Everything You Should Know About Septic Arthritis

Contrary to popular belief, arthritis is not always associated with old age. Septic arthritis, also known as infectious arthritis, is a serious form of arthritis triggered by a microbial infection, resulting in inflammation in one or multiple joints of the body. It is a serious condition that severely limits the range of motion of the affected joint and causes intense pain and swelling. This condition requires prompt medical intervention to prevent irreversible joint damage and complications. This blog is an introductory guide to understanding septic arthritis, including its symptoms, causes, and treatment options. 

What is Septic Arthritis?

Septic arthritis is a condition caused by a bacterial, viral, or fungal infection travelling through the bloodstream from another part of the body. In some cases, direct contamination of the joint during an injury or medical procedure can also lead to the condition. It is a serious condition that results in inflammation in the cartilage and synovial fluid, which lubricates the joints. Septic arthritis typically affects a single large joint, though multiple joints can sometimes be involved. Children with underdeveloped immune systems are at a higher risk of developing this condition than adults. 

Early recognition of symptoms is crucial to avoid complications. Common symptoms of septic arthritis include:

• Severe pain and tenderness in the affected joint
• Inability to move the infected joint
• Swelling and warmth in the affected joint
• Limited range of motion in the affected joint 
• Fever and chills
• Fatigue and weakness

Which Joints Are Susceptible to Septic Arthritis?

Larger joints, especially those in the lower half of the body, such as knees, hips, ankles, and pelvis, are most frequently affected by septic arthritis due to their weight-bearing function and frequent use. However, an infection in small joints, such as the shoulder joints, fingers, toes, and spinal joints, is not uncommon. Certain pre-existing conditions, such as rheumatoid arthritis or joint replacements, further increase susceptibility.

The knees are the most commonly infected joints in adults whereas the hip joint is more prone to septic arthritis in children. It is important to note that susceptibility to infection depends on various factors, including pre-existing joint conditions, previous injuries, structure and general usage of certain joints. 

What are the Causes of Septic Arthritis?

Septic arthritis develops when microbes enter the joint through the bloodstream or direct contamination, often originating from sources such as an open wound or surgical procedure. Immunocompromised individuals, such as those with diabetes or HIV, are at greater risk. Bacterial infections are the leading cause of septic arthritis, though viral and fungal infections are less common contributors to its development. In rare cases, fungal infections can mimic bacterial septic arthritis, delaying diagnosis and treatment. Below are the common causes of septic arthritis:

Bacterial infections:

• Methicillin-resistant Staphylococcus aureus (MRSA): Acquired from direct contact with infected wounds or contaminated surfaces, especially in healthcare settings.
• Streptococcus: Transmitted through respiratory droplets or direct contact with infected individuals, often in crowded environments.
• Neisseria gonorrhoeae: Spread through unprotected sexual contact with an infected person.
• Neisseria meningitidis: Spread through respiratory droplets or close contact with an infected person.

Viral infections:

• Adenovirus: Spread through respiratory droplets, contaminated surfaces, or fecal-oral transmission.
• HIV: Spread through unprotected sexual contact, sharing needles, or from mother to child during childbirth or breastfeeding.
• Hepatitis A, B, and C: Hepatitis A is contracted through contaminated food or water; Hepatitis B and C spread through blood or bodily fluids.
• Parvovirus B19: Spread through respiratory droplets or close contact with an infected person.
• Mumps: Spread through respiratory droplets or direct contact with an infected person’s saliva.
• Alphaviruses: Transmitted through mosquito bites or from infected animals.
• Coxsackie viruses: Spread through feces, respiratory droplets, or direct contact with an infected person.
• Flaviviruses: Transmitted through mosquito or tick bites, depending on the specific virus.
• HTLV-1: Spread through blood, unprotected sexual contact, or from mother to child during childbirth or breastfeeding.

Fungal Infections

• Coccidioides: Acquired by inhaling fungal spores from soil, particularly in arid regions.
• Blastomyces: Inhaled from fungal spores in soil and decaying organic matter.
• Histoplasma: Spread through inhalation of fungal spores found in soil contaminated with bird or bat droppings.

Can Septic Arthritis Spread To Other Parts of the Body?

Usually, septic arthritis affects only one joint, but though rare, certain infections like Neisseria gonorrhoeae can affect multiple joints. If left untreated, septic arthritis can lead to life-threatening complications like sepsis, emphasizing the need for urgent care. 

How Serious is Septic Arthritis?

Septic arthritis is a rare condition requiring immediate medical attention. Without timely treatment, it can result in irreversible joint damage, sepsis, or even death. 

How is Septic Arthritis Diagnosed?

