Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis

Abstract

Whether the levels of procalcitonin (PCT) in the serum and synovial fluid are effective indicators for distinguishing septic arthritis (SA) from non-infectious arthritis remains controversial. The present study aimed to evaluate whether PCT levels in fresh serum or fresh joint fluid may be used in the differential diagnosis of SA from rheumatoid arthritis (RA), osteoarthritis (OA) and gouty arthritis (GA). From January 2012 to June 2013, 23 patients with knee SA, 21 patients with RA, 40 patients with OA and 11 patients with GA were enrolled in the current study. The levels of PCT were measured within 24 h after specimen collection at room temperature. An enzyme-linked fluorescence assay (ELFA) was used to detect the levels of PCT in the serum and synovial fluid. The correlations between the levels of PCT in the serum and synovial fluid and the arthritic patient groups were determined by the Nemenyi test. Areas under the receiver operating characteristic (ROC) curve were calculated to evaluate the accuracy of the correlations. The levels of PCT in the serum and joint fluid of the patients in the SA group were higher compared with those of the other groups (P<0.01) and there were no significant differences among the RA, OA and GA groups in these levels. A PCT level of <0.5 μg/l in the serum and synovial fluid had high specificity in the differential diagnosis of SA from RA, OA and GA. Synovial fluid PCT revealed significantly greater sensitivity than serum PCT. The accuracy of the differential diagnosis of SA by the serum levels of PCT was significantly lower than that by the synovial fluid levels of PCT. The levels of PCT in the serum and synovial fluid may be used as alternative laboratory indicators to distinguish between SA and the non-infectious types of arthritis; however, the PCT levels in fresh synovial fluid are more sensitive and accurate indicators than PCT levels in fresh serum.

Effects of high intensity exhaustive exercise on SOD, MDA, and NO levels in rats with knee osteoarthritis

“…High-intensity exhaustive exercise might increase cell damage leading to a significant change in cell membrane permeability. Meanwhile, highintensity exhaustive exercise might also decrease the free radical scavenging ability of SOD, thereby slowing the decrease in the MDA level (Wang et al, 2014).…”

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

“…A PCT value beyond 0.5 ng/ml does not, however, rule out bacterial infection and appropriate treatment may be indicated [79]. Otherwise, PCT accuracy is highest when measured in fresh joint fluid [80]. We found no new studies evaluating PCT-guided antibiotic therapy in septic arthritis.…”

Osteosarcoma of the Proximal Femur Mimicking Septic Arthritis of the Hip: A diagnostic dilemma

“…A few months later, following completion of the neoadjuvant chemotherapy regimen, he underwent limb salvage surgery in India; at this time, a histological analysis revealed 50-60% tumour response to treat- early detection of septic arthritis-including synovial procalcitonin estimations, combined leukocyte esterase/ glucose strip tests, α-defensin synovial fluid measurements and next-generation DNA sequencing-were unavailable at the time of presentation. [7][8][9][10] Kocher et al proposed certain criteria to help diagnose septic arthritis, with at least three of the following four conditions indicating a 93-99% risk of septic arthritis: (1) lack of weight-bearing on the affected side; (2) ESR of >40 mm/hour; (3) fever of >38.5 °C ; and (4) WBC of >12,000 cells/mm 3 . 11,12 The risk falls to 40% if only two of the criteria are met, dwindling to 3% if only one criterion is met.…”