Septic arthritis in patients with pre-existing inflammatory arthritis

Abstract

The case: A 56-year-old woman presents to her family physician with a 7-day history of tenderness, swelling and redness of 2 metacarpophalangeal joints and 1 proximal interphalangeal joint in her right hand. She also reports pain and redness of her right knee that makes it difficult to walk. On examination, her right knee appears swollen and red. The patient has a 10-year history of rheumatoid arthritis with intermittent polyarticular flares, primarily involving her wrists, fingers (metacarpophalangeal and proximal interphalangeal joints), feet (metatarsophalangeal joints) and occasionally her knees. However, the condition has been well managed with methotrexate and hydroxychloroquine therapy. She had no flares in the year before presentation and is able to perform household chores and to work as a dry-cleaning attendant. What other history, physical examination and laboratory investigations would you seek to distinguish a simple flare of inflammatory polyarthritis from a superimposed infection?

Superior detection of pathogens in synovial fluid by the Bactec 9240 Peds Plus/F system compared to the conventional agar-based culture method

“…This correlates with other reports citing that the knee is affected in more than 50% of septic arthritis cases. 2,11,16 S. aureus was the most common pathogen isolated and all six isolates were detected by all three culture methods. Worldwide, S. aureus remains the most common cause of septic arthritis.…”

Septic Complications Involving Hand and Wrist in Patients with Pre-existing Rheumatoid Arthritis: The Role of Magnetic Resonance Imaging and Sonography

“…The first is Graif's [14] analysis of difference between septic and non-septic joint in naïve patients (without preexisting diagnosis of inflammatory arthritis), which provided us with the methodological background; the second is Kherani's case report [9], which focalized the importance and toughness of differentiate RA reactivation and infective complication in patients with pre-existing articular disease.…”

“…Literature has reported that 46% of patients with septic arthritis (SA) had a pre-existing joint disease and, of these patients, 14% had RA and 10% other inflammatory arthritis [9].…”

Septic Oligoarthritis Caused by Klebsiella pneumoniae and Acinetobacter baumannii

“…Septic arthritis is an uncommon and potentially fatal emergency associated with significant mortality and morbidity rates, with an incidence in the general population reported to be 2 to 5 per 100,000 1 . Bacteria may spread directly from adjacent osteomyelitis or from a local soft-tissue infection, diagnostic or therapeutic procedure, or penetrating trauma 1 .…”

“…Bacteria may spread directly from adjacent osteomyelitis or from a local soft-tissue infection, diagnostic or therapeutic procedure, or penetrating trauma 1 . Usually, this condition is caused by S. aureus, which accounts for two-thirds of the cases, whereas septic arthritis caused by Klebsiella pneumoniae or Acinetobacter baumannii are rare conditions seldom reported 2,3,4,5 .…”