Early diagnosis is critical to prevent long-term complications. Doctors use a combination of approaches to accurately diagnose the condition. These include tests such as:

• Clinical examination: Doctors check for pain, swelling, redness, warmth, and mobility of the affected joint. They also discuss the patient’s medical and medication history. 
• Synovial fluid aspiration (Arthrocentesis): An essential and definitive test for diagnosing septic arthritis, it involves the extraction of fluid from the affected joint to test for bacterial presence, abnormal glucose and protein levels, and elevated white blood cell (WBC) count. 
• X-rays: An imaging test to assess the extent and nature of damage, bone erosion, and abnormalities in the affected joint.
• Blood tests: A lab test to detect and monitor the level of inflammation, through elevated levels of WBCs, increased C-reactive protein, and high erythrocyte sedimentation rate.
• Ultrasound: An imaging test using sound waves to evaluate joint effusion (or leakage of fluid), and inflammation in the joint, as well as serve as a guiding tool for arthrocentesis. 
• MRI: An imaging test using radio waves and magnets to assess the damage in the hard and soft structures of the affected joint; may be useful in the early detection of septic arthritis. 

What are the Treatments for Septic Arthritis?

Prompt interventions, including antibiotics and drainage, to treat septic arthritis are known to improve patient outcomes significantly. A multidisciplinary approach involving rheumatologists, surgeons, and physiotherapists often provides the best outcomes. Doctors prescribe antibiotics along with procedures to drain fluid from the joints. Surgery may also be advised in some cases. Let’s look at some of the treatments for septic arthritis:

• Antibiotics: Intravenous antibiotics are commonly prescribed to patients to treat microbial infections.
• Joint fluid drainage: Synovial fluid drainage from the affected joint is essential for clearing the infection and promoting healing. Needle aspiration, arthroscopic drainage, or open surgery may be used for joint fluid drainage. It may be required more than once or in cycles during the entire course of the treatment depending on the severity of damage and the joint’s response to the treatment. 
• Surgery:

Debridement: Surgical removal of dead and damaged tissue, also known as debridement, is essential to eliminate infection and promote recovery in severe cases. It promotes the healing of the affected joint. Depending on the joint affected, minimally invasive techniques may be employed for quicker recovery.

Joint replacement surgery: Surgical removal of the infected artificial joint and insertion of an antibiotic spacer until the area has healed properly and is ready for replacement with a new artificial joint.

• Physical therapy: Most patients are advised physical therapy. Physiotherapists use a variety of techniques to help restore mobility, strength, and function in the affected joint and surrounding muscles. 

How Long Does It Take Septic Arthritis to Heal?

Recovery from septic arthritis varies based on infection severity, treatment, and patient health. Most patients are prescribed antibiotics for at least a couple of weeks. It may take longer if the infection has spread or is causing other complications. Patients should adhere to the full course of antibiotics and follow-up appointments for optimal outcomes.

Does Septic Arthritis Go Away On Its Own?

No, since septic arthritis is an infection caused by bacteria, viruses, or fungi, it does not go away on its own. Antibiotics are necessary for its treatment. Other approaches, including surgery, may also be required depending on the patient’s symptoms and general health.

What Are the Risk Factors For Septic Arthritis?

Some people are at a increased susceptibility to septic arthritis than others, such as:

• People with a weakened immune system
• People with recent joint surgery, previous joint damage, or injury
• People with rheumatoid arthritis or osteoarthritis
• People with an artificial joint
• People with preexisting conditions (such as HIV or cancer) and chronic diseases (such as diabetes)
• People over the age of 80 and infants
• People with skin infections
• People who take injectable drugs, such as heroin
• People with gonorrhoea, a sexually transmitted disease caused by Neisseria gonorrhoeae
• Individuals with poor wound hygiene or exposure to crowded healthcare settings are also at higher risk.

How to Prevent Septic Arthritis

Not all cases of septic arthritis are preventable, however,certain precautions can help lower the likelihood of infection:

• Keep cuts and wounds clean to prevent infection
• Manage chronic health conditions under the guidance of a doctor
• Abstain from using toxic drugs
• Practice safe sex
• Ensure timely treatment of skin infections or minor injuries to prevent microbial spread to joints.

Conclusion

Septic arthritis is a medical emergency that can cause permanent joint damage. However, timely treatment and care can significantly improve patient outcomes and cure the disease. If you or someone near you experiences or suspects symptoms of septic arthritis, do not waste time. Call us today at 1800-889-7351 or request a call back here. Alternatively, you can book an appointment online with experienced rheumatologists or orthopaedists at Graphic Era Hospital. With state-of-the-art diagnostic equipment and advanced treatment options, we are here to help septic arthritis patients manage their condition and improve their quality of life.

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