Infectious arthritis (septic arthritis) is infection in the fluid and tissues of a joint usually caused by bacteria, but sometimes

caused by viruses or fungi. Bacteria or sometimes viruses or fungi may spread through the bloodstream or fro m nearby infected tissue to a joint, causing infection. Pain, swelling, and fever usually develop within hours or a couple of days. Joint fluid is withdrawn in a needle and tested. Antibiotics are begun immediately. People at risk of infectious arthritis include those who have abnormal joints be cause of arthritis (including rheumatoid arthritis, osteoarthritis, or arthritis from injury) who develop an infection that reaches the bloodstream. For example , an older person with pneumonia and sepsis (a bloodstream infection) may fall a nd injure a wrist. Bleeding into the injured wrist may then result in infectious arthritis. Infecting organisms, mainly bacteria, usually reach the joint through the bloods tream, but a joint can be infected directly if it is contaminated during surgery or by an injection or an injury. Different bacteria can infect a joint, but the bacteria most likely to cause infection depend on a person's age. Staphylococci and bacteria known as gram-negative bacilli most often infect infants and young children, whereas gonococci (bacteria that cause gonorrhea), staphylococci, and streptococci most often infect older children and adults. Occasionally, spiroch etes (a type of bacteria), such as those that cause Lyme disease and syphilis, c an infect joints. Viruses such as the human immunodeficiency virus (HIV), parvoviruses, and those th at cause rubella, mumps, and hepatitis B can infect joints in people of any age. A slowly developing chronic infectious arthritis is most often caused by Mycobact erium tuberculosis (the main cause of tuberculosis) or fungi. Symptoms Infants usually have fever and pain and tend to be fussy. Generally, infants do not move the infected joint because moving or touching it is painful. Young chil dren with knee or hip infections may refuse to walk. In older children and adult s, symptoms usually begin over hours to a few days. The infected joint usually b ecomes red and warm, and moving or touching it is very painful. Fluid collects i n the infected joint, causing it to swell and stiffen. Symptoms also include fev er and chills. Less dramatic symptoms (such as less pain and a lower fever) usua lly occur in people with chronic infectious arthritis that is caused by mycobact eria or fungi.

An abnormal magnetic resonance image (MRI) reveals extensive damage to the bones in the knee (arrows). In this case, this finding is a result of an infectious a rthritis caused by tuberculosis. The joints most commonly infected are the knee, shoulder, wrist, hip, elbow, and the joints of the fingers. Most bacterial, fungal, and mycobacterial infections affect only one joint or, occasionally, several joints. For example, the bacter ia that cause Lyme disease most often infect knee joints. Gonococcal bacteria an d viruses can infect a few or many joints at the same time. Diagnosis Usually, a sample of joint fluid is removed with a needle as soon as possible. I t is examined for white blood cells and tested for bacteria and other organisms. The laboratory can almost always grow and identify the infecting bacteria from the joint fluid, unless the person has recently taken antibiotics. However, the bacteria that cause gonorrhea, Lyme disease, and syphilis are difficult to recov er from joint fluid. If bacteria do grow in culture, the laboratory then tests w hich antibiotics would be effective. A doctor usually orders blood tests because bacteria from joint infections often appear in the bloodstream. Sputum, spinal fluid, and urine may also be tested f or bacteria to help determine the source of infection.

