Explore the causes, symptoms, and treatment options for septic arthritis. Find comprehensive information and expert advice on Meri Sehat.

Septic Arthritis

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Septic arthritis, also called infectious arthritis, is defined as joint inflammation that results from various infections. 
Septic arthritis is a painful joint infection that results from pathogens entering the bloodstream from another area of the body.

&nbsp;

The immune system normally eliminates pathogens from the body, but when they reach small spaces like a joint, they can quickly multiply and cause significant inflammation and tissue damage. Septic arthritis can also develop when an injury that penetrates the skin, like an animal bite or trauma, allows bacteria to enter the joint.&nbsp; Moreover, people with prosthetic joints can also be affected.

The prevalence of septic arthritis varies depending on the presence of risk factors. It ranges from 2 to 6 cases per 100,000 people<a href="#accordion">[1]</a>. Compared to adults, children are more likely to develop septic arthritis. The occurrence of septic arthritis is highest in children between the ages of 2 and 3 and is more common in men<a href="#accordion">[1]</a>. 
&nbsp;

Staphylococcus and streptococcus are&nbsp;bacteria that frequently&nbsp;cause acute septic arthritis in both adults and children. Neisseria gonorrhoeae is the most prevalent pathogen for the disorder in young, sexually active adults. These invaders get into the bloodstream and infect the joint, which results in swelling and discomfort<a href="#accordion">[2]</a>. Approximately 7-15% of patients with the illness who are hospitalized will pass away<a href="#accordion">[4]</a>.

Although large joints, like the hip and knee are more frequently impacted, septic arthritis can also affect other joints, including the shoulder and ankle. Prompt treatment is essential since the infection has the potential to quickly and severely harm the joint&#39;s bone and cartilage. The long-term mortality in elderly patients with&nbsp;septic arthritis&nbsp;is&nbsp;increased due to an increase in comorbids<a href="#accordion">[1]</a>. 
&nbsp;

There are no known types of septic arthritis. 
&nbsp;

Signs and Symptoms

Septic arthritis typically only affects one large joint (monoarticular), such as the knee or hip. However, in some cases, polyarticular septic arthritis occurs, affecting multiple, smaller joints. Symptoms usually have a sudden onset and include severe joint pain, joint swelling, and fever. Other septic arthritis symptoms are:

<ul>
	<li>Chills</li>
	<li>Weakness and fatigue</li>
	<li>Fever</li>
	<li>Intense pain and tenderness in the affected joint, particularly with movement</li>
	<li>Difficulty moving the limb with the infected joint</li>
	<li>Swelling due to increased fluid in the joint</li>
	<li>Warmth and redness of the joint due to increased blood flow</li>
	<li>Skin rashes</li>
	<li>Changes in appetite 
	&nbsp;</li>
</ul>

If septic arthritis occurs in an artificial joint, slight pain and swelling may develop a few months or years after knee or hip replacement surgery. This may cause loosening or in extreme cases, dislocation of the joint. 
&nbsp;

<h5>Symptoms In Newborns And Infants:</h5>

<ul>
	<li>Crying when the infected joint is moved, such as during changing of the diaper</li>
	<li>Fever</li>
	<li>Not able to move the infected limb</li>
	<li>Fussiness 
	&nbsp;</li>
</ul>

Note: If you experience severe joint pain in any one joint along with swelling, skin color change over the joint, or fever and chills, contact a healthcare professional immediately. 
&nbsp;

<h5>Infectious Arthritis Vs. Reactive Arthritis</h5>

Septic arthritis is often mistaken for reactive arthritis since the two can cause similar symptoms. However, reactive arthritis results from a recent infection elsewhere in the body, and not from an infection spreading into a joint. Instead, it occurs from the immune system overreacting to an initial infection. Thus, triggering joint inflammation. Whereas, septic arthritis is characterized by an active infection in the joint. 
&nbsp;

