scholarly journals Synovial fluid presepsin as a novel biomarker for the rapid differential diagnosis of native joint septic arthritis from crystal arthritis

2021 ◽  
Vol 102 ◽  
pp. 472-477
Author(s):  
Takashi Imagama ◽  
Kazushige Seki ◽  
Toshihiro Seki ◽  
Atsunori Tokushige ◽  
Yuta Matsuki ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Crystal Arthritis

scholarly journals AB0940 BIOMARKERS IN THE DIAGNOSIS OF ACUTE HOT JOINTS: AN EVALUATION OF RESEARCH INTEREST 1960-2018

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1769.2-1769
Author(s):  
M. Dey ◽  
M. Al-Attar ◽  
L. Peruffo ◽  
I. Wilson ◽  
S. S. Zhao ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
United Kingdom ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Joint Infection ◽  
Research Interest ◽  
Diagnostic Biomarkers ◽  
Prosthetic Joints ◽  
Prosthetic Joint ◽  
Crystal Arthritis

Background:The acute hot joint presentation is a common clinical emergency, often the result of crystal arthritis or trauma. However, all diagnoses can mimic septic arthritis, which should be excluded promptly due to the potential for rapid joint destruction and significant morbidity. The gold-standard test for septic arthritis is synovial fluid culture, which can take several days to perform. Meanwhile, patients are often admitted and given antimicrobials. Other specialties have made use of rapid biomarkers to exclude infection, for example, exclusion of empyema using pleural fluid pH and glucose [1]. Such biomarkers could reduce the need for lengthy hospital admissions and inappropriate antibiotic use in the acute hot joint presentation.Objectives:1.Evaluate research interest over time, on the use of diagnostic biomarkers in the acute hot joint presentation.2.Compare research interest in the use of diagnostic biomarkers in acute hot native versus acute hot prosthetic joints.Methods:We performed a review of the number of publications reporting the use and diagnostic accuracy of biomarkers to exclude infection in the acute hot joint presentations. The database,Scopus, was searched for English-language studies (1946-2018) using search terms relating to septic arthritis, crystal arthritis, and diagnostic markers derived from synovial fluid/aspirate. The number of papers published per year on prosthetic joints only was also calculated. Therefore, the following were recorded for each year 1946-2018: total number of studies; prosthetic joints only; native joints only. Values were plotted, with polynomial trend-lines and R2calculated.Results:Our search yielded 2279 relevant studies in total (561 on prosthetic joints), published 1946-2018. Only 1 study was identified for the year 1946; the next recorded publication was in 1960. Therefore, this single study was excluded as an outlier. Results are presented in Figure 1. The number of studies on diagnostic biomarkers for acute hot joints continued to increase after 1960. From 2016, the number of studies conducted in prosthetic joints outnumbered those done in native joints. Polynomial trend-lines applied to the results showed studies on native acute hot joints are predicted to decline, while those in prosthetic joints will continue to increase.Conclusion:Reasons for an increasing number of studies on prosthetic compared to native acute hot joints include a narrower differential diagnosis in prosthetic joints, i.e. septic vs aseptic. In contrast, native acute hot joints may be the result of various causes including crystal arthritis, inflammatory arthritis, and trauma. Having a narrower differential diagnosis may facilitate diagnostic research in prosthetic joint presentations. Furthermore, incidence of prosthetic joint infection is also greater than that of native joint infection [2]. Nonetheless, the incidence of native joint infection is increasing [3]. This, and the lack of methods by which to rapidly distinguish native joint septic arthritis from non-infective causes, indicates that more research is required in this area.References:[1]Heffner JE et al. Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis. Am J Respir Crit Care Med. 1995 Jun;151(6):1700–8.[2]Roerdink RL et al. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong).[3]Rutherford AI et al. A population study of the reported incidence of native joint septic arthritis in the United Kingdom between 1998 and 2013. Rheumatol (United Kingdom). 2016;55(12):2176–80.Disclosure of Interests:None declared

Concomitant Septic Arthritis in Crystal Monoarthritis

2011 ◽  
Vol 39 (1) ◽  
pp. 157-160 ◽  
Author(s):  
LITO ELECTRA PAPANICOLAS ◽  
PAUL HAKENDORF ◽  
DAVID LLEWELLYN GORDON
Keyword(s):  
Synovial Fluid ◽  
Blood Culture ◽  
Septic Arthritis ◽  
Gram Stain ◽  
C Reactive Protein ◽  
Predictive Values ◽  
Reactive Protein ◽  
Crystal Arthritis ◽  
Clinically Significant ◽  
Wbc Count

