Septic arthritis in adults
- Don L Goldenberg, MD
Don L Goldenberg, MD
- Section Editor — Pain Disorders in Rheumatology
- Affiliate Assistant Professor of Medicine
- Rheumatology Division, Oregon Health Science University
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Septic arthritis refers to infection in a joint; it is usually caused by bacteria but can be caused by fungi or mycobacteria. Septic arthritis due to bacterial infection is often a destructive form of acute arthritis. The predisposing factors, pathogenesis, clinical manifestations, diagnosis, and treatment of nongonococcal bacterial arthritis are reviewed here. Prosthetic joint infections, gonococcal arthritis, and fungal and mycobacterial arthritis are discussed separately. (See "Clinical manifestations and diagnosis of prosthetic joint infections" and "Treatment of prosthetic joint infections" and "Disseminated gonococcal infection" and "Skeletal tuberculosis".)
Prevalence — The prevalence of bacterial arthritis as the diagnosis among adults presenting with one or more acutely painful joints has been estimated to range from 8 to 27 percent; the lower figure is based on a series of 100 patients presenting to an urban hospital emergency department; the latter figure is based on a study of 75 patients presenting emergently in Taiwan [1,2]. These series included some patients with prosthetic joints and a small minority in whom the final diagnosis was gonococcal septic arthritis.
Predisposing factors — Predisposing factors for septic arthritis were identified in a systematic review that included more than 6200 patients with acutely painful joints; 10 percent had septic arthritis . The predisposing factors are summarized as follows [3,4]:
●Age >80 years
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- Predisposing factors
- MECHANISM OF INFECTION
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Crystal-induced arthritis
- Reactive arthritis
- Rheumatoid arthritis
- Lyme disease
- Antibiotic therapy
- Duration of therapy
- Joint drainage
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS