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Speeding Up Healing Time for Children with Septic Arthritis
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Posted on: 03/17/2011
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Most parents and childcare givers know the symptoms of strep throat or a staph infection: fever and sore throat for strep and inflamed, red skin for a local staph infection. But staph infection of any joint is also possible and presents as painful joint swelling, loss of motion, warmth, and local tenderness to the touch.
The treatment is the same since the underlying problem is a bacterial infection: antibiotics. But in the case of joint infection (called septic arthritis), damage can be done to the joint surface if the infectious and inflammatory processes are not stopped quickly.
That's where this study comes in. The authors (pediatric orthopedic surgeons and pediatric rheumatologists) tried using antibiotics along with another type of drug called dexamethasone. Dexamethasone is a powerful steroid medication often used to treat rheumatoid arthritis or other inflammatory conditions.
In this study, 49 children were enrolled. They all had septic (infectious) arthritis from either staphylococcus aureus or another bacteria called Kingella kingae. Half the children were treated with the standard antibiotic protocol. The other half received both the antibiotic and a four-day course of intravenous dexamethasone.
The children ranged in age from six months up to 13 years old. Patients in each group were matched closely so there was no difference in ages, joints affected, and length of time they had the septic arthritis. Hips and knees were affected most often. Less often, the children had elbow, ankles, or shoulders involved.
They used blood lab values and length of stay in the hospital as their measures to compare results between the two groups. In all cases, they found the children who received the dexamethasone got better faster.
They had fewer days of fever, less pain and swelling, and a shorter hospital stay. Blood values also showed lower levels of all inflammatory cells and that's important because it means less inflammation and less damage to the joint.
There were an equal number of children from both groups who ended up having surgery to drain the joint of fluid. Surgical drainage was usually done when improvement didn't occur within 48 hours of treatment. Surgical drainage was also advised when fluid was drained by needle aspiration but the joint filled right back up with fluid.
The authors concluded that the added use of dexamethasone along with antibiotics for the treatment of septic joint arthritis in children is safe and very effective. The drug appears to reduce the number of reactive immunological cells like T- and B-cells, cytokines, interleukins, and tumor necrosis factor. The end-result is less cartilage destruction.
There were no negative side effects from the treatment. Long-term follow-up (by phone) showed that everyone in both groups was doing well: no pain, no limping, and no limitations in joint motion or activity level. There were no deformities or differences in leg length from side-to-side.
It appears that dexamethasone (a corticosteroid drug) is chondroprotective (protects the joint surface). Early use is advised for rapid recovery and lowered medical costs for the family.
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References:
Liora Harel, MD, et al. Dexamethasone Therapy for Septic Arthritis in Children. In Journal of Pediatric Orthopaedics. March 2011. Vol. 31. No. 2. Pp. 211-215.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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