Septic Arthritis in the Elderly

Abstract

Septic arthritis is a rather common acute, intensely painful, pyogenic infection of the synovial joints. Etiopathogenetic mechanisms include: (a) hematogenous seeding and spreading, (b) direct inoculation (previous orthopedic interventions, joint surgery and therapeutic intra-articular injections of corticosteroids), and (c) continuous extension from a contiguous infectious focus affecting adjacent structures, such as bones or skin. Elderly people are at higher risk of developing septic arthritis, because of (a) frailty and significantly reduced physiological reserve, (b) co-morbidities (diabetes mellitus, metabolic impairments, immunological dysfunctions, HIV, or malignancies), and (c) degenerative musculo-skeletal disorders (including osteoarthritis, chondrocalcinosis and rheumatoid arthritis) or rheumatological diseases (such as gout and systemic lupus erythematosus). emergency among the elderly, leading to reduced functioning and motion, to morbidity and, ultimately, to mortality. As such, it should receive a prompt diagnosis and management. Removing infected fluids, using antibiotics, eventually performing surgery and providing supportive care are the best evidence-based options for properly treating older adults with septic arthritis. When oral treatment or surgical management are unfeasible options, prolonged suppressive antibiotic therapy (PSAT) can be a valid solution.