Septic arthritis: what is the role for the rheumatologist?

Schiavon, Franco; Favero, Marta; Carraro, Valentina; Riato, L.

doi:10.4081/reumatismo.2008.1

Cited by 2 publications

(3 citation statements)

References 32 publications

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“…An important disease for which the SF analysis is frequently decisive is septic arthritis. Although potentially severe, it is less frequently seen than crystal‐induced arthritis 27,28 . Prompt microscopic analysis and culture of SF are fundamental diagnostic tools in the evaluation of possible joint sepsis.…”

Section: Synovial Fluid Analysismentioning

confidence: 99%

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Arthrocentesis and Synovial Fluid Analysis in Clinical Practice

Punzi

Oliviero

2009

Annals of the New York Academy of Sciences

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Joint aspiration, or arthrocentesis, is one of the most useful and commonly performed procedures for the diagnosis and treatment of joint diseases. The synovial fluid aspirated may be examined to evaluate the degree of inflammation and, mainly, to detect the presence of some relevant pathogenic agents, such as crystals or microorganisms. In these cases, synovial fluid analysis still represents the best diagnostic procedure. Arthrocentesis is thus particularly required for the diagnosis and management of the acute "hot red joint," which may be considered a true medical emergency because of the morbidity and mortality related to septic arthritis. The most recent recommendations on arthrocentesis confirm the need for the procedure in the presence of synovial effusion of unknown origin, especially if septic or crystal arthritis is suspected. Owing to the importance of this analysis, it is clearly recommended that ultrasonography should be used to facilitate arthrocentesis in difficult cases. Furthermore, ultrasonography may be useful in revealing the presence of synovial fluid before the joint aspiration and, subsequently, distinguishing some aspects characteristic of crystal-induced arthropathies.

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Section: Synovial Fluid Analysismentioning

confidence: 99%

“…Although potentially severe, it is less frequently seen than crystal-induced arthritis. 27,28 Prompt microscopic analysis and culture of SF are fundamental diagnostic tools in the evaluation of possible joint sepsis. Some centers stain SF by Gram's and acid-fast methods in order to obtain early information on possible infection.…”

Section: Microbiologic Studiesmentioning

confidence: 99%

Arthrocentesis and Synovial Fluid Analysis in Clinical Practice

Punzi

Oliviero

2009

Annals of the New York Academy of Sciences

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“…However, this has a number of disadvantages including aseptic surgery, a long turn-around time and the potential generation of a false positive or negative result (2,3). Prior to the bacterial culture results becoming available, several other clinical tests, including X-ray imaging (4), routine blood tests (5), erythrocyte sedimentation rate (ESR) measurements (6), synovial fluid white blood cell (WBC) count (7) and levels of CRP (C reactive protein) (8,9) may be used for SA diagnosis. However, none of these tests are sensitive enough to produce an accurate diagnosis and they frequently lead to misdiagnosis and/or the delay of treatment.…”

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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Septic arthritis: what is the role for the rheumatologist?

Cited by 2 publications

References 32 publications

Arthrocentesis and Synovial Fluid Analysis in Clinical Practice

Arthrocentesis and Synovial Fluid Analysis in Clinical Practice

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

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