Arthritis Cure

🔥+ Arthritis Cure 31 May 2020 Common sports injuries that can trigger post-traumatic arthritis include sprains, knee injuries, cartilage tears, fractures and dislocations. These ...

Arthritis Cure Glenohumeral osteoarthritis is a common pathology heralded by activity related pain, stiffness and limited function. Once conservative management options have ...

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Septic arthritis

Sean T. O’Leary MD, ... Sarah Parker the 1 last update 2020/05/31 MD, in Sean T. O’Leary MD, ... Sarah Parker MD, in Berman's Pediatric Decision Making (Fifth Edition), 2011

Septic arthritis is microbial invasion of the joint space with a subsequent inflammatory response, and is most commonly caused by a bacterial infection. Acute septic arthritis is a medical, and often surgical, emergency. In children younger than 18 months, septic arthritis is often secondary to osteomyelitis, which has eroded through the boney cortex. Pediatric acute septic arthritis is primarily hematogenous in origin (AHO); this chapter focuses on this form. Other forms of septic arthritis, including alternate forms of bacterial introduction (including trauma and postsurgical), chronic septic arthritis, septic arthritis with unusual pathogens (fungal, mycobacterial), and septic arthritis in special hosts (neonates, immunocompromised, sickle cell disease, unusual exposures) are more complicated, and consultation with orthopedic and infectious disease specialists should be considered.

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Septic Arthritis

Arthritis Curehow to Arthritis Cure for Matija Tomšič, ... John Townes, in Targeted Treatment of the Rheumatic Diseases, 2010

Arthritis Curehow to Arthritis Cure for Septic arthritis is a term often used to describe patients with an acute pyogenic joint infection due to a bacterial pathogen. The term may also be used in reference to patients with more indolent presentations of infectious arthritis, typically caused by fungi, mycobacteria, or other slow-growing bacteria. In patients who present with an acutely painful and swollen joint, the reported prevalence of septic arthritis is 8% to 27%.1–3 Patients with pre-existing inflammatory joint diseases such as gout or rheumatoid arthritis (RA) are at increased risk of septic arthritis, and disease-modifying agents such as corticosteroids and tumor necrosis factor (TNF) inhibitors can alter inflammatory responses, making common bacterial infections more difficult to recognize and infections due to unusual pathogens more common. Patients with septic arthritis need prompt therapy to avoid chronic sequelae and risk of death (often justifying immediate empiric institution of anti-infectives), but there is a general lack of data to support clinical decision making. Thus, patients with septic arthritis provide significant diagnostic and therapeutic challenges, not only for general practitioners, but also for experienced rheumatologists. A proposed diagnostic and treatment algorithm is shown below (Fig. 20-1).

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Septic Arthritis

Shahryar Ahmadi, Joaquin Sanchez-Sotelo, in Morrey's the Elbow and its Disorders (Fifth Edition), 2018

Introduction

Septic arthritis is an inflammatory joint condition secondary to pathologic joint inoculation with infectious microorganisms. It can be the result of either direct inoculation (penetrating trauma) or more commonly caused by hematogenous seeding of the vascular synovial membrane due to a bacteremic episode.22 Because there is no limiting basement plate under the vascularized synovium, it is easy for bacteria to enter the joint during bacteremia. for 1 last update 2020/05/31 3535 Similarly, recent injury to a joint may facilitate bacterial inoculation because extracellular matrix proteins produced at an injured joint can facilitate bacterial attachment and progression to infection.35

Delayed or suboptimal management can cause irreversible joint damage.42 In addition to the morbidity associated with permanent damage to the joint, in extremely poorly managed situations septic arthritis has been linked to death. the 1 last update 2020/05/31 9,13,15,28,429,13,15,28,42 Therefore, it is very important to make an early diagnosis and start treatment immediately. Septic arthritis after joint replacement will be discussed in Chapters the 1 last update 2020/05/31 100Chapters 100 and 101. Infection complicating other surgical procedures is discussed throughout this book. This chapter focuses on septic arthritis of the native elbow joint.