Osteomyelitis

Osteomyelitis is a bone infection usually caused by bacteria, including mycobacteria, but is sometimes caused by fungi. Bacteria or fungi can infect bones by spreading through the bloodstream, spreadi ng from nearby tissue, or directly invading the bone. People have pain in one part of the bone, fever, and weight loss. Blood tests and x-rays are done, and doctors remove a sample of bone for tests. Antibiotics are given for weeks, and surgery may be needed. Osteomyelitis occurs most commonly in young children and in older people, but al l age groups are at risk. Osteomyelitis is also more likely to occur in people w ith serious medical conditions. When a bone becomes infected, the soft, inner part (bone marrow) often swells. A s the swollen tissue presses against the rigid outer wall of the bone, the blood vessels in the bone marrow may become compressed, which reduces or cuts off the blood supply to the bone. Without an adequate blood supply, parts of the bone m ay die. These areas of dead bone are difficult to cure of infection because it i s difficult for the body's natural infection-fighting cells and antibiotics to r each them. The infection can also spread outward from the bone to form collectio ns of pus (abscesses) in adjacent soft tissues, such as the muscle. Causes Bones, which usually are well protected from infection, can become infected thro ugh three routes: The bloodstream (which may carry an infection from another part of the body to t he bones) Direct invasion (infection) Infections in adjacent bone or soft tissues When organisms that cause osteomyelitis spread through the bloodstream, infectio n usually occurs in the ends of leg and arm bones in children and in the spine ( vertebrae) in adults, particularly in older people. Infections of the vertebrae are referred to as vertebral osteomyelitis. People who undergo kidney dialysis a nd those who inject drugs using nonsterile needles are particularly susceptible to vertebral osteomyelitis. Bacteria or fungal spores may infect the bone directly through open fractures, d uring bone surgery, or from contaminated objects that pierce the bone. Staphyloc occus aureus is the bacteria most commonly responsible. Mycobacterium tuberculos is (the main cause of tuberculosis) can infect the vertebrae to cause osteomyeli tis. Osteomyelitis may also occur where a piece of metal has been surgically attached to a bone, as is done to repair hip or other fractures. Also, bacteria or funga l spores may infect the bone to which an artificial joint is attached. The organ isms may be carried into the area of bone surrounding the artificial joint durin g the operation in which the joint is installed, or the infection may occur late r. Osteomyelitis may also result from an infection in an adjacent soft tissue. The infection spreads to the bone after several days or weeks. This type of spread i s particularly likely to occur in older people. Such an infection may start in a n area damaged by an injury, radiation therapy, or cancer, or in a skin ulcer (p articularly a foot ulcer) caused by poor circulation or diabetes. A sinus, gum, or tooth infection may spread to the skull. Symptoms Infections of the leg and arm bones cause fever and, sometimes days later, pain in the infected bone. The area over the bone may be sore, warm, and swollen, and movement may be painful. The person may lose weight and feel tired.

Infections of the vertebrae usually develop gradually, causing persistent back p ain and tenderness when touched. Pain worsens with movement and is not relieved by resting, applying heat, or taking analgesics. Fever, usually the most obvious sign of an infection, is often absent. When osteomyelitis results from infections in adjacent soft tissues or direct in vasion by an organism, the area over the bone swells and becomes painful. Absces ses may form in the surrounding tissue. These infections may not cause fever. In fection around an infected artificial joint or limb typically causes persistent pain in that area. Chronic osteomyelitis may develop if osteomyelitis is not treated successfully. It is a persistent infection that is very difficult to eradicate. Sometimes, chr onic osteomyelitis is undetectable for a long time, causing no symptoms for mont hs or years. More commonly, chronic osteomyelitis causes bone pain, recurring in fections in the soft tissue over the bone, and constant or intermittent drainage of pus through the skin. Such drainage occurs when a passage (sinus tract) form s from the infected bone to the skin surface and pus drains through the sinus tr act. Diagnosis Symptoms and findings during a physical examination may suggest osteomyelitis. F or example, doctors may suspect osteomyelitis in a person who has persistent pai n in part of a bone with or without a fever and feels tired much of the time. Usually, the erythrocyte sedimentation rate (ESR a test that measures the rate at which red blood cells settle to the bottom of a test tube containing blood) incr eases, as does the level of C-reactive protein (a protein that circulates in the blood and dramatically increases in level when there is inflammation). Also, bl ood tests often indicate elevated levels of white blood cells. However, these bl ood tests are not sufficient to diagnose osteomyelitis. An x-ray may show changes characteristic of osteomyelitis, but sometimes not unt il more than 3 weeks after the first symptoms occur. Computed tomography (CT) an d magnetic resonance imaging (MRI) can also identify the infected area. However, these tests cannot always distinguish infections from other bone