{"id":8926,"date":"2021-12-08T20:48:18","date_gmt":"2021-12-08T18:48:18","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/rheumatology\/infectious-arthritis\/"},"modified":"2022-04-23T16:19:26","modified_gmt":"2022-04-23T14:19:26","slug":"infectious-arthritis","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/infectious-arthritis\/","title":{"rendered":"Infectious (septic) arthritis"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Infectious (septic) arthritis is inflammation of a joint associated with the presence of microorganisms.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The synovial membrane is highly vascularized, found in an enclosed space, and has a poor barrier against infectious organisms.<\/li><li>Infections arthritis presents with pain, swelling, movement restriction, and if left untreated, destruction of the affected joint.<\/li><li><strong>Classification<\/strong>. The condition can be classified based on the timeframe (acute\/chronic), and the type of microorganism (bacterial\/fungal\/viral).<\/li><li><strong>Etiology<\/strong><ul><li>Hematogenous (most cases)<\/li><li>Direct inoculation (injury or iatrogenic)<\/li><li>Spread from a nearby infection (osteomyelitis)<\/li><\/ul><\/li><li><strong>Diagnosis<\/strong><ul><li>Blood tests (CRP, IL-6, procalcitonin) and culture<\/li><li>PCR<\/li><li>X-ray<\/li><li>US\/CT\/MRI (in hard-to-reach joints)<\/li><li>Arthrocentesis with synovial fluid examination and culture<\/li><\/ul><\/li><li><strong>Treatment.<\/strong> The treatment involves drainage of the synovial fluid, IV and oral antibiotics.<ul><li><strong>S. aureus<\/strong>. MSSA is treated with oxacillin, MRSA with vancomycin, VRSA with tigecycline<\/li><li><strong>N. gonorrhea<\/strong>. 7 days 4x500mg ampicillin<\/li><li><strong>Borrelia burgdorferi<\/strong>. 60 days 100mg doxycycline<\/li><li><strong>Tuberculosis<\/strong>. Long-term therapy of rifampin, isoniazid, pyrazinamide, and ethambutol<\/li><\/ul><\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Acute infectious arthritis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Acute infectious arthritis presents with rapid (hours-days) onset of pain and movement restriction, typically affecting a single joint. The joint is warm and erythematous. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>May present with fever, fatigue, chills<\/li><li>Usually affects younger adults<\/li><li>Most often affects the knee joint.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Bacterial infections<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">In adults, acute bacterial infections are divided into gonococcal and non-gonococcal infections.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-0f819d31-e381-4df2-8a6e-0398ef3b8551\"><li>Most common agents in adults include S. aureus, N. gonorrhea, Streptococci<\/li><li>In children, the most common agents are H. influenza, and Kingella sp.<\/li><li><strong>Gonorrheal <\/strong>infections are less destructive, may be polyarticular, and present with skin lesions.<\/li><li><strong>Non-gonorrheal <\/strong>infections are typically much more destructive and painful.<\/li><li><strong>B. burgdorferi<\/strong> infections may present with acute or recurrent monoarthritis or oligoarthritis, along with other symptoms of Lyme disease.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Viral infections<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Viral infectious arthritis typically presents similar to non-gonorrheal arthritis and is typically oligo\/poly-articular. Common agents include parvovirus, rubella, hepatitis, alphavirus, and flavivirus.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Chronic infectious arthritis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Chronic infections arthritis presents with indolent, gradual swelling of the joint, mild pain, usually no erythema, and varying degrees of movement restriction.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Common agents include M. tuberculosis (and other mycobacteria), fungi (Candida, Histoplasma, Cryptococcus, Aspergillus)<\/li><li>Cartilage and bone destruction secondary to synovial membrane proliferation and erosion.<\/li><li>Risk factors include immunosuppression, prosthetic joints, and RA.<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Acute infectious arthritis<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Bacterial infections<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Viral infections<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Chronic infectious arthritis<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Infectious (septic) arthritis is inflammation of a joint associated with the presence of microorganisms. The synovial membrane is highly vascularized, found in an enclosed space, and has a poor barrier against infectious organisms. Infections arthritis presents with pain, swelling, movement restriction, and if left untreated, destruction of the affected joint. Classification. The condition can be [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8424,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8926","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Infectious (septic) arthritis &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/infectious-arthritis\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/infectious-arthritis\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/infectious-arthritis\\\/\",\"name\":\"Infectious (septic) arthritis &#8211; 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