Non-gonococcal bacterial arthritis is a dangerous form of acute arthritis that commonly affects large joints like the knee. It requires prompt diagnosis via joint aspiration and treatment with antibiotics like flucloxicillin along with joint drainage to prevent long-term damage like joint destruction and disability. Risk factors include prior joint disease, age, and immunosuppression which can make symptoms and tests less definitive, emphasizing the need for joint aspiration.

2.  A joint inflammation due to an infection usually involving
the synovial joints
 50% cases - children less than 5 years
 30% cases - children less than 2 years
 Most dangerous and destructive monoarthritis
 Can destroy cartilage within days
 Mortality 7-15 % despite antibiotic use

4.  Knee – 53%
 Hip – 20%
 Elbow – 17%
 Shoulder – 10%

5.  Knee – 39%
 Hip – 32%

6.  Can be bacterial, fungal, mycobacterial or viral
 Bacterial divided into
gonococcal –more common less morbid
nongonococcal
Staphylococcus
Hemophilus influenza
Streptococcus
E. coli
Proteus

10.  RA
 SLE
 Immosupressive therapy or disorders
 DM
 Chronic debilitating disorders – CLD, RF

11.  Previous joint trauma
 h/o arthritis to same joint
 Degenerative joint disease
 Gout/ pseudogout

13.  Bacteria rapidly gains access to the joint cavity and settles in the synovial
membrane.
 Acute inflammatory reaction occurs with formation of serous or seropurulent
exudate.
 Articular cartilage is eroded and destroyed due to the action of bacterial toxins
and by enzymes released from the synovium and inflammatory cells.
 In late cases- extensive erosion due to synovial proliferation and ingrowth.

14.  If untreated- spread to the underlying bone or burst out of the joint to form
abscesses and sinuses.
 With healing:
1. Complete resolution.
2. Partial loss of cartilage and fibrosis of joint.
3. Loss of articular cartilage and bony ankylosis.
4. Bone destruction and permanent deformity of the joint.

16.  Fever
 Pain
 Pseudo paresis

17.  Neonates
 FEW CLININCAL SIGNS
 May not be febrile
 Loss of spontaneous movement of extremity
 Hip- flexion, abduction, eternally rotated

18.  In children
 Local signs of inflammation
 Rapid pulse and SWINGING FEVER
 All joint movements - RESTRICTED

19.  In adults
Often a superficial joint – knee, ankle, wrist
Joint is painful, swollen, inflamed
Restriction of movements

20. 1. Decreased or absent range of motion.
2. Signs of inflammation: joint swelling, warmth,tenderness and erythema.
3. Joint orientation as to minimize pain (position of comfort):
Hip: abducted, flexed and externally rotated.
Knee, ankle and elbow: partially flexed.
Shoulder: abducted and internally rotated

21.  Routine blood investigations
 Xray
 USG
 Diagnostic aspiration
 MRI

22.  Leucocytosis >12,000.
 ESR>40 mm/hr.
 CRP- elevated.
 Blood culture-may be positive.

23.  In early stages- usually normal.
 Later on- joint space widening may be present and subluxation of the joint may be
present.
 In late stages- irregularity of the joint.

28.  Can be used to detect even the smallest amount of joint effusion.
 Non invasive, inexpensive and easy to use.
 Can be used to guide joint aspiration.

30.  In early cases- fluid may be clear.
 Sample sent for Gram staining, microscopy,
culture, and antibiotic sensitivity.
 Normal synovial fluid leucocyte count: under
300/ml.
 Leucocyte count>50,000 per ml with 90%
PMN strongly suggestive of septic arthritis.

32. STREPTOCOCCUS

33. H. INFLUENZA

35.  Can detect infection and extent of infection.
 Useful in diagnosing infections that are difficult
to access.
 Also useful in differentiating between bone and
soft tissue infections and in detecting joint
effusion.

37.  Acute osteomyelitis.
 Trauma
 Irritable joint
 Hemophilic joint.
 Rheumatic fever
 Gout and pseudogout
 Gaucher’s disease.

38.  IV fluids- to prevent dehydration.
 Analgesics- for pain.
 Joint must be rested either on splint or in a widely split plaster.

39.  Broad spectrum IV antibiotics are started immediately and then depending on
microbiological investigations, specific antimicrobial therapy is started.

40.  Duration of treatment: IV antibiotics given for minimum of 2 weeks.
 Oral antibiotics:
Children-2-4 weeks.
Adults- 4-6 weeks.

41. 1-Joints that do not respond to antimicrobial therapy and daily arthrocentesis
2-.Any joint with limited accessibility, including the sternoclavicular or the hip joint
3-Patients with underlying disease, including diabetes, rheumatoid arthritis,
immunosuppression, or others systemic symptoms, should be treated more
aggressively with earlier surgical intervention

42.  In septic arthritis of hip- surgical drainage is always done.
Best approach-anterolateral
Joint is opened through a small incision and washed with normal saline.
Small drain is left in place after incision is closed.
Suction-irrigation is continued for another 2 or 3 days.

43.  In knee- arthroscopic debridement and copious irrigation.
In adults- repeated closed aspiration of joint may be done.
But if no improvement within 48 hours- open drainage is necessary.

44.  Joint Destruction
 Coxa magna
 Pathological Dislocation
 Acute Osteomyelitis
 Septicemia
 Secondary osteoarthritis
 Avascular necrosis

45.  Non gonococcal bacterial arthritis is a dangerous and destructive form of acute
arthritis
 Risk factors include pre-existing joint disease, joint replacement, old age,
immunosuppression and overlying infection or ulceration
 It usually presents as monoarthritis involving a large joint like the knee
 Because symptoms such as fever may be absent and tests such as FBC and CRP are
non specific, joint aspiration is necessary to establish the diagnosis- for cell count,
microscopy and culture. BC are also useful
 Staph and strep are the most common pathogens and are usually treated with
flucloxicillin, but older patients, ICU patients, IVDUs may have gram-ves and
given3rd gen cephalosporin
 Joint drainage- by needle aspiration or surgical means should also be considered