disorders. The infected area almost always appears abnormal on bone scans (images of bone made after injecting radioactive technetium), except in infants, because scans do no t reliably indicate abnormalities in growing bones. White blood cell scans (imag es made after radioactive indium labeled white blood cells are injected into a vei n) can help distinguish between infection and other disorders in areas that are abnormal on bone scans. To diagnose a bone infection and identify the organisms causing it, doctors may take samples of blood, pus, joint fluid, or the bone itself to test. Usually, fo r vertebral osteomyelitis, samples of bone tissue are removed with a needle or d uring surgery. An abnormal bone scan of the lower leg and foot shows an area of inflammation in the bone (arrow). In this case, the cause is osteomyelitis. Treatment For children and adults who have recently developed bone infections through the bloodstream, antibiotics are the most effective treatment. If the bacteria causi ng the infection cannot be identified, then antibiotics that are effective again st Staphylococcus aureus and many types of bacteria (broad-spectrum antibiotics) are used. Depending on the severity of the infection, antibiotics may be given by vein (intravenously) for about 4 to 8 weeks but then may be given by mouth la ter. Some people need months of antibiotic treatment. If a fungal infection is identified or suspected, antifungal drugs are required for several months. If the infection is detected at an early stage, surgery is u sually not necessary. For adults who have bacterial osteomyelitis of the vertebrae, the usual treatmen t is antibiotics for 6 to 8 weeks. Sometimes bed rest is needed, and the person

may need to wear a brace. Surgery may be needed to drain abscesses or to stabili ze affected vertebrae (to prevent the vertebrae from collapsing and thereby dama ging nearby nerves, the spinal cord, or blood vessels). When osteomyelitis results from an adjacent soft-tissue infection (such as in a foot ulcer caused by poor circulation or diabetes), treatment is more complex. U sually, all the dead tissue and bone are removed surgically, and the resulting e mpty space is packed with healthy bone, muscle, or skin. Then the infection is t reated with antibiotics. When an abscess is present, it usually needs to be drained surgically. Surgery m ay also be needed for people with persistent fever and weight loss. Usually, an artificial joint that has an infection around it is removed and repl aced. Antibiotics may be given several weeks before surgery to try to eradicate the infection, so that the contaminated artificial joint can be removed and a ne w one can be implanted at the same time. Rarely, treatment is not successful and the infection continues, requiring surgery to fuse the joint or amputate the li mb. Basics of infectious arthritis Infectious arthritis is a form of arthritis that is produced by an infection. It is also called "septic arthritis." Infections An infection is an illness that is caused by certain types of germs. There are t hree major kinds of germs that can cause infections: bacteria, viruses, or fungi . Normally, these germs are not found in a person's body. They can live in the air , in uncooked food, plants, soil, animals, or trash. When they enter a person's body, these germs generally cause the person to become sick. Doctors call an ill ness that is directly caused by any one of these germs an "infection." Arthritis Arthritis means joint inflammation ("arthr-" = joint"; "-itis" = inflammation). There are over 100 kinds of arthritis. How does a person know if he or she has i nflammation in a joint or another part of the body? Generally, that area becomes warm, painful, swollen, red, and/or stiff. Prognosis Unlike other types of arthritis, infectious arthritis is usually not a long-term illness. Treated promptly and properly, it is generally a curable form of arthr itis. However, without proper treatment, infectious arthritis can result in seri ous damage to the joints involved, and may spread to other parts of the body. Th at's why it is important to recognize the symptoms of infectious arthritis and g et prompt treatment. Incidence Anyone can get infectious arthritis, but some people are more likely to get it t han others. These are people who have other diseases or whose bodies are not as strong at fi ghting off infections. This includes people who have: diabetes, sickle cell anem ia, severe kidney disease, immune deficiency, some forms of cancer, abnormal hea rt valve, or drug or alcohol abuse problems. Infants and elderly people also hav e more difficulty fighting certain infections. People who have auto immune deficiency syndrome (AIDS) may develop a severe form of Reiter's syndrome. One symptom of this syndrome is pain and inflammation in one or more joints. Children who have strep throat are particularly at risk for getting rheumatic fever, if not treated promptly with antibiotics. In addition t o other symptoms, rheumatic fever may involve joint pain in many joints. People who have some other form of arthritis are more likely to get infectious arthriti s. This is because germs are more likely to invade damaged joints rather than he althy ones. People who have surgery to replace a damaged joint have about a 1% chance of get ting infectious arthritis. Most of these infections generally occur within a few days to months after surgery, but infection can also appear several years later . People having joint replacement surgery should alert their doctor if symptoms such as fever or persistent joint pain occur.

