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Maleitzke T, Dietrich T, Hildebrandt A, Weber J, Appelt J, Jahn D, Otto E, Zocholl D, Jiang S, Baranowsky A, Duda GN, Tsitsilonis S, Keller J. Inactivation of the gene encoding procalcitonin prevents antibody-mediated arthritis. Inflamm Res 2023; 72:1069-1081. [PMID: 37039837 DOI: 10.1007/s00011-023-01719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Procalcitonin (PCT) is applied as a sensitive biomarker to exclude bacterial infections in patients with rheumatoid arthritis (RA) flare-ups. Beyond its diagnostic value, little is known about the pathophysiological role of PCT in RA. METHODS Collagen antibody-induced arthritis (CAIA) was induced in Calca-deficient mice (Calca-/-), lacking PCT (n = 15), and wild-type (WT) mice (n = 13), while control (CTRL) animals (n = 8 for each genotype) received phosphate-buffered saline. Arthritis severity and grip strength were assessed daily for 10 or 48 days. Articular inflammation, cartilage degradation, and bone lesions were assessed by histology, gene expression analysis, and µ-computed tomography. RESULTS Serum PCT levels and intra-articular PCT expression increased following CAIA induction. While WT animals developed a full arthritic phenotype, Calca-deficient mice were protected from clinical and histological signs of arthritis and grip strength was preserved. Cartilage turnover markers and Tnfa were exclusively elevated in WT mice. Calca-deficient animals expressed increased levels of Il1b. Decreased bone surface and increased subchondral bone porosity were observed in WT mice, while Calca-deficiency preserved bone integrity. CONCLUSION The inactivation of Calca and thereby PCT provided full protection from joint inflammation and arthritic bone loss in mice exposed to CAIA. Together with our previous findings on the pathophysiological function of Calca-derived peptides, these data indicate an independent pro-inflammatory role of PCT in RA.
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Affiliation(s)
- Tazio Maleitzke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Tamara Dietrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Alexander Hildebrandt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Jérôme Weber
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Jessika Appelt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Denise Jahn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Ellen Otto
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Dario Zocholl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Shan Jiang
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, Hamburg, Germany
| | - Anke Baranowsky
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, Hamburg, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Serafeim Tsitsilonis
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Johannes Keller
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, Hamburg, Germany.
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Efficacy of Lavage by Tube under Local Anesthesia versus Arthroscopic Treatment of Acute Septic Arthritis of Native Knee. Diagnostics (Basel) 2023; 13:diagnostics13030371. [PMID: 36766476 PMCID: PMC9914019 DOI: 10.3390/diagnostics13030371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
Although arthroscopic treatment is a minimally invasive surgery that effectively treats septic arthritis of the knee joint, it requires general or regional anesthesia. This study aimed to compare the clinical results of lavage after tube insertion versus arthroscopic treatment. Patients treated with arthroscopic treatment were included in group I (n = 76), while those treated with lavage by tube were included in group II (n = 34). We investigated the following in all patients: demographics, underlying disorders, initial serum white blood cell (WBC) count, C-reactive protein (CRP) level, synovial fluid WBC and polymorphonuclear cell counts, causative organism, initial Kellgren-Lawrence grade, lavage number, interventional delay, hospitalization days, CRP normalization time, and Western Ontario McMaster Universities Osteoarthritis index scores for clinical outcomes at 3 months postoperative. The mean interventional delay was significantly greater in group I (23.6 ± 15.6 h vs. 8.7 ± 9.3 h, p < 0.001). The lavage by tube featured a significantly shorter interventional delay time than arthroscopy, while the CRP decrease rate did not differ between groups. Moreover, lavage by tube showed no significant differences in outcomes, including laboratory results and functional outcomes at 3 months postoperative.
