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October 27, 1978

Sympathetic Joint Effusion in Septic Arthritis

Author Affiliations

From the Department of Medicine, Harvard Medical School (Drs Baker and Robinson), and the Arthritis Unit of the Medical Services, Massachusetts General Hospital (Drs Baker and Robinson), Boston.

JAMA. 1978;240(18):1989. doi:10.1001/jama.1978.03290180063030

SYMPATHETIC joint effusions have not received much attention in the rheumatologic literature; in fact, we have been unable to find a general discussion of this phenomenon. A sympathetic effusion may be defined as a transudative, noninflammatory synovial fluid in a joint adjacent to a site of inflammation. The clinical picture is that of an acute arthritis or periarthritis; with synoviocentesis, a noninflammatory fluid is found. A variety of diseases are associated with this combination, including sarcoidosis, erythema nodosum, calcific periarthritis, apatite arthritis, gout, systemic lupus erythematosus, hypertrophic pulmonary osteoarthropathy, and an acute arthritis associated with chronic hemodialysis. In these entities, the supposition is that the primary inflammatory process occurs adjacent to the joint, in the periarticular structures, and the synovial fluid represents a secondary or sympathetic response. A similar phenomenon can occur between two adjacent joints. In particular, a focus of sepsis in one joint can cause a sympathetic effusion