Causes

Septic arthritis occurs when an infection, such as a skin infection or urinary tract infection, travels to a joint through your circulation. Less frequently, the germs can enter the joint space by a puncture wound, a medication injection, or surgery performed on or close to a joint, including joint replacement surgery. Your joints&rsquo; lining has a limited capacity to defend itself against infection. The damage is a result of your body&#39;s response to the infection, which includes inflammation that can raise pressure and decrease blood flow within the joint. It may also be more likely if you have a weaker immune system or a history of other joint issues like gout, rheumatoid arthritis, lupus, or osteoarthritis since injured joints may be more prone to infection. 
&nbsp;

The following are the most common bacteria that cause septic arthritis<a href="#accordion">[3]</a>:

<ul>
	<li>Staphylococcus Aureus - It is the most common cause of septic arthritis in both adults and children. According to an analysis published in 2019, more than half cases of septic arthritis are caused by the bacteria belonging to the Staphylococci family<a href="#accordion">[4]</a>. 
	&nbsp;</li>
	<li>Methicillin-Resistant Staphylococcus Aureus (MRSA) - This is a type of staphylococcal aureus which is resistant to several antibiotics. People at risk of acquiring septic arthritis from MRSA are those who use IV drugs, have HIV or diabetes. 
	&nbsp;</li>
	<li>Streptococci Groups A And B - This type of bacteria mostly infects elderly people with chronic diseases, such as diabetes or cirrhosis. 
	&nbsp;</li>
	<li>Neisseria Gonorrhoeae - This is the most prevalent cause of septic arthritis in young, sexually active adults. The bacteria is responsible for causing the sexually transmitted disease, gonorrhea. Gonococcal arthritis, a type of septic arthritis, can develop in gonorrhea patients. 
	&nbsp;</li>
	<li>Neisseria Meningitidis (Meningococcus) - Meningitis, brought on by this bacterium, is characterized by swelling and inflammation of the membranes that protect your brain and spinal cord. However, in rare cases, Neisseria meningitidis can also cause septic arthritis. 
	&nbsp;</li>
</ul>

The following viruses can cause septic arthritis:

<ul>
	<li><a href="https://merisehat.pk/disease/hepatitis-a&amp;e">Hepatitis A</a>, <a href="https://merisehat.pk/disease/hepatitis-b-113">B</a>, and <a href="https://merisehat.pk/disease/hepatitis-c-114">C</a></li>
	<li>Parvovirus B19</li>
	<li><a href="https://merisehat.pk/disease/hiv-61">HIV </a></li>
	<li>HTLV-1</li>
	<li>Adenovirus</li>
	<li>Coxsackie viruses</li>
	<li><a href="https://merisehat.pk/disease/mumps-76">Mumps</a></li>
	<li>Alphaviruses</li>
	<li>Flaviviruses 
	&nbsp;</li>
</ul>

Fungi that can cause septic arthritis are:

<ul>
	<li>Histoplasma</li>
	<li>Coccidioides</li>
	<li>Blastomyces 
	&nbsp;</li>
</ul>

Note: Though septic arthritis is not contagious, the bacteria causing it such as staphylococcus aureus, MRSA, and Neisseria gonorrhoeae can spread from one person to another through contact. 
&nbsp;

There are currently no screening tests for septic arthritis. However, a clinical history and physical examination can help doctors diagnose septic arthritis. 
&nbsp;

Diagnosis

During a physical examination, the doctor assesses the joint for signs of inflammation and issues with mobility. The following tests may also be ordered to confirm the diagnosis: 
&nbsp;

<ul>
	<li>Synovial Fluid Aspiration (Arthrocentesis): Using a fine needle, synovial fluid which lubricates the joint, is withdrawn from the affected joint. This fluid is then sent for lab testing. A white blood cell (WBC) count&nbsp; greater than 50,000 and 90% neutrophil predominance points to a bacterial infection. The identification of bacteria in the fluid helps confirm the diagnosis of septic arthritis. In prosthetic joint infections, a WBC count of 1,100 and a 64% neutrophil differentiation suggests septic arthritis. 
	&nbsp;</li>
	<li>Blood Tests: A complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein, and blood cultures are performed. These help confirm infection. The cervix, rectum, and throat should all be cultured if Neisseria is suspected. 
	&nbsp;</li>
	<li>X-Rays: Widening joint gaps and soft tissue swelling on X-rays may be indicative of septic arthritis. 
	&nbsp;</li>
	<li>Ultrasound: An ultrasound helps identify and quantify joint effusion. It also helps guide the needle for arthrocentesis. 
	&nbsp;</li>
	<li>MRI: An MRI scan provides detailed images of your bones and organs. It helps in early detection of joint fluid and reveals abnormalities in surrounding bone and soft tissue. It also detects the extent of cartilaginous involvement<a href="#accordion">[1][3]</a>. 
	&nbsp;</li>
</ul>