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West K, Almekdash H, Fisher J, Rounds AD, Murphree J, Simpson J. Procalcitonin as a Predictor of Septic Knee Arthritis: A Retrospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202301000-00003. [PMID: 37450766 PMCID: PMC9831185 DOI: 10.5435/jaaosglobal-d-22-00261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Differentiating septic arthritis from aseptic arthritis (AA) of the knee is difficult without arthrocentesis. Although procalcitonin (PCT) has shown diagnostic value in identifying bacterial infections, it has not been established as a reliable marker for identifying septic arthritis (SA). Recent studies have shown promise in the use of PCT as a useful systemic marker for identifying septic arthritis versus AA. This observational retrospective review compares PCT with routine inflammatory markers as a tool for differentiating septic arthritis versus AA in patients with acute, atraumatic knee pain. METHODS Fifty-three consecutive patients (24 SA, 29 AA) were retrospectively reviewed at one institution with concern for SA. SA was diagnosed based on a physical examination, laboratory markers, and arthrocentesis. Laboratory indices were compared between the septic arthritis and AA groups. Data analysis was conducted to define sensitivity and specificity. Receiver operator characteristic curve analysis and regression were conducted to determine the best marker for acute SA of the knee. RESULTS Using multiple logistic regression, bacteremia (OR 6.75 ± 5.75) was determined to be the greatest predictor of SA. On linear regression, concomitant bacteremia (coef 3.07 ± 0.87), SA (coef 2.18 ± 0.70), and the presence of pseudogout crystals (coef 1.80 ± 0.83) on microscopy predicted an increase in PCT. Using a PCT cutoff of 0.25 ng/mL yields a sensitivity of 91.7% and specificity of 55.2% for predicting SA; however, the ideal cutoff in our series was 0.32 ng/mL with a sensitivity of 79.2% and specificity of 72.4%. PCT was superior to the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein in the area under the receiver-operating characteristic curve analysis. DISCUSSION Procalcitonin seems to be the most sensitive and specific systemic marker in differentiating septic from AA.
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Affiliation(s)
- Kevin West
- From the Department of Orthopaedic Surgery, (Dr. West, Fisher, Dr. Rounds, and Dr. Simpson); the Clinical Research Institute (Dr. Almekdash), Texas Tech University Health Science Center, Lubbock, TX; and the Department of Orthopaedics and Rehabilitation, University of Florida School of Medicine, Gainesville, FL (Dr. Murphree)
| | - Hasan Almekdash
- From the Department of Orthopaedic Surgery, (Dr. West, Fisher, Dr. Rounds, and Dr. Simpson); the Clinical Research Institute (Dr. Almekdash), Texas Tech University Health Science Center, Lubbock, TX; and the Department of Orthopaedics and Rehabilitation, University of Florida School of Medicine, Gainesville, FL (Dr. Murphree)
| | - John Fisher
- From the Department of Orthopaedic Surgery, (Dr. West, Fisher, Dr. Rounds, and Dr. Simpson); the Clinical Research Institute (Dr. Almekdash), Texas Tech University Health Science Center, Lubbock, TX; and the Department of Orthopaedics and Rehabilitation, University of Florida School of Medicine, Gainesville, FL (Dr. Murphree)
| | - Alexis D. Rounds
- From the Department of Orthopaedic Surgery, (Dr. West, Fisher, Dr. Rounds, and Dr. Simpson); the Clinical Research Institute (Dr. Almekdash), Texas Tech University Health Science Center, Lubbock, TX; and the Department of Orthopaedics and Rehabilitation, University of Florida School of Medicine, Gainesville, FL (Dr. Murphree)
| | - Jefferson Murphree
- From the Department of Orthopaedic Surgery, (Dr. West, Fisher, Dr. Rounds, and Dr. Simpson); the Clinical Research Institute (Dr. Almekdash), Texas Tech University Health Science Center, Lubbock, TX; and the Department of Orthopaedics and Rehabilitation, University of Florida School of Medicine, Gainesville, FL (Dr. Murphree)
| | - Jordan Simpson
- From the Department of Orthopaedic Surgery, (Dr. West, Fisher, Dr. Rounds, and Dr. Simpson); the Clinical Research Institute (Dr. Almekdash), Texas Tech University Health Science Center, Lubbock, TX; and the Department of Orthopaedics and Rehabilitation, University of Florida School of Medicine, Gainesville, FL (Dr. Murphree)
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Miranda-Martínez A, Sufrate-Vergara B, Fernández-Puntero B, Alcaide-Martin MJ, Buño-Soto A, Serrano-Olmedo JJ. ANN-Based Discernment of Septic and Inflammatory Synovial Fluid: A Novel Method Using Viscosity Data from a QCR Sensor. SENSORS (BASEL, SWITZERLAND) 2022; 22:9413. [PMID: 36502129 PMCID: PMC9740680 DOI: 10.3390/s22239413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/08/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
