Infektološki glasnik, Vol. 43 No. 2, 2023.
Pregledni rad
https://doi.org/10.37797/ig.43.2.3
Sternoclavicular joint arthritis - a diagnostic dilemma: inflammatory or septic etiology?
Petra Margetić
orcid.org/0000-0002-8371-1232
; Klinika za traumatologiju Kliničkog bolničkog centra „Sestre milosrdnice“, Zagreb, Hrvatska; Medicinski fakultet, Hrvatsko katoličko sveučilište, Zagreb, Hrvatska
*
Ivana Župetić
; Klinika za traumatologiju Kliničkog bolničkog centra „Sestre milosrdnice“, Zagreb, Hrvatska
* Dopisni autor.
Sažetak
Background: The sternoclavicular joint (SCJ) is rarely affected by arthritis, but in these cases it is important to distinguish between non-infectious (inflammatory) and septic arthritis.
Objective: This review article aims to emphasize the value of timely and accurate diagnosis in non-traumatic SCJ diseases. It is important to distinguish the etiology of painful SCJ conditions when the infection requires urgent antibiotic and sometimes surgical intervention, from inflammatory arthritis that requires immunosuppressive or anti-inflammatory therapy, all with the aim of preventing the spread of infection or the development of chronic pain and disability.
Methods: The definitive diagnosis of inflammatory or infectious (septic) arthritis of the SCJ is established through the integration of clinical findings and data obtained from laboratory, microbiological, and imaging studies, among which magnetic resonance imaging (MRI) plays a significant role. MRI examination is performed both before and after intravenous administration of a paramagnetic contrast agent, using a standardized imaging protocol that includes predefined imaging planes and sequences, such as T1- and T2-weighted imaging and fluid-sensitive sequences.
Results: Due to its characteristics, tissue specificity, and excellent contrast resolution, MRI is the method of choice for SCJ imaging. The characteristics of MRI changes in SCJ with joint effusion and synovial proliferation and changes in the bone-articular part and surrounding soft tissue structures as well as the pattern of post-contrast imbibition significantly contribute to the differentiation of SCJ pathology and in establishing the final diagnosis. When interpreted in conjunction with clinical presentation and disease course, MRI findings may facilitate differentiation between inflammatory and infectious processes affecting the SCJ.
Conclusion: MRI significantly contributes to early detection and evaluation of SCJ arthritis. However, its ability to differentiate septic form inflammatory arthritis may be limited due to overlapping imaging characteristics. In the presence of MR findings suggestive of abscess formation and bone destruction, particularly when accompanied by clinical suspicion of infection, prompt microbiological confirmation is warranted, followed by the initiation of appropriate antimicrobial therapy and, when indicated, surgical intervention. Conversely, the absence of these findings in conjunction with positive serological findings is more suggestive of a non-infectious inflammatory process and should prompt further rheumatological evaluation.
Ključne riječi
sternoclavicular joint; septic arthritis; inflammatory arthritis; magnetic resonance imaging
Hrčak ID:
350074
URI
Datum izdavanja:
10.7.2026.
Posjeta: 0 *