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Information for Septic Arthritis Sufferers

What is Septic Arthritis?

Septic Arthritis in the hip joint.

Septic arthritis is a form of arthritis where joint inflammation is caused by a germ. The germ can be a bacterium, a virus, or a fungus. Infection of the joints usually occurs after a previous infection elsewhere in the body. After these invasive agents have found their way into your body, they travel into the synovial fluid of the joint and infect it. This causes the arthritis to occur.

Synovial fluid is a fluid secreted by tissues surrounding the joints that lubricates the joints. Essentially, the synovial fluid acts as a sort of second joint within the joints, as well “sheath” for the joints and cartilage.

Usually, only one joint is affected, but more than one can be infected. It is most commonly found in the joints of the arms and legs (especially the knee), but other joints can be affected.

  • Infectious arthritis is another name for septic arthritis.
  • Septic arthritis is most commonly found in elderly adults (over 80) and very young children (under 5).
  • High risk groups for contracting septic arthritis include: individuals with diabetes, those with a weakened immune system, drug users and alcohol abusers, or someone with another condition affecting the joints, such as rheumatoid arthritis or gout.

Do I have it?

If one or more of your joints are displaying symptoms of arthritis (inflammation, stabbing pain), and you have a fever or feel feverish, you may have septic (infectious) arthritis. See your doctor immediately.

Infectious arthritis often has a sudden onset, but symptoms can develop over a period of three to 14 days. Children sometimes develop nausea and vomiting.

It is critical to have septic arthritis diagnosed by a medical professional and treated, as it can destroy joints in a short period of time.

How is it diagnosed?

The diagnosis of septic arthritis depends on a combination of laboratory testing with careful history-taking and physical examination of the affected joint. It is important to keep in mind that septic arthritis can coexist with other forms of arthritis, gout, rheumatic fever, Lyme disease, or other disorders that can cause a combination of joint pain and fever. Your doctor may consult a specialist in rheumatology to avoid misdiagnosis.

A rheumatologist is a doctor who has received special training in the diagnosis and treatment of problems with joints, muscles, and bones.

Patient history. Your medical history will tell your doctor whether you belong to a high-risk group for infectious arthritis. Sudden onset of joint pain is also important information.

Physical examination. The doctor will examine the affected joint for swelling, soreness, warmth, and other signs of infection. Location is sometimes a clue to diagnosis; infection of an unusual joint (joints between the breastbone and collarbone, or the pelvic joints) occurs in drug abusers.

Laboratory tests. Laboratory testing is necessary to confirm septic arthritis. The doctor will perform an arthrocentesis. The fluid sample is sent for culture in a sealed syringe. Synovial fluid from infected joints is usually streaked with pus or looks cloudy and watery. Cell counts usually indicate a high level of white cells. A neutrophil proportion greater than 90% suggests septic arthritis.

An arthocentesis is a painful procedure that involves withdrawing a sample of synovial fluid from the joint with a needle and syringe.

Your doctor may order a biopsy of the synovial tissue near the joint if the fluid sample is negative. Cultures of other body fluids, such as urine, blood, or cervical mucus, may be taken as well.

Diagnostic imaging. Diagnostic imaging isn’t helpful in the early stages of infectious arthritis. Destruction of bone or cartilage won’t appear on x-rays until 10-14 days after the onset of symptoms. Imaging studies are sometimes useful if the infection is in a deep-seated joint.

How did I get it?

Invasive bacteria, viruses, or fungi can enter the body and the bloodstream in a variety of ways; for example, complications resulting from medical treatment, wounds that penetrate the joint, injections, or by spreading from other infections elsewhere in the body or on the skin.

Depending on your health, you may be more susceptible to infection. Perhaps you fall into one of the high risk groups for contracting septic arthritis. These include: individuals with diabetes, those with a weakened immune system, intravenous drug users and alcohol abusers, or someone with another condition affecting the joints, such as rheumatoid arthritis or gout.

People who work in jobs where exposure to animals, plants, marine life, and soil is common also have a higher chance of contracting infectious arthritis.

Bacteria has been shown to cause septic arthritis. Culprits include:

  • Staphylococcus aureus (also known as golden staph). The most common cause of staph infections. It is a bacteria frequently living on the skin or in the nose of a person. About 20–30% of the population are "staph carriers".
  • Streptococcus pneumoniae. This organism causes many types of infection other than pneumonia, including acute sinusitis, middle ear infections, meningitis, septic arthritis and brain abscess. It is the most common cause of bacterial meningitis in adults and children.
  • Mycobacterium tuberculosis. The bacteria that causes most cases of tuberculosis.
  • Candida albicans (also known as thrush). A common condition which is usually easily cured in people who are not immunocompromised. However, a compromised immune system (HIV-positive, cancer chemotherapy, organ or bone marrow transplantation) can develop septic arthritis.
  • Haemophilus influenzae. Most strains are opportunistic pathogens, meaning they live in their host without causing disease only causing harm when other factors (a viral infection or reduced immune function) create an opportunity. In infants and young children, it can cause joint infections.
  • Neisseria gonorrhoea. A species of bacteria responsible for the sexually transmitted disease gonorrhoea.
  • Escherichia coli. This bacteria is most commonly found in the lower intestine. Most E. coli strains are harmless.
  • Salmonella. The bacteria that causes typhoid fever, paratyphoid fever, and foodborne illness. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. Some people later experience arthritis.
  • Brucella. This bacteria is transmitted by ingesting infected food, direct contact with an infected animal, or inhalation of aerosols.

Viruses can also cause infectious arthritis. They include:

  • infectious hepatitis
  • mumps
  • infectious mononucleosis

Fungi are the least common cause of infectious arthritis. They are often found in:

  • soil
  • bird droppings
  • certain plants, such as roses


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