Description

• Invasion of joints by pyogenic microorganisms:
  • One of the curable causes of arthritis
  • May be part of systemic infection/disease
• System(s) affected: Musculoskeletal
• Synonym(s): Suppurative arthritis; Septic arthritis; Pyarthrosis; Pyogenic arthritis; Bacterial arthritis

Epidemiology

• Predominant age:
  • Neisserial:
    • Especially 15–40 years of age
    • Can occur at any age
  • Nonneisserial (approximate):
    • <2 years: 60% Staphylococcus, 20% Streptococcus, 10% gram-negative rods, <5% miscellaneous
    • 2–14 years: 60% Staphylococcus, 30% Streptococcus, 5% Haemophilus, 5% other gram-negative rods, 5% miscellaneous
    • Adult: 60% Staphylococcus, 25% Streptococcus, <1% Haemophilus, and 15% other gram-negative rods
• Predominant gender:
  • Neisserial: Female > Male (4:1)
  • Nonneisserial: Male > Female (2:1)

• Neisserial:
  • Responsible for 50% of all types of infectious arthritis
  • 0.6% of women with gonorrhea
  • 0.1% of men with gonorrhea
  • Arthritis occurs in 7% of individuals with Neisseria meningitidis.
• Nonneisserial: Half as frequent as neisserial
• The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is ~27% (1).

Risk Factors

• Sexual exposure: Neisserial
• Inflammatory arthritis (e.g., rheumatoid arthritis)
• Concurrent extra-articular infection
• Prior arthritis in affected joint
• Trauma
• Joint puncture or surgery
• Prosthetic joint (2)[A]
• Prior corticosteroid or immunosuppressive therapy
• Serious chronic systemic illness (e.g., diabetes, liver disease, malignancy, immunodeficiency)
• Defective phagocytic mechanisms (e.g., chronic granulomatous disease)
• Injection drug use
• Sickle cell anemia
• Complement deficiency
• Systemic infection; infection elsewhere
• Immunodeficiency; immunosuppression
• Dental procedures; poor dental/gingival hygiene
• Advanced age (>80 years)

General Prevention

• Prompt treatment of skin and soft tissue infections
• Condoms and limiting number of sexual partners for STD protection

Etiology

• Hematogenous invasion (80–90%)
• Contiguous spread (10–15%)
• Direct penetration of microorganisms secondary to trauma or joint infection (5%)

Commonly Associated Conditions

• Serious chronic illness (e.g., rheumatoid arthritis, diabetes, liver disease, malignancy, primary immunodeficiency, complement deficiencies)
• Immunosuppressive therapy (disease-modifying antirheumatic drugs [DMARDs] agents, glucocorticoids, chemotherapy)
• Systemic infection associated with bacteremia, especially endocarditis