Queen Elizabeth Hospital, South London Healthcare Trust, London, UK.
Lancet. 2010 Mar 6;375(9717):846-55. doi: 10.1016/S0140-6736(09)61595-6.
Symptoms and signs of septic arthritis are an important medical emergency, with high morbidity and mortality. We review the changing epidemiology of septic arthritis of native joints in adults, encompassing the increasing frequency of the disorder and its evolving antibiotic resistance. We discuss various risk factors for development of septic arthritis and examine host factors (tumour necrosis factor alpha, interleukins 1 and 10) and bacterial proteins, toxins, and enzymes reported to be important determinants of pathogenesis in mouse models. Diagnosis of disease is largely clinical, guided by investigations and the opinion of skilled clinicians. We emphasise the need for timely medical and surgical intervention-most importantly, through diagnostic aspiration of relevant joints, choice of suitable antibiotic, and appropriate supportive measures. Management is growing in complexity with the advent of novel and antibiotic-resistant causative microorganisms and within the current climate of increased immunosuppression. Findings from animal models and patients are shedding light on disease pathogenesis and the possibility of novel adjunctive treatments, including systemic corticosteroids, cytokines and anticytokines, and bisphosphonates.
感染性关节炎的症状和体征是一种重要的医学急症，具有较高的发病率和死亡率。我们回顾了成人原发性关节感染性关节炎的不断变化的流行病学情况，包括该病发病率的增加和抗生素耐药性的演变。我们讨论了各种导致感染性关节炎发生的危险因素，并研究了宿主因素（肿瘤坏死因子-α、白细胞介素 1 和 10）以及细菌蛋白、毒素和酶，这些因素被认为是小鼠模型中发病机制的重要决定因素。疾病的诊断主要是临床诊断，依据检查结果和熟练临床医生的意见。我们强调需要及时进行医疗和手术干预——最重要的是，通过对相关关节进行诊断性抽吸、选择合适的抗生素以及采取适当的支持措施。随着新型和抗生素耐药性致病微生物的出现以及当前免疫抑制程度增加的背景下，管理变得越来越复杂。动物模型和患者的研究结果揭示了疾病发病机制的可能性，并为包括全身皮质类固醇、细胞因子和抗细胞因子以及双膦酸盐在内的新型辅助治疗提供了可能性。