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Septic Arthritis

P. René van Weeren, in Joint Disease in the Horse (Second Edition), 2016

Adjunctive Therapeutic Measures

Septic arthritis is a very painful condition and in the acute stage adjunctive therapy will virtually always include the oral application of NSAIDs. Phenylbutazone has for long been, and still is in the U.S. and many other places, the drug of choice. Phenylbutazone has proven to be very effective for musculoskeletal pain, but it has been banned in the European Union (EU) for use in food-producing animals. According to EU legislation, where the horse is considered a food-producing animal, treatment of horses with phenylbutazone must be recorded in their “horse passport,” resulting in their definitive exclusion from slaughter for human consumption.68 Although some EU member states permit the use of the drug in horses for the management of chronic bone and joint problems, for example, arthritis, under the above-mentioned conditions, others do not, severely limiting the use of phenylbutazone in those countries. Alternatives are more specific cyclooxygenase 2 (COX-2) inhibitors, such as firocoxib and meloxicam, that have been registered for use the 1 last update 2020/05/31 in the horse in large parts of the world. Oral application of meloxicam in horses with experimentally induced acute synovitis (by intraarticular injection of bacterial LPS) resulted in significant suppression of PGE2 and of substance P release. It further decreased general MMP activity significantly versus placebo-treated controls and limited inflammation-induced cartilage catabolism.69 In a recent study in horses using the LPS-induced synovitis model, phenylbutazone did not reduce MMP activity or substance P release and there was no reduction of cartilage catabolism, as with meloxicam. In contrast, concentration of the anabolic collagen marker CPII (see Chapter 10) was reduced, suggesting a transient reduction of collagen anabolism.70 In rabbits, the NSAID naproxen was shown to have a chondroprotective effect in an experimental study of staphylococcal septic arthritis.71Septic arthritis is a very painful condition and in the acute stage adjunctive therapy will virtually always include the oral application of NSAIDs. Phenylbutazone has for long been, and still is in the U.S. and many other places, the drug of choice. Phenylbutazone has proven to be very effective for musculoskeletal pain, but it has been banned in the European Union (EU) for use in food-producing animals. According to EU legislation, where the horse is considered a food-producing animal, treatment of horses with phenylbutazone must be recorded in their “horse passport,” resulting in their definitive exclusion from slaughter for human consumption.68 Although some EU member states permit the use of the drug in horses for the management of chronic bone and joint problems, for example, arthritis, under the above-mentioned conditions, others do not, severely limiting the use of phenylbutazone in those countries. Alternatives are more specific cyclooxygenase 2 (COX-2) inhibitors, such as firocoxib and meloxicam, that have been registered for use in the horse in large parts of the world. Oral application of meloxicam in horses with experimentally induced acute synovitis (by intraarticular injection of bacterial LPS) resulted in significant suppression of PGE2 and of substance P release. It further decreased general MMP activity significantly versus placebo-treated controls and limited inflammation-induced cartilage catabolism.69 In a recent study in horses using the LPS-induced synovitis model, phenylbutazone did not reduce MMP activity or substance P release and there was no reduction of cartilage catabolism, as with meloxicam. In contrast, concentration of the anabolic collagen marker CPII (see Chapter 10) was reduced, suggesting a transient reduction of collagen anabolism.70 In rabbits, the NSAID naproxen was shown to have a chondroprotective effect in an experimental study of staphylococcal septic arthritis.71

Other adjunctive medical therapy that has been reported includes the intraarticular application of hyaluronic acid and of corticosteroids. In a study of six adult horses in which septic arthritis was experimentally induced by the injection of 1 × 104 colony-forming units of S. aureus, joints treated with sodium hyaluronate showed less signs of inflammation than the contralateral controls. Apart from injection with sodium hyaluronate or placebo, all horses were treated systemically with trimethoprim/sulfamethoxazole and phenylbutazone and all joints were lavaged with sterile Ringer solution 24 hours after inoculation. Glycosaminoglycan loss from the cartilage in treated joints was less than in control joints, but this difference was not significant.72