The synovial fluid (SF) analysis involves a series of chemical and physical studies that allow opportune diagnosing of septic, inflammatory, non-inflammatory, and other pathologies in joints. Among the variety of analyses to be performed on the synovial fluid, the study of viscosity can help distinguish between these conditions, since this property is affected in pathological cases. The problem with viscosity measurement is that it usually requires a large sample volume, or the necessary instrumentation is bulky and expensive. This study compares the viscosity of normal synovial fluid samples with samples with infectious and inflammatory pathologies and classifies them using an ANN (Artificial Neural Network). For this purpose, a low-cost, portable QCR-based sensor (10 MHz) was used to measure the viscous responses of the samples by obtaining three parameters: Δf, ΔΓ (parameters associated with the viscoelastic properties of the fluid), and viscosity calculation. These values were used to train the algorithm. Different versions of the ANN were compared, along with other models, such as SVM and random forest. Thirty-three samples of SF were analyzed. Our study suggests that the viscosity characterized by our sensor can help distinguish infectious synovial fluid, and that implementation of ANN improves the accuracy of synovial fluid classification.
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Affiliation(s)
- Andrés Miranda-Martínez
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
| | - Berta Sufrate-Vergara
- Department of Clinical Analysis-Emergency, Hospital Universitario La Paz (HULP), 28046 Madrid, Spain
| | - Belén Fernández-Puntero
- Department of Clinical Analysis-Emergency, Hospital Universitario La Paz (HULP), 28046 Madrid, Spain
| | - María José Alcaide-Martin
- Department of Clinical Analysis-Emergency, Hospital Universitario La Paz (HULP), 28046 Madrid, Spain
| | - Antonio Buño-Soto
- Department of Clinical Analysis-Emergency, Hospital Universitario La Paz (HULP), 28046 Madrid, Spain
| | - José Javier Serrano-Olmedo
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
- Networking Research Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
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A Clinical Prediction Rule for Bacterial Musculoskeletal Infections in Children with Monoarthritis in Lyme Endemic Regions. Ann Emerg Med 2022; 80:225-234. [DOI: 10.1016/j.annemergmed.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/22/2022]
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6
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Walinga AB, Stornebrink T, Langerhuizen DWG, Struijs PAA, Kerkhoffs GMMJ, Janssen SJ. What are the best diagnostic tests for diagnosing bacterial arthritis of a native joint? : a systematic review of 27 studies. Bone Joint J 2021; 103-B:1745-1753. [PMID: 34847715 DOI: 10.1302/0301-620x.103b12.bjj-2021-0114.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS This study aimed to answer two questions: what are the best diagnostic methods for diagnosing bacterial arthritis of a native joint?; and what are the most commonly used definitions for bacterial arthritis of a native joint? METHODS We performed a search of PubMed, Embase, and Cochrane libraries for relevant studies published between January 1980 and April 2020. Of 3,209 identified studies, we included 27 after full screening. Sensitivity, specificity, area under the curve, and Youden index of diagnostic tests were extracted from included studies. We grouped test characteristics per diagnostic modality. We extracted the definitions used to establish a definitive diagnosis of bacterial arthritis of a native joint per study. RESULTS Overall, 28 unique diagnostic tests for diagnosing bacterial arthritis of a native joint were identified. The following five tests were deemed most useful: serum ESR (sensitivity: 34% to 100%, specificity: 23% to 93%), serum CRP (sensitivity: 58% to 100%, specificity: 0% to 96%), serum procalcitonin (sensitivity: 0% to 100%, specificity: 68% to 100%), the proportion of synovial polymorphonuclear cells (sensitivity: 42% to 100%, specificity: 54% to 94%), and the gram stain of synovial fluid (sensitivity: 27% to 81%, specificity: 99% to 100%). CONCLUSION Diagnostic methods with relatively high sensitivities, such as serum CRP, ESR, and synovial polymorphonuclear cells, are useful for screening. Diagnostic methods with a relatively high specificity, such as serum procalcitonin and synovial fluid gram stain, are useful for establishing a diagnosis of bacterial arthritis. This review helps to interpret the value of various diagnostic tests for diagnosing bacterial arthritis of a native joint in clinical practice. Cite this article: Bone Joint J 2021;103-B(12):1745-1753.