Certain drugs can make it more likely for people to get infectious arthritis. So me people who have rheumatoid arthritisCorticosteroids, such as prednisone, also affect a person's resistance. People who receive repeated injections of cortico steroids into the same joint have an increased risk of getting infectious arthri tis. are treated with agents such as azathioprine, methotrexate, and cyclophosph amide. These medications can decrease a person's ability to resist infections. If people with rheumatoid arthritis get infectious arthritis, they might think t he symptoms are a "flare-up." That is why it is important to tell one's doctor a bout any sudden pain, swelling, warmth, or redness that occurs--particularly if it occurs in only one joint. Certain jobs can expose workers to disease-producing germs. For example, people who work with animals, plants, soil or marine life, such as farmers, gardeners, or fishermen, may be more likely to get infectious arthritis. This is because th e animals and materials they work with can carry the infectious germs. One person cannot get infectious arthritis from someone else who has it. In othe r words, it is not contagious (spread from one person to another). However certa in infections, for example measles and gonorrhea, can be spread from one person to another, and then produce infectious arthritis. Anatomy Infectious arthritis may occur without any other infection present. However, it is usually the result of a previous infection. That is, a germ first causes an i nfection elsewhere in the body, then spreads to one or more joints to produce in fectious arthritis. A germ can enter through almost any place in a person's body. The most common pl aces of entry are a person's skin, throat, ears, or nose. Once inside the body, the germs can get into the blood stream. From there they can travel to the perso n's joints (or any place that is suitable for them to live). Sometimes, a bacter ium, virus, or fungus can enter a person's joint directly through a wound. Most often, only one joint is affected. Sometimes, two or three joints become in volved. The large joints are most often infected, especially the shoulders, hips , and knees, although other joints can also become involved. Sometimes a condition called erythema nodosum can occur along with an infection. Although it is most often associated with tuberculosis and infections by certai n fungi, it is not due directly to these infectious germs. Symptoms The most noticeable symptom of erythema nodosum is red, tender bumps about the s ize of a quarter--in the skin of the lower legs, and sometimes on other parts of the body. Other symptoms that may appear include inflammation of the ankle (and sometimes other joints) and fever. Causes Infectious arthritis may be caused by bacteria, viruses, or fungi. Bacteria Most types of infectious arthritis are caused by bacteria. There are many differ ent kinds of bacteria that produce a variety of infections. Bacteria that can ca use infectious arthritis include: gonococcus, certain Gram-positive bacteria, ce rtain Gram-negative bacteria, spirochetes, and tuberculosis. Descriptions of the se bacteria and the symptoms they produce are listed below. Gonococcus Gonococcus is the name of the bacterium that causes gonorrhea. Gonorrhea is a se xually transmitted disease. It primarily affects the genital area. However, the gonococcus bacterium can travel through the blood stream to other parts of the b ody. If it settles in one or more joints, infectious arthritis can develop in th ose joints and the area that surrounds the joints. Gonococcus generally affects the knee joints, and can also affect the tendons and bursae to cause tendonitis and bursitis. This infectious arthritis can occur within days or weeks after the symptoms of g onorrhea appear. It occurs more often in women than in men. The symptoms of gono rrhea are not as obvious for women. Therefore, women generally seek treatment la ter than men. This delay in treatment gives the bacteria more time to travel thr ough the bloodstream.

