Practice Lesson of the week

Polyarticular septic arthritis

BMJ 2006; 333 doi: (Published 23 November 2006) Cite this as: BMJ 2006;333:1107
  1. C Christodoulou, specialist registrar1,
  2. P Gordon, consultant2,
  3. G Coakley, consultant1
  1. 1Department of Rheumatology, Queen Elizabeth Hospital, London SE18 4QH
  2. 2Department of Rheumatology, King's College Hospital, London SE5 9RS
  1. Correspondence to: C Christodoulou chrisc{at}
  • Accepted 16 October 2006

Septic arthritis can be polyarticular, and joints suspected of harbouring infection should be aspirated urgently

Septic arthritis is an uncommon but potentially fatal emergency that can lead to poor functional outcomes of the affected joints. The fact that it can be polyarticular in presentation is insufficiently recognised. We report a case of a patient initially thought to have reactive arthritis who in fact had polyarticular septic arthritis. This case shows the importance of keeping in mind the possibility of septic arthritis and that joint aspiration for microscopy and culture is of paramount importance.

Case report

A 54 year old man was admitted to hospital with polyarthritis affecting both knees and the right wrist. His only medical history was of intermittent episodes of sciatica over the past 14 years. In January 2005 he developed a “bad cold” with a headache and sore throat, along with back pain and sciatica. Five days later he had severe pain and swelling affecting both knees and the right wrist. His polyarthritis was so severe that he was unable to walk and spent four days lying on the floor before his admission to hospital.

On admission, nine days after his first symptoms, he had a fever of 38.3ºC and acutely hot swollen knees and right wrist. No neurological signs were present. The admitting team believed that he had reactive arthritis but asked the orthopaedic surgeons to rule out septic arthritis of the right wrist. The orthopaedic opinion was that septic arthritis was unlikely on clinical grounds, and a rheumatology review was suggested.

By the next morning, the patient appeared very unwell and …

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