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Affiliation(s)
- Alex B Walinga
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-based Sports medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Tobias Stornebrink
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-based Sports medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - David W G Langerhuizen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-based Sports medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Peter A A Struijs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-based Sports medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-based Sports medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Stein J Janssen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-based Sports medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam, the Netherlands
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Gonzalez-Chapa JA, Peña-Martinez VM, Vílchez-Cavazos JF, Salinas-Carmona MC, Rosas-Taraco AG. Systemic and Local Cytokines Profile Determine Severity and Prognosis in Human Septic Arthritis: A Pilot Study. Arch Med Res 2021; 53:170-178. [PMID: 34702588 DOI: 10.1016/j.arcmed.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Septic arthritis (SA) is a medical emergency. The most common etiological agents are bacteria, which activate the local immune response coordinated by cytokines; however, little is known about the cytokine profile in human SA. AIM To determine the association of local and systemic cytokine profiles with the severity and prognosis of patients with SA. METHODS Patients with clinical and laboratory diagnosed SA were enrolled as well as a control group. Serum and synovial fluid (SF) samples were obtained for determining cytokines and glucose levels; SF samples were used for histological analysis. Osteochondral damage and general health status and quality of life (SF-36) were evaluated during recruitment day. WOMAC osteoarthritis index score and SF-36 questionnaire were used a year after recruitment day as a follow up. RESULTS A systemic and local proinflammatory cytokine profile was found in patients compared to the control group (p <0.05). IL-6 was 28 and 525 times higher than controls in sera and SF, respectively (p <0.0001). Systemic IL-6 correlated negatively with general mental health score (p = 0.0184) and was associated with a higher osteoarthritis index after one year follow-up in the patients (p = 0.0352). HMGB1 in SF was found higher in patients with SA (p <0.0001), and it was associated with osteochondral damage (p = 0.0042). TNF-α in SF correlated negatively with SF-36 questionnaire one year after patients' recruitment in role limitation score (p = 0.0318), body pain score (p = 0.0315), and general mental health score (p = 0.0197). CONCLUSION Serum and SF cytokine signatures are associated with disease severity and prognosis in patients with SA.
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Affiliation(s)
- Jorge A Gonzalez-Chapa
- Departamento de Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Nuevo León, Monterrey, México
| | - Victor M Peña-Martinez
- Servicio de Ortopedia y Traumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Dr. José Eleuterio González, Nuevo León, Monterrey, México
| | - José F Vílchez-Cavazos
- Servicio de Ortopedia y Traumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Dr. José Eleuterio González, Nuevo León, Monterrey, México
| | - Mario C Salinas-Carmona
- Departamento de Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Nuevo León, Monterrey, México
| | - Adrian G Rosas-Taraco
- Departamento de Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Nuevo León, Monterrey, México.
