Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2003 Apr;62(4):327–331. doi: 10.1136/ard.62.4.327

Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis

M Gupta 1, R Sturrock 1, M Field 1
PMCID: PMC1754487  PMID: 12634231

Abstract

Objective: To investigate whether patients with acute septic arthritis (SA) diagnosed by positive synovial fluid (SF) culture (Newman grade A) have different clinical and serological features from those with sterile SF in whom there is nonetheless a high suspicion of SA (Newman grades B and C).

Patients and methods: A prospective 12 month multicentre hospital based study of adult patients with SA recruited 47 patients with culture positive SA and 35 patients with clinically suspected SA but sterile SF.

Results: Patient demography, clinical and laboratory features at presentation were similar irrespective of the underlying diagnosis, SF culture, and the presence of prosthetic joints. Medical and surgical treatment and outcome were comparable in the two patient groups. Patients with both suspected and proven SA were more likely to be from the more socially deprived areas of our community (p<0.0001).

Conclusion: Patients in whom there is a high clinical suspicion of SA are comparable to those patients with SA with a positive SF culture and have similar morbidity and mortality on follow up. Therefore, if clinical suspicion of SA is high then it is correct to treat as SA in the absence of bacterial proof.

Full Text

The Full Text of this article is available as a PDF (142.7 KB).

Figure 1 .

