What is the incidence of septic arthritis in patients with infective endocarditis? A systematic review

Abstract

• Incidence of osteoarticular infection in infective endocarditis was unknown. • Evaluation of the limited, available evidence to date would suggest septic arthritis occurs in 3.5–3.9% of cases. • Early identification of septic arthritis is shown to be of vital importance. • Predictive factors are herein identified to assist clinicians in diagnosis and management. The clinical scenario of a hospital inpatient receiving treatment for infective endocarditis who suddenly develops a painful joint will probably be familiar to most. Arthralgia and myalgia are common manifestations of acute, severe infection, and of systemic disease in general. Nevertheless a proportion of patients with infective endocarditis will develop secondary osteoarticular infections. These may be a focus for life-threatening sepsis and in the case of septic arthritis can result in irreversible and massively disabling destruction of major synovial joints. The aim of this systematic review is to establish the incidence of this clinical phenomenon based on the available literature, and to aid physicians in its identification and management by means of a proposed guidance summary. A targeted literature review was produced using appropriate medical subject heading terms to search the PUBMED database for pertinent studies. Dual author consensus was reached following independent assessment of the papers using a critical appraisal tool. 6 papers in total were found to have met the inclusion criteria and were included for review, ranging in study dates from 1992 to 2020. The reported incidence rates varied from 2.5% to 10.6%. However detailed analysis of methodologies and study populations facilitated more precise figures to be reached when focusing on those studies whose participants were felt to more closely reflect a modern European/North American case-mix. Although the quality of the available data does not allow for firm conclusions to be drawn in terms of an exact incidence, evaluation of the largest and most recent case-series available on this subject would indicate that the rate of patients with IE developing synchronous SA is in the region of 3.5–3.9%. This review also highlights the poor outcomes associated with such phenomena, and a proposed clinical guidance summary is also included in order to aid clinicians in its early identification and appropriate management.