Septic Arthritis

Septic Arthritis Definition Symptoms Cause Diet Regimen Homeopathic Medicine Homeopath Treatment In Rajkot India

The Septic Arthritis:

Septic Arthritis

Definition:

Septic arthritis is an infection in the joint (synovial) fluid and joint tissues. It is also known as “Infectious Arthritis.” [1]

Overview

Septic arthritis is the most rapid and destructive joint disease, and is associated with significant morbidity and a mortality of 10%.

This has not improved over the last 20 years, despite advances in antimicrobial therapy.

The incidence is 2–10 per 100,000 in the general population, and 30–70 per 100,000 in those with pre­existing joint disease or joint replacement.

Septic arthritis is usually due to haematogenous spread from either skin or upper respiratory tract; infection from direct puncture wounds or secondary to joint aspiration is uncommon.

Risk factors include;
  • Increasing age,
  • Pre existing joint disease (principally RA),
  • Diabetes mellitus,
  • Immunosuppression (by drugs or disease),
  • Intravenous drug misuse.

In RA, the skin is a frequent portal of entry because of maceration of skin between the toes due to joint deformity and difficulties with foot hygiene due to hand deformity. [1]

Infants and older adults are most likely to develop septic arthritis.

Knees are most commonly affected, but septic arthritis also can affect hips, shoulders and other joints.

The infection can quickly and severely damage the cartilage and bone within the joint, so prompt treatment is crucial. [2]

  • Severe pain that worsens with movement
  • Swelling of the joint
  • Warmth and redness around the joint
  • Fever
  • Chills
  • Fatigue
  • Weakness
  • Decreased appetite
  • Rapid heart rate
  • Irritability [3]

Any joint can be affected, lower limb joints, such as the knee and hip, are commonly targeted. [1]

Causes

Infectious arthritis is a type of arthritis that occurs when bacteria or viruses, or other organisms get into the fluid between joints and multiply.

In adults, the most likely organism is Staphylococcus aureus, particularly in patients with RA and diabetes.

In young, sexually active adults, disseminated gonococcal infection occurs in up to 3% of untreated gonorrhoea, usually presenting with migratory arthralgia, low grade fever and tenosynovitis, which may precede the development of oligo­ or monoarthritis.

other factors

Painful pustular skin lesions may also be present.

Amongst the older people and intravenous drug users, Gram Negative bacilli or group B, C and G streptococci are important causes.

Group A streptococci, pneumococci, meningococci and Haemophilus influenzae are occasionally isolated. [1]

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Joint and bone infection in old age:

Vertebral infection i.e.:
  • More common.
  • Recognition may be delayed, as symptoms may be attributed to compression fractures caused by osteoporosis.
Peripheral vascular disease i.e.:
  • Leads to more frequent involvement of the bones of the feet, and diabetic foot ulcers are also commonly complicated by osteomyelitis.
Prosthetic joint infections i.e.:
  • Now more common because of the increased frequency of prosthetic joint insertion in older people.
Gram-negative bacilli i.e.:
  • More frequent pathogens than in younger people. [1]

Prompt diagnosis of septic arthritis is necessary to prevent permanent damage to the joint.

In addition to a complete medical history and physical examination, diagnostic procedures for septic arthritis may include:

Removal of joint fluid:

  • This is done to examine for white blood cells also bacteria.

Blood tests:

  • In brief, These tests are done to detect bacteria.

Phlegm, spinal fluid, and urine tests:

  • These tests are done to detect bacteria also find the source of infection.

X-ray:

  • A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, also organs onto film.

Bone scan:

  • A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints to detect bone diseases also tumors to determine the cause of bone pain or inflammation.

Magnetic resonance imaging (MRI):

  • A diagnostic procedure that uses a combination of large magnets, radio frequencies, additionally a computer to produce detailed images of organs and structures within the body.

Radionuclide scans:

  • Generally, Nuclear scans of various organs to determine blood flow to the organs. [4]

Risk factors for septic arthritis include:

Existing joint problems i.e.:
  • Chronic diseases and conditions that affect your joints such as osteoarthritis, gout, rheumatoid arthritis or lupus can increase your risk of septic arthritis, as can an artificial joint, previous joint surgery and joint injury.
Taking medications for rheumatoid arthritis i.e.:
  • People with rheumatoid arthritis have a further increase in risk because of medications they take that can suppress the immune system, making infections more likely to occur.
  • Diagnosing septic arthritis in people with rheumatoid arthritis is difficult because many of the signs and symptoms are similar.
Skin fragility i.e.:
  • Skin that breaks easily and heals poorly can give bacteria access to your body.
  • Some skin conditions such as psoriasis and eczema increase your risk of septic arthritis, as do infected skin wounds.
  • People who regularly inject drugs also have a higher risk of infection at the site of injection.
Weak immune system i.e.:
  • People with a weak immune system are at greater risk of septic arthritis.
  • This includes people with diabetes, kidney and liver problems, and those taking drugs that suppress their immune systems.
Joint trauma i.e.:
  • Animal bites, puncture wounds or cuts over a joint can put you at risk of septic arthritis.
  • Having a combination of risk factors puts you at greater risk than having just one risk factor does. [2]

Treatment

A full recovery can take several weeks, but the infection should disappear entirely.

The best treatment for infectious arthritis depends on the cause.

