Highlights
- •Concomitant septic arthritis and gout poses significant challenge in the diagnostic stage and carries high risks of complications.
- •A notable proportion of patients needed supportive care in the high dependency unit and/or intensive care unit during treatment and having concurrent septic arthritis and gout independently predicted a significantly longer length of stay by 12.6 days on average.
- •The patients are also more likely to end up with limb amputation when compared to those without coexisting gout on univariate analysis.
Abstract
Background
We aim to review and describe the proportion of patients with co-existing gout amongst
patients with surgical treated septic arthritis, characterize their clinical presentation,
outcomes and complications compared to patients with native joint septic arthritis.
Methods
Sixty-one patients with surgically treated primary joint septic arthritis were identified
from the period of January 2011 to December 2016. There were 13 (21.3%) patients with
co-existing septic arthritis and crystal proven gout. Pertinent details such as demographics,
comorbidities, clinical features on presentation, infection markers, number of surgeries,
length of stay (LOS) in general and individual LOS in supportive care units, limb
amputations, readmissions and mortality were reviewed. Multiple linear and logistic
regression models were used to control for confounders during analysis.
Results
The average age of patients was 60.8 years (range: 23–87 years). The patients with
gout are associated with comorbidities such as being hypertensive, hyperlipidemia
and renal impaired. They tend to present with ankle joint involvement (46.2% vs 8.3%;
p = 0.004) while septic arthritis patients without gout tend to present with knee joint
involvement (75% vs 46.2%; p = 0.046). In terms of complications, up to two thirds of them require supportive
care in the High Dependency Unit and/or Intensive Care Unit during treatment (61.5%
vs 29.2%; p = 0.031) and having gout with septic arthritis independently predicted a significant
increase in LOS by an additional 12.6 days on average (95% CI: 2.11 – 23.03; p = 0.019). They are also more likely to end up with limb amputation (23.1% vs 0%;
p = 0.008) on univariate analysis.
Conclusion
Gout accompanying septic arthritis in the same joint is potentially associated with
major systemic and joint related sequela, complications in terms of prolonged hospital
stay, need for complex care and risk for limb amputation. Our findings further indicate
the value and need for well-designed prospective controlled cohort studies to explore
the relationship between gout and septic arthritis
Keywords
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Article info
Publication history
Published online: October 26, 2022
Accepted:
October 24,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
