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Septic Arthritis Masquerading as a Flare of Rheumatoid Arthritis: A Not So Straightforward Diagnosis
Internal Medicine
  • Ramin Ahmad, HCA Healthcare
  • Mejhorn Flash, HCA Healthcare
  • Zekarias Asnake, HCA Healthcare
  • Joshua K Salabei, HCA Healthcare
  • Mathew Calestino, HCA Healthcare
Division
North Florida
Hospital
North Florida Regional Medical Center
Document Type
Case Report
Publication Date
9-27-2021
Keywords
  • rheumatoid arthritis,
  • septic arthritis,
  • synovial fluid analysis,
  • fever,
  • immunosuppression,
  • polyarticular,
  • pain
Abstract

A typical presentation of septic arthritis (SA) includes pain, swelling, and erythema in the affected joint. Often, patients complain of inability to bear weight on the affected limb. However, some patients may present with subtle symptoms of pain and no fever or obvious swelling of the affected limb thus making the initial suspicion of SA low. Especially, patients with rheumatoid arthritis (RA) may present with polyarticular joint pain and initial synovial fluid analysis from an infected joint not consistent with overt septic arthritis. In such situations, the diagnosis of septic arthritis could be missed on delayed. In this case report, we present a 79-year-old female with a history of RA who presents with polyarticular pain, most notably in her right knee. SA was not initially suspected because of her history of RA and her current presentation with polyarticular pain. The initial synovial analysis did not suggest SA as well. However, cultures of synovial fluid from her right knee confirmed SA. Thus, we have highlighted that physicians should have a high suspicion for SA when addressing joint pain in RA patients.

Publisher or Conference
Cureus
Citation Information
Ahmad R, Flash M, Asnake ZT, Salabei JK, Calestino M. Septic Arthritis Masquerading as a Flare of Rheumatoid Arthritis: A Not So Straightforward Diagnosis. Cureus. 2021;13(9):e18336. doi:10.7759/cureus.18336