Rheumatoid arthritis is the major risk factor for septic arthritis in rheumatological settings

Autoimmun Rev. 2008 Oct;8(1):59-61. doi: 10.1016/j.autrev.2008.07.018. Epub 2008 Aug 13.


Septic arthritis (SA) is a clinical emergency with considerable morbidity and mortality that can lead to rapid joint destruction and irreversible functional loss. The reported incidence varies from 2-5 cases/100,000 person-years in the general population to 70 cases/100,000 person-years among patients with rheumatoid arthritis. In fact, individuals with rheumatoid arthritis are at particular risk for developing SA. This may be due to several reasons: joint disease predisposes to bacterial joint colonization and RA itself and its treatment with corticosteroids, disease-modifying antirheumatic drugs (DMARDs) and biological therapies may decrease the immune function required for protection from pathogens. Steroids and DMARDs seem to affect the leukocyte synovial count; indeed, RA patients with SA have a leukocyte count in synovial fluid (SF) lower than patients with SA without underlying rheumatic diseases. The diagnosis of SA in RA patients can be difficult because the development of a hot painful joint is often confused with a relapse of the underlying joint disease leading to delay in diagnosis. For this reason the microscopic analysis and culture of synovial fluid are crucial to exclude septic arthritis.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Infectious / drug therapy
  • Arthritis, Infectious / epidemiology*
  • Arthritis, Rheumatoid / immunology
  • Causality
  • Female
  • Humans
  • Immunity, Active / drug effects*
  • Immunosuppression Therapy
  • Leukocyte Count
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Synovial Fluid / cytology*
  • Synovial Fluid / drug effects


  • Antirheumatic Agents