title: Septic arthritis in adults with sickle cell disease often is associated with osteomyelitis or osteonecrosis.
abstract: BACKGROUND
  Septic arthritis is a known complication of sickle cell disease (SCD) in children, and the association with osteomyelitis and osteonecrosis has been described. However, it is unclear whether this association applies to adults.
  
  
  OBJECTIVE
  We therefore asked whether septic arthritis is a frequent complication in adults with SCD and whether it also is associated with osteomyelitis or osteonecrosis.
  
  
  METHODS
  We retrospectively reviewed the charts of 2000 consecutive adult patients diagnosed with SCD and recorded symptoms, select findings during physical examination, laboratory data, and select radiographic CT, and MRI observations.
  
  
  RESULTS
  Fifty-nine of the 2000 patients (3%) had septic arthritis, 56 of the 59 patients had hemoglobin SS. Thirty-six of the 59 infections (61%) were in the hip. The most frequent findings were pain, swelling, fever greater than 38.2 degrees C (71% of cases), a leukocyte count exceeding 15,000/mm(3) (range, 7900-32,300/mm(3)), a Westergren sedimentation rate greater than 24 mm/hour, and C-reactive protein exceeding 20 mg/L. Cultures were positive in 96% of the joint aspirates. Staphylococcus and Gram-negative infection predominated; no patients had Salmonella joint infections. Preexisting factors of bacterial arthritis included osteonecrosis (29 patients) and osteomyelitis (37 cases) in childhood. Diabetes, rheumatoid arthritis, glucocorticoids, and immunoparesis related to medical treatment by hydroxyurea were associated comorbidities. CT and MRI confirmed the diagnosis of associated osteonecrosis or osteomyelitis and allowed joint aspiration and detection of soft tissue abscess.
  
  
  CONCLUSIONS
  The incidence of septic arthritis in adults with SCD is low, but often is associated with osteomyelitis or osteonecrosis.
  
  
  METHODS
  Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. philippe.hernigou@wanadoo.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Hernigou
authors.forename: Gildasio
authors.initials: G
authors.lastname: Daltro
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Flouzat-Lachaniette
authors.forename: Xavier
authors.initials: X
authors.lastname: Roussignol
authors.forename: Alexandre
authors.initials: A
authors.lastname: Poignard
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000382:microbiology*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D010020:Osteonecrosis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult