Introduction: Septic arthritis is an infection of the joint. Considered a medical emergency, it requires prompt diagnosis and treatment. Local data on the clinical profile of septic arthritis patients in the Philippines are still limited. Therefore, this study aims to determine the clinical characteristics and outcomes of patients with septic arthritis in the local setting. Objective: To determine the clinical profile and outcome of adult Filipino patients with septic arthritis admitted at a tertiary hospital. Methodology: This is a retrospective descriptive study of the medical records of patients with septic arthritis admitted at Chong Hua Hospital, Cebu City, from January 2012 to December 2019. Results: Fifty- seven patients were included in this study. Sixty-four percent were males. Forty-three percent were between the ages of 45 to 64 years old. Diabetes mellitus (49.12%) was identified as the most common comorbidity. 94% of patients presented with monoarthritis, with the knee being the most commonly involved joint (73%). 85% of patients presented with joint pain and swelling. Gram-negative bacilli were the most common pathogen isolated at 31.5%. In addition, 87% of patients had synovial fluid white blood cell counts of more than 50,000/uL. Ceftriaxone was the most commonly used empiric antibiotic (31.5%). Based on sensitivity results, empiric antibiotic treatment was adequate in 66.67% of the cases. 64% of patients underwent surgical intervention in addition to antibiotic therapy. Conclusion This study highlights the unique characteristics of septic arthritis in this population, such as its prevalence in middle-aged patients and the isolation of gram-negative bacilli as the most common isolate. This study showed that the majority of patients were male, with monoarthritis as the most common presentation. Half of the studied population had diabetes mellitus. High clinical suspicion and awareness of risk factors should be emphasized so that timely and adequate treatment may be provided.
Septic arthritis

PURPOSE: The purpose of this study was to define the factors affecting results in acute septic hip arthritis in children and to reduce the complications. MATERIALS AND METHODS: This is a retrospective study of 27 children with 28 hip joint infections, treated with arthrotomy and followed up for more than 12 months. Results were evaluated according to Merle D'Aubigne's clinical grade and Bennett's radiological grade, and correlated with the time between symptom onset and treatment, the existence of a causative organism, its species, concomitant osteomyelitis, age of onset and normalized time of C-reactive protein (CRP). We analysed results using the Pearson Chi Square method. RESULTS: A delay in treatment, concomitant osteomyelitis of the proximal femur and old age, were factors associated with poor prognosis. Normalized time of CRP, the existence of a causative organism and species were not correlated with the treatment results. CONCLUSION: Shorter duration of disease from clinical onset to the initiation of therapy and concomitant osteomyelitis of the proximal femur are the most important factors in the treatment of acute septic hip arthritis in children. When analysing results correlated with the age of onset, precise prospective study is required in many cases of acute septic hip arthritis in children.
Age of Onset ; Arthritis ; Arthritis, Infectious* ; C-Reactive Protein ; Child* ; Early Diagnosis ; Femur ; Hip Joint* ; Hip* ; Humans ; Osteomyelitis ; Prognosis ; Retrospective Studies

We report a patient with reactive arthritis induced by recent streptococcal infection. A 27 year man had suffered from fever, sore throat and pain on left sternoclavicular joint. Arthritis occurred two days after tonsillitis and involved left sternoclavicular joint. Left sternoclavicular joint showed redness, swelling and tenderness. There were no growth of microorganism in blood cultures, no evidence of group Abeta-streptococcus in throat cultures, but antistreptolysin-O (ASO) and c-reactive protein (CRP) serum titers were elevated in sequential monitoring. Bone scan showed focal hot uptake at left sternoclavicular joint and Gallium scan showed diffuse inflammation at left sternoclavicular joint and soft tissue biopsy around sternoclavicular joint showed mild chronic inflammation. We suspected septic arthritis and prescribed empirical antibiotics but his symptoms were wax and wane. From the poor responsiveness to antibiotics, sustained high titers of ASO and recent history of tonsillitis, we confirmed poststreptococcal reactive arthritis, and attempted high-dose anti-inflammatory drug (aspirin 6 gram). Left sternoclavicular and shoulder pain improved.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Arthritis, Reactive* ; Biopsy ; C-Reactive Protein ; Fever ; Gallium ; Humans ; Inflammation ; Palatine Tonsil ; Pharyngitis ; Pharynx ; Shoulder Pain ; Sternoclavicular Joint* ; Streptococcal Infections ; Tonsillitis

Septic arthritis is a surgical emergency. Prompt diagnosis and immediate treatment reduce the destruction of articular cartilage and give better outcome. We describe a simple, minimally invasive closed tube irrigation system for the initial treatment of septic arthritis of the knee in a patient with complex medical problems who was unfit to undergo surgery.
Arthritis, Infectious

Patients with systemic lupus erythematosus(SLE) are at increased risk for infection. Insufficiency of the reticuloendothelial system caused by either immunosuppressive therapy or inadequate opsonization is the mechanism that Salmonella infections in particular appear in these patients. Salmonella infections can provoke a polyarticular reactive arthritis while septic arthritis caused by Salmonella is monoarticular. We report a rare case of septic arthritis caused by Salmonella Group D in a patient with systemic lupus erythematosus. A 20-year-old female patient with systemic lupus erythematosus admitted with a painful swelling of right knee joint. The culture of synovial fluid obtained by aspiration yielded growth of Salmonella Group D. With trimethoprimsulfamethoxazole, the patient was recovered completely.
Arthritis, Infectious* ; Arthritis, Reactive ; Female ; Humans ; Knee Joint ; Lupus Erythematosus, Systemic* ; Mononuclear Phagocyte System ; Salmonella Infections ; Salmonella* ; Synovial Fluid ; Young Adult

PURPOSE: This study analyzed the treatment effects of drain insertion in the posteromedial portal after an arthroscopic synovectomy and posterior septum resection for pyogenic arthritis. MATERIALS AND METHODS: From June 2005 to December 2016, 56 cases (55 patients, 1 case of bilateral knee) were diagnosed with pyogenic arthritis and arthroscopic treatment was performed. Fourteen patients (25.0%) were identified with causative organisms. The average follow-up period was 12.3 months, and the mean age was 67.8 years old. Twenty-four cases were males and 31 cases were females. Kellgrene–Lawrence grade (K–L grade) I was 6 patients, II was 20 patients, III was 11 patients, and IV was 18 patients. Surgery was performed through six portal. The posterior septum was removed and a drainage tube was inserted from the posterior medial side to the posterior side of the joint. The Lysholm score was used after surgery for a functional evaluation. The K–L grade at the time of admission and at the last follow-up were compared for a radiological evaluation. RESULTS: The mean normalization period of the C-reactive protein was 59.8 days (6–164 days). Intravenous antibiotics were used for an average of 37.1 days. The results of the functional evaluation revealed a mean Lysholm score of 64.5 (30–98) in a total of 56 cases. Two reoperations was performed, but the treatment was completed with same method in all patients. The K–L grade was similar at the time of surgery and at the last follow-up (p>0.05). CONCLUSION: The method of drain insertion in the posteromedial portal after arthroscopic synovectomy and posterior septum resection for pyogenic arthritis is an effective technique that can obtain satisfactory results by inducing proper exudate discharge.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Arthroscopy ; C-Reactive Protein ; Drainage ; Exudates and Transudates ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Methods

Gout attacks are often accompanied by systemic inflammatory response. The aim of the retrospective study was to compare gout patients in different age groups in terms of their clinical features at gout attacks. Patients, who were treated for gout attack in two tertiary medical centers between January 2000 and April 2014, were divided into young (≤ 50 years), middle-aged, and elderly (> 65 years) groups. Patients in three age groups were compared in terms of presence of fever (> 37.8°C), C-reactive protein (CRP) levels, and erythrocyte sedimentation ratio (ESR) at the gout attacks. Monocytes, which were isolated from 10 consecutive patients who previously experienced gout attacks, were stimulated with monosodium urate (MSU) crystals and cytokine production was measured by flow cytometry. Among 254 patients analyzed in this study, 48 were young, 65 were middle-aged, and 141 were elderly. The elderly patients were more likely to have fever (51.1%) during the attack than the young (20.8%) and middle-aged (30.8%) patients (P < 0.001 by χ² test). They were also more likely to have higher ESR and CRP levels than the young patients (P = 0.002 for ESR, P < 0.001 for CRP). Patients' age correlated significantly with CRP and ESR levels (both P < 0.001). After stimulation with MSU, the production of interleukin-1β by monocytes increased with patients' age (r = 0.670, P = 0.03). In conclusion, gout attacks in elderly patients are associated with fever and higher ESR and CRP levels, often resembling a septic arthritis.
Aged* ; Aging ; Arthritis, Infectious ; Blood Sedimentation ; C-Reactive Protein ; Fever ; Flow Cytometry ; Gout* ; Humans ; Inflammation ; Monocytes ; Retrospective Studies ; Uric Acid

PURPOSE: The purpose of this study was to describe the clinical and MR imaging features of acute gouty arthritis and to define the characteristic findings that would be helpful for differentiating acute gouty arthritis from septic arthritis. MATERIALS AND METHODS: The authors retrospectively studied seven patients who suffered from acute gouty arthritis. The MR imaging findings were analyzed by two musculoskeletal radiologists who focused on joint effusion, subchondral bone erosion, bone marrow edema, synovial thickening (regular and even, or irregular and nodular), and the soft tissue changes (edema or abscess). The clinical records of the patients were reviewed with regard to age and gender, the clinical presentation and the laboratory findings (serum uric acid, WBC, erythrocyte sedimentation rate, C-reactive protein and synovial fluid culture). RESULTS: The patients consisted of six men and one woman whose mean age was 41 years (age range: 24-65 years). The joints involved were the knee (n=6), and ankle (n=1). Two patients had medical histories of gouty attacks that involved the first metatarsophalangeal joint. In six cases, the serum uric acid level during acute attacks was elevated. In all the patients, the affected joint became swollen, hot, erythematous and extremely tender, and this was accompanied by a high ESR and a high C-reactive protein level at the time of presentation. The results of Gram stain and culture of the synovial fluid were negative. In all patients, the MR images showed large amounts of joint effusion, thick irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosions and soft tissue abscess. In one case, subchondral bone marrow edema of the medial femoral condyle was present. In five cases, there were multiple low signal foci in the joint on the spin-echo T2-weighted MR image. CONCLUSION: Even though the MR imaging findings of acute gouty arthritis are nonspecific, it should be considered as a possible diagnosis when a large amount of joint effusion, irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosion, bone marrow edema or soft tissue abscess are seen in the knee or ankle joint, and especially if this is accompanied by the clinical and laboratory features of infection.
Abscess ; Ankle ; Ankle Joint ; Arthritis ; Arthritis, Gouty* ; Arthritis, Infectious ; Blood Sedimentation ; Bone Marrow ; C-Reactive Protein ; Diagnosis ; Edema ; Female ; Gout ; Humans ; Joints ; Knee ; Magnetic Resonance Imaging* ; Male ; Metatarsophalangeal Joint ; Retrospective Studies ; Synovial Fluid ; Uric Acid

Arthritis is caused by various diseases including rheumatoid arthritis (RA), osteoarthritis, gout and trauma, and joint involvement also occurs in some autoimmune diseases, such as systemic lupus erythematosus and Sjogren's syndrome. Some laboratory tests provide useful information in both diagnosis and prognosis. RF and anti-CCP (cyclic citrullinated peptide) antibody are detected in approximately 70-80% of patients with RA, and often associated with a worse prognosis (e.g., bony erosion and joint deformity). Acute phase reactants, such as erythrocyte sedimentation rate and C-reactive protein, parallel the activity of RA, and their persistent elevation are also associated with a poor prognosis. Crystal examination in synovial fluid is essential to confirm the diagnosis of gout and pseudogout, and the synovial fluid culture is also important in septic arthritis. Anti-nuclear antibody helps to distinguish non-immune arthritis from systemic rheumatic diseases. However, arthritis cannot be diagnosed only with laboratory findings, and physician should consider comprehensive physical examination, clinical findings, and imaging findings as well as laboratory findings. In this topic review, laboratory tests useful for diagnosis of arthritis will be discussed and summarized.
Acute-Phase Proteins ; Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Blood Sedimentation ; C-Reactive Protein ; Chondrocalcinosis ; Gout ; Humans ; Joints ; Lupus Erythematosus, Systemic ; Osteoarthritis ; Physical Examination ; Prognosis ; Rheumatic Diseases ; Sjogren's Syndrome ; Synovial Fluid

Acute bacterial infection of bone and joint presents a real challenge to orthopedist because early diagnosis and treatment are difficult and also essential. In almost all practices, fever and erythrocyte sedimentation rate(ESR) are widely used for monitoring the course, for estimating the effectiveness of treatment, and for the recovery of such illnesses. However, interpreting body temperature is difficult and ESR is nonspecific, is not not sensitive, normalizes slowly. Otherwise, C-reactive protein(CRP) is very sensitive and normalizes fast. CRP, body temperature, and ESR were sequentially measured until a normal value was reached in twenty seven patients in whom acute osteomyelitis (17 patients), acute exacerbation of chronic osteomyelitis(4 patients), and septic arthritis(6 patients) had been diagnosed by positive bacterial culture at Kyungpook National University Hospital from June 1984 to May 1985. The results were as follows: 1. CRP normalized within 8.8 days on average. 2. Fever lasted 4.5 days on average. 3. ESR normalized within 41.6 days on average. 4. Initial mean value of CRP was 4.2 positive in acute in acute osteomyelitis and septic arthritis and 3.5 positive in acute exacerbation of chronic osteomyelitis, therefore CRP can be considered as a very sensitive indicator for early detection of acute bacterial infection of bone and joint. Also sequential CRP determination can be used for monitoring the course, for estimating the effectiveness of treatment, and for the recovery of such illnesses.
Arthritis, Infectious ; Bacterial Infections ; Blood Sedimentation ; Body Temperature ; C-Reactive Protein ; Early Diagnosis ; Fever ; Gyeongsangbuk-do ; Humans ; Joints ; Osteomyelitis ; Reference Values