Septic versus inflammatory arthritis: discriminating the ability of serum inflammatory markers

Talebi-Taher, Mahshid; Shirani, Fatemeh; Nikanjam, Najmeh; Shekarabi, Mehdi

doi:10.1007/s00296-012-2363-y

Cited by 40 publications

(35 citation statements)

References 21 publications

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“…Despite the widespread use of PCT in the diagnosis of numerous systemic infectious diseases, including sepsis and pneumonia (30–33), the use of PCT in the diagnosis of SA, RA, OA and GA remains limited. Serum levels of PCT perform better than synovial fluid levels of PCT in the diagnosis of SA (34). However, PCT levels among non-infectious types of arthritis (OA, RA and GA) have not, to the best of our knowledge, been compared, although the level of PCT in SA has been compared with that of non-inflammatory arthritis in the current study.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Zhong

Liao

et al. 2014

Experimental and Therapeutic Medicine

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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.

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Section: Introductionmentioning

confidence: 99%

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

Wang

Zhong

Liao

et al. 2014

Experimental and Therapeutic Medicine

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“…The prevalence of this situation ranges from 7% to 35% with significant differences in large case series. [14][15][16] To exclude these cases would lead to an underestimation of the frequency of SA. Second, none of the diagnostic criteria have been validated in adults; therefore, a pragmatic definition was adopted to include both bacteriological positive and negative SA as defined as: SA was considered probable when the clinician retained the diagnosis and treated accordingly, with antibiotic therapy for at least 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

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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“…ESR has been used for more than a 100 years in the diagnosis of infections, but its role in septic arthritis is limited, especially in individuals with rheumatic diseases who may have a high ESR due to their underlying rheumatological conditions. In patients with native joints without underlying hematological or rheumatological conditions, ESR can be useful [132,133]. Serial ESR measurements are used to define the duration of therapy for patients on long-term antibiotic therapy for septic arthritis, especially with prosthetic joint infections.…”

Section: Diagnosismentioning

confidence: 99%

Septic arthritis in immunocompetent and immunosuppressed hosts

Wang

Tambyah

2015

Best Practice & Research Clinical Rheumatology

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Septic versus inflammatory arthritis: discriminating the ability of serum inflammatory markers

Cited by 40 publications

References 21 publications

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

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

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

Septic arthritis in immunocompetent and immunosuppressed hosts

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