Treatment

The treatment options for septic arthritis vary according to the causative pathogen. They include: 
&nbsp;

<h5>Antibiotics</h5>

As soon as arthritis is diagnosed, antibiotics are started to stop the further spread of infection. This is the first stage of treatment and the medication is administered through IV. Symptoms can improve within 48 hours of treatment with antibiotics. However, 2-4 weeks of IV antibiotics may be needed which can later be followed by 2-6 weeks of oral antibiotics if necessary. 
&nbsp;

<h5>Draining The Joint</h5>

In order to help the body rid itself of dangerous microorganisms and inflammatory substances, doctors may need to drain fluid from a joint that is infected. 
&nbsp;

<ul>
	<li>Needle Aspiration: The fluid is drawn into a syringe by inserting a needle into the joint space. Needle aspiration may need to be repeated 2-3 times a day during the first few days as fluid can reaccumulate. 
	&nbsp;</li>
	<li>Arthroscopy: A soft tube is placed in the joint with a video camera at its tip via a small incision. Drainage and suction tubes are inserted through small incisions around the joint. 
	&nbsp;</li>
	<li>Open Surgery: Surgical drainage is only recommended if needle aspiration and antibiotics fail to clear the infection in 5-7 days, the infected joints are hard to aspirate, or if the nearby soft tissue is also infected<a href="#accordion">[6]</a>. 
	&nbsp;</li>
</ul>

<h5>Surgery</h5>

The inflamed tissue may need to be removed surgically. 
&nbsp;

Artificial Joint Removal

If you have septic arthritis in an artificial joint, it will need to be removed and replaced with a joint spacer (made of antibiotic cement) which will control the infection in the joint space. Once you have healed, the doctor will replace your artificial joint after several months. 
&nbsp;

A doctor may clean the joint, remove any injured tissue, and leave the artificial joint in place if a replacement joint cannot be removed. To stop the illness from returning, oral antibiotics are given for several months after intravenous treatment. 
&nbsp;

Physical Therapy

Physical therapy may be given to people with infectious arthritis to help with symptom relief and maintain the range of motion and functionality of the joint. A splint may also be advised by a physician to support the injured joint. To keep the joint muscles from shortening while wearing a splint, range-of-motion exercises are crucial. The splint shouldn&#39;t be worn continuously, either.

Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) will be given to relieve pain and help with inflammation. 
&nbsp;

Note: If you have septic arthritis symptoms, call your doctor straight away or go to the hospital that is closest to you. If left untreated, septic arthritis can result in serious consequences and can be fatal. 
&nbsp;

Complications of septic arthritis include: 
&nbsp;

<ul>
	<li>Permanent damage to the tissue or bone</li>
	<li>Osteomyelitis (infection of the bone)</li>
	<li>Chronic pain</li>
	<li><a href="https://merisehat.pk/disease/osteonecrosis">Osteonecrosis </a>(bone death due to lack of blood flow)</li>
	<li>Difference in the length of both legs</li>
	<li>Joint loosening</li>
	<li>Joint dislocation</li>
	<li>Sepsis</li>
	<li>Death 
	&nbsp;</li>
</ul>

Some people are more likely to get septic arthritis than others. The risk factors are: 
&nbsp;