Symptoms of infectious arthritis caused by gonococcus may include: fever chills abdominal pain in women discharge from the penis or vagina rash, which appears as a few, red rimmed, dime-sized, pus filled spots that are raised in the center inflammation of the tendons (bands that connect bones to muscles) arthritis which develops in joints such as the knees or wrists This type of arthritis should be treated immediately--as soon as you notice symp toms--to prevent serious damage to the joints. Gonorrhea is spread from person to person by sexual contact. Therefore, care sho uld be taken in sexual relationships where there may be a chance of getting the disease. The spread of gonorrhea can usually be prevented by the correct use of condoms. Anyone who thinks he or she may have gonorrhea should see a doctor as s oon as possible. Appropriate treatment with antibiotics can prevent damage to jo ints and other parts of the body. Gram-positive bacteria There are several different kinds of Gram-positive bacteria. They are called Gra m-positive because when mixed in the laboratory with a solution called "Gram's s tain," they take on a bluish-purple stain or color. Some of the Gram-positive ba cteria that can cause infectious arthritis are: staphylococcus, streptococcus, a nd pneumococcus. These Gram-positive bacteria cause other illnesses such as meningitis, pneumonia , or an abscess. Often people with these illnesses develop infectious arthritis when the bacteria spread to a joint and produce inflammation. In other cases, Gr am-positive bacteria cause infectious arthritis, but no other illness is detecte d. Staphylococcus is the second most common cause of infectious arthritis. It is of ten called a "staph infection." A staph infection can occur as a result of a ski n or sinus infection, or after surgery. People who have rheumatoid arthritis or who take steroids or immunosuppressive agents (such as imuran, cytoxan, and meth otrexate) are more apt to get infectious arthritis from staphylococcus bacteria. Symptoms of a "staph infection" in a joint may include: fever redness, swelling, extreme tenderness occurring in a single joint pus (yellowish-white substance) draining from a wound or abscess Gram-Negative Bacteria These bacteria are called Gram-negative because they do not take on a bluish-pur ple color when mixed with the Gram's stain. They are less likely to produce infe ctious arthritis than Gram-positive bacteria. Gram-negative bacteria commonly in fect people whose bacteria-fighting defense system (immune system) is already we ak. Hemophilus is a Gram-negative bacterium that causes severe sore throat and menin gitis. It is a major cause of infectious arthritis in infants, but rarely causes it in adults. Spirochete- Lyme Disease Spirochetes are bacteria that appear spiral shaped under a microscope. There are many different kinds of spirochetes. One kind (called Borrelia) causes a form o f infectious arthritis called Lyme disease. This disease occurs in people as a r esult of a tick bite. Anyone can get Lyme disease, but it is more common in chil dren. The Borrelia spirochete is carried by a small tick (called Ixodes) that lives on deer and mice. It is found in wooded areas during the spring and early summer. Many areas of the country have reported cases of Lyme disease. However, most cas es occur in seven states: New York, New Jersey, Rhode Island, Connecticut, Massa chusetts, Wisconsin, and Minnesota. People infected may not have seen the tick because it is very tiny. It is oval, has eight legs, and is often no larger than a pinhead or match head.