The use of corticosteroids in septic arthritis is controversial. In principle, corticosteroids are immunosuppressive and hence contraindicated in cases of acute infections in which the host defense system should be boosted rather than suppressed. Nevertheless, in a study in experimentally infected rabbits, the group treated with a combination of intraarticular corticosteroids and systemic antibiotics showed less histologic damage than the group treated with systemic antibiotics alone.73 In the horse it is certainly not recommended to use corticosteroids in the acute phase of septic arthritis, owing to their immunosuppressive properties and also to their capacity to mask clinical signs for several days, as was shown in a study in artificially infected horses.Arthritis Curehow to Arthritis Cure for 27 However, corticosteroids are potent antiinflammatory drugs and judicious use in a later phase of septic arthritis may be warranted, that is, in those cases in which the infection has been eliminated and clinical signs linger on because of a persistent, chronic inflammation. In these cases a single application of triamcinolone may have an immediate and lasting effect. The procedure is somewhat risky though and requires good clinical judgment, as it is difficult to be completely sure that the joint is entirely devoid of viable microorganisms.

Further adjunctive therapy includes restriction of motion (box confinement) in acute cases and the application and regular change of sterile bandages in case of open drainage wounds. If progress is good, physical therapy can be used to prevent stiffening of the periarticular area, which is a common sequel to septic arthritis, and a gradual rehabilitation regimen may be started. In some cases in which the damage to the joint is too extensive to allow for regaining acceptable joint function, ankylosis formation may still result in an acceptable outcome, depending on the joint involved (Figure 7-4), especially in animals of great genetic or emotional value. Ankylosis may occur spontaneously74 or it can be facilitated surgically if degeneration occurs more rapidly than the horse can accommodate, to reestablish pain-free weight bearing on the affected limb for protection of the contralateral one.75,76

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Bacterial for 1 last update 2020/05/31 ArthritisBacterial Arthritis

Arthritis Curehow to Arthritis Cure for Paul P. Cook, Dawd S. Siraj, in Kelley and Firestein's Textbook of Rheumatology (Tenth Edition), 2017

Arthritis Curehow to Arthritis Cure for Diagnosis and Diagnostic Tests

Whenever bacterial arthritis is suspected, the most important diagnostic procedures are arthrocentesis and examination of the synovial fluid. Arthrocentesis and synovial fluid analysis should be performed in patients who are seen with an inflamed joint for which alternative explanations are not immediately apparent. For example, a patient with a history of gout or evidence of a generalized flare of rheumatoid arthritis might not require arthrocentesis. However, the clinician should follow up carefully and reassess for an infectious process if the decision is made to treat for a diagnosis other than infection. For joints that are deep and more difficult to aspirate, ultrasound-guided or fluoroscopy-guided needle aspiration should be done.

Normal joints contain a small amount of synovial fluid that is clear, is highly viscous, and has few white blood cells (WBCs). The protein concentration is approximately one-third that of plasma, and the glucose concentration is similar to that of plasma. Infected synovial fluid is usually purulent with an elevated leukocyte count typically greater than 50,000 WBC/mm3 and often exceeding 100,000 WBC/mm3 with polymorphonuclear cell predominance. Synovial fluid levels of glucose, lactate dehydrogenase, and total protein have limited value in the diagnosis of septic arthritis. Although a low synovial fluid glucose (<40 mg/dL or less than half the serum glucose concentration) and an elevated lactate dehydrogenase suggest bacterial infection, they are not sufficiently sensitive or specific for the diagnosis.48 Figure 109-2 is an algorithm for synovial fluid analysis, and Table 109-4 lists the differential diagnoses of septic arthritis and the known causes of pseudoseptic arthritis.49

A definite diagnosis of bacterial arthritis can be made only by visualizing bacteria on a Gram-stained smear or by culturing bacteria from the synovial fluid. In patients not previously treated with antibiotics, synovial fluid cultures are positive in 70% to 90% of cases of nongonococcal bacterial arthritis.4,50 Blood cultures are positive in 40% to 50% of cases of septic arthritis and are the only method of identifying the pathogen in approximately 10% of cases.51,52 Occasionally, an extra-articular site of infection offers a clue to the etiologic organism infecting the joint. Examples include septic arthritis in association with pneumococcal pneumonia, E. coli urinary tract infection, and cellulitis caused by staphylococci or streptococci. Gram-positive cocci are identified in 50% to 75% of synovial fluid Gram-stained smears, but Gram-negative bacilli are identified less than 50% of the time in culture-proven cases.50