<ul>
	<li>Joint damage</li>
	<li>Pre-existing joint disease, such as arthritis, lupus, gout, or <a href="https://merisehat.pk/disease/osteoarthritis-64627">osteoarthritis</a></li>
	<li>Skin infections</li>
	<li>Puncture wounds</li>
	<li>Prolonged antibiotic therapy</li>
	<li>Recent joint surgery</li>
	<li>Use of IV drugs</li>
	<li>Having an artificial joint</li>
	<li>Medication for rheumatoid arthritis</li>
	<li>Fragile skin that breaks easily</li>
	<li>Weak immunity</li>
	<li>Animal bites</li>
	<li>Cancer</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a></li>
	<li>Smoking<a href="#accordion">[4][6]</a>. 
	&nbsp;</li>
</ul>

Although not all septic arthritis cases are preventable, some measures you can take to prevent it are: 
&nbsp;

<ul>
	<li>Keep all cuts and wounds clean to prevent infection</li>
	<li>Do not delay treatment for any chronic health conditions</li>
	<li>Practice safe sex and use condoms to prevent the spread of STIs</li>
	<li>Quit Smoking, recreational drug use and drinking alcohol<a href="#accordion">[3]</a>. 
	&nbsp;</li>
</ul>

Staphylococcus aureus has been the most common pathogen associated with septic arthritis, accounting for 40%&ndash;50% of cases. Additionally, 6%&ndash;22% of S. aureus isolates have been identified as MRSA, suggesting the frequent involvement of MRSA in bone and joint infections and its rise in orthopedic settings. In comparison to cases caused by methicillin-sensitive S. aureus (MSSA), MRSA-associated cases of septic arthritis have worse clinical outcomes, higher mortality, and longer hospital stays. Therefore, there is a need for new therapeutic approaches against septic arthritis. 
&nbsp;

A recent study discussed the mechanism of action and clinical success of new alternative approaches. They reviewed the use of anti-microbial peptides, phage therapy, and adjunctive immunotherapies for septic arthritis. As per the results, in vitro and non-human model-based studies for the non-antibiotic approaches showed promise. However, clinical trials in humans are yet to be undertaken. Nonetheless, the novel strategies hold the potential to cause a decrease in morbidity and mortality rates of septic arthritis<a href="#accordion">[7]</a>. 
&nbsp;

Key Points

<ul>
	<li>Septic arthritis, also known as infectious arthritis, develops when the infection spreads to one or more of your joints and produces inflammation.</li>
	<li>The common culprit is mostly bacteria, but occasionally fungal, mycobacterial, viral, or other pathogens can also cause septic arthritis.</li>
	<li>Septic arthritis can also develop when an injury that penetrates the skin, like an animal bite or trauma, allows bacteria to enter the joint.</li>
	<li>Although large joints like the hip and knee are more frequently impacted, septic arthritis can also affect other joints including the shoulder and ankle.</li>
	<li>Staphylococcus and streptococcus &nbsp;bacteria&nbsp; frequently&nbsp;cause acute septic arthritis in both adults and children. Neisseria gonorrhoeae is the most prevalent pathogen&nbsp; in young, sexually active adults.</li>
	<li>Compared to adults, kids are more likely to develop septic arthritis. The occurrence of septic arthritis is highest in children between the ages of 2 and 3 and is more common in men</li>
	<li>Septic arthritis symptoms typically appear suddenly and include severe pain, joint swelling, and fever.</li>
	<li>Though septic arthritis is not contagious, the bacteria causing it such as staphylococcal aureus, MRSA, and Neisseria gonorrhoeae can spread from one person to another through contact.</li>
	<li>As soon as arthritis is diagnosed, treatment with antibiotics is started to stop the further spread of infection. This is the first stage of treatment and the medication is administered through IV.</li>
	<li>In order to help the body rid itself of dangerous microorganisms and inflammatory substances, doctors may need to drain fluid from a joint that is infected. </li>
	<li>Physical therapy can help septic arthritis patients with relief of symptoms and improve mobility and functionality of the joint. </li>
	<li>If you have septic arthritis in an artificial joint, it will need to be removed and replaced with a joint spacer (made of antibiotic cement) which will control the infection in the joint space. Once you have healed, your doctor will replace your artificial joint after several months.</li>
	<li>Septic arthritis can result in serious complications that can be fatal. If you develop septic arthritis, contact a doctor immediately. 
	&nbsp;</li>
</ul>