When the tick bites someone, it injects the spirochete into the person's blood s tream. Symptoms of the infection usually do not appear until 1-3 weeks after the bite. You may want to protect yourself and others from Lyme disease when you visit woo ded or lake areas, as suggested below. The following measures may help prevent tick bites: wear long sleeves and pants pull socks over pant legs wear closed shoes wear a hat use tick repellent on clothes shower afterwards and inspect for ticks, particularly checking arms, legs, and h airline Symptoms of early Lyme disease include: Skin rash which is 5-20 inches in diameter. It is white in the center and bright red on the outside. The center is hard and hot to touch. It may occur around th e bite and on different parts of the body. It may last up to a month. Flu-like symptoms of fever and chills, fatigue, headache, vomiting, and soreness all over. Joint pain and swelling usually in the knees, and sometimes also in the hips, sh oulders, and ankles. Sore throat, dry cough, stiff neck, swollen glands. Dizziness and sensitivity to sunlight. If untreated, the spirochete may spread to the person's brain, heart, and nervou s system. This could lead to symptoms such as: temporary paralysis of the face numbness and tingling in the hands or feet severe headaches, depression, memory lapses poor muscle coordination heart problems. With proper medication, Lyme disease usually goes away in a short time. However, if not diagnosed and treated properly, symptoms can become more severe and recu r several times over a year or more. Tuberculosis Bacteria The bacterium that causes tuberculosis can also cause infectious arthritis. It i s much less common today than it was years ago. When it does occur, it is often very slow to develop, and usually spreads from the lung to involve only one join t. Viruses Infectious arthritis can also be caused by viruses. It is usually produced by a viral infection that is already present in a person's body. Infectious hepatitis , mumps, and infectious mononucleosis are viral infections that can lead to a sh ort bout of infectious arthritis. Generally, the joint inflammation lasts no mor e than one to two weeks. German measles can also produce an infectious arthritis which may occasionally last as long as one year after the measles rash is gone. Fungi Fungi are the least common cause of infectious arthritis. Arthritis produced by a fungus usually develops very slowly. Types of fungi that can produce arthritis are usually found in soil, bird droppings and certain plants (especially roses) . Chicken farmers and gardeners are especially likely to be exposed to this type of arthritis. Differences Differences Bacterial, viral, and fungal infections are different from each other in the fol lowing ways: Bacterial infection: 1. Generally located in one place or area 2. Usually accompanied by fever and shaking chills 3. Usually begins quite suddenly 4. Usually cured by taking antibiotics

Viral infection: 1. Ache all over 2. Usually mild or no fever 3. Not cured by antibiotics 4. Usually goes away on its own Fungal infection: 1. May be in one area or throughout the body 2. May have low-grade fever or none at all 3. Usually begins quite slowly, over weeks or months 4. Usually treated with anti-fungal medication Can periodontal surgery cause infectious arthritis? Any significant manipulation of the gums can cause bacteria to enter the blood s tream--even brushing the teeth in the presence of gum disease. Periodontal healt h is important. In rare cases, periodontal disease may cause an infectious arthr itis especially when extensive dental work is being done. We worry about it in p articular for those with artificial joints in place as they can not combat the b acterial that might get into the blood stream. Infectious arthritis occurs more frequently in people with abnormal joints especially rheumatoid arthritis, peopl e with artificial joints or those with diabetes. For those with arthritis or art ificial joints in place, consult your rheumatogist or orthopedist before having dental work done. An antibiotic 1 hour before and 8 hours after may be in order. Diagnosis To determine if a person has infectious arthritis, the doctor will first ask abo ut the person's symptoms and any other medical conditions. The doctor will want to know about any recent travel, illness, or contact with p eople who have had infections. Work or home conditions might also give the docto r clues about the illness. After the medical history the doctor will do a physical exam and order special t ests. X-rays may be taken to determine if there is joint damage. Various laborat ory tests can be done to find out if an infection is present. It is most important to identify the specific germ causing the infection. Bacter ia and fungi can usually be identified from joint fluid, blood, urine, or the in fected area. The doctor will almost always want to remove and examine fluid from the infected joint. If tuberculosis or fungi