Arthritis Curehow to Arthritis Cure for Inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and WBC are usually raised, but the sensitivity is low, and their absence does not exclude the diagnosis of septic arthritis.43,53 Procalcitonin, the peptide precursor of calcitonin, has been extensively investigated as a biomarker for bacterial infection.54 Procalcitonin levels are elevated in bacterial infections, and the levels return to normal relatively rapidly once the bacterial infection is controlled. Unlike the ESR and CRP, procalcitonin levels are not elevated in many other inflammatory conditions, such as gout, systemic lupus erythematosus, or Still's disease.55 Also, the levels are not affected by NSAIDs or glucocorticoids. It is postulated that cytokines and endotoxins released from bacteria inhibit conversion of procalcitonin to calcitonin. Viral infections are not associated with procalcitonin elevations because viruses stimulate release of IFN, which blocks procalcitonin production in human cells. The majority of procalcitonin is produced in nonthyroidal tissue. Therefore procalcitonin elevations may occur in post-thyroidectomy patients who have a bacterial infection. In healthy individuals, serum procalcitonin levels are less than 1 ng/mL. A meta-analysis of studies on the use of procalcitonin for the diagnosis of septic arthritis recommended that procalcitonin be used as a rule-in test at the cutoff value of 0.5 ng/mL and as a rule-out test at the cutoff value of 0.3 ng/mL, with specificity and sensitivity in the range of 90%.56 In this meta-analysis, procalcitonin was more sensitive and specific than CRP for diagnosing or ruling out septic arthritis.

Culture for N. gonorrhoeae is almost always negative in skin lesions and is positive in less than 50% of synovial fluid samples and in less than one-third of blood cultures; this phenomenon may be the result of the fastidious growth requirements of N. gonorrhoeae. The organism can often be easily recovered from other sites, such as urethral, cervical, rectal, or pharyngeal specimens (i.e., the genitourinary tract). In culture-negative septic arthritis in which N. gonorrhoeae is suspected, polymerase chain reaction techniques can be used to detect gonococcal DNA in the synovial fluid. Unfortunately, the technique is not standardized and is not widely avilable.Arthritis Curehow to Arthritis Cure for 57

When culturing the synovial fluid, it should be brought directly to the laboratory and placed on conventional broth and solid media or into aerobic and anaerobic blood culture bottles. Inoculating blood culture bottles with 5 to 10 mL of joint fluid or smaller volumes into isolator tubes may increase the yield of positive cultures beyond that of standard techniques.58,59 Synovial the 1 last update 2020/05/31 fluid culture can use specialized collection and detection systems that can identify significantly more pathogens and fewer contaminants than culture by the agar-plate method.60When culturing the synovial fluid, it should be brought directly to the laboratory and placed on conventional broth and solid media or into aerobic and anaerobic blood culture bottles. Inoculating blood culture bottles with 5 to 10 mL of joint fluid or smaller volumes into isolator tubes may increase the yield of positive cultures beyond that of standard techniques.58,59 Synovial fluid culture can use specialized collection and detection systems that can identify significantly more pathogens and fewer contaminants than culture by the agar-plate method.60

Plain radiographs in septic arthritis are usually normal early in the course of the infection, but baseline films should be obtained to look for evidence of other disease and for 1 last update 2020/05/31 contiguous osteomyelitis. Radiographs often show nonspecific changes of inflammatory arthritis, including periarticular osteopenia, joint effusion, soft tissue swelling, and joint space loss. In more advanced infection, periosteal reaction, marginal or central erosions, and destruction of subchondral bone may be seen. Bony ankylosis is a late sequela of septic arthritis. Dislocation or subluxation of the femoral head is unique to hip infection of neonates.61Plain radiographs in septic arthritis are usually normal early in the course of the infection, but baseline films should be obtained to look for evidence of other disease and contiguous osteomyelitis. Radiographs often show nonspecific changes of inflammatory arthritis, including periarticular osteopenia, joint effusion, soft tissue swelling, and joint space loss. In more advanced infection, periosteal reaction, marginal or central erosions, and destruction of subchondral bone may be seen. Bony ankylosis is a late sequela of septic arthritis. Dislocation or subluxation of the femoral head is unique to hip infection of neonates.61

