are recommended in order to control infection (Tarkowski 2006). Based on the type of bacteria, different antibiotics may be recommended, including but not limited to:
To prevent damage by the body’s inflammatory responses, corticosteroids, namely dexamethasone, need to be used in addition to antibiotics (Verba, Sakiniene, and Tarkowski 1997).
Hassan, Ahmed S., Allison Rao, Augustine M. Manadan, and Joel A. Block. 2017. “Peripheral Bacterial Septic Arthritis: Review of Diagnosis and Management.” JCR: Journal of Clinical Rheumatology 23 (8): 435–442. https://doi.org/10.1097/RHU.0000000000000588.
Kaandorp, C. J., D. Van Schaardenburg, P. Krijnen, J. D. Habbema, and M. A. van de Laar. 1995. “Risk Factors for Septic Arthritis in Patients with Joint Disease. A Prospective Study.” Arthritis and Rheumatism 38 (12): 1819–25. https://doi.org/10.1002/art.1780381215.
Odio, Carla M., Tobias Ramirez, Gloria Arias, Arturo Abdelnour, Isabel Hidalgo, Marco L. Herrera, Willy Bolaños, Jorge Alpízar, and Patricio Alvarez. 2003. “Double Blind, Randomized, Placebo-Controlled Study of Dexamethasone Therapy for Hematogenous Septic Arthritis in Children.” The Pediatric Infectious Disease Journal 22 (10): 883–89. https://doi.org/10.1097/01.inf.0000091293.32187.7b.
Shirtliff, Mark E., and Jon T. Mader. 2002. “Acute Septic Arthritis.” Clinical Microbiology Reviews 15 (4): 527–44. https://doi.org/10.1128/CMR.15.4.527-544.2002.
Singh, Jasvinder A., and Shaohua Yu. 2017. “The Burden of Septic Arthritis on the U.S. Inpatient Care: A National Study.” PLoS ONE 12 (8). https://doi.org/10.1371/journal.pone.0182577.
Smith, I. D. M., K. M. Milto, C. J. Doherty, S. G. B. Amyes, A. H. R. W. Simpson, and A. C. Hall. 2018. “A Potential Key Role for Alpha-Haemolysin of Staphylococcus Aureus in Mediating Chondrocyte Death in Septic Arthritis.” Bone & Joint Research 7 (7): 457–67. https://doi.org/10.1302/2046-3758.77.BJR-2017-0165.R1.
Smith, J. W., P. Chalupa, and M. Shabaz Hasan. 2006. “Infectious Arthritis: Clinical Features, Laboratory Findings and Treatment.” Clinical Microbiology and Infection 12 (4): 309–14. https://doi.org/10.1111/j.1469-0691.2006.01366.x.
Smith, J. W., and J. P. Sanford. 1967. “Viral Arthritis.” Annals of Internal Medicine 67 (3): 651–59. https://doi.org/10.7326/0003-4819-67-3-651.
Tarkowski, Andrej. 2006. “Infectious Arthritis.” Best Practice & Research Clinical Rheumatology, Infection and Musculoskeletal Conditions, 20 (6): 1029–44. https://doi.org/10.1016/j.berh.2006.08.001.
Verba, V., E. Sakiniene, and A. Tarkowski. 1997. “Beneficial Effect of Glucocorticoids on the Course of Haematogenously Acquired Staphylococcus Aureus Nephritis.” Scandinavian Journal of Immunology 45 (3): 282–86. https://doi.org/10.1046/j.1365-3083.1997.d01-400.x.
Visser, Shaun, and Jennifer Tupper. 2009. “Septic until Proven Otherwise.” Canadian Family Physician 55 (4): 374–75.
Wu, Chia-Jung, Chien-Cheng Huang, Shih-Feng Weng, Ping-Jen Chen, Chien-Chin Hsu, Jhi-Joung Wang, How-Ran Guo, and Hung-Jung Lin. 2017. “Septic Arthritis Significantly Increased the Long-Term Mortality in Geriatric Patients.” BMC Geriatrics 17 (August). https://doi.org/10.1186/s12877-017-0561-x.