Nongonococcal Infectious Arthritis 

  • Author: Edward Dwyer, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Jan 19, 2012
 

Background

Nongonococcal infectious arthritis is an acute or subacute illness with potentially significant morbidity and mortality. Bacteria, mycobacteria, and fungi can cause the disease. Both healthy individuals and individuals with predisposing conditions can be infected. Nongonococcal infectious arthritis is typically a monoarticular disease, but, in approximately 10% of patients, it affects multiple joints.[1, 2] Without treatment, the condition results in joint destruction.

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Pathophysiology

Infectious arthritis ensues when foreign organisms invade the synovium or joint space. These organisms invade the joint via (1) hematogenous dissemination from a distant site; (2) periarticular infection, such as osteomyelitis or adjacent soft-tissue infection; or (3) direct introduction through penetrating trauma or procedural intervention, such as arthrocentesis or surgical repair.

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Epidemiology

Frequency

United States

The yearly incidence of bacterial arthritis varies from 2-5 cases per 100,000 persons in the general population to 28-38 cases per 100,000 persons in patients with rheumatoid arthritis.[1]

Mortality/Morbidity

  • Nongonococcal infectious arthritis carries a mortality rate of 11%.[3]
  • Joint destruction occurs in 25%-50% of cases.[4]

Race

  • No inherent racial predilections for infectious arthritis are recognized.

Sex

  • Sex is not an independent risk factor for infectious arthritis.

Age

  • Age older than 80 years has been shown in some studies to be an independent risk factor for susceptibility to bacterial arthritis.
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Contributor Information and Disclosures
Author

Edward Dwyer, MD  Assistant Professor, Department of Medicine, Columbia University College of Physicians and Surgeons

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

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.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; 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, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

References

  1. Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect. Apr 2006;12(4):309-14. [Medline].

  2. García-De La Torre I, Nava-Zavala A. Gonococcal and nongonococcal arthritis. Rheum Dis Clin North Am. Feb 2009;35(1):63-73. [Medline].

  3. Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). Jan 2001;40(1):24-30. [Medline].

  4. Kaandorp CJ, Krijnen P, Moens HJ, Habbema JD, van Schaardenburg D. The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum. May 1997;40(5):884-92. [Medline].

  5. Goldenberg DL, Reed JI. Bacterial arthritis. N Engl J Med. Mar 21 1985;312(12):764-71. [Medline].

  6. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. Oct 2002;15(4):527-44. [Medline].

  7. von Essen R. Culture of joint specimens in bacterial arthritis. Impact of blood culture bottle utilization. Scand J Rheumatol. 1997;26(4):293-300. [Medline].

  8. Chambers HF. Community-associated MRSA--resistance and virulence converge. N Engl J Med. Apr 7 2005;352(14):1485-7. [Medline].

  9. Harrington JT. Mycobacterial and fungal arthritis. Curr Opin Rheumatol. Jul 1998;10(4):335-8. [Medline].

  10. [Best Evidence] Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M, et al. Management of septic arthritis: a systematic review. Ann Rheum Dis. Apr 2007;66(4):440-5. [Medline].

 
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