Ultrasound of the hip is the modality of choice to detect fluid collections in this deep joint and can serve as a guide in its aspiration. Ultrasound can be similarly used in other joints, such as the popliteal cyst of the knee, shoulder, acromioclavicular, or sternoclavicular joints. Triple-phase bone scan using technetium 99m is often done in children to identify an associated metaphyseal osteomyelitis or avascular necrosis of the femoral head. Whole-body bone scan is preferred in young children because, despite focal symptoms, septic arthritis and osteomyelitis may be multifocal in this age group.62 In septic arthritis of all age groups, the periarticular distribution of increased uptake is seen on the early “blood-pool” phase and the delayed images of the joint. Bone scans provide only nonspecific information, however, and cannot differentiate septic from noninfectious causes of joint inflammation. Bone scans are more sensitive than standard radiography in the diagnosis of arthritis because radionuclide uptake precedes morphologic bone changes that are seen on radiograph. A suggestive bone scan must be interpreted in the proper clinical context and supported by microbiologic data for a definitive diagnosis of joint or bone infection.

In joints that are difficult to evaluate otherwise or that have complex anatomic structures, computed tomography (CT) and MRI can provide useful images to delineate the extent of the infection.63 MRI is highly sensitive in early detection of joint fluid and is superior to CT in the delineation of soft tissue structures and soft tissue abscess. These images can show early bone erosion, reveal soft tissue extension, and facilitate arthrocentesis of joints such as shoulders, hips, acromioclavicular,64 sternoclavicular, sacroiliac, and facet joints of the spine. MRI findings such as reactive bone marrow can suggest the presence of secondary osteomyelitis, which can complicate septic arthritis. When multiple joint involvement is suspected, triple-phase bone scintigraphy is the preferred modality of investigation.

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Septic Arthritis

Arthritis Curehow to Arthritis Cure for In Imaging in Pediatrics, 2018

CLINICAL ISSUES

Presentation

Fever, pain, swelling, ↓ motion, non-weight-bearing

Kocher criteria: ↑ likelihood the 1 last update 2020/05/31 for hip septic arthritis over transient synovitis with ↑ number of predictors

Fever > 38.5°C, non-weight-bearing, WBC > 12 x 10⁹ cells/L, ESR ≥ 40 mm/hour; later addition to original criteria: CRP > 20 mg/L

With all present, specificity for septic arthritis ∼ 60-99%

Kocher criteria: ↑ likelihood for hip septic arthritis over transient synovitis with ↑ number of predictors

Fever > 38.5°C, non-weight-bearing, WBC > 12 x 10⁹ cells/L, ESR ≥ 40 mm/hour; later addition to original criteria: CRP > 20 mg/L

With all present, specificity for septic arthritis ∼ 60-99%

Demographics

∼ 6.5% of pediatric arthritis; peak age: ∼ 2-3 years

Arthritis Curehow to Arthritis Cure for Natural History & Prognosis

Long-term sequelae in up to 40%

Limited motion, dislocation, degeneration, ankylosis, limb length discrepancy, avascular necrosis

Long-term sequelae in up to 40%

Limited motion, dislocation, degeneration, ankylosis, limb length discrepancy, avascular necrosis

Treatment

Arthritis Curehow to Arthritis Cure for Emergent arthroscopy or arthrotomy + joint irrigation

IV antibiotics for 2-4 days followed by oral antibiotics for 10 days; longer course for concomitant osteomyelitis

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Surgery of the Bovine Musculoskeletal System

André Desrochers, ... Norm G. Ducharme, in Farm Animal Surgery (Second Edition), 2017

Septic arthritis is the most common condition that affects the joints in cattle. Indeed 47% to 72.2% of all lameness other than from the foot is located in the joints and ligaments. Few data are available on the importance of septic arthritis in cattle. In Israel, arthritis counts for 13.8% of lameness cases. Although not as common as claw diseases, the consequences of septic arthritis are dramatic if left untreated, with potential irreversible joint dysfunction. Regardless of the incidence or prevalence of septic arthritis in a herd, it is always potentially serious and detrimental to the productive life of the individual animal. Septic arthritis needs to be addressed quickly with aggressive treatment to control the infection and limit its degenerative action on articular cartilage. It can also be the first sign of a contagious disease like Histophilus somni or Mycoplasma bovis.