Objective.In acute monoarthritis, the presence of crystals in synovial fluid may lead to a diagnosis of crystal arthritis (CA) before septic arthritis (SA) can be excluded by culture. We aimed to identify the frequency of coexistence of CA with SA and to compare these with regard to synovial fluid microscopy, C-reactive protein (CRP), and blood culture.Methods.We examined 1612 synovial aspirates from 2004 to 2009 retrospectively. Of these, 104 patients with clinically significant SA were identified. These were compared to 295 patients with isolated CA.Results.Five percent of joints with CA had concomitant infection. A high synovial white blood cell (WBC) count and elevated CRP (> 100 mg/l) were predictive of concomitant SA with a sensitivity of 86.4%, specificity of 48.3% and 54.6%, and negative predictive values of 98.5% and 98.7%, respectively. In patients with SA who had a blood culture, 42.5% were positive with a matching organism. SA of the shoulder had a 90% rate of bacteremia.Conclusion.Crystals alone in synovial fluid from acute monoarthritis cannot exclude SA, as CA and SA frequently coexist. High WBC counts and elevated CRP are common to both SA and CA. Blood cultures should be collected and septic arthritis considered, even when crystals are present, particularly if the shoulder is affected. The exception is when Gram stain is negative and the CRP is < 100 mg/l and joint WBC count is < 10,000/μl. In these circumstances it is very unlikely that there will be concomitant SA.

scholarly journals P100 Acute crystal arthritis: a leading cause of hospital admission, yet poorly recognised and mistreated

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
A Abdalla
Keyword(s):  
Synovial Fluid ◽  
Hospital Admission ◽  
Septic Arthritis ◽  
Acute Hospital ◽  
University Hospital ◽  
Acute Arthritis ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis ◽  
Crystal Arthritis ◽  
Acute Hospital Admission

Abstract Background/Aims  Crystal arthritis is the commonest inflammatory arthritis in adults. A common mimic is septic arthritis. Without appropriate synovial fluid analysis, a mis-diagnosis of sepsis can be made with resultant unnecessary hospitalization, inappropriate intravenous antibiotic therapy and excess cost. Such cases are frequently described as ‘culture-negative’ septic arthritis. We aimed to examine and analyse the cases of acute arthritis requiring acute hospital admission in a tertiary referral centre in Dublin. Methods  A retrospective review of database between Jan - Dec 2019 at the Mater Misericordiae University Hospital, Dublin, was carried out. All cases of acute arthritis requiring acute hospital admission were identified. Cases treated at the Emergency Department, Acute Medical Unit or Outpatients which did not require hospital admission were excluded. Results  30 patients were identified during this period, 16 (53%) had an ultimate diagnosis of crystal arthritis, 8 (27%) had confirmed septic arthritis and 6 (20%) had other arthritides (e.g. haemoarthrosis). The median age for crystal arthritis was significantly higher (85.5 y) compared to septic arthritis (47 y). Apart from age, the clinical profile and biomarkers for crystal and septic arthritis were comparable. The majority of crystal arthritis cases were due to pseudogout (69 %), ultimately diagnosed by rheumatology. Septic arthritis led to more days in hospital than crystal arthritis (median 14 vs 5.5 days). All 30 patients received IV antimicrobial therapy for presumed septic arthritis. Conclusion  This retrospective study showed crystal arthritis, especially pseudogout, was the commonest cause of hospital admission (53%) with acute arthritis particularly among elderly patients. Accurate diagnosis by synovial fluid analysis with appropriate equipment is extremely useful in the assessment of these cases. More awareness and training among orthopedic, emergency and acute clinicians is needed in order to avoid unnecessary admissions and interventions. Disclosure  A. Abdalla: None.

scholarly journals Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis

2015 ◽  
Vol 30 (6) ◽  
pp. 700 ◽  
Author(s):  
Kwang-Hoon Lee ◽  
Sang-Tae Choi ◽  
Soo-Kyung Lee ◽  
Joo-Hyun Lee ◽  
Bo-Young Yoon
Keyword(s):  
Differential Diagnosis ◽  
Septic Arthritis ◽  
Gouty Arthritis ◽  
Acute Gouty Arthritis

