Contents
Etiology
- most commonly caused by Staph. aureus in adults
- consider Neisseria gonorrheae in sexually active adults
- most common route of infection is hematogenous
Clinical Presentation
- localized joint pain, erythema, warmth, swelling with pain on active and passive ROM, inability to bear weight, ± fever
Investigations
- XR (to r/o fracture, tumour, metabolic bone disease), ESR, CRP, WBC, bloodbcultures
- joint aspirate (WBC >80,000 with >90% neutrophils, protein level >4.4 mg/dL; glucose level << blood glucose level, no crystals, positive gram stain results)
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PEARL
knee > hip > elbow > shoulder > wrist > ankle; if unusual joints are involved (SI joint, sternum, pubic symphysis) -> suspicion of IV drug use |
Management
- IV antibiotics
- for small joints: needle aspiration, serial if necessary, until sterile; major joints such as knee, hip, or shoulder should be decompressed and drained surgically in emergent fashion
- serial C-reactive protein (CRP) can be used to monitor response to therapy