Nongonococcal Infectious Arthritis Clinical Presentation

Updated: Dec 31, 2019
  • Author: Edward Dwyer, MD; Chief Editor: Herbert S Diamond, MD  more...
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Presentation

History

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. Onset of Kingella kingae septic arthritis in pediatric patients likewise is typically insidious, and clinical manifestations tend to be milder than those of septic arthritis from other bacteria. [6]

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). [14]

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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). [2]

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.

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