Why do we not prescribe steroids in acute native septic arthritis?

Excerpt

Orthopaedic surgeons rightly fear infections in joints, since the destruction of the articular cartilage has devastating consequences for the quality-of-life for their patient. The incidence of septic arthritis in Western Europe is 4–10 per 100,000 patient-years per year, and appears to be rising due to an ageing population, orthopaedic-related infection, more invasive procedures, and increased use of immunosuppression [8]. It is in the culture of orthopaedics that steroids have adverse effects on joints and when used in the presence of a bacterial infection. The adverse effects of immunosuppression are seen in patients on long-term steroids, e.g. patients with rheumatoid arthritis, who have an increased risk of septic arthritis, as does injecting steroids for the degenerate knee [13]. However, knee injection is part of the multimodal management of the degenerate knee and the rate of complications is extremely low [10], as is the quality of the evidence. Indeed, Petersen et al. [11] from the Danish island of Funen, have shown the risk of septic arthritis following 22,370 glucocorticoid injections was 0.08%. The risk factors were male gender, age, and pre-existing conditions. A literature review of factors affecting articular cartilage in arthroscopic procedures [5] included corticosteroids. Six papers were found. Corticosteroids were noted to be protective of articular cartilage whether young and healthy, or degenerate, although this was based on work in dogs, or from donor cartilage. A randomised controlled trial of 58 patients (59 knees) between lidocaine & saline and lidocaine & methyl prednisolone given after portal closure in patients with post-meniscectomy degenerate knees showed better pain control and function at 6 weeks’ follow-up in the steroid group, but no difference at 12 months [6]. …