Early diagnosis of septic arthritis using synovial fluid presepsin: A preliminary study

2019 ◽  
Vol 25 (3) ◽  
pp. 170-174 ◽  
Author(s):  
Takashi Imagama ◽  
Atsunori Tokushige ◽  
Kazushige Seki ◽  
Toshihiro Seki ◽  
Daisuke Nakashima ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Early Diagnosis ◽  
Septic Arthritis ◽  
Preliminary Study

Monoarticular disease

2013 ◽  
pp. 63-68
Author(s):  
Mark Lillicrap ◽  
Shazia Abdullah
Keyword(s):  
Differential Diagnosis ◽  
Light Microscopy ◽  
Septic Arthritis ◽  
Polarized Light ◽  
Diagnostic Reasoning ◽  
Polarized Light Microscopy ◽  
Primary Concern ◽  
Gram Stain ◽  
Acute Setting ◽  
Careful History

Non-traumatic monoarthritis is a common presenting problem in both primary and secondary care. The differential diagnosis is broad, encompassing both inflammatory and non-inflammatory causes. A careful history and examination will allow the underlying cause to be elicited in many cases. However, particularly in the acute setting, the history and examination findings do not allow exclusion of the diagnosis of primary concern-septic arthritis. Arthrocentesis with Gram stain and culture of the aspirated fluid, alongside polarized light microscopy, is the key initial investigation in any patient with an acute monoarthritis. Additional laboratory and radiological investigations can supplement the diagnostic reasoning process, in cases where the diagnosis remains unclear.

scholarly journals MP031: Synovial fluid analysis in the diagnosis of septic arthritis: comparing local data to the literature

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S76-S77
Author(s):  
E. Logan ◽  
J. Fedwick
Keyword(s):  
Synovial Fluid ◽  
Septic Arthritis ◽  
Emergency Departments ◽  
Positive Culture ◽  
Diagnostic Algorithm ◽  
Clinical Findings ◽  
Gram Stain ◽  
Local Data ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis

Introduction: A hot, painful, swollen joint is a common presentation to the emergency department. Of the potential etiologies, septic arthritis (SA) is the most devastating. Prompt diagnosis and treatment are essential to improve outcomes. Both culture proven and clinically suspected SA are thought to have the same prognosis, with similar morbidity and mortality estimates. No clinical exam or serum lab finding has the sensitivity or specificity to diagnose or exclude SA. Instead, diagnosis relies mainly on joint aspiration and synovial fluid analysis. A synovial white blood cell count (sWBC) greater than 50,000 cells/microliter is suggestive of SA and organisms seen on gram stain or growing in culture effectively makes the diagnosis. However, culture and gram stain are positive in only 67% and 50% of cases respectively. The objective of this study was to analyze the accuracy of synovial fluid analysis in our local practice environment. Methods: All those encounters with diagnoses related to SA at four adult emergency departments in Calgary between 2013-2014 were reviewed. Hospital records were analyzed for synovial analysis, antibiotic usage and surgical procedures. Results: Of 286 encounters, 87 were determined to satisfy the definition for SA in that culture was positive, gram stain was positive or clinical findings lead to treatment with antibiotics and/or surgical intervention. Gram stain was positive in 22% of cases with cultures positive in 51% of patients. sWBC were less than 50000 in 55% of cases and less than 25000 in 24% of cases. Of 88 gram stains performed, 28% were negative but had positive culture. All positive gram stains were associated with positive cultures. Conclusion: Culture, gram stain and sWBC of patients diagnosed with SA in Calgary show differences compared with the published literature. In Calgary, the majority of SA diagnoses were made clinically. The sWBC is central to making the diagnosis. Interestingly, 55% of patients diagnosed with SA had a count less than 50,000. It remains unclear what features of history, physical exam, imaging and lab analysis lead to the diagnosis of SA in these cases. Future studies will focus on these outliers to see if a more appropriate diagnostic algorithm would be useful in Calgary. Collaboration between infectious disease specialists, orthopedics, and emergency departments guided by local data is needed to ensure accurate and timely diagnosis.

Sign in / Sign up

Export Citation Format

Share Document