Pyogenic arthritis is an inflammatory joint disease caused by various infections, most commonly from Staphylococcus aureus, and can result from multiple pathways of pathogen entry. Symptoms include fever, joint pain, and swelling, primarily affecting one joint, and diagnosis typically involves imaging and joint fluid analysis. Treatment focuses on joint aspiration, antibiotics, and supportive care to prevent complications like dislocation, growth disturbances, and secondary osteoarthritis.

2. P Y O G E N I C
A R T H R I T I S
B Y: M U H A M M A D A N A S

3. Pyogenic Arthritis:
is an inflammatory joint disease caused by bacterial, viral,
and fungal infection
Route of infection
• dissemination of pathogens via the blood, from distant site….
(most common)
• dissemination from an acute osteomylitic focus
• dissemination from adjacent soft tissue infection,
• entry via penetrating trauma
• entry via iatrogenic means

5. What causes Pyogenic Arthritis?
• Staphylococci. ( S. aureus) >>>>> Most Common.
• Haemophilus influenzae. ( in Children)
• Gram negative bacilli.
• Streptococci.
• Gonococci.
• Viruses.

6. The Infectious agent can enter the body in a number of
ways, such as:
• A broken bone that goes through the skin (open fracture)
• An infection that spreads from another place on the body, such
as the skin or genitals
• An infected wound
• Foreign object that goes through the skin
• Injury that breaks the skin

7. Pathology
• There is an acute synovitis with a purulent joint effusion and
Synovial membrane becomes edematous, swollen and
hyperemic, and produces increase amount of cloudy exudates
contains leukocytes and bacteria
• As infection spread through the joint, articular cartilage is
destroyed by bacterial and cellular enzymes.
• If the infection is not arrested the cartilage may be completely
destroyed.
• Pus may burst out of the joint to form abscesses and sinuses.
• The joint may be become pathologically dislocated

8. • Who is at risk for Pyogenic arthritis?
• A systemic blood-borne infection
• IV drug use
• Osteoarthritis
• Past history of septic arthritis
• Rheumatoid arthritis
• Other factors that may increase the risk for Pyogenic arthritis
include:
• HIV
• Old age
• Suppressed immune system

9. Clinical presentation/ symptoms:
• The most common joints affected by septic arthritis are the
knee, hip, shoulder, elbow, wrist, and finger. Most often, only
one joint is affected. Symptoms can occur a bit differently in
each person, but common symptoms include:
• Fever
• Joint pain
• Joint swelling
• Inspection: Erythema, Effusion, Jt tend to be in Max.Vol
position
• Palpation: Tender, Warm
• Motion: Inability to tolerate weight, Inability to tolerate PROM

10. Diagnosis ( Imagimg)
• Radiograph :
• May show Jt space widening or effusion
• Periarticular osteopenia
• Ultrasound:
• For confirmation of effusion in large Jt’s
• For guiding aspirations
• MRI:
• detects jt effusion

11. Diagnosis (Studies)
• CBC: high WBC with left shift
• ESR: High ( > 30)
• CRP: High ( > 5)
• Joiny fluid Aspirate:
• gold standard for treatment and allows directed antibiotic treatment
Should be analysed for
• Cell count
• Gram stain
• Culture
• Glucose level
• Crystal analysis

12. Complications:
• Dislocation: a tense effusion may cause dislocation
• Epiphyseal destruction: in neglected infants the largely
cartilaginous epiphysis may be destroyed ,leaving an unstable
pseudarthrosis.
• Growth disturbance: physeal damage may result in
shortening or deformity
• Ankylosis: if articular cartilage is eroded healing may lead to
ankylosis
• Secondary osteoarthritis
• Osteomyleitis/abcess/sinus

13. Treatment
• General Measures:
The first priority is to aspirate the joint and examine the fluid, treatment is
then started without further delay.
• Analgesics and splinting of the involved joint in the position of maximal
comfort alleviate pain.
• Fluid replacement and nutritional support may be required.
• Other foci of infection and any coexisting medical conditions must be
identified and treated appropriately
• Intravenous antibiotics should be given empirically and started as soon
as joint fluid and blood sample have been taken for culture

14. • If gram –positive organisms are identified ,Flucloxacillin is
suitable . If in doubt ,a third generation cephalosporin will cover
both game+ and gram- organisms.
• Children less than 4 yr( if suspicion of H.Infl) treated with
Ampicillin.
• Once the bacterial sensitivity is known the appropriate drug is
substituted.
• Intravenous administration is continued for several weeks and is
followed by oral antibiotics for a further 2 or 3 weeks.