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Septic Arthritis

Septic Arthritis

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Pathology

Pathogens, most commonly bacteria, can invade joints through a variety of means, primarily through the bloodstream or direct inoculation due to trauma. Joints that have been previously damaged, prosthetic, or associated with inflammatory conditions are more susceptible to infection.

Aetiology

The causes of infection of joints vary, but most commonly arise from previous trauma, damage, prosthetic parts, and inflammatory arthritis conditions.

Symptoms and Signs

  • Joint pain
  • Erythema
  • Swelling
  • Warmth
  • Fever
  • Decreased range of motion

Investigations

  • Full Blood Count (FBC)
  • Urea and Electrolytes (U&E)
  • C-reactive Protein (CRP)
  • Blood Cultures
  • Uric Acid
  • X-Ray to exclude osteomyelitis or signs of crystal arthropathy
  • Joint Aspiration to see cloudy synovial fluid with Raised White Cell Count

Treatment

  • Medical: intravenous antibiotics (after joint aspiration) and analgesia
  • Surgical: referral to orthopaedics if prosthetic joint

Complications

Patients who are infected by pathogens in joints have a fifty percent chance of having significant sequelae such as decreased range of motion, chronic pain, dysfunctional joints, osteomyelitis, and sepsis.

Prognosis

The prognosis of joint infection depends on a variety of indicators, including age (risk increases over the age of 60), infected hip or shoulder joints, underlying rheumatoid arthritis, positive results of fluid cultures after seven days of treatment, and delay of seven days or longer in the treatment of the infection.

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