LAUSR

Background Intraarticular (IA) procedures have both diagnostic and therapeutic purposes in patients with arthritis. The therapeutic benefit of IA glucocorticoids (GC) injection in patients with rheumatologic diseases is well described. However, IA procedures are associated with increased risk of Septic arthritis (SA). Rapid diagnose and correct treatment is crucial to avoid joint damage, sepsis and potential fatal outcome. However, patients in risk of evolving SA secondarily to GC injection or arthrocentesis are not well defined. Objectives The aim of this study was to evaluate the risk of SA in patients who received an IA GC injection or an isolated joint puncture, and to describe possible characteristics for these patients. Methods All patients' undergoing IA procedures at the orthopaedic and rheumatological departments of Fuhnen from January 2006 to December 2013 were identified in the central database and included by register extraction. Patients who developed SA within 30 days after IA GC injection were registered as cases. SA was defined as clinically inflamed joint and positive synovial fluid culture. Retrospectively, data on age, gender, affected joint location, bacterial agent, pre-existing inflammatory disorder and death within 30 days were extracted from the patient files. According to local recommendations a non-touch sterile technic where used for IA procedures. Patients were informed about the risk for SA and motivated to seek medical attention if suspicion of infection or lack of improvement. Results 22370 IA procedures were registered; 14118 IA GC injections and 8252 arthrocentesis. Eleven patients with SA were registered. Eleven patients developed SA subsequently to IA GC injection (0.08% of all GC injections). For patients' demography, joint distribution, bacterial agent and pre-excisting joint disease (Table 1). One patient died within 30 days after IA GC injection. Sex Age Joint Bacterial agent Inflammatory Disease Death, 30 days M 83 Shoulder Grp. A streptococcus No + M 53 Elbow S. Aureus No – M 55 Ancle S. Aureus Gout – M 67 Knee Grp. A streptococcus No – F 83 Knee E. Faecalis No – M 58 Knee S. Aureus No – M 73 Knee S. Aureus Gout – F 50 Shoulder Grp. A streptococcus RA – F 66 Knee S. Aureus No – F 80 Knee S. Aureus RA – M 73 Elbow E. coli RA – Conclusions This study demonstrates that IA procedures can be performed with little risk of SA. The risk factors identified i.e. elderly patients with inflammatory joint diseases are consistent with those described in the literature [1]. We consider joint puncture technique and patient information for being essential when doing IA procedures. However, if SA occurs it is potentially fatal and therefore GC injection should be preserved for doctors with experience in joint diseases. References RA Andreasen et al. Prognostic factors associated with mortality in patients with septic arthritis: a descriptive study. Scand J Rheumatoly 2016, 1–6. Disclosure of Interest None declared