emDocs - May 9, 2015 - By Brit Long
"Summary:
Septic arthritis presents clinicians with a significant diagnostic challenge. Early identification and prompt treatment of bacterial arthritis is essential to minimize morbidity and mortality. Despite a long history of reports identifying classic symptoms at presentation, characteristic historical elements, physical exam findings on evaluation, and traditional parameters on serum and synovial studies during laboratory testing, septic arthritis remains a diagnostic conundrum.
Pitfalls:
- Failing to consider septic arthritis in a oligoarticular/polyarticular presentation
- Relying solely on history, physical examination, ESR, and CRP to rule out septic arthritis
- Not recognizing non-bacterial etiologies of septic arthritis
- Allowing an uncomplicated cellulitis or therapeutic INR to thwart joint aspiration
- Not considering MRSA in initial antibiotic choice
- Not considering the overlap in clinical presentation and both serum and synovial studies in differentiating septic and noninfectious arthritis
- MRSA presenting with low synovial fluid cell counts
- Not performing arthrocentesis of a prosthetic joint in consultation with the treating surgeon"
http://www.emdocs.net/septic-joint-reminders-updates-and-pitfalls/