Figure 1

Open in a new tab

Sites of infection in patients with proven (n=47) and suspected (n=35) septic arthritis.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Avimadje M., Goupille P., Jeannou J., Gouthière C., Valat J. P. Can an anomalous lumbo-sacral or lumbo-iliac articulation cause low back pain? A retrospective study of 12 cases. Rev Rhum Engl Ed. 1999 Jan;66(1):35–39. [PubMed] [Google Scholar]
  2. Baker D. G., Schumacher H. R., Jr Acute monoarthritis. N Engl J Med. 1993 Sep 30;329(14):1013–1020. doi: 10.1056/NEJM199309303291407. [DOI] [PubMed] [Google Scholar]
  3. Berman A., Espinoza L. R., Diaz J. D., Aguilar J. L., Rolando T., Vasey F. B., Germain B. F., Lockey R. F. Rheumatic manifestations of human immunodeficiency virus infection. Am J Med. 1988 Jul;85(1):59–64. doi: 10.1016/0002-9343(88)90503-7. [DOI] [PubMed] [Google Scholar]
  4. Berney S., Goldstein M., Bishko F. Clinical and diagnostic features of tuberculous arthritis. Am J Med. 1972 Jul;53(1):36–42. doi: 10.1016/0002-9343(72)90113-1. [DOI] [PubMed] [Google Scholar]
  5. Bremell T., Lange S., Svensson L., Jennische E., Gröndahl K., Carlsten H., Tarkowski A. Outbreak of spontaneous staphylococcal arthritis and osteitis in mice. Arthritis Rheum. 1990 Nov;33(11):1739–1744. doi: 10.1002/art.1780331120. [DOI] [PubMed] [Google Scholar]
  6. Brower A. C. Septic arthritis. Radiol Clin North Am. 1996 Mar;34(2):293-309, x. [PubMed] [Google Scholar]
  7. Canvin J. M., Goutcher S. C., Hagig M., Gemmell C. G., Sturrock R. D. Persistence of Staphylococcus aureus as detected by polymerase chain reaction in the synovial fluid of a patient with septic arthritis. Br J Rheumatol. 1997 Feb;36(2):203–206. doi: 10.1093/rheumatology/36.2.203. [DOI] [PubMed] [Google Scholar]
  8. Cimmino M. A. Recognition and management of bacterial arthritis. Drugs. 1997 Jul;54(1):50–60. doi: 10.2165/00003495-199754010-00004. [DOI] [PubMed] [Google Scholar]
  9. Cooper C., Cawley M. I. Bacterial arthritis in an English health district: a 10 year review. Ann Rheum Dis. 1986 Jun;45(6):458–463. doi: 10.1136/ard.45.6.458. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Goldenberg D. L. Infectious arthritis complicating rheumatoid arthritis and other chronic rheumatic disorders. Arthritis Rheum. 1989 Apr;32(4):496–502. doi: 10.1002/anr.1780320422. [DOI] [PubMed] [Google Scholar]
  11. Greenspan A., Tehranzadeh J. Imaging of infectious arthritis. Radiol Clin North Am. 2001 Mar;39(2):267–276. doi: 10.1016/s0033-8389(05)70277-3. [DOI] [PubMed] [Google Scholar]
  12. Gupta M. N., Gemmell C., Kelly B., Sturrock R. D. Can the routine culture of synovial fluid be justified? Br J Rheumatol. 1998 Jul;37(7):798–799. doi: 10.1093/rheumatology/37.7.798. [DOI] [PubMed] [Google Scholar]
  13. Gupta M. N., Sturrock R. D., Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford) 2001 Jan;40(1):24–30. doi: 10.1093/rheumatology/40.1.24. [DOI] [PubMed] [Google Scholar]
  14. Hamed K. A., Tam J. Y., Prober C. G. Pharmacokinetic optimisation of the treatment of septic arthritis. Clin Pharmacokinet. 1996 Aug;31(2):156–163. doi: 10.2165/00003088-199631020-00006. [DOI] [PubMed] [Google Scholar]
  15. Hortas C., Ferreiro J. L., Galdo B., Arasa F. J., Barbazán C., Mera A. J., Mosquera J. A. Tuberculous arthritis of peripheral joints in patients with previous inflammatory rheumatic disease. Br J Rheumatol. 1988 Feb;27(1):65–67. doi: 10.1093/rheumatology/27.1.65. [DOI] [PubMed] [Google Scholar]
  16. Ilahi O. A., Swarna U., Hamill R. J., Young E. J., Tullos H. S. Concomitant crystal and septic arthritis. Orthopedics. 1996 Jul;19(7):613–617. [PubMed] [Google Scholar]
  17. Jacobs J. C., Li S. C., Ruzal-Shapiro C., Kiernan H., Parisien M., Shapiro A. Tuberculous arthritis in children. Diagnosis by needle biopsy of the synovium. Clin Pediatr (Phila) 1994 Jun;33(6):344–348. doi: 10.1177/000992289403300606. [DOI] [PubMed] [Google Scholar]
  18. Kaandorp C. J., Krijnen P., Moens H. J., Habbema J. D., van Schaardenburg D. The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum. 1997 May;40(5):884–892. doi: 10.1002/art.1780400516. [DOI] [PubMed] [Google Scholar]
  19. Kaandorp C. J., Van Schaardenburg D., Krijnen P., Habbema J. D., van de Laar M. A. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum. 1995 Dec;38(12):1819–1825. doi: 10.1002/art.1780381215. [DOI] [PubMed] [Google Scholar]
  20. Lossos I. S., Yossepowitch O., Kandel L., Yardeni D., Arber N. Septic arthritis of the glenohumeral joint. A report of 11 cases and review of the literature. Medicine (Baltimore) 1998 May;77(3):177–187. doi: 10.1097/00005792-199805000-00003. [DOI] [PubMed] [Google Scholar]
  21. Louie J. S., Liebling M. R. The polymerase chain reaction in infectious and post-infectious arthritis. A review. Rheum Dis Clin North Am. 1998 May;24(2):227–236. doi: 10.1016/s0889-857x(05)70006-5. [DOI] [PubMed] [Google Scholar]
  22. Martens P. B., Ho G., Jr Septic arthritis in adults: clinical features, outcome, and intensive care requirements. J Intensive Care Med. 1995 Sep-Oct;10(5):246–252. doi: 10.1177/088506669501000507. [DOI] [PubMed] [Google Scholar]
  23. Mitchell W. S., Brooks P. M., Stevenson R. D., Buchanan W. W. Septic arthritis in patients with rheumatoid disease: a still underdiagnosed complication. J Rheumatol. 1976 Jun;3(2):124–133. [PubMed] [Google Scholar]
  24. Morgan D. S., Fisher D., Merianos A., Currie B. J. An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect. 1996 Dec;117(3):423–428. doi: 10.1017/s0950268800059070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Newman J. H. Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis. 1976 Jun;35(3):198–205. doi: 10.1136/ard.35.3.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rynes R. I., Goldenberg D. L., DiGiacomo R., Olson R., Hussain M., Veazey J. Acquired immunodeficiency syndrome-associated arthritis. Am J Med. 1988 May;84(5):810–816. doi: 10.1016/0002-9343(88)90057-5. [DOI] [PubMed] [Google Scholar]
  27. Tunney M. M., Patrick S., Gorman S. P., Nixon J. R., Anderson N., Davis R. I., Hanna D., Ramage G. Improved detection of infection in hip replacements. A currently underestimated problem. J Bone Joint Surg Br. 1998 Jul;80(4):568–572. doi: 10.1302/0301-620x.80b4.8473. [DOI] [PubMed] [Google Scholar]
  28. Weston V. C., Jones A. C., Bradbury N., Fawthrop F., Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis. 1999 Apr;58(4):214–219. doi: 10.1136/ard.58.4.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Winchester R., Bernstein D. H., Fischer H. D., Enlow R., Solomon G. The co-occurrence of Reiter's syndrome and acquired immunodeficiency. Ann Intern Med. 1987 Jan;106(1):19–26. doi: 10.7326/0003-4819-106-1-19. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES