Rheumatology

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Septic until proven otherwise: Approach to and treatment of the septic joint in adult patients
Canadian Family Physician, 04/15/09

Visser S et al. - Bacterial arthritis is the most dangerous form of acute monoarthritis; it can result in cartilage destruction, septicemia, and death within a few days if unrecognized. Prompt diagnosis and treatment are critical. Laboratory tests are neither sensitive nor specific in diagnosing or excluding septic arthritis. Arthrocentesis and synovial fluid analysis are mandatory for this differential. Immediately give broad-spectrum antibiotics to at-risk patients and consult an orthopedic surgeon. Mortality from septic arthritis is reported to be between 8% and 15%. Unfortunately, this has not changed dramatically despite the advent of intravenous antibiotics. The patient’s outcome depends on a host of factors, such as previous joint damage, the virulence of the infecting organism, and the speed with which adequate treatment is begun.

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