Advances in the Management of Bacterial Septic Arthritis

Myo M Lynn; Catherine J Mathews

Disclosures

Int J Clin Rheumatol. 2012;7(3):335-342. 

In This Article

Abstract and Introduction

Abstract

The acute hot, swollen joint is a common medical presentation. It has a broad differential diagnosis, the most serious of which is bacterial septic arthritis. This article will discuss the epidemiology and pathogenesis of bacterial septic arthritis. The emergence of newer pathogenic organisms with changing antibiotic sensitivities will also be reviewed. The role that experimental animal models have played in clarifying some of the pathogenetic pathways of disease, as well as providing potential targets for novel therapies, will be presented. The clinical criteria for diagnosis will be discussed as well as the role of serum and synovial investigations to aid diagnosis. A guideline for antibiotic therapy will be shown as well as evidence suggesting that therapies, such as adjunctive corticosteroids, bisphosphonates and cytokine therapies, could improve the prognosis of septic arthritis. This article emphasizes that the diagnosis of septic arthritis rests principally on maintaining a high level of clinical suspicion. Early diagnosis with prompt and appropriate investigation and treatment is the mainstay of reducing the morbidity and mortality associated with the disease.

Introduction

The clinical presentation of a patient with one or more hot, swollen joints is common. The differential diagnosis is broad but the most serious potential cause is bacterial septic arthritis. The management of bacterial septic arthritis relies on early recognition, diagnosis and timely drainage of purulent material, together with prompt administration of antibiotic therapy. If the diagnosis is not made rapidly then the treatment of septic arthritis may be delayed, which can lead to substantial morbidity due to catastrophic joint damage,[1] as well as significant mortality due to overwhelming septicemia.[2]

The differential diagnosis of bacterial septic arthritis includes inflammatory arthritis, crystal arthropathy, trauma, hemarthrosis and degenerative joint disease. Even in the hands of experienced physicians, the crucial diagnosis of septic arthritis can be a difficult one to confirm. Despite advances in laboratory techniques, efforts are still being made to find a synovial or serum investigation of sufficient sensitivity and specificity to clinch the diagnosis. In addition, the emergence of unusual and resistant organisms makes the management of septic arthritis an ongoing challenge.

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