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Rheumatologists, orthopedic surgeons share similar views on septic arthritis management
Butt U. Clin Rheumatol. 2011. doi:10.1007/s10067-010-1672-3.
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Rheumatologists and orthopedic surgeons displayed poor awareness of British Society of Rheumatology guidelines for septic arthritis management, according to United Kingdom researchers.
Usman Butt and colleagues at Royal Oldham Hospital, Oldham, United Kingdom, e-mailed a link to a web-based survey tool to 200 orthopedic surgeons and 200 rheumatologists. The survey focused on septic arthritis management, such as the respondent’s view on antibiotic therapy, joint drainage, which specialty should manage these cases and the clinician’s evidence base.
The researchers received 151 complete responses from 77 orthopedic surgeons and 74 rheumatologists which were included in the analysis.
Overall, 80% of rheumatologists and 82% of orthopedic surgeons recommended 6-weeks of total antibiotic therapy, the authors wrote. In each group, 73% recommended 1 to 2 weeks of intravenous therapy followed by oral continuation therapy. For those patients at risk of developing methicillin-resistant Staphyloccocus aureus (MRSA), 25% of rheumatologists and 14% of orthopedic surgeons required MRSA cover.
With regard to surgical joint drainage, 77% of rheumatologists and 66% of orthopedic surgeons would recommend the procedure. Twenty-two percent of rheumatologists and 27% of orthopedic surgeons recommended repeat closed needle aspiration for joint drainage. According to these findings, 66% of rheumatologists and 65% of orthopedic surgeons felt that orthopedic surgeons should manage septic arthritis.
Twenty-three percent of rheumatologists and 22% of orthopedic surgeons relied on published guidance as their main evidence base. When asked if they were aware of any guidelines, 24% of rheumatologists and 34% of orthopedic surgeons quoted the British Society of Rheumatology (BSR) guidance.
“Surprisingly, rheumatologists are more aggressive regarding the recommendation for surgical joint drainage,” the authors wrote. Both groups displayed variations in management principles that differed from the BSR recommendations. “There are poor awareness levels of the BSR guidelines,” the authors noted.