are suspected, it will be necessar y to remove a tiny piece of tissue from the joint. This is called a biopsy. In t he laboratory, the fluid or tissue will be examined under the microscope to dete rmine what kind of bacteria or fungi are present. A viral infection is usually diagnosed by a person's symptoms and medical histor y. After the infection has been present for weeks or longer, blood tests may sho w the presence and amount of a person's own virus-fighting proteins (antibodies) in response to a viral infection. Treatment Most often, people with infectious arthritis need to go into the hospital for di agnosis and treatment; the treatment and length of stay will vary depending on t he type of infectious arthritis present. Treating bacterial infections Almost all people whose infectious arthritis is caused by bacteria are given an antibiotic. Antibiotics are medications that fight off bacteria. Different antib iotics destroy different bacteria. Therefore, the antibiotic prescribed depends on the type of bacteria present. Antibiotics can be taken by mouth or given through the person's vein. When given through a vein, it is called an intravenous or IV injection. An IV releases the antibiotic directly into the bloodstream. This allows the infection-fighting dr ug to travel faster, in higher concentration, and directly to the infected joint . Often, antibiotics can destroy an infection in a few days or weeks. In some case s, antibiotics must be taken over several months. Remember to take antibiotics f or the number of days prescribed--even if symptoms disappear. Many people think they can stop taking the medication when the symptoms are gone. Even though symp

toms disappear, bacteria may still be present. If not destroyed by the antibioti c, the bacteria can re-infect the area. Treating viral infections Generally infectious arthritis caused by a virus goes away by itself. Medication s are not available to treat viral infections. Resting in bed and drinking plent y of liquids are usually recommended. Treating fungal infections Fungal infections are often difficult to treat. Doctors can prescribe a fungus-f ighting medication. This may need to be used for months. Surgery is sometimes pe rformed to clean out the infected joint. Fungal infections are difficult to elim inate entirely. Even after successful treatment they may recur. Treating inflammation For all types of infectious arthritis the doctor may prescribe a medication to r elieve pain and inflammation. These are called anti-inflammatory drugs. In many cases, the doctor may need to drain one or more joints. This is done by inserting a needle into the joint and withdrawing fluid. This procedure is gener ally easy and usually not painful. It is done to remove any harmful substances r eleased by the bacteria or by the body's bacteria fighting cells. Joint fluid dr ainage may need to be done several times. Most of the time repeated drainage, al ong with high doses of IV antibiotics, can prevent the need for surgery. Other treatments Arthritis treatment may also include resting and protecting the joints. Splints can be used to limit movement. This helps reduce pain and tissue damage. After the infection is gone, the doctor will frequently recommend exercises to b uild up muscle strength. Other exercises may be recommended to increase the join t's range of motion. A physical therapist can demonstrate and assist with exerci ses that can be done at home. Summary of infectious arthritis Infectious arthritis is a form of arthritis that is caused by bacteria, viruses, or fungi. Many different types of infections can produce joint inflammation. This type of arthritis is almost always curable. If the infection is diagnosed and treated promptly, there is usually no lasting joint damage. If the infection is not treated early, permanent joint damage may result. Bacterial and fungal infections are usually treated with medication. A v iral infection will generally go away on its own. Most often, people with infectious arthritis are able to resume their normal act ivities once the infection is gone. What is septic arthritis? Septic, or infectious, arthritis is infection of one or more joints by microorga nisms. Normally, the joint is lubricated with a small amount of fluid that is re ferred to as synovial fluid or joint fluid. The normal joint fluid is sterile an d, if removed and cultured in the laboratory, no microbes will be found. With se ptic arthritis, microbes are identifiable in an affected joint fluid. Most commonly, septic arthritis affects a single joint, but occasionally more jo ints are involved. The joints affected vary somewhat depending on the microbe ca using the infection and the predisposing risk factors of the person affected. Se ptic arthritis is also called infectious arthritis. What microbes cause septic arthritis? Septic arthritis can be caused by bacteria, viruses, and fungi. The most common causes of septic arthritis are bacteria, including Staphylococcus aureus and Hae mophilus influenzae. In certain "high-risk" individuals, other bacteria may caus e septic arthritis, such as E. coli and Pseudomonas spp. in intravenous drug abu sers and the elderly, Neisseria gonorrhoeae in sexually active young adults, and Salmonella spp. in young children or in people with sickle cell disease. Other bacteria that can cause septic arthritis include Mycobacterium tuberculosis and the spirochete bacterium that causes Lyme disease. Viruses that can cause septic arthritis include hepatitis A, B, and C, parvoviru

