Septic Arthritis (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
In this Article
- Septic arthritis facts
- What is septic arthritis?
- What microbes cause septic arthritis?
- Who is at risk of developing septic arthritis?
- What are symptoms and signs of septic arthritis?
- How do physicians diagnose septic arthritis?
- How is septic arthritis treated?
- What are complications of septic arthritis?
- What is the prognosis of septic arthritis?
- Is it possible to prevent septic arthritis?
What are symptoms and signs of septic arthritis?
Symptoms of septic arthritis include fever, chills, as well as joint pain, swelling, redness, stiffness, and warmth. Joints most commonly involved are large joints, such as the knees, ankles, hips, and elbows. In people with risk factors for joint infection, unusual joints can be infected, including the joint where the collarbone (clavicle) meets the breastbone (sternum). With uncommon microbes, such as Brucella spp., atypical joints can be infected, such as the sacroiliac joints.
How do physicians diagnose septic arthritis?
Health-care professionals diagnose septic arthritis by identifying infected joint fluid. Joint fluid can easily be removed sterilely in the office, clinic, or hospital with a needle and syringe. The fluid is analyzed in a laboratory to determine if there is an elevated number of white blood cells to suggest inflammation. A culture of the joint fluid can identify the particular microbe and determine its susceptibility to a variety of antibiotics.
X-ray studies of the joint can be helpful to detect injury of bone adjacent to the joint. MRI scanning is very sensitive in evaluating joint destruction. Blood tests are frequently used to detect and monitor inflammation. These tests include the white blood cell count, sedimentation rate, and C-reactive protein.
How is septic arthritis treated?
Septic arthritis is treated with antibiotics and drainage of the infected joint (synovial) fluid from the joint.
Optimally, antibiotics are given immediately. Often, health-care professionals administer intravenous antibiotics in a hospital setting. The choice of antibiotics can be guided by the results of the culture of joint fluid. Until those results are known, empiric antibiotics are chosen to cover a wider range of possible infectious agents. Sometimes, combinations of antibiotics are given. Antibiotics may be required for four to six weeks.
Drainage is essential for rapid clearing of the infection. Drainage can be done by regular aspirations with a needle and syringe, often daily early on, or via surgical procedures. Arthroscopy can be used to irrigate the joint and remove infected joint lining tissue. If adequate drainage cannot be accomplished with joint aspirations or arthroscopy, open joint surgery is used to drain the joint. After arthroscopy or open joint surgery, drains are sometimes left in place to drain excess fluid that can accumulate after the procedure.
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