Risk factors for septic arthritis in patients with joint disease

Kaandorp, C. J. E.; Schaardenburg, Dirkjan van; Krijnen, Pieta; Habbema, J. Dik F.; Laar, Mart A F J van de

doi:10.1002/art.1780381215

Cited by 383 publications

(270 citation statements)

References 23 publications

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“…The appearance of multiple drug resistance has reawakened interest in natural host defense mechanisms against this organism. In particular, S. aureus is the most frequent etiological agent implicated in septic arthritis, which is characterized by severe articular destruction often complicated by septicemia with associated morbidity and mortality (12,13). The disease can be reproduced in a murine model in which i.v.…”

mentioning

confidence: 99%

Enhanced Th1 Response toStaphylococcus aureusInfection in Human Lactoferrin-Transgenic Mice

Guillén

McInnes

Vaughan

et al. 2002

The Journal of Immunology

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Lactoferrin (Lf) is an iron-binding protein of external secretions and neutrophil secondary granules with antimicrobial and immunomodulatory activities. To further define these properties of Lf, we have investigated the response to Staphylococcus aureus infection in transgenic mice carrying a functional human Lf gene. The transgenic mice cleared bacteria significantly better than congenic littermates, associated with a trend to reduced incidence of arthritis, septicemia, and mortality. We identified two pathways by which S. aureus clearance was enhanced. First, human Lf directly inhibited the growth of S. aureus LS-1 in vitro. Second, S. aureus-infected transgenic mice exhibited enhanced Th1 immune polarization. Thus, spleen cells from infected transgenic mice produced higher levels of TNF-α and IFN-γ and less IL-5 and IL-10 upon stimulation ex vivo with the exotoxin toxic shock syndrome toxin-1 compared with congenic controls. To confirm that these effects of Lf transgene expression could occur in the absence of live bacterial infection, we also showed that Lf-transgenic DBA/1 mice exhibited enhanced severity of collagen-induced arthritis, an established model of Th1-induced articular inflammation. Higher levels of stainable iron in the spleens of transgenic mice correlated with human Lf distribution, but all other parameters of iron metabolism did not differ between transgenic mice and wild-type littermates. These results demonstrate that human Lf can mediate both antimicrobial and immunomodulatory activities with downstream effects on the outcome of immune pathology in infectious and inflammatory disease.

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mentioning

confidence: 99%

Enhanced Th1 Response toStaphylococcus aureusInfection in Human Lactoferrin-Transgenic Mice

Guillén

McInnes

Vaughan

et al. 2002

The Journal of Immunology

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“…Age > 80 years, diabetes, and rheumatoid arthritis, which are risk factors for SA, have a comparable frequency in SA and non-SA groups. 10 On the contrary, a history of crystalinduced arthritis (gout or chondrocalcinosis) was more frequent in the non-SA group (28% v. 5%), and its presence decreased the probability of SA (LR + 0.58). In our study, chills appeared to be more frequent, present in 40% of SA cases, and an independent factor in multivariate analysis; however, the LR + was only 2.2 and its sensitivity was weak, notably 19% based on a prior study.…”

Section: Discussionmentioning

confidence: 94%

Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis

Couderc¹,

Pereira²,

Mathieu³

et al. 2015

CJEM

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Objective: To determine the sensitivity and specificity of clinical and laboratory signs for the diagnosis of septic arthritis (SA). Patients and methods: This prospective study included all adult patients with suspected SA seen in the emergency department or rheumatology department at the University Hospital, Clermont-Ferrand, France, over a period of 18 months. Results: In total, 105 patients with suspected SA were included, 38 (36%) presenting with SA (29 [28%] with bacteriologically documented SA). In the univariate analysis, chills (p = 0.015), gradual onset (p = 0.04), local redness (p = 0.01), as well as an entry site for infection (p = 0.01) were most often identified in SA. A history of crystal-induced arthritis (p = 0.004) was more frequent in non-SA cases. An erythrocyte sedimentation rate (ESR) > 50 mm (p = 0.005), a C-reactive protein (CRP) level >100 mg/L (p = 0.019), and radiological signs suggestive of SA (p = 0.001) were more frequent in the SA cases. Synovial fluid appearance: purulent (p < 0.001) and clear (p = 0.007), synovial white blood cell (WBC) count >50,000/μL (p < 0.001), differentiated between SA and non-SA.In multivariate analysis, only chills (odds ration [OR] = 4.7, 95% confidence interval [CI] 1.3-17.1), a history of crystalinduced arthritis (OR = 0.09, 95% CI 0.01-0.9), purulent appearance of the joint fluid (OR = 8.4, 95% CI 2.4-28.5), synovial WBC count >50,000/mm 3 (OR = 6.8, 95% CI 1.3-36), and radiological findings (OR = 7.1, 95% CI 13-37.9) remained significant. Conclusion:No clinical sign or laboratory test (excluding bacteriological test), taken alone, is conclusive for the differentiation between SA and non-SA, but the association of several signs, notably chills, history of crystal-induced arthritis, radiological findings, and the appearance and cellularity of joint fluid may be suggestive.

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“…In our patient it is likely that septicemia originated from the perianal skin infection, which is considered an important risk factor for septic arthritis in patients with joint disease 6 , and the infection affected bursae, causing the development of retrocalcaneal abscess, which facilitated the Achilles tendon rupture.…”

Section: To the Editormentioning

confidence: 86%

Multiple Septic Bursitis and Spontaneous Achilles Tendon Tear in Systemic Lupus Erythematosus

Piga¹,

Gabba²,

Vacca³

et al. 2010

J Rheumatol

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Risk factors for septic arthritis in patients with joint disease

Cited by 383 publications

References 23 publications

Enhanced Th1 Response toStaphylococcus aureusInfection in Human Lactoferrin-Transgenic Mice

Enhanced Th1 Response toStaphylococcus aureusInfection in Human Lactoferrin-Transgenic Mice

Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis

Multiple Septic Bursitis and Spontaneous Achilles Tendon Tear in Systemic Lupus Erythematosus

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