  • The patient should admit to hospital for pain relief and administration of parenteral antibiotics.
  • Flucloxacillin (2 g IV 4 times daily) is the antibiotic of first choice pending the results of cultures, since it will cover most staphylococcal and streptococcal infections.
  • If there is reason to suspect a Gram Negative infection, then a cephalosporin or gentamicin should add.
  • Microbiology advice should sought in complicated situations such as intravenous drug users, patients in intensive care and those who might colonise by resistant organisms.
  • It is traditional to continue intravenous antibiotics for 2 weeks and to follow this with oral treatment for another 4 weeks, but there is no evidence to support the optimal duration of treatment.
  • Joint aspiration should perform using a large bore needle once or twice daily.
  • If this is not possible, arthroscopic or open surgical drainage may need to be undertaken.
  • Regular passive movement should undertake from the outset, and active movements encouraged once the condition has stabilised.

Other Treatment

  • Infected prosthetic joints require management by the orthopaedic team, but often prolonged antibiotic treatment on its own is ineffective and removal of the prosthesis is required for eradication of the infection.
  • Arthritis may be a feature of Lyme disease caused by members of the Borrelia species of microorganisms.
  • It is generally a late manifestation, which usually affects large joints.
  • Brucellosis presents with an acute febrile illness, followed in some cases by the development of localised infection, which can result in arthritis, bursitis, osteomyelitis, sacroiliitis also paravertebral or psoas abscesses.
  • If bacteria are responsible for the infection, additionally doctors will usually prescribe antibiotics.
  • Moreover, People should take antibiotics as early as possible to reduce the risk of permanent damage.
  • People can take antibiotics as an oral treatment over several weeks.
  • In detail, A full course of treatment can take up to 6–8 weeks to complete.
  • Besides this, Some people may need to spend some time in the hospital to allow continuous administration of antibiotics also to drain fluids through an IV.
  • This treatment can last a few either days or weeks, depending on the severity of the condition.
  • All in all, If a fungus causes the infection, doctors will treat it with an antifungal medication instead of antibiotics. [1]

Other treatment methods to reduce pain may be used along with treatment for the infection.

These methods include:

  • Using nonsteroidal anti-inflammatory drugs
  • Resting the joint
  • Splinting the affected joint
  • Going to physical therapy [3]

Emergency management of suspected septic arthritis:

Admit patient to hospital i.e.:
Perform urgent investigations
  • Aspirate joint
  • Send synovial fluid for Gram stain also culture
  • Use imaging guidance if required (e.g. for hip)
  • Send blood for culture, routine biochemistry and haematology, including ESR also CRP
  • Consider sending other samples (e.g. sputum, urine, wound swab) for culture, depending on patient history, to determine primary source of infection
Commence intravenous antibiotic i.e.:
  • Flucloxacillin 2 g 4 times daily
  • If penicillin-allergic, give clindamycin 450–600 mg 4 times daily
  • If at high risk of Gram-negative sepsis (older people, frail, recurrent urinary tract infection), Then add a cephalosporin (cefuroxime 1.5 g 3 times daily)
Relieve pain i.e.:
  • Oral also intravenous analgesics
  • Consider local ice-packs
Aspirate joint i.e.:
  • Perform serial needle aspiration to dryness (1–3 times/day or as required)
  • Consider arthroscopic drainage if needle aspiration difficult
Arrange physiotherapy i.e.:
  • Early regular passive movement, progressing to active movements once pain controlled also effusion not re-accumulating

 

Homeopathic treatment for septic arthritis is natural, safe and without any side-effects, and one can enjoy immense relief from these frustrating symptoms.

It is a patient-oriented science and medicines are prescribed on the characteristics of the individual rather than just the symptoms of the disease.

Apis Mellifica:

  • Used for swelling of joint with synovitis also synovial effusion, septic arthritis, red hot swollen joint , pain on slightest either pressure or motion, gout , rheumatoid arthritis , post viral arthritis and arthralgia.

Arnica Montana:

  • Use in blunt injury also trauma, sore unimpressive bruised sensation with swelling concussion and contusion call for this remedy.

Bryonia Alba:

  • Generally, Stiffness and pain with hot swelling, redness of joints with stitching and tearing pain aggravation on least motion every spot is painful on slightest pressure.

Hypericum Perfoliatum:

  • This is the remedy for degenerative changes of joints involving nerves, sciatica, coccygodynia, cervical and lumbar spondylosis with nerve compression, additionally tingling burning and numb sensation with lancinating pain calls for the remedy, darting pain of shoulders , cramps in calf muscles, pain in tips of toes also fingers, sensation of pressure along the ulnar side if arm.

Other remedies:

  • Rhus Toxicodendron
  • Ledum Palustre
  • Bellis Perennis
  • Belladonna [5]

Frequently Asked Questions

What is Septic Arthritis?

Septic arthritis is an infection in the joint (especially synovial) fluid and joint tissues. It is also known as “Infectious Arthritis.”

Homeopathic Medicines used by Homeopathic Doctors in treatment of Septic Arthritis?

  • Apis Mellifica
  • Arnica Montana
  • Bryonia Alba
  • Hypericum Perfoliatum
  • Rhus Toxicodendron
  • Ledum Palustre

What is the most common cause Septic Arthritis?

The most likely organism is Staphylococcus aureus.

What are the symptoms of Septic Arthritis?

  • Severe pain that worsens with movement
  • Swelling of the joint
  • Warmth and redness around the joint
  • Fever
  • Chills
  • Fatigue
  • Weakness
  1. Davidson’s Principles and Practice of Medicine (22nd edition) Ch. 25
  2. https://www.mayoclinic.org/diseases-conditions/bone-and-joint-infections/diagnosis-treatment/drc-20350760
  3. https://www.healthline.com/health/septic-arthritis#treatments
  4. https://www.stanfordchildrens.org/en/topic/default?id=septic-infectious-arthritis-90-P01730
  5. https://atomictherapy.org/arthritis/

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