Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates

  • You can purchase this item in Pay Per ViewPay per View - FAQ : 30,00 € Taxes included to order
    Pages Iconography Videos Other
    4 0 0 0

Joint Bone Spine
Volume 79, n° 2
pages 156-159 (mars 2012)
Doi : 10.1016/j.jbspin.2011.04.019
accepted : 27 April 2011
Septic arthritis with negative bacteriological findings in adult native joints: A retrospective study of 74 cases

Julie Eberst-Ledoux, Anne Tournadre, Sylvain Mathieu, Natacha Mrozek, Martin Soubrier, Jean-Jacques Dubost
Rheumatology department, G.-Montpied Teaching Hospital, Faculty of Medicine, Clermont-Ferrand 1 University, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France 

Corresponding author.

No microorganism is identified in 7–35% of cases of septic arthritis. The diagnosis is, therefore, only presumptive. We reviewed our cases of septic arthritis in adult native joints to determine the frequency of negative cultures, disease characteristics and the frequency of misdiagnosis of septic arthritis.


This retrospective study included all patients admitted to our department from 1979–2005 with arthritis, diagnosed and treated as septic.


No microorganism was isolated from synovial fluid or blood samples from 74 out of 398 (19%) patients with presumed septic arthritis. Patients without microorganisms were younger (54 vs 62 years), less likely to have risk factors for septic arthritis (31% vs 41%) and had lower mortality (0 vs 5%) than patients with positive cultures. Long-term outcome was known for 48 patients. A retrospective analysis of all data and long-term outcome concluded that septic arthritis was probable in 18 patients and improbable in 13. Ten of the latter developed rheumatic disease after a mean time of 6 months: rheumatoid arthritis (n =3), spondyloarthropathies (n =3), unclassified rheumatic disease (n =2), Wegener granulomatosis (n =1) and cytosteatonecrosis (n =1). Fever and signs of inflammation were more frequent and synovial fluid cell counts were higher in patients with improbable septic arthritis. Conversely, radiological signs were more common in patients with probable septic arthritis.


At least 14% of patients diagnosed with septic arthritis with negative bacteriological results subsequently develop rheumatic disease. This pseudoseptic arthritis is indistinguishable from true septic arthritis. When no microorganism is identified, the diagnosis remains presumptive and follow-up is necessary to screen for other diseases, especially rheumatic diseases.

The full text of this article is available in PDF format.

Keywords : Septic arthritis, Pseudoseptic arthritis, Infectious arthritis

© 2011  Société française de rhumatologie@@#104156@@