Septic Arthritis is basically a painful & septic condition inside a joint. Also known as Infectious Arthritis, this infection mostly comes from germs which travel through the bloodstream from some other part of the body to the joint. Septic arthritis can also occur some penetrating injury has directly delivered germs straight into the joint. It is commonly infants & older adults who are most likely to develop infectious arthritis. Although, it is knees which are most commonly affected, but infectious arthritis can also develop in shoulders, hips & other joints. Infection in this condition can quickly damage bone & cartilage within the joint, therefore, prompt treatment is very crucial for saving a joint. Treatments in this condition usually involve surgery or draining the joint with a needle. Antibiotics also are most often needed during treatment of infection.
Typically, Septic arthritis causes extreme discomfort along with difficulty in using the affected joint. The joints are usually warm, red & swollen & patients may have fever as well.
Septic arthritis is usually caused by fungal, viral or bacterial infections. Bacterial infection with staph (staphylococcus aureus) is one of the most common causes of developing infectious arthritis. Staph is commonly found to live even on healthy skin. Infectious arthritis will develop when infections like a urinary tract infection or skin infection spread through the bloodstream into a joint. Less commonly a drug injection, punctured wound or surgery inside or near a joint can allow germs to enter joint space. Lining of synovium (joints) has very little inherited ability to protect itself from infections. Body’s reaction to infection generally includes inflammation which eventually increases pressure while reducing flow of blood within the joint & which will only end up contributing to damage the joint.
Risk factors which are associated with Septic arthritis include the following.
- Existing Joint Problems – Chronic diseases & conditions which can affect joints include osteoarthritis, rheumatoid arthritis, gout or lupus. These can increase risk of developing infectious arthritis, as joint injury, previous joint injury or even an artificial joint can.
- Medications for Rheumatoid Arthritis – Rheumatoid arthritis patients have an increased risk of developing Septic arthritis because of medications which they have to take in order to suppress the immune system. This can make infections more likely to occur within joints. Diagnosing infectious arthritis among rheumatoid arthritis patients is moreover, extremely difficult because signs & symptoms are quite similar.
- Skin Fragility – Skin which easily breaks & heals quite poorly can allow bacteria access the body. Moreover, skin conditions like eczema & psoriasis also increase risk of infectious arthritis, as do infected wounds in skin. People who are regularly injecting drugs are also having higher risk of infection at injection sites.
- Weak Immune System – Generally, people with weak immune systems are at higher risk of developing Septic arthritis. This will also include people with diabetes, liver & kidney problems & also those who are taking drugs to suppress immune systems.
- Joint Trauma – Punctured wounds, animal bites or cuts over joints can eventually increase risks of developing infectious arthritis.
Moreover, having a combination of the above risk factors will put people at a greater risk of developing Septic arthritis.
Infectious arthritis will most often lead to joint degeneration & permanent damage whenever treatment is delayed.
Following tests would typically help orthopedists diagnose infectious arthritis.
- Joint Fluid Analysis – Infections within joints will usually alter volume, consistency, color & makeup of fluid within joints. Sample of this fluid can therefore be withdrawn from affected joints with help of a needle. Laboratory tests can now be performed in order to determine as to which organism is causing infection. This information will eventually help orthopedists determine as to which medications should be prescribed.
- Blood Tests – These are meant to determine if there are any signs of infections present in the blood. For this purpose, a sample of blood can be removed from veins with help of a needle.
- Imaging Tests – These include x-rays & other imaging tests of affected joints which can assess damage to joints.
People having painful & inflamed joints are most likely to start by consulting a family doctor & who may eventually refer them to a infectious disease specialist, rheumatologist (joint specialist) or an orthopedic surgeon. It is time to see an orthopedist when people have sudden onset of severe pain within joints. However, prompt treatment of Septic arthritis can effectively help minimize damage to joints. Here is some information which can help infectious arthritis patients get ready for the initial appointment.
- What Septic Arthritis Patients Can Do Prior to Initial Appointment
Whenever patients call to make an appointment, they should also check whether they are required to do anything in advance, including fasting which is required for certain tests. Patients can also make a list of the following.
- Signs & Symptoms – This should also include any information which may seem unrelated to the reason for which this initial appointment is sought.
- Key Personal Information – This would generally include list of other medical conditions which the patient is having along with any recent infections.
- Medications – This list would contain names of all medications including doses of all vitamins & supplements which the patient is taking.
- Questions to Ask Orthopedists
It would be sensible to take along a friend or family member, if possible, & who can help patients remember information shared during initial appointment. Questions which can be asked to orthopedists concerning infectious arthritis include the following.
- What is most likely to be causing my symptoms?
- Are there any other possible causes for my condition?
- Which tests will I need to undergo?
- Is my condition chronic or temporary in nature?
- Which is the best course of action I can take?
- Are there any alternatives to the treatment you are suggesting?
- How soon can I expect symptoms to improve with suggested treatment?
- What can I do in the meantime so as to help relieve joint pain?
- What are risks of long-term complications associated with this condition?
- How best can I manage this condition along with other health problems?
- Will I need to see some other specialist as well?
- Can you provide me with brochures or other printed matter which is available on the subject?
- Which websites would you recommend I refer to for further information?
Apart from these questions, patients should not hesitate to ask any other questions which come to their mind.
Orthopedists are most likely to ask the following questions to patients.
- When did you first notice these symptoms?
- Have these symptoms been occasional or continuous?
- How severe are these symptoms?
- What is it, if anything, that seem to improve symptoms?
- What is it, if anything, which appear to worsen symptoms?
- Have you ever undergone joint replacement or joint surgery in the past?
- Are you using any type of recreational drugs?
Orthopedists usually rely on joint drainage & antibiotic medications for treatment of Septic arthritis.
- Joint Drainage – Removal of fluid which is inside the infected joint is crucial for treatment. Methods of drainage can include the following.
- Needle – Orthopedists can in some cases withdraw infected fluid with help of a needle inserted into the infected joint space.
- Scope Procedure – A flexible tube with video camera at the tip is placed within the joint through a small incision in arthroscopy procedure. Following this, suction & drainage tubes are also inserted through small incisions around the joint.
- Open Surgery – Some joints like the hip joint are more difficult to drain with help of a needle or through arthroscopy. In such a situation, open surgical procedure may be essentially required.
- Antibiotic Administration – In order to select the most effective antibiotic medication, orthopedists must first identify the microbe which is causing infectious arthritis. Antibiotics are usually administered through veins in arms at first & can later be switched to oral antibiotics. This treatment typically lasts between 2 – 6 weeks of time. Risk of side effects, which antibiotics generally carry include diarrhea, vomiting & nausea. Sometimes allergic reactions may also occur, therefore infectious arthritis patients should ask orthopedists about the kind of side effects they can expect from the prescribed antibiotic medication.
Early & accurate diagnosis along with prompt intervention is a crucial factor for successful outcome of infectious arthritis treatment. Appropriate drainage of infectious joint & antibiotic treatment usually results in prompt recovery with minimum or short-term morbidity. However, a close follow-up is essentially required in order to monitor growth of affected limbs until skeletal maturity is obtained. Nevertheless, orthopedist will require to maintain high index of suspicion & to educate the patient about avoiding improper use of antibiotics & regular follow-up after acute pathology.
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