Does the presence of crystal arthritis rule out septic arthritis?

Shah, Kaushal; Spear, Jeffrey; Nathanson, Larry; McCauley, Jon; Edlow, Jonathan A.

doi:10.1016/j.jemermed.2006.07.019

Cited by 112 publications

(59 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although both crystal and septic arthritis can affect any joint their coexistence is rare, with only 1.5% of all samples with crystal disease having concomitant bacterial growth [9]. Several theories have been proposed but the mechanism for the simultaneous occurrence of septic and acute crystal arthritis is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Role of Newman’s classification in predicting outcomes in patients with crystal arthritis

Hujazi

Ambler

Arora

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The aim of the study was to evaluate the utility of Newman's classification in predicting outcomes in patients presenting with crystal arthritis. Methods Between January and December 2009, all patients who presented to our institution with acute crystal arthritis and were investigated with microbiological assessment of their synovial fluid were included in the study. Patients were divided into two groups depending on the fulfilment of Newman's criteria for culture-negative septic arthritis. Group 1 included patients that fulfilled Newman's B criteria. Group 2 included patients that fulfilled Newman's C criteria. A database looking at the demographics, mode of presentation, investigations, treatment and outcomes was then established and the results compared between the two groups. Results A total of 58 patients were identified (group 1: n0 13; group 2: n045). The average age was 71 years (range 33-96). The joint most commonly involved was the knee followed by the wrist. Clinical findings at presentation were comparable in both groups; however, WBC and C-reactive protein (CRP) were more likely to be raised in group 1. Although most patients in group 1 were treated with antibiotics (62%) there was still a higher rate of morbidity, greater use of supportive therapy and a longer hospital stay (22.3 days, SD 17.4) in comparison with group 2, where most patients were treated by observation only (76%, mean hospital stay 3.5 days, SD±4.4). The difference in length of hospital stay was statistically significant (p<0.0001).Conclusions Newman's criteria are a good indicator for prognosis in patients with crystal arthritis. However, the presence of crystals in an acutely inflamed joint does not exclude the need for supportive therapy and long hospital stay even in the absence of positive synovial fluid culture.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of Newman’s classification in predicting outcomes in patients with crystal arthritis

Hujazi

Ambler

Arora

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Continuous recruitment of neutrophils to the site of inflammation results in very high neutrophil densities [57]. After the neutrophil concentration in the tissue exceeds a certain threshold, NETs begin to aggregate and build aggNETs in which the crystals are embedded in a mesh of DNA and proteins from neutrophil granules (Fig.…”

Section: Local Situation In Goutmentioning

confidence: 99%

How neutrophil extracellular traps orchestrate the local immune response in gout

et al. 2015

View full text Add to dashboard Cite

Neutrophil granulocytes possess a large arsenal of pro-inflammatory substances and mechanisms that empower them to drive local acute immune reactions to invading microorganisms or endogenous inflammatory triggers. The use of this armory needs to be tightly controlled to avoid chronic inflammation and collateral tissue damage. In gout, inflammation arises from precipitation of uric acid in the form of needle-shaped monosodium urate crystals. Inflammasome activation by these crystals in local immune cells results in a rapid and dramatic recruitment of neutrophils. This neutrophil influx is accompanied by the infamously intense clinical symptoms of inflammation during an acute gout attack. Neutrophilic inflammation however is equipped with a built-in safeguard; activated neutrophils form neutrophil extracellular traps (NETs). At the very high neutrophil densities that occur at the site of inflammation, NETs build aggregates that densely pack the monosodium urate (MSU) crystals and trap and degrade pro-inflammatory mediators by inherent proteases. Local removal of cytokines and chemokines by aggregated NETs explains how acute inflammation can stop in the consistent presence of the inflammatory trigger. Aggregated NETs resemble early stages of the typical large MSU deposits that constitute the pathognomonic structures of gout, tophi. Although tophi contribute to muscosceletal damage and mortality in patients with chronic gout, they can therefore be considered as a payoff that is necessary to silence the intense inflammatory response during acute gout.

show abstract

“…2) and had the highest discriminative value, with an AUC of 0.800 [95% confidence interval (CI) 0.665-0.934), followed by CRP (AUC 0.710; 95% CI Crystal-induced arthritis including acute gouty attack and pseudogout can initially be misdiagnosed as septic arthritis because symptoms such as warmth, redness, and tenderness, are similar. In addition, it was already reported that acute crystal-induced arthritis and septic arthritis can occur simultaneously [6,7]. So we next investigated CD64 expression levels in 22 patients affected with acute crystal arthritis.…”

Section: Resultsmentioning

confidence: 99%

Neutrophil CD64 expression as a diagnostic marker for local infection and crystal-induced arthritis

Doi

Miyazaki

Nishino³

et al. 2010

Mod Rheumatol

View full text Add to dashboard Cite

The usefulness of neutrophil CD64 expression was examined in diagnosing local infection, including soft tissue, bone, and joint infections. Among 99 patients suspected of local infection, 31 were confirmed and 68 patients were not. The CD64 level of patients with local infection was significantly higher than in those without infection [4,193 ± 1,132 vs. 1,017 ± 59 molecules/cell (mean ± standard deviation); p < 0.001]. The area under the curve of CD64 calculated by receiver operating characteristic curve analysis was larger than that of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), or white blood cell (WBC) count. In addition, CD64 levels of patients with crystal-induced arthritis remained within cutoff value (2,000 molecules/cell). These data suggest that measuring CD64 expression can be a useful diagnostic marker for local musculoskeletal infection and crystal-induced arthritis.

show abstract

Does the presence of crystal arthritis rule out septic arthritis?

Cited by 112 publications

References 17 publications

Role of Newman’s classification in predicting outcomes in patients with crystal arthritis

Role of Newman’s classification in predicting outcomes in patients with crystal arthritis

How neutrophil extracellular traps orchestrate the local immune response in gout

Neutrophil CD64 expression as a diagnostic marker for local infection and crystal-induced arthritis

Contact Info

Product

Resources

About