Septic Arthritis - Ways to Manage Joint Infection

What Is Septic Arthritis?

Septic arthritis is the infection of the joint, synovial fluid, and the tissues of the joint. More commonly affected than adults are children, in whom the infection reaches the joints via the bloodstream. The joints may also become infected due to an injection, surgery, or injury. The condition is excruciating and can develop and aggravate quickly. Septic arthritis, a severe condition that can strike anybody at any time, should, therefore, be treated on an emergency basis in a hospital.

Is Septic Arthritis Contagious?

Infectious arthritis is not contagious, although the name may be misleading. It can, however, be quite severe. According to studies, at least one-third of those with the condition get sick from septic arthritis, and 7 to 15 % of those who are hospitalized pass away from it. It is mainly a threat to patients whose immune systems have been compromised. The list of these patients includes the elderly, small children, diabetics, and others with artificial joints or patients who have some other underlying medical conditions that might make their immune systems weak. Among them are those suffering from diabetes and immunosuppressant medication, either for an autoimmune condition, cancer, or for an organ transplant.

What Causes Septic Arthritis?

Several strains of bacteria, viruses, and fungi can cause infection in a joint. Septic arthritis causes are as follows:

• Staphylococci: These are common bacteria causing skin infections.

• Haemophilus influenzae: These bacteria cause laryngeal, tracheal, and bronchial infections.

• Gram-negative Bacilli: This bacterial group includes E. coli.

• Streptococci: This group of bacteria is responsible for many diseases.

• Gonococci: This is the bacterium responsible for the sexually transmitted disease known as gonorrhea.

• Viruses: Human Immunodeficiency virus can result in the infection of the joints.

The strain Staphylococcus aureus principally causes septic arthritis. It is also known as S. aureus. The entry point of the bacteria into the bloodstream may be in several ways, such as:

• A broken bone is piercing the skin, known as an open fracture.

• Spread of infection from another place on the body, such as the skin or genitals.

• An infected wound.

• Foreign objects that go through the skin.

• An injury that breaks the skin.

Symptoms of Septic Arthritis?

Septic arthritis commonly affects the knee, hip, shoulder, elbow, wrist, and finger joints, often affecting only one joint. Symptoms vary across affected persons, but the most common septic arthritis symptoms include:

• Fever or pyrexia.

• Joint pain or arthralgia.

• Swelling of the joints.

• Limited mobility.

The symptoms mentioned earlier of septic arthritis may mimic other health conditions, and a healthcare provider should be consulted for a confirmed diagnosis.

What Are the Types of Septic Arthritis?

• Acute Septic Arthritis: The most common type is acute septic arthritis, which results from an infection caused by a bacterium or fungus. Usually, it affects one joint alone but can cause dramatic destruction of the area affected if it does not receive timely intervention.

• Chronic Septic Arthritis: Here, the infection has been there in the joint for a long time and leads to the erosion of cartilage and joint architecture over time. Chronic septic arthritis tends to involve more than one joint at the same time, and thus, its treatment is quite challenging.

• Asymptomatic Septic Arthritis: This is a type that is usually difficult to diagnose since there are no symptoms or signs of infection. However, it is essential to diagnose because, if left untreated, it can cause long-term damage.

Septic Arthritis vs Osteomyelitis

Septic arthritis and osteomyelitis are rare, serious infections affecting bones and joints, and thus are often confused with each other.

Septic Arthritis: An infection within the synovial fluid of a joint, also involving its cartilage surface. It typically affects the hip or knee but any other synovial joint as well. Signs are pain, tenderness, swelling, fever, and chills. It can be encountered at any ag, except a specific infantile form of osteomyelitis.

Osteomyelitis: This is an infection of the bone or bone marrow. It most often affects the tibia, femur, pelvis, or humerus but can occur in any bone. Swelling, tenderness, and pain are common symptoms; fever may be present or absent. It occurs most commonly in children.

