Septic Arthritis

septic-arthritis

Kocher’s Criteria

Predictors associated with risk of Septic Arthritis

  1. Fever
  2. Non-weight-bearing
  3. ESR = 40 or more
  4. Serum WBC = 12,000 or more

Probability of Septic Arthritis based on number of Predictors

  • 0 Predictors – <0.2 %
  • 1 Predictor – 3.0%
  • 2 Predictors – 40.0%
  • 3 Predictors – 93.1%
  • 4 Predictors – 99.6%

Use this information wisely… not blindly.

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Septic Arthritis and Arthrocentesis Landmarks

SYNOVIAL FLUID ANALYSIS

  • sWBC > 50,000 – essentially rules IN septic arthritis
  • sWBC < 50,000 – unhelpful for clinical diagnosis
  • Gram Stain: useful when positive, unhelpful when negative
  • Culture: not available when we need it in the ED
  • Lactate >10 – essentially rules IN septic arthritis

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Acute gouty arthritis treatment pearls

podagra

  • NSAIDs, if contraindications then topical still great for single joint
  • Colchicine (1.8mg a day) at a low dose, can be used chronically. Remember SEs (sepsis, home marrow suppression. Mostly D&V)
  • Steroids

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