Arthritis Cure

ūüĒ•+ Arthritis Cure 25 May 2020 Learn about five procedures used to treat joint damage and pain caused by ... first carpometacarpal (CMC) joint, where the thumb meets the trapezium bone in ...

Arthritis Cure Common Reasons for Pain in the Big Toe Joint: Turf Toe Toe Injuries, ... herbal remedies oregon Ombre Hair how to dye ombre hair Health Benefits, Health Tips, ... The Pain Of Arthritis And How To Deal With It. There are a lot of different ways ...

×
Articles
Log In
Cases
Sign Up
Courses
Quiz
Blog
Donate
About
×
Radiopaedia is free thanks to our Supporters & AdvertisersBecome a Gold Supporter, and see no ads
{"url":"/signup-modal-props.json?lang=us\u0026email="}
Dr Yahya Baba and Radswiki ‚óČ et al.

Septic arthritis is a destructive arthropathy caused by an intra-articular infection that usually is related to severe symptoms such as pain and decreased range of motion. This condition requires prompt treatment aiming to avoid permanent damage to joint, which may result in chronic deformity or mechanical arthritis.

Clinical presentation

The diagnosis of joint sepsis is often considered straightforward. Patients often present with a painful joint, fever, and purulent synovial fluid.

Pathology

Risk factors for septic arthritis include bacteremia, advanced age, an immunocompromised state, rheumatoid arthritis, intra-articular injections, and prosthetic joints.

In the absence of trauma or recent instrumentation of the joint, septic arthritis is usually secondary to haematogenous seeding. S aureus is the most commonly isolated agent (31.3% of casesref).

Location

Large joints with abundant blood supply to the metaphyses are most prone to bacterial infection, with the most commonly affected joints theoretically being the shoulder, hip, and knee.

In intravenous drug abusers, the sternoclavicular and sacroiliac joints are more frequently affected.

Radiographic features

Imaging generally plays an adjunct role to arthrocentesis in the diagnosis of joint sepsis. If synovial fluid cannot be retrieved, however, radiologic studies become of the utmost importance.

Radiograph
  • x-rays may be normal in the very early stage of the disease
  • joint effusion¬†may be seen
  • juxta-articular osteoporosis¬†due to hyperemia¬†
  • narrowing of the joint space due cartilage destruction in the acute phase
  • destruction of the subchondral bone on both sides of a joint
  • if left untreated, reactive juxta-articular sclerosis and, in severe cases, ankylosis will develop¬†
Ultrasound
  • useful in superficial joints and in children
  • shows joint effusion
    • echogenic debris may be present
  • color Doppler may show increased peri-synovial vascularity¬†
  • can be used to guide the joint aspiration
CT
  • CT features of septic arthritis are similar to those spotted on radiographs¬†
  • a fat-fluid level can be a specific sign in the absence of trauma
MRI

Treatment and prognosis

The treatment principals for septic arthritis is drainage and appropriate antibiotics.

If the patient is heamodynamically stable then attempts should be made to obtain a sample of joint fluid for microscopy and culture prior to starting treatment with antibiotics. This will allow focused treatment of the infection4.

With smaller joints needle drainage or aspiration to decompress the joint followed by antibiotics may be adequate. For larger joints or persistent infection surgical debridement and washout will be required4.   

If unrecognised and left untreated, septic arthritis can result in irreversible joint damage within 48 hours of the onset of infection due to the proteolytic enzymes of the white blood cells that flood the infected synovial space. Osteonecrosis is also an important sequela of septic arthritis due to effusion and increase in intra-articular pressure compromises blood circulation. 

Conversely, approximately 90% of patients with septic arthritis will recover with appropriate antibiotic treatment. Therefore, timely diagnosis and treatment are critical.

See also

References

  • 1. Fayad LM, Carrino JA, Fishman EK. Musculoskeletal infection: role of CT in the emergency department. Radiographics. 27 (6): 1723-36. doi:10.1148/rg.276075033 - Pubmed citation
  • 2. Karchevsky M, Schweitzer ME, Morrison WB et-al. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR Am J Roentgenol. 2004;182 (1): 119-22. AJR Am J Roentgenol (full text) - Pubmed citation
  • 3. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. Mosby Inc. (2003) ISBN:0323023282. Read it at Google Books - Find it at Amazon
  • 4. Don L. Goldenberg, Kenneth D. Brandt, Alan S. Cohen, Edgar S. Cathcart. Treatment of septic arthritis. (1975) Arthritis & Rheumatism. 18 (1): 83. doi:10.1002/art.1780180116 - Pubmed for 1 last update 2020/05/25
  • 5. Justin W. Kung, Corrie Yablon, Edward S. Huang, Hooman Hennessey, Jim S. Wu. Clinical and Radiologic Predictive Factors of Septic Hip Arthritis. (2012) American Journal of Roentgenology. 199 (4): 868-72. doi:10.2214/AJR.10.6273 - Pubmed Arthritis Curehow to Arthritis Cure for the 1 last update 2020/05/25

Arthritis Curehow to Arthritis Cure for Related Radiopaedia articles

Arthritis Curehow to Arthritis Cure for Arthritides

Promoted articles Arthritis Curehow to Arthritis Cure for (advertising)

Article information

rID: 12846
Synonyms or Alternate Spellings:
  • Infectious arthritis

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1: involving neonatal knee Arthritis Curehow to Arthritis Cure for Case 1: involving neonatal knee
    Drag here to reorder.
  • Case 2: involving the hipCase 2: involving the hip
    Drag here to reorder.
  • Case 3: involving sacroiliac joint with psoas abscessCase 3: involving sacroiliac joint with psoas abscess
    Drag here to reorder.
  • Case 4: involving TMJ with skull base osteomyelitisCase 4: involving TMJ with skull base osteomyelitis
    Drag here to reorder.
  • Case 5: involving right hipCase 5: involving right hip
    Drag here the 1 last update 2020/05/25 to reorder.Drag here to reorder.
  • Case 6: involving symphysis pubisArthritis Curehow to Arthritis Cure for Case 6: involving symphysis pubis
    Arthritis Curehow to Arthritis Cure for Drag here to reorder.
  • Case 7Case for 1 last update 2020/05/25 7Case 7
    Drag here to reorder.
  • Case 8: septic arthritis of the right hip jointCase 8: septic arthritis of the right hip joint
    Drag here to reorder.
  • Case 9: shoulder Case 9: shoulder
    Drag here to reorder.
  • Case 10Case for 1 last update 2020/05/25 10Case 10
    Drag here to reorder.
  • Case 11: sternoclavicular joint septic arthritisCase 11: sternoclavicular joint septic arthritis
    Drag here to reorder.
  • Case 12Case 12
    Drag here to reorder.
  • the 1 last update 2020/05/25

    Loading more images...

    Loading Stack -

    0 images remaining

      Updating… Please wait.

      Arthritis Curehow to Arthritis Cure for

      Arthritis Curehow to Arthritis Cure for  Unable to process the form. Check for errors and try again.

       Thank you for updating your the 1 last update 2020/05/25 details.  Thank you for updating your details.

      © 2005–2020 Radiopaedia.org