Use of corticosteroid therapy in persistent synovitis following septic arthritis in adults: Report of 12 cases.

CONTEXT: Septic arthritis management relies on appropriate antibiotic therapy and joint drainage. Despite quick microbial eradication, recovery is often incomplete, with significant sequelae such as loss of joint mobility affecting over 30% of patients, sometimes requiring surgery. Persistent synovitis after treatment poses clinical challenges, and the use of corticosteroids as a way to reduce this residual inflammation has been poorly studied.

METHOD: This retrospective, uncontrolled series evaluated the clinical efficacy of corticosteroid therapy in 12 adult patients with persistent synovitis following native septic arthritis.

RESULTS

Twelve patients were included, most with knee arthritis (10/12, 83.3%). Median antibiotics course before corticosteroids was 14 days (7-30) and all had controlled infections. Route of administration was mostly intra-articular (10/12, 83.3%). Complete (8/12, 66.7%) or partial (3/12, 25.0%) clinical improvement was obtained with a median response time of 2 days. At the end of follow-up, 75% of cases (9/12) met primary endpoint. There were no early infectious complications. Three cases were classified as treatment failures: one patient had no clinical improvement, and two eventually required knee arthroplasty.

CONCLUSION

Addressing an issue for which there is no data for adult patients, our results suggest that corticosteroids could be an effective option to treat « persistent synovitis » after septic arthritis restoring joint function and preventing long-term disability. This small, retrospective and descriptive study has limitations and larger, randomized studies are needed to confirm these results.