Asian Journal of Orthopaedic Research

Relevance of the Clinical and Laboratory Profile in Decision-making for Patients with Septic Arthritis

Abdulelah Alfuraym Alanazi

First Cluster, Ministry of Health, Riyadh, Saudi Arabia.

Faisal Eid Nazal Alanazi

King Saud Medical City, Riyadh, Saudi Arabia.

Yaser Ahmad Alhulaimi

King Saud Medical City, Riyadh, Saudi Arabia.

Mazi Mohammed Mazi

First Cluster, Ministry of Health, Riyadh, Saudi Arabia.

*Author to whom correspondence should be addressed.

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Abstract

Background: 10%–30% of patients with adult-onset septic arthritis septic arthritis had sterile synovial fluid (SF), and it was difficult to diagnose these individuals, making care difficult. The goal of this study was to analyse the variations between persons with proven and suspected septic arthritis.

Methods: A cross-sectional descriptive study was conducted in a tertiary referral facility at King Saud Medical City, Riyadh, Saudi Arabia, from January 2022 to February 2023. After receiving clearance from the institutional ethics board, a practical sample approach was employed. The patients were recruited in the experiment after providing written informed consent. Patients over the age of 18 who had been scheduled for an arthrotomy and joint lavage by the treating surgeon and had clinical symptoms that suggested SA were included in the study. Based on the results of the analysis of the SF and tissue taken during the arthrotomy, the patients were divided into two groups: group 1 (Newman A/confirmed), and group 2 (Newman B and C/suspected).

Results: 40 patients was involved, with 21 patients placed in group 1 and 17 in group 2. The median age of the study population was 49 (36-59), and men dominated both categories (85% and 73%, respectively). Pain was the most common immediate symptom (100%) and was followed by edoema around the injured joint. Except for hip and shoulder swelling, only 25 out of the 28 people who experienced swelling. At the time of admission, a fever was found in 23.8% of patients. Seven patients were on immune-modulative drugs at the time of presentation for a number of ailments, including polymyositis, immune thrombocytopenic purpura, and post-renal transplant.

Conclusion: In order to avoid life-threatening consequences, septic arthritis is an orthopedic emergency that requires immediate and urgent treatment. Similar demographics, clinical characteristics, and laboratory data are present in both confirmed and suspected cases of septic arthritis at presentation, which might lead the treating surgeon. In the case that bacteria cannot be cultured, treatment should be based on solid clinical judgment.

Keywords: Decision-making, Septic arthritis, immediate symptom, polymyositis

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References

Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). 2001;40(1):24-30. DOI: 10.1093/rheumatology/40.1.24

Newman JH. Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis. 1976;35(3):198-205.

DOI:10.1136/ard.35.3.198

Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. 2002; 15(4):527-544. DOI: 10.1128/CMR.15.4.527-544.2002

Nema SK, Basel SK, Austine J, Mirza K. Clinical and laboratory profile in confirmed vs. suspected septic arthritis patients and its relevance in decision making: A comparative cross-sectional study. Chinese Journal of Traumatology. 2021; 24(02):94-9.

Gupta MN, Sturrock RD, Field M. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis. 2003;62(4):327-331. DOI: 10.1136/ard.62.4.327

Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum. 1995;38(12):1819-1825. DOI: 10.1002/art.1780381215

Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis?. JAMA. 2007;297(13):1478-1488. DOI: 10.1001/jama.297.13.1478

Madruga Dias J, Costa MM, Pereira da Silva JA, Viana de Queiroz M. Septic arthritis: Patients with or without isolated infectious agents have similar characteristics. Infection. 2014;42(2):385-391.

DOI: 10.1007/s15010-013-0567-z

Shmerling RH, Delbanco TL, Tosteson AN, Trentham DE. Synovial fluid tests. What should be ordered?. JAMA. 1990; 264(8):1009-1014.

Swan A, Amer H, Dieppe P. The value of synovial fluid assays in the diagnosis of joint disease: a literature survey. Ann Rheum Dis. 2002;61(6): 493-498. DOI: 10.1136/ard.61.6.493

Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis. 1999;58(4):214-219. DOI: 10.1136/ard.58.4.214