What are we doing about septic arthritis? A survey of UK-based rheumatologists and orthopedic surgeons

Abstract

This study aims to determine the current practices and beliefs of United Kingdom (UK)-based rheumatologists and orthopedic surgeons (OS) in managing septic arthritis (SA) and to determine awareness levels of national guidance. Two-hundred OS and 200 rheumatologists were sent a link to a web-based survey tool via email. Questions posed related to the management of SA, including the respondent's views on antibiotic therapy, joint drainage, which specialty should manage these cases, and also the clinician's evidence base. There were 354 functioning addresses with 182 responses (51%). One hundred fifty-one (77 OS, 74 rheumatologists) (43%) responses were complete and included for analysis. Eighty percent of rheumatologists and 82% of OS recommended 6-weeks total antibiotic therapy. Seventy-three percent in each group recommended 1-2 weeks intravenous therapy initially followed by oral continuation therapy. In patients at risk of methicillin-resistant Staphylococcus aureus (MRSA), 25% rheumatologists and 14% OS would ensure MRSA cover. Seventy-seven percent of rheumatologists and 66% of OS recommended surgical joint drainage; 22% and 27%, respectively, recommended repeated closed needle aspiration as their chosen method of joint drainage. Sixty-six percent of rheumatologists and 65% of OS believed OS should manage SA. Twenty-three percent of rheumatologists and 22% of OS quoted published guidance as their main evidence base in the treatment of SA. Only 24% of rheumatologists and 34% of OS quoted British Society of Rheumatology (BSR) guidance when asked if they were aware of any guidelines. Views of rheumatologists and OS are not that dissimilar in managing SA. Surprisingly, rheumatologists are more aggressive regarding the recommendation for surgical joint drainage. Within both groups, significant variation in management principles exists often discrepant to recommendations laid out by the BSR. There are poor awareness levels of the BSR guidelines.