# Bacterial (septic) arthritis

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD01.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Septic Arthritis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538176/
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Bacterial (septic) arthritis - disease-level clinical article (bacterial-septic-arthritis-clinical.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
BACTERIAL (SEPTIC) ARTHRITIS
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD01.00 -
         condition scope only, no dose · No dose - referral pathway, no medicine given in primary
         care · Septic Arthritis - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK538176/
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Bacterial (septic) arthritis - disease-level clinical article
               (bacterial-septic-arthritis-clinical.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (5)
    - Sudden-onset pain, fever and swelling in a single joint, with reluctance to move it  [fever ·
      refusing to use a limb]
    - Fever is present in only 40 to 60 percent of cases, so its absence does not rule out infection
      [fever]
    - Suspected gonococcal arthritis typically occurs in young, healthy, sexually active adults
    - In children, local symptoms include pain, swelling, limp, and refusal to use the joint  [limp
      · refusing to use a limb]
    - Children may also show systemic illness: fever, fast heart rate, irritability, and poor
      appetite  [fever · irritability · poor appetite · tachycardia]
  SIGNS - what you find (4)
    - Gonococcal arthritis can present with skin rash, tendon sheath inflammation and a migratory
      joint pattern  [rash]
    - The knee is the joint most often involved, followed by the hip, shoulder and ankle
    - Joint effusion is common, with limited range of motion and pain on palpation  [joint swelling
      · reduced range of movement]
    - Most prosthetic joint infections present with a draining sinus tract
  TESTS (9)
    - Synovial fluid analysis, culture, gram stain, crystals, cell count, is the key diagnostic test
    - A synovial white cell count above 50,000 with over 90 percent neutrophils suggests bacterial
      infection
    - Peripheral blood count is usually elevated with a left shift
    - A high ESR and CRP back up the diagnosis without being conclusive by themselves
    - In a prosthetic joint, a synovial count of 1100 with 64 percent neutrophils suggests infection
    - Two sets of blood cultures should be drawn to check for bacteremia
    - Plain x-rays may show a widened joint space or soft-tissue swelling, but a normal film does
      not exclude the diagnosis
    - MRI is sensitive for early joint fluid and can show soft-tissue or bone involvement
    - Bone scan is nonspecific but useful for localized infection of the hip or sacroiliac joint
  IF NOT THIS - what else fits (7)
    - Non-bacterial infectious arthritis: fungal, viral, spirochete or mycoplasma organisms
    - Crystal arthropathy such as gout or pseudogout
    - An intra-articular injury: fracture, meniscal tear, or a foreign body
    - An inflammatory arthritis such as rheumatoid arthritis, lupus, or a spondyloarthropathy
    - A systemic infection: endocarditis, HIV, or Lyme disease presenting with joint symptoms
    - A joint tumor, including metastasis or pigmented villonodular synovitis
    - Bleeding into the joint, a clotting disorder, anticoagulant use, or avascular necrosis
  Source  StatPearls "Septic Arthritis" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    An orthopaedic emergency that risks permanent joint destruction; the GP recognises it
            and refers urgently for joint aspiration and inpatient intravenous antibiotics rather
            than treating as an outpatient. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      An orthopaedic emergency that risks permanent joint destruction; the GP recognises it
            and refers urgently for joint aspiration and inpatient intravenous antibiotics rather
            than treating as an outpatient.
   Caution  Hot, swollen, immobile joint, inability to bear weight, fever, rapid onset, prosthetic
            joint involvement.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Staphylococcal septic arthritis carries a mortality rate exceeding 50%,
            requiring urgent emergency orthopedic evaluation.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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