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Nongonococcal Infectious Arthritis Clinical Presentation

  • Author: Edward Dwyer, MD; Chief Editor: Herbert S Diamond, MD  more...
Updated: Mar 15, 2016


The clinical course of bacterial arthritis is typically acute in onset. Patients with joint prostheses are the exception to this general rule: Their symptoms may persist for weeks or months before a diagnosis is made. Individuals with mycobacterial or fungal arthritis also tend to have a much more indolent or subacute prodrome before the diagnosis is considered.

Joint pain, swelling, erythema, and loss of motion are common presenting symptoms. The most commonly affected joint in persons with bacterial arthritis is the knee. The shoulder, hip, elbow, and wrist joints are infected less frequently. The sternoclavicular and sacroiliac joints are preferentially involved in patients who use illicit parenteral drugs.

Approximately 10% of individuals with bacterial arthritis have infection in multiple joints, particularly in the presence of a preexisting destructive joint disease (eg, rheumatoid arthritis) or compromising medical conditions (eg, diabetes and conditions necessitating glucocorticoid therapy).[8]


Physical Examination

During the first 24 hours of hospitalization, 78% of patients with nongonococcal bacterial arthritis exhibit fever; however, the fever rarely exceeds 39°C (102.2°F).[1]

The patient may have decreased range of motion in the joint. Swelling, tenderness to palpation, erythema, warmth to touch, and pain upon movement of the affected joint are common physical examination findings.

Contributor Information and Disclosures

Edward Dwyer, MD Associate Professor of Medicine, Columbia University Medical Center

Edward Dwyer, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.


Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert E Wolf, MD, PhD Professor Emeritus, Department of Medicine, Louisiana State University School of Medicine in Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Affairs Medical Center

Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, and Society for Leukocyte Biology

Disclosure: Nothing to disclose.

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