Arthritis (SEPTIC)

Signs and Symptoms

• Fever
• Swollen, painful, warm joint
• Severe local tenderness
• Pain on joint motion

Investigations

• Joint aspiration for diagnostic and therapeutic purposes
• ↑↑ WCC (e.g. >50,000/mm3): mostly PMN
• ↑ESR/CRP, ↑WCC, Blood cultures
• X-ray
• FBC,
• VDRL

Pharmacological

Treatment Adults:

• Give Flucloxacillin 1g IV 6 hourly for at least 14 days plus Ciprofloxacin 500mg 12 hourly PO or Doxycycline 100mg 12 hourly PO.
• A further 2-4 weeks of oral antibiotics (Flucloxacillin and Ciprofloxacin) may be required

Alternatively, if penicillin allergic:

• Give Clindamycin 450mg 12 hourly or, if not available use Ceftriaxone 2g IV daily for 2 weeks followed by oral Erythromycin 500mg 6 hourly and Ciprofloxacin 500mg 12 hourly for a duration of 2-4 weeks

Note : If Pus present, always refer early for anthrotomy

Children

• Give Ceftriaxone 50mg/kg daily for 14 days

Or alternatively when staphylococcal infection is suspected:

• Give Flucloxacillin 25 mg/kg IV q6h for 14 days

Or if above drugs not available

• Give Chloramphenicol 12.5 mg/kg every 6hrs for at least 14 days, or 4 weeks if there is associated osteomyelitis, clinically evident by bone swelling or proven by

X-rays after the initial 14 day course

Non-pharmacological

• Consider joint washout under GA
• Splint joint
• Physiotherapy after infection resolved

Complications

• Osteomyelitis
• Arthritis
• Ankylosis: fusion

Note: Surgical drainage may be indicated

TB septic arthritis is treated as for other forms of extra-pulmonary TB

When to refer a septic arthritis patient

• If pus present, always refer early for arthrotomy.
• Suspicion of joint destruction
• No response to the available antibiotics

RED FLAG: Always refer early to hospital for systemic treatment and arthrotomy