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Arthritis, Muscle, Adipose Tissue, and Bone Diseases of Nonhuman Primates

Kenneth the 1 last update 2020/05/31 P.H. Pritzker, Matthew J. Kessler, in Kenneth P.H. Pritzker, Matthew J. Kessler, in Arthritis Curehow to Arthritis Cure for Nonhuman Primates in Biomedical Research (Second Edition), 2012

Septic Arthritis

Septic arthritis, the purulent invasion of a joint by an infectious agent, has been infrequently described in nonhuman primates. Septic arthritis in multiple joints secondary to Streptococcus aureus has been reported in a neonatal male orangutan (Pongo pygmaeus) (Hoopes et al., 1978). This animal, given penicillin prophylactically at birth, developed septicemia and septic arthritis from penicillin-resistant staphylococci and streptococci. Septic arthritis has also been described in association with hematogenous osteomyelitis in the rhesus macaque (Klumpp et al., 1986) and in a titi monkey (Callicebus sp.) infected with Streptobacillus moniliformis, a causative agent of human rat bite fever (Valverde et al., 2002).

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Infectious arthritis I

Alejandro Balsa, Emilio Martín-Mola, in Rheumatology (Sixth Edition), 2015

Septic arthritis

Arthritis Curehow to Arthritis Cure for Septic arthritis usually presents as the abrupt onset of a hot, swollen, and painful joint, but significant delays may occur with low-virulence organisms, tuberculosis, and prosthesis infection. Mild fever is common, but up to 40% of individuals have high fever.6 The knee is the most common site in adults and the hip is most common in children, followed by the shoulder, wrist, and ankle.20 Infections of cartilaginous joints is frequent in intravenous drug users.21 Patients with sacroiliac septic arthritis have buttock pain, fever, and pain on maneuvers that stress the sacroiliac joint. Infection of the pubic symphysis presents as fever, suprapubic and hip pain, and an antalgic gait. Septic sternoclavicular arthritis can be a result of infected central lines. Septic arthritis usually affects only one joint but is polyarticular in 10% to 20% when comorbid systemic diseases or overwhelming sepsis occurs.22 In children, the pattern of acute septic arthritis is similar to that in adults.4 Septic arthritis does not appear to occur more often in patients with human immunodeficiency virus (HIV) infection than in other patients except in patients with advanced HIV infection, who may develop septic arthritis caused by S. aureus or opportunistic organisms.23 Clinical experience suggests that elderly patients are more likely than others with septic arthritis to be afebrile. There may be evidence of an associated skin, urinary tract, or respiratory tract infection, which should provide a clue to the likely infecting organism.

Risk of septic arthritis is increased in patients with rheumatoid arthritis, and S. aureus is the microorganism most frequently responsible. Data from the British registries has shown that the use of anti–tumor necrosis factor (TNF) therapy in rheumatoid arthritis is associated with a doubling in the risk of septic arthritis, and the risk did not differ significantly between the three anti-TNF agents. The risk was highest in the early months of therapy, and the patterns of reported organisms differed in the cohort receiving anti-TNF treatment. Prior joint replacement surgery was a risk factor for septic arthritis in all patients. the 1 last update 2020/05/31 2424

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Radiographic Signs of Joint Disease in Dogs and Cats

Arthritis Curehow to Arthritis Cure for Graeme Allan, Sarah Davies, in Textbook of Veterinary Diagnostic Radiology (Seventh Edition), 2018

