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Query: UMLS:C0003873 (rheumatoid arthritis)
 53,068 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Septic arthritis is a serious and sometimes fatal complication of rheumatoid arthritis. We have examined the clinical characteristics of 16 patients with infectious arthritis seen during an eight-year period. This represented 0.5% of all admissions to our hospital for patients with rheumatoid arthritis. Although rheumatoid arthritis is considered a predisposing factor for joint sepsis, 15 of our patients had other conditions that most likely increased their susceptibility to infection. Many patients lacked distinctive features of joint sepsis (fever, chills) and only one half had leukocytosis. Six had polyarticular complaints despite documented monarthric sepsis. Delay in diagnosis of joint infection and persistent effusions of the infected joints portended a poor prognosis.
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PMID:Infection versus disease activity in rheumatoid arthritis: eight years' experience. 376 20

Two cases of coexistent gout and septic arthritis are presented. The known increased incidence of joint injections in patients with rheumatoid arthritis is contrasted with the relative rarity of this complication in persons with gouty arthritis. The reason for this dichotomy is not clear but it is suggested that an important factor may be the more episodic nature of the gouty process. For patients presenting with acute arthritis the possible concurrence of sepsis and gout should be considered.
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PMID:Coexistent gout and septic arthritis: a report of two cases and literature review. 390 98

The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Fifteen patients had pre-existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Eight patients had underlying systemic illnesses, and eight patients were receiving systemic corticosteroid therapy prior to the development of septic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2 per cent of patients), enteric gram-negative bacilli were found in seven of 23 patients (30.4 per cent). Five patients died (21.7 per cent mortality), two as a result of their infection and three of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4 per cent) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre-existing joint disease is very common and enteric gram-negative bacilli are often the causative organisms.
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PMID:Septic arthritis in the elderly. 397 35

Septic arthritis is a recognised complication of rheumatoid arthritis but has not been well described in sero-negative spondarthritis. We report 3 patients with sero-negative inflammatory joint disease who developed joint sepsis early in the course of the disease. In none was there a recognisable source of infection. Two cases were complicated by osteomyelitis and in one the sepsis has been recurrent over thirty years.
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PMID:Joint sepsis as a complication of sero-negative arthritis. 398 1

This retrospective study interprets the results of 370 evaluations of the lactate level of joint fluid. 5 groups were established: joint fluid from cases of mechanical (114) and microcrystalline (67) joint diseases, from inflammatory arthritis (149) and from septic arthritis (40). There was a significant difference between the lactate level in fluid from septic joints and that in the other groups. However, there was no significant difference between the rheumatoid joint fluid and the septic joint fluid. The increased level of intra-articular lactate can therefore be considered to be an argument in favour of the diagnosis of septic arthritis, but there is a certain rate of false positives (particularly in the case of rheumatoid arthritis) and false negatives, which require a very careful interpretation of the test. In cases of inflammatory arthritis with a cell count of more than 10,000 per mm3, there is a correlation between the white cell count and the lactate level. This relation is not observed in the case of septic arthritis. The authors did not detect any difference in the levels of intra-articular lactate according to the nature of the infecting organism. They studied 4 specimens of joint fluid from gonococcal arthritis and the levels of lactate were similar to those of other types of septic arthritis.
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PMID:[Value of the measurement of intra-articular lactates. Contribution to the diagnosis of septic arthritis. Interpretation of 370 evaluations]. 408 84

Four patients whose rheumatoid arthritis (RA) was complicated by staphylococcal arthritis were identified. All patients had active, long-standing disease with destructive changes. Affected joints included hip (two patients), knee (one patient), and shoulder (one patient). Pain and loss of motion in the affected joint were prominent, but toxic features of pyogenic infections--hectic fever, chills, sweats, local warmth, or erythema--were conspicuously absent. Two patients had moderate fever and three patients had mild leukocytosis. No patient was leukopenic. When present, fever was attributed to infected decubiti or urinary tract infection and treated with antibiotics. Therapy with corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) probably masked symptoms and delayed the correct diagnosis. Purulent synovial effusions were discovered serendipitously--during arthrography (knee), attempted Girdlestone procedure (hip), and aspiration prior to steroid injection (shoulder). Sepsis was included in the preoperative diagnoses only once (hip). Prior instrumentation (aspiration or injection) of the affected joint was not a feature in any patients, although one patient had undergone insertion of a knee prosthesis one year prior to sepsis. Infectious organisms were Staphylococcus aureus in three patients and Staphylococcus epidermidis in one. Severe sequelae ensued in three of four patients: death from recurrent sepsis (one patient), loss of prosthesis leading to knee arthrodesis (one patient), and protracted sepsis with additional pyarthrosis (one patient). The only patient to regain preseptic joint function (shoulder) had not been on long-standing corticosteroids. Pyarthrosis must be considered in RA patients with unusually painful or stiff joints even in the absence of toxic symptoms.
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PMID:Unrecognized staphylococcal pyarthrosis with rheumatoid arthritis. 408 87

It is generally recognized that patients with rheumatoid arthritis are at greater risk than the general population for the development of bacterial joint infection. It is not usually appreciated, however, that such patients may present with a clinical syndrome that mimics septic arthritis in most respects except that all cultures are consistently negative and antibiotics are not essential for treatment. We report our experience with five cases of "pseudoseptic" arthritis in patients with rheumatoid arthritis and suggest an approach for management.
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PMID:'Pseudoseptic' arthritis in patients with rheumatoid arthritis. 409 Apr 78

Thirteen cases (in twelve patients) of septic arthritis complicating rheumatoid arthritis are reported. One ankle, one metacarpopophalangeal joint, one shoulder, and ten knees were involved. Staphylococcus aureus was cultured from twelve joints and Escherichia coli, from one. Treatment consisted of repeated needle aspirations in two patients, arthrotomy with Penrose drainage in six, and arthrotomy with through-and-through irrigation in four. Needle aspiration was the least effective therapy. The authors recommend as the treatment of choice: systemic antibiotic therapy and immediate arthrotomy followed by through-and-through irrigation with fluid containing the appropriate antibiotics.
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PMID:Spontaneous septic arthritis complicating rheumatoid arthritis. 461 43

The routine battery of tests for synovial fluid analysis includes culture and Gram staining, polarizing microscopy, and total WBC and differential counts. If the volume of fluid collected is low, culture and polarizing microscopy have highest priority. Synovial fluid data are diagnostic in only two diseases: septic arthritis and crystal-induced arthritis. In traumatic arthritis, degenerative joint disease, rheumatoid arthritis, and systemic lupus erythematosus, synovial fluid data may provide evidence supporting the diagnosis.
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PMID:Interpretation of synovial fluid data. 615 17

The identification of monosodium urate crystals in joint effusions of patients with gouty arthritis established that crystals can cause arthritis. Other crystals causing arthritis have also been identified, including calcium, pyrophosphate dihydrate (chondrocalcinosis, pseudo-gout), calcium hydroxapatite crystals (calcific periarthritis, acute arthritis) and depot corticosteroid crystals (which occasionally cause arthritis when injected intra-articularly.) Crystal-induced arthritis is characterized by acute articular inflammation although rarely causing joint destruction or permanent disability. It is important for clinicians because it can mimic more serious joint diseases like septic arthritis or even rheumatoid arthritis. It can be diagnosed with precision and in some types as in gout can be treated effectively. Also, it constitutes one of the best understood articular inflammatory processes and often is the first clinical clue for the presence of curable metabolic or endocrine diseases.
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PMID:Crystal-induced arthritis. 628 63


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