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Akdoğan D, Güzel M, Kuzucu EA, Çalışkan E, Kuzucu Y, Erdem G, Akpınar O. Diagnostic values of HNP 1-3 and procalcitonin levels in synovial fluid aspirates in the differential diagnosis between septic arthritis and noninfectious arthritis. J Infect Chemother 2021; 27:1591-1595. [PMID: 34294530 DOI: 10.1016/j.jiac.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/08/2021] [Accepted: 07/03/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although early diagnosis of septic arthritis may reduce mortality rates, and limit unnecessary surgical interventions, clinical parameters alone are not adequate for making the diagnosis of septic arthritis. Therefore, relevant laboratory parameters are used to enhance diagnostic sensitivity. The aim of our study was to assist in making the diagnosis of septic arthritis, and prevent delays in the diagnosis. For this purpose; we aimed to determine the diagnostic values of human neutrophil peptides 1-3 (HNP 1-3) and procalcitonin (PCT) in synovial fluids of patients with arthritis. By comparing the HNP 1-3 and procalcitonin levels, as well as CRP, in synovial fluid aspirates, we evaluated the significance of these data in the differential diagnosis of septic arthritis from noninfectious arthritis. METHODS A total of 67 adults consisting of 37 septic arthritis and 30 noninfectious arthritis patients were included in our study. As bioindicators; levels of HNP 1-3, PCT, synovial and serum CRP levels were found to have significant ROC areas in discriminating septic arthritis patients from noninfectious arthritis patients. RESULTS As a result, synovial fluid HNP 1-3 levels were significantly higher in septic arthritis patients compared to noninfectious arthritis patients (p < 0.001). The sensitivity, specificity, and accuracy of HNP 1-3 levels in the diagnosis of septic and noninfectious arthritis were found as 86%, 87%, and 87%, respectively (AUC of the ROC curve = 0.828). CONCLUSIONS It was decided that the level of HNP 1-3 in the synovial fluid can be used as an alternative indicator in the diagnosis of septic arthritis.
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Affiliation(s)
- Doğan Akdoğan
- Pursaklar State Hospital Department of Medical Microbiology, Ankara, Turkey
| | - Mustafa Güzel
- Maltepe Medical Center Department of Medical Microbiology, Istanbul, Turkey
| | - Esra Akkan Kuzucu
- Agri Patnos State Hospital Medical Microbiology Laboratory, Agri, Turkey
| | - Elif Çalışkan
- Ardahan State Hospital Medical Microbiology Laboratory, Ardahan, Turkey
| | - Yakup Kuzucu
- Agri Patnos State Hospital Orthopedic Clinic, Agri, Turkey
| | - Gül Erdem
- Department of Medical Microbiology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Orhan Akpınar
- Department of Medical Microbiology, Health Sciences Institute, University of Süleyman Demirel, Isparta, 32260, Turkey.
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Liu X, Jiang N, Wang T, Yu B. Serum and Synovial Biomarkers for the Diagnosis of Implant-Associated Infection After Orthopedic Surgery. Orthopedics 2021; 44:e158-e166. [PMID: 33416900 DOI: 10.3928/01477447-20210104-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Implant-associated infection is one of the most devastating complications following orthopedic surgery. Early identification is crucial for treatment. Currently, however, a reliable diagnostic tool is lacking, partly due to disparate bacteria colonies (virulent vs non-virulent), difficulty in distinguishing infection from inflammatory disease, and highly diverse diagnostic thresholds and testing methods. Given the importance of biomarkers in the initial screening for the infection, an extensive effort has been made to develop serum and synovial biomarkers. In this review, the authors summarize the results from the most relevant studies to provide comprehensive information on biomarkers for the diagnosis of implant-associated infection. [Orthopedics. 2021;44(2):e158-e166.].
