infectious%20arthritis
INFECTIOUS ARTHRITIS
The classical presentation of infectious arthritis is acute onset of pain, warmth and swelling of a single joint.
The range of motion is usually decreased.
The knee is the most commonly affected but any joint may be involved.
Fever and chills may be present.
More than 1 joint may be involved in patients with pre-existing joint disease, other inflammatory conditions or severe sepsis, and in some patients infected with certain pathogens eg N gonorrheae, N meningitidis and Salmonella spp.
Infectious arthritis must always be a part of the differential diagnosis in a patient with an acute monoarthritis. 

Etiology

S aureus

  • Most common pathogen in infectious arthritis of both native & prosthetic joints
  • Infections caused by Methicillin-resistant S aureus are usually more aggressive, w/ involvement of >1 joint

S epidermidis

  • More common in prosthetic joint infection

Streptococci

  • Next to S aureus, most common Gram positive aerobes causing infectious arthritis
  • Group B streptococci is a common cause of infectious arthritis in neonates while S pyogenes & S pneumoniaeare are common pathogens in children ≤ 5 years old who have infectious arthritis
  • Streptococci are important infectious arthritis pathogens in patients w/ serious infections of the genitourinary or gastrointestinal tract

Gram-negative bacilli

  • Common etiologic agents of infectious arthritis in intravenous (IV) drug users, elderly & immunocompromised persons
    • Elderly patients frequently have underlying joint diseases & concomitant diseases like diabetes mellitus (DM)  & rheumatoid arthritis
    • Disease-modifying drugs used to treat rheumatoid arthritis (eg Infliximab & Etanercept) may predispose patients to the development of infectious arthritis
  • H influenzae was formerly a common pathogen in infectious arthritis in children aged 1 month-5 years but widespread vaccination against the organism has drastically reduced the number of cases
  • P aeruginosa may be a cause of infectious arthritis in IV drugs users, premature infants & patients w/ central vascular catheters

N gonorrhoeae

  • Possible etiologic agent in young, healthy, sexually active adults w/ infectious arthritis
  • Incidence frequently related to socioeconomic status

Anaerobes

  • More common in patients w/ DM & those w/ prosthetic joint infection

Mycobacterial species & fungi

  • Much less common cause of infectious arthritis compared to bacteria
  • Low immune system, recent travel & living in endemic areas are determinants for people susceptible to mycobacterial infections
  • Infectious arthritis caused by these organisms usually presents w/ marked joint swelling, mild signs of acute inflammation & few systemic symptoms
  • Tuberculous infectious arthritis may be more common in low-income groups while other mycobacterial species can cause infectious arthritis in human immunodeficiency virus (HIV)-infected persons
  • Candida arthritis is more common in immunocompromised persons & is associated w/ the presence of a central vascular catheter

Signs and Symptoms

  • Classical presentation: Acute onset of pain, warmth & swelling of a single joint
    • Range of motion is usually decreased
    • The knee is most commonly affected but any joint may be involved
    • >1 joint may be involved in patients w/ pre-existing joint disease, other inflammatory conditions or severe sepsis & in some patients infected w/ certain pathogens (eg N gonorrhoeae, N meningitidis & Salmonella spp)
  • Fever & chills may be present
  • Infectious arthritis must always be part of the differential diagnosis in a patient w/ an acute monoarthritis
  • Children may present w/ more subtle symptoms:
    • Anorexia, malaise, irritability
    • Limp or refusal to walk
    • Refusal to use the affected joint
    • Redness & swelling of skin & soft tissue overlying the involved joint early in the disease

Risk Factors

  • Newborns & persons >60 years old
  • Recent joint surgery, prosthetic joints, arthroscopy, osteoarthritis, rheumatoid arthritis in a specific joint, direct joint injury, open reduction of fracture & intra-articular steroid injection
  • Systemic diseases [eg rheumatoid arthritis, diabetes mellitus (DM), malignancies, use of glucocorticoids & other immunosuppressive drugs]
  • Extra-articular site of infection that may have given rise to bacteremic seeding in a joint (eg pyelonephritis, pneumonia & skin infection)
  • Alcoholism & intravenous (IV) drug abuse
  • Low socioeconomic status
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Infectious Diseases - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Tristan Manalac, 06 Nov 2018
Intravenous cefiderocol thrice daily is noninferior to imipenem-cilastatin for treating complicated urinary tract infection (UTI) patients with multidrug-resistant, Gram-negative infections, according to a recent study.
01 Nov 2018
Genotype 4 hepatitis E virus infection does not appear to be correlated with acute, nontraumatic neurologic disorders, according to a recent China study.
01 Nov 2018
In patients with genotype 3 hepatitis C virus (HCV) infection and decompensated cirrhosis, the rate of achieving sustained virologic response 12 weeks after treatment (SVR12) is high with treatment regimens consisting of sofosbuvir and velpatasvir with or without ribavirin, according to the results of a phase II trial. However, the rate appears to be lower in the subgroup of patients with baseline resistance-associated substitutions in nonstructural protein 5A.
07 Nov 2018
In infants with early-life acute respiratory infection (ARI) with respiratory syncytial virus (RSV), elevated nasopharyngeal Lactobacillus levels protect against wheezing illnesses at 2 years of age, a recent study has found.