[Bacterial septic arthritis as rheumatological emergency]

Septic arthritis has always been a challenge to rheumatologists and surgeons. Treatment according to the current classification needs to be stage-adapted and has to be initiated rapidly as the time factor constitutes the key prognostic criterion. Failure to treat and late treatment initiation result in irreversible joint damage, functional impairment and increasing mortality. Particularly in cases of acute joint infection, clinical findings, laboratory markers of inflammation and synovial analysis lead to a rapid diagnosis of empyema in most cases. However, chronic septic arthritis may be associated with considerable diagnostic problems. In these cases further diagnostic methods, e.g. magnetic resonance imaging (MRI), computed tomography (CT) and skeletal scintigraphy may be needed. Consideration of prior treatment, extent of the infection and of the degree of joint damage is of high clinical relevance. After an optional initial antibiotic pretreatment, definitive surgical treatment is always necessary either arthroscopically or using open techniques, depending on the stage of infection. Both surgical techniques have comparable treatment success rates. Surgical radicality in removing the infected tissue is of high importance. Local and systemic antibiotic treatment is of adjuvant and supportive value. An intensive physical therapy should be initiated early to avoid functional deficits.