Arthritis (Septic)

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Clinical Features 

SIGNS AND SYMPTOMS

  • Fever
  • Swollen, painful, warm joint
  • Severe local tenderness
  • Pain on joint motion

INVESTIGATIONS

  • Joint aspiration for diagnostic and therapeutic purposes
    • ↑↑ WCC (e.g. >50,000/mm3): mostly PMN
  • ↑ESR/CRP, ↑WCC, Blood cultures
  • X-ray
  • FBC,
  • VDRL

Treatment

PHARMACOLOGICAL

Treatment Adults:

  • Give Flucloxacillin 1g IV 6 hourly for at least 14 days plus Ciprofloxacin 500mg 12 hourly PO or Doxycycline 100mg 12 hourly PO.
  • A further 2-4 weeks of oral antibiotics (Flucloxacillin and Ciprofloxacin) may be required

Alternatively, if penicillin allergic:

  • Give Clindamycin 450mg 12 hourly or, if not available use Ceftriaxone 2g IV daily for 2 weeks followed by oral Erythromycin 500mg 6 hourly and Ciprofloxacin 500mg 12 hourly for a duration of 2-4 weeks

Note : If Pus present, always refer early for anthrotomy

Children:

  • Give Ceftriaxone 50mg/kg daily for 14 days

Or alternatively when staphylococcal infection is suspected:

  • Give Flucloxacillin 25mg/kg IV q6h for 14 days

Or if above drugs not available

  • Give Chloramphenicol 12.5mg/kg every 6hrs for at least 14 days, or 4 weeks if there is associated osteomyelitis, clinically evident by bone swelling or proven by X-rays after the initial 14 day course

NON-PHARMACOLOGICAL

  • Consider joint washout under GA
  • Splint joint
  • Physiotherapy after infection resolved

Complications

  • Osteomyelitis
  • Arthritis
  • Ankylosis: fusion

Note: Surgical drainage may be indicated

TB septic arthritis is treated as for other forms of extra-pulmonary TB

When to refer a septic arthritis patient

  • If pus present, always refer early for arthrotomy.
  • Suspicion of joint destruction
  • No response to the available antibiotics

RED FLAG: Always refer early to hospital for systemic treatment and arthrotomy