# Knowledge, Attitudes, and Practices of Moroccan Rheumatologists in the Management of Acute Septic Arthritis: Results of a National Cross-Sectional Survey

## TL;DR

This study surveyed Moroccan rheumatologists about their knowledge and practices in managing acute septic arthritis, finding gaps in awareness and treatment approaches.

## Contribution

The study provides insights into the current practices and knowledge gaps among Moroccan rheumatologists in managing acute septic arthritis.

## Key findings

- Most rheumatologists consider septic arthritis in acute monoarthritis cases, but few recognize the qSOFA score's significance.
- Third-generation cephalosporins are commonly used, but few prescribe short-course antibiotics or surgical interventions.
- Delayed diagnosis and complicated case management are major challenges, with a call for standardized protocols and better collaboration.

## Abstract

Objective

To assess the level of knowledge of Moroccan rheumatologists regarding the management of acute septic arthritis and analyze their attitudes and clinical practices toward this condition.

Methods

A descriptive cross-sectional study was conducted among Moroccan rheumatologists through a Google Forms questionnaire distributed via email. The data collected included sociodemographic characteristics of Moroccan rheumatologists, their level of knowledge, as well as their attitudes and clinical practices, assessed on a Likert scale (1 to 5).

Results

Out of the 440 questionnaires sent, 131 rheumatologists replied, corresponding to a response rate of 131 (33.58%). The average age of participants was 42.9±12.7 years, with a predominance of females (103 (84.8%)) and an average of 13.8 ± 11.3 years of experience in rheumatology. The diagnosis of septic arthritis was systematically considered in the case of acute monoarthritis, even in the absence of fever, by 122 (93.1%) rheumatologists. However, only 68 (51.9%) were aware of the association between a quick Sequential Organ Failure Assessment (qSOFA) score ≥2 and a high risk of mortality. Regarding therapeutic management, 115 (87.8%) rheumatologists preferred a third-generation cephalosporin, often combined with an aminoglycoside (110 (84%)). However, only 18 (13.7%) prescribed short-course antibiotics for small joints, and 13 (9.9%) associated this with joint lavage and/or surgical synovectomy. Furthermore, in cases of unfavorable evolution, only 19 (14.5%) routinely referred the patient to an orthopedic surgeon for surgical lavage. The main challenges identified were delayed diagnosis (90 (68.7%)) and the management of complicated cases (91 (69.5%)). To address these issues, a large majority of rheumatologists recommended the development of standardized protocols (118 (90.1%)), raising awareness among healthcare professionals about early diagnosis (116 (88.5%)), and strengthening collaboration with orthopedic surgeons (111 (84.7%)).

Conclusion

This study highlights gaps in the management of acute septic arthritis and emphasizes the need for better awareness, standardization of practices, and improved coordination with other specialties to optimize patient care.