Septic Arthritis in Patients with Systemic Lupus Erythematosus: Salmonella and Nonsalmonella Infections Compared

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Objectives

To assess the clinical characteristics and outcome of systemic lupus erythematosus (SLE) with septic arthritis.

Methods

In this 20-year retrospective study, we reviewed the charts of SLE patients with septic arthritis confirmed by synovial fluid analysis and culture. To identify risk factors for septic arthritis, data of SLE patients with septic arthritis were compared with data of 100 hospitalized SLE patients without septic arthritis.

Results

There were 10,732 inpatient records of 3,127 SLE patients; 29 SLE patients had septic arthritis. Their ages ranged from 14 to 68 years (mean, 35.1 ± 14.1 years). The mean SLE duration before septic arthritis onset was 30.6 months. All patients received corticosteroids; 93% had active disease (SLEDAI ≥ 4). Compared with controls, avascular necrosis (AVN) of the femoral head was the most common predisposing articular disease (Odds ratio, 3.799;CI, 1.59 to 9.05). Of the 29 patients, 17 (59%) had salmonella infections and 12 (41%) had other infections. Salmonella-infected patients were younger (28.7 ± 10.4 years) than those with nonsalmonella infections (44.1 ± 14.0 years; P = 0.002). The hip was the most commonly affected joint, especially in the salmonella group, followed by the knees and ankles. Salmonella-infected patients were more prone to oligo-articular septic arthritis. The overall mortality rate was 10%.

Conclusions

Salmonella enteritidis B is the most common pathogen causing septic arthritis in younger SLE patients. Septic arthritis tended to be oligo-articular and involve the hip joint. AVN of the femoral head was the most common predisposing articular disease. Once septic arthritis is suspected, culture specimens should be collected and appropriate antibiotics given immediately.

Section snippets

Patients and Methods

The clinical charts of SLE patients with septic arthritis who were admitted to our hospital between January 1984 and June 2003 were retrospectively reviewed. All of the cases fulfilled the criteria of the 1982 American Rheumatism Association revised classification criteria for SLE (10, 11). Patients were considered to have septic arthritis only when they presented with joint swelling and pain, and a bacterial organism was isolated from the synovial fluid or a synovial tissue specimen. In this

Characteristics of Patients with Septic Arthritis

Over the 20-year study period, there was a total of 10,732 inpatient records for 3,128 SLE patients, of which 29 were cases of septic arthritis. The characteristics of the 29 patients are summarized in Table 1. Of the 29 patients with septic arthritis, 21 had chronic renal disease and 16 had hypertension; 17 patients (59%) had salmonella infection and 12 (41%) had nonsalmonella infections.

Risk Factor Analysis

The age of the 29 SLE patients with septic arthritis ranged from 14 to 68 years (mean, 35.1 ± 14.1 years)

Discussion

Infection is a major problem during the treatment of patients with SLE. Although bacterial arthritis is not a common infection in these patients, it may cause rapid joint destruction and result in permanent loss of joint function. Thus, physicians should suspect bacterial arthritis when SLE patients present with acute joint pain and swelling.

In non-SLE patients, the risk factors for septic arthritis are trauma, recent joint surgery or arthroscopy, presence of arthritis, and a prosthetic joint.

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