Pyogenic arthritis in adults

Septic arthritis has shown no change in incidence, and despite advances in antimicrobial therapy is often responsible for residual functional impairme nt and for a high mortality rate among debilitated patients. Risk factors i nclude older age, diabetes mellitus, rheumatoid arthritis, immunodeficiency , and a preexisting joint disease (e.g., rheumatoid arthritis) to which the symptoms of septic arthritis are sometimes ascribed. Staphylococcus aureus contributes over two-thirds of identified organisms; a range of streptococ ci and gram-negative bacilli are next in frequency. The most common site is the knee, followed by the hip and shoulder. Over 10% of patients have poly articular involvement reflecting bacteremia and diminished resistance to in fection; (over 50% of polyarticular forms occur in rheumatoid arthritis pat ients). Prosthetic joint infection is becoming increasingly common; chronic forms due to intraoperative contamination and resulting in septic loosenin g should be distinguished from acute hematogenous infection in which emerge ncy treatment can allow to salvage the prosthesis. Demonstration of the org anism in the joint is the key to the diagnosis. Joint aspiration should be performed on an emergency basis, if needed after identification of radiogra phic landmarks or under ultrasonographic guidance. Seeding the fluid on blo od culture flasks immediately after aspiration increases the yield. Antibio tics should be started as soon as the microbiological specimens have been c ollected. When aspiration is difficult (hip) or inadequate, arthroscopic dr ainage usually makes arthrotomy unnecessary. Early antiinflammatory therapy (nonsteroidal antiinflammatory drugs, systemic or local glucocorticoids, a nticytokines, and antiinflammatory cytokines) are being considered as tools for limiting joint damage; their efficacy and safety will first have to be established in animal studies. (C) 2000 Editions scientifiques et medicale s Elsevier SAS.