Serum and Synovial Markers in Patients with Rheumatoid Arthritis and Periprosthetic Joint Infection

Ren, Yi; Biedermann, Lara; Gwinner, Clemens; Perka, Carsten; Kienzle, Arne

doi:10.3390/jpm12050810

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…[30][31][32][33] The cutoff values with the highest sensitivity and specificity for synovial fluid WBC and differential will facilitate the accurate diagnosis of infection after TJR in RA patients. A study by Ren et al 8 reported that in patients with chronic PJI, the optimal cutoff values of synovial fluid WBC and PMN% were significantly elevated in RA patients, showing acceptable-to-excellent discrimination. The results of this study showed that the optimal cutoff values of synovial fluid WBC and PMN% for diagnosing RA-PJI were higher than those of OA-PJI.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the application of the conventional PJI diagnostic threshold for patients who have RA can lead to misdiagnosis, leading to incorrect treatment. 8 The current focus of research on the diagnosis of PJI includes markers such as alpha-defensin. [9][10][11] However, CRP, ESR, synovial fluid WBC, and PMN% are classical indexes for diagnosing PJI, which are economical and convenient to operate, so it is of great clinical importance to establish the thresholds of these common detection indexes for PJI diagnosis in patients who have RA.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis

Wang,

Li,

et al. 2023

Bone Joint Res

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AimsTo investigate the optimal thresholds and diagnostic efficacy of commonly used serological and synovial fluid detection indexes for diagnosing periprosthetic joint infection (PJI) in patients who have rheumatoid arthritis (RA).MethodsThe data from 348 patients who had RA or osteoarthritis (OA) and had previously undergone a total knee (TKA) and/or a total hip arthroplasty (THA) (including RA-PJI: 60 cases, RA-non-PJI: 80 cases; OA-PJI: 104 cases, OA-non-PJI: 104 cases) were retrospectively analyzed. A receiver operating characteristic curve was used to determine the optimal thresholds of the CRP, ESR, synovial fluid white blood cell count (WBC), and polymorphonuclear neutrophil percentage (PMN%) for diagnosing RA-PJI and OA-PJI. The diagnostic efficacy was evaluated by comparing the area under the curve (AUC) of each index and applying the results of the combined index diagnostic test.ResultsFor PJI prediction, the results of serological and synovial fluid indexes were different between the RA-PJI and OA-PJI groups. The optimal cutoff value of CRP for diagnosing RA-PJI was 12.5 mg/l, ESR was 39 mm/hour, synovial fluid WBC was 3,654/μl, and PMN% was 65.9%; and those of OA-PJI were 8.2 mg/l, 31 mm/hour, 2,673/μl, and 62.0%, respectively. In the RA-PJI group, the specificity (94.4%), positive predictive value (97.1%), and AUC (0.916) of synovial fluid WBC were higher than those of the other indexes. The optimal cutoff values of synovial fluid WBC and PMN% for diagnosing RA-PJI after THA were significantly higher than those of TKA. The specificity and positive predictive value of the combined index were 100%.ConclusionSerum inflammatory and synovial fluid indexes can be used for diagnosing RA-PJI, for which synovial fluid WBC is the best detection index. Combining multiple detection indexes can provide a reference basis for the early and accurate diagnosis of RA-PJI.Cite this article: Bone Joint Res 2023;12(9):559–570.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis

Wang,

Li,

et al. 2023

Bone Joint Res

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“…Previous research has mainly focused on reliably diagnosing PJI with use of serum, synovial fluid, and intraoperatively collected implants 15 , 16 . Several authors have identified increased levels of inflammatory cytokines, such as IL-6, in the synovial fluid and serum 15 , 17 , 18 .…”

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confidence: 99%

Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee

et al. 2023

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Background:Despite the general success of total knee arthroplasty (TKA), addressing periprosthetic joint infection (PJI) and the resulting long-term complications is a growing medical need given the aging population and the increasing demand for arthroplasty. A larger proportion of patients face revision surgery because of the long-term complication of aseptic loosening despite clearance of the infection. The pathomechanisms leading to prosthetic loosening are not understood as it has been widely assumed that the bone stock recovers after explantation revision surgery. While clinical observations suggest a reduced osteogenic potential in patients with PJI, knowledge regarding the relevant biology is sparse. In the present study, we investigated the inflammatory impact of PJI on the bone and bone marrow in the vicinity of the joint. Additionally, we evaluated changes in the local inflammatory environment in a 2-stage exchange at both explantation and reimplantation.Methods:In this study, we analyzed 75 human bone and bone-marrow specimens (obtained from 65 patients undergoing revision arthroplasty with cement for the treatment of PJI) for markers of inflammation. Samples were analyzed using hematoxylin and eosin overview staining, fluorescent immunohistochemical staining, flow cytometry, and polymerase chain reaction (PCR).Results:Leukocyte prevalence was significantly elevated at explantation (femur, +218.9%; tibia, +134.2%). While leukocyte prevalence decreased at reimplantation (femur, −49.5%; tibia, −34.2%), the number of cells remained significantly higher compared with the control group (femur, +61.2%; tibia, +54.2%). Expression of inflammatory markers interleukin (IL)-1α (femur, +2,748.7%; tibia, +1,605.9%), IL-6 (femur, +2,062.5%; tibia, +2,385.7%), IL-10 (femur, +913.7%; tibia, +897.5%), IL-12 (femur, +386.1%; tibia, +52.5%), IL-18 (femur, +805.3%; tibia, +547.7%), and tumor necrosis factor (TNF)-α (femur, +296.9%; tibia, +220.9%) was significantly elevated at prosthesis explantation in both femoral and tibial specimens. Expression remained significantly elevated at reimplantation for all inflammatory markers except IL-12 compared with the control group. Conversely, there were only limited inflammatory changes in the bone marrow environment.Conclusions:The present study demonstrated a strong and lasting upregulation of the proinflammatory environment in the joint-surrounding osseous scaffold in patients with PJI. Our data suggest that modulating the inflammatory environment has substantial potential to improve the clinical outcome in affected patients.

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The predictive value and reliability of ultrasound-guided synovial aspiration and biopsies for diagnosing periprosthetic shoulder infections

Pruijn,

Heesterbeek,

Susan

et al. 2024

Arch Orthop Trauma Surg

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Serum and Synovial Markers in Patients with Rheumatoid Arthritis and Periprosthetic Joint Infection

Cited by 5 publications

References 33 publications

Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis

Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis

Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee

The predictive value and reliability of ultrasound-guided synovial aspiration and biopsies for diagnosing periprosthetic shoulder infections

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