s B19, herpes viruses, HIV (AIDS virus), HTLV-1, adenovirus, coxsackie viruses, mumps, and ebola. Fungi that can cause septic arthritis include histoplasma, coc cidiomyces, and blastomyces. Who is at risk of developing septic arthritis? While joint infection occasionally affects people with no known predisposing ris k factors, it more commonly occurs when certain risk situations are present. Ris ks for the development of septic arthritis include taking medications that suppr ess the immune system, intravenous drug abuse, past joint disease, injury, or su rgery, and underlying medical illnesses including diabetes, alcoholism, sickle c ell disease, rheumatic diseases, and immune deficiency disorders. People with an y of these conditions who develop symptoms of septic arthritis should promptly s eek medical attention. What are symptoms and signs of septic arthritis? Symptoms of septic arthritis include fever, chills, as well as joint pain, swell ing, redness, stiffness, and warmth. Joints most commonly involved are large joi nts, such as the knees, ankles, hips, and elbows. In people with risk factors fo r joint infection, unusual joints can be infected, including the joint where the collar bone (clavicle) meets the breastbone (sternum). With uncommon microbes, such as Brucella spp., atypical joints can be infected, such as the sacroiliac j oints. How is septic arthritis diagnosed? Septic arthritis is diagnosed by identifying infected joint fluid. Joint fluid c an easily be removed sterilely in the office, clinic, or hospital with a needle and syringe. The fluid is analyzed in a laboratory to determine if there is an e levated number of white blood cells to suggest inflammation. A culture of the jo int fluid can identify the particular microbe and determine its susceptibility t o a variety of antibiotics. X-ray studies of the joint can be helpful to detect injury of bone adjacent to t he joint. MRI scanning is very sensitive in evaluating joint destruction. Blood tests are frequently used to detect and monitor inflammation. These tests includ e the white blood cell count, sedimentation rate, and C-reactive protein. How is septic arthritis treated? Septic arthritis is treated with antibiotics and drainage of the infected joint (synovial) fluid from the joint. Optimally, antibiotics are given immediately. Often, intravenous antibiotics are administered in a hospital setting. The choice of antibiotics can be guided by the results of the culture of joint fluid. Until those results are known, empiri c antibiotics are chosen to cover a wider range of possible infectious agents. S ometimes, combinations of antibiotics are given. Antibiotics can be required for four to six weeks. Drainage is essential for rapid clearing of the infection. Drainage can be done by regular aspirations with a needle and syringe, often daily early on, or via s urgical procedures. Arthroscopy can be used to irrigate the joint and remove inf ected joint lining tissue. If adequate drainage cannot be accomplished with join t aspirations or arthroscopy, open joint surgery is used to drain the joint. Aft er arthroscopy or open joint surgery, drains are sometimes left in place to drai n excess fluid that can accumulate after the procedure. What are complications of septic arthritis? Rapid clearing of the infection is critical to preserve the joint. If appropriat e antibiotics are begun immediately, joint integrity can be maintained, and retu rn to function is expected. If the infection has been long-standing, the possibi lity of joint destruction exists. The keys to successful outcome are rapid medic al attention and drainage and the accurate administration of antibiotics to whic h the offending microbes are susceptible. Septic Arthritis At A Glance Septic arthritis is infection of one or more joints by microorganisms. Septic arthritis can be caused by bacteria, viruses, and fungi. Risks for the development of septic arthritis include taking immune-suppression medicines, intravenous drug abuse, past joint disease, injury or surgery, and un

derlying medical illnesses including diabetes, alcoholism, sickle cell disease, rheumatic diseases, and immune deficiency disorders. Symptoms of septic arthritis include fever, chills, as well as joint pain, swell ing, redness, stiffness, and warmth. Septic arthritis is diagnosed by identifying infected joint fluid. Septic arthritis is treated with antibiotics and drainage of the infected joint fluid from the joint.