Septic Arthritis

Septic arthritis is diagnosed infrequently in small animals, with the incidence being lower than that of immune-mediated joint disease. Septic arthritis is difficult to diagnose radiographically. Initial radiographic changes are usually limited to joint effusion and periarticular swelling. Ideally, the arthritis should be diagnosed and treated successfully before radiographic changes become apparent.43 Polyarticular septic arthritis may occur as a result of bacteremia associated with an isolated focus of infection (endocarditis, discospondylitis, or omphalophlebitis) or in conjunction with a systemic disease (as in Mycoplasma arthritis, canine leishmaniasis, or feline caliciviral lameness).Arthritis Curehow to Arthritis Cure for 44 Polyarticular septic arthritis must be differentiated from immune-mediated joint disease. The former is more likely to affect the larger, more proximal joints of the appendicular skeleton, whereas the latter more commonly affects the joints nearer the distal extremities (Box 21.6). Monoarticular septic arthritis most likely results from extension of focal osteomyelitis into an adjacent joint, direct joint trauma, or foreign body penetration (grass seed awns), or it may occur after joint surgery or intraarticular therapy. Hematogenous dissemination of infection to joints is more common in young animals. Septic arthritis as a complication of surgery, particularly addressing cranial cruciate insufficiency, is more common in older animals.

As already noted, the earliest radiographic changes of septic arthritis are synovial effusion and increased synovial mass, which represent an inflammatory response of the synovium. Soft tissue swelling is usually demarcated by the distended joint capsule. Joint capsule distention is identified more easily in carpal, tarsal, and stifle joints. A useful landmark in the stifle is the infrapatellar fat pad. When the fat pad is compressed cranially, it becomes smaller and unclear, indicating synovial effusion is present. In untreated septic arthritis, joint cartilage destruction follows synovial effusion and is followed by subchondral and perichondral bone destruction (Figs. 21.51 and 21.52; Box 21.7).

Arthritis Curehow to Arthritis Cure for Septic arthritis is being identified increasingly in joints that have chronic degenerative joint disease. Initial radiographs are characterized by degenerative joint disease, often leading to inappropriate therapy for the infection. Radiographs made 2 to 4 weeks later reveal more aggressive signs of periosteal new bone formation and intraarticular bone destruction. Septic arthritis should be suspected when acute lameness and joint pain are identified in individual animals whose degenerative joint disease has been controlled previously.

Diagnosis of septic arthritis is based on cytologic assessment of synovial fluid and microbiologic examination of synovial fluid and/or synovium and joint capsule. Radiographic assessment alone has low specificity for septic arthritis, but survey radiographs are useful to rule out other conditions, as well as to follow the progress of a joint infection once a diagnosis of septic arthritis is confirmed.

Septic Arthritis in Cats

In cats, hematogenously disseminated septic arthritis may be caused by a variety of microorganisms, which include Mycoplasma gateae, Mycoplasma felis, bacterial L-form infection (Pasteurella spp.), calicivirus (transient the 1 last update 2020/05/31 arthritis in kittens), coronavirus (feline infectious peritonitis), and fungi (cryptococcosis, histoplasmosis). Hematogenously disseminated septic arthritis initially causes a nonerosive polyarthropathy characterized by lameness, synovial effusion, and synovial thickening. Affected cats may be systemically ill. Viremic polyarthropathies tend to be transient, whereas bacterial arthritis can have a protracted course. Direct injection of bacteria from bite wounds can result in mixed infections of microorganisms, which may include anaerobic bacteria.In cats, hematogenously disseminated septic arthritis may be caused by a variety of microorganisms, which include Mycoplasma gateae, Mycoplasma felis, bacterial L-form infection (Pasteurella spp.), calicivirus (transient arthritis in kittens), coronavirus (feline infectious peritonitis), and fungi (cryptococcosis, histoplasmosis). Hematogenously disseminated septic arthritis initially causes a nonerosive polyarthropathy characterized by lameness, synovial effusion, and synovial thickening. Affected cats may be systemically ill. Viremic polyarthropathies tend to be transient, whereas bacterial arthritis can have a protracted course. Direct injection of bacteria from bite wounds can result in mixed infections of microorganisms, which may include anaerobic bacteria.

Septic arthritis from penetrating bite wounds causes lameness that is usually restricted to one joint. Synovial effusion and periarticular soft tissue thickening precede secondary changes (such as, subchondral bone erosion) by weeks or months. CT can facilitate early detection of bone erosions and demonstrate synovitis. Joint infections that extend through the synovium and joint capsule into extracapsular tissue stimulate periosteal new bone formation on bone surfaces adjacent to the joint. Septic arthritis can lead to osteomyelitis in bones on either side of an affected joint.

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