Septic arthritis - Rheumatologic emergency case

Acute painfull swelling and painfull motion of a joint, hyperemia combined with signs of systemic infection are real emergency cases in rheumatology. They have to be diagnosed and treated within a very short period of time. Delay in treatment may lead to severe and lasting joint damage or even death (mortality rates: 5-20 %). In suspect clinical cases with only a few basic diagnostic measurements (standard blood tests, standard x-rays, ultrasound, demonstration of infectious agent) the definitive diagnosis can be secured. Aspiration of synovial fluid with analysis of its content is most important. The infection of a joint is graded in different stages (empyema, synovitis, panarthritis). Systemic failure of immunological competence is an important factor in hematogenic distribution of bacteria. Also iatrogenic factors like previous operation or intraarticular injections can be the cause of septic arthritis. Conservative treatment: with immobilisation and cooling of the joint and systemic antibiotics is principally possible. We prefer the early surgical approach with removing the infectious agents from the joint continued with the above mentioned conservative procedures especially at weight bearing joints.