How Is Septic Arthritis Diagnosed?

Early diagnosis leads to avoiding permanent loss due to the effect on the joint. Septic arthritis diagnosis includes a medical history and a physical examination along with tests that need to be performed, such as:

• Aspiration of the joint fluid to check for white blood cells, inflammation, and bacterial infections.

• Blood tests are done to look for the various strains of bacteria responsible for the disease.

• Other body fluids and secretions such as phlegm, cerebrospinal fluid, urine examinations, and culture sensitivity tests identify bacterial strains and locate the infection source.

How Is Septic Arthritis Treated?

Septic arthritis treatment depends upon the symptoms, age, and general health of a patient and the severity of the disease.

Often, prompt treatment with antibiotics is instrumental, which can improve symptoms within the next 48 hours. Fungal infections need treatment with antifungal medicine. Viral infections are not treated with medication. Pus drainage may be required from the joint as a build-up of purulent material, which can irreversibly cause damage to the joint. Drainage is usually done with a needle, tube, or surgery, and a single site may be drained multiple times from the joint throughout treatment. Other septic arthritis treatment modalities include palliative therapies to provide symptomatic relief:

• Antipyretics for fever.

• Analgesics for pain and tenderness.

• Physiotherapy to maintain or regain muscular strength and functionality.

• A splint may be placed.

Who Is at Risk for Septic Arthritis?

Risk factors for children include:

• Newborn children.

• Patients with hemophilia.

• Immunocompromised patients.

• Patients undergoing chemotherapy.

Risk factors for adults are as follows:

• Older adults.

• Patients with rheumatoid arthritis or osteoarthritis.

• HIV (human immunodeficiency virus) patients.

• Diabetic patients.

• Skin infections.

• Patients underwent joint surgery.

• Patients having artificial or prosthetic joints.

• STI (sexually transmitted infections).

What Are the Complications of Septic Arthritis?

Septic arthritis is a severe condition. The complications of septic arthritis include the following:

• Chronic pain.

• Osteomyelitis (a painful infection that becomes inflamed, swollen, or red in a bone).

• Osteonecrosis (a condition whereby the blood supply to a bone is interrupted and, therefore, the bone tissue dies).

• A difference in leg length.

• Sepsis (an extreme response of the body to an infection that eventually leads to potentially life-threatening conditions, medical emergency).

• Death in extreme cases.

Steps to Improve Recovery Post-Treatment?

When the symptoms start to ease after treatment, getting the affected joints moving again is essential. A gentle movement helps faster recovery and prevents long-term stiffness or restricted activities.

A physiotherapist can advise specific exercises to help get the joint moving. With gentle exercise and completing the entire antibiotic regimen as prescribed, most people fully recover without long-term damage. However, certain cases may show aggravated symptoms or delayed recovery. If the pain persists following the treatment mentioned above, the following may be done:

• Resting from time to time prevents overuse or abuse of the affected joint.

• Raising the joint above the heart level, if possible, will reduce swelling and pain.

• Ice packs on the joint to help reduce swelling and pain. This should be done for 20 minutes at the least.

• Daily stretching and strengthening exercises, as suggested by a professional increase the flexibility of the joint, restore functionality, and get some relief from the pain.

Conclusion:

Septic arthritis is an acute condition that requires early medical diagnosis and therapy to avoid any further damage to the joint. Bacteria is the common cause of this infection. The most prevalent pathogen is Staphylococcus aureus. Age, a compromised immune system, and other pre-existing conditions in the joints are risk factors for developing the condition. The best way to manage the condition is through early identification through clinical evaluation, laboratory tests, and imaging. Common treatment includes administration of antibiotics and, in some scenarios, surgical drainage of infected fluid from the joint. With timely medical care, most patients recover well. However, if treatment is delayed, it can lead to severe complications, including joint damage, persistent pain, and reduced mobility. Taking proper care of wounds and staying up to date with vaccinations can help prevent septic arthritis.