TOC | Rheumatology

Septic/Bacterial Arthritis

Characteristics of Septic Arthritis  

1. Most rapidly destructive

2. Gonococcal and Meningococcal

3. Non-Gonococcal

4. Predisposing Factors for Non-Gonococcal Arthritis

Joints Involved

Organisms (non-gonococcal)

  1. S. aureus ~50%
  2. Group A Strep ~15%
  3. Gram Negative Rods ~15%
  4. S. pneumoniae ~ 5%
  5. Polymicrobial ~ 5%
  6. Mycobacterium [3]
  7. Fungi (usually in immunosuppressed hosts)


1.In nearly all cases, an acute monoarthritis should be aspirated to rule out infection


3.Gram stain

4.Leukocyte Joint Fluid Count

5.Lactate Dehydrogenase - low or normal usually rules out bacterial disease

E. Differential Diagnosis

  1. Mycobacterial or fungal arthritis - usually insidious (slow) onset
  2. Viral arthritis - usually with rash, usually polyarthritis
  3. HIV Infection - often with reactive arthritis, sterile acute synovitis
  4. Hemearthrosis - especially with trauma, coagulopathy, blood-thinners
  5. Lyme Disease
  6. Reactive Arthritis - compenents of Reiter's syndrome
  7. Rheumatoid Arthritis
  8. Crystal Disease - gout, pseudogout


1.Depends on organism and host


3.Open vs. closed joint aspiration

4.In general, joint should be drained daily until accumulation (nearly) ceases

5.Indications for surgery

6.NSAID Therapy can decrease pain and inflammation (better than acetaminophen)

Septic Bursitis

1.Most commonly occurs in olecranon or pre-patellar bursa

2.Etiology of Bursitis


4.Symptoms of Septic Bursitis

5.Laboratory Findings

6.Associated Diseases


Outline Medicine on Physician Online 2000