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Combining Calcitonin and Procalcitonin and Rheumatoid Arthritis-Related Biomarkers Improve Diagnostic Outcomes in Early Rheumatoid Arthritis. DISEASE MARKERS 2021; 2021:6331994. [PMID: 34136020 PMCID: PMC8175179 DOI: 10.1155/2021/6331994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/25/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022]
Abstract
Objective To demonstrate whether procalcitonin (PCT) combined with calcitonin (CT) could provide additional diagnostic value to other clinically available rheumatoid arthritis- (RA-) related biomarkers in the early diagnosis of RA. Method The blood samples aseptically collected by venipuncture were centrifuged within 1 hour and frozen at -80°C. PCT and CT levels were measured using electrochemiluminescence immunoassay (ECLIA) in 260 subjects (48 patients with early RA, 34 patients with established RA, 37 patients with systemic lupus erythematosus, 30 with osteoarthritis, 31 with gouty arthritis, and 80 healthy participants). Anti-cyclic citrullinated peptide (Anti-CCP) and anti-RA33 antibodies (Anti-RA33) were analyzed by ELISA. RF was detected by transmission immunoturbidimetry. Mann-Whitney U tests and Kruskal-Wallis tests compared differences among groups. Spearman's rank correlation analysis determined the relationship between biomarkers. Receiver-operator characteristic (ROC) curves were generated, and diagnostic performance was assessed by area under the curve (AUC), as well as specificity, sensitivity, likelihood ratios (LR). Results Median serum PCT concentrations were significantly higher (p < 0.0001) in patients with early RA (0.065 ng/ml) when compared with healthy controls (0.024 ng/ml), and patients with osteoarthritis (0.025 ng/ml). When compared with gouty arthritis (GA) controls (0.072 ng/ml) and systemic lupus erythematosus (SLE) controls (0.093 ng/ml), median serum PCT concentrations were not significant in patients with early RA (0.065 ng/ml). Median serum CT concentrations were significantly lower (p < 0.0001) in patients with early RA (0.880 pg/ml) compared with healthy controls (3.159 pg/ml), patients with SLE (2.480 pg/ml), and patients with GA (2.550 pg/ml). When compared with osteoarthritis controls (0.586 pg/ml), median serum CT concentrations were not significant in patients with early RA (0.880 pg/ml). ROC curve analysis comparing early RA with healthy controls demonstrated that the AUC of RF, anti-CCP, and anti-RA33 were 0.66, 0.73, and 0.64, respectively; the additions of PCT and CT further improved the diagnostic ability of early RA with the AUC of 0.97, 0.98, and 0.97, respectively (p < 0.01). The sensitivities of RF, anti-CCP, and anti-RA33 for early RA were 33.33%, 44.74%, and 58.33%, respectively, and the additions of PCT and CT showed very high sensitivities of 83.33%, 92.11%, and 87.50%. The high-value groups of PCT moderately correlated with the anti-RA33 levels (r = 0.417, p < 0.05). CT had no significant correlation with disease duration, radiographic progression, or clinical/serological variables, such as ESR levels, CRP levels, RF, anti-CCP, and anti-RA33 levels in early RA. Conclusions Serum PCT and CT combined with clinically available RA-related biomarkers could further improve the diagnostic efficiency of early RA.
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Roth CA, Da Lomba T, Dadwani R, Dahm J, Strelzow J. Analysis of factors that drives arthrocentesis for suspected septic joint. Ther Adv Musculoskelet Dis 2021; 13:1759720X211002582. [PMID: 33995601 PMCID: PMC8072930 DOI: 10.1177/1759720x211002582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: This study aims to develop a simple diagnostic criterion that could be used to justify arthrocentesis in adults with suspected septic arthritis. Our hypothesis is that no single factor will be predictive for a decision to aspirate a questionable septic joint. Methods: A prospective observational cohort study was performed at a Level 1 Trauma institution including all patients over the age of 18 years referred to Orthopaedics through the Emergency Department or inpatient orthopaedic consultations for a suspected septic joint. Patient information recorded was age, laboratory markers (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, physical exam findings (fever, pain with range-of-motion), and presence of smoking, diabetes, end-stage renal disease (ESRD) on dialysis, and body mass index > 30. Continuous data was analyzed using logistic regression, and nominal data was analyzed using a two-tailed Fisher’s exact test. Results: A total of 128 patients met inclusion criteria for this study; 71 patients underwent arthrocentesis for suspected septic joint. On analysis of risk factors, the demographics, laboratory markers, physical exam and comorbidities were not significant between the two groups. On subset analysis of the septic joints, we found the only risk factor to be significantly predictive of whether a joint was septic was the presence of ESRD on dialysis (p = 0.042). Conclusion: Past data have looked solely at predictive risk factors for septic arthritis; however, this study aims to predict what drives physicians towards aspirating a joint even before it is determined to be septic. We found no single factor was predictive of joint aspiration. Only ESRD on dialysis is predictive of whether a joint with concern for septic arthritis would ultimately be septic in our institution. The decision to aspirate continues to be best determined by clinician judgment in light of experience and available clinical information.
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Affiliation(s)
- Cameron A Roth
- Department of Orthopaedic Surgery, University of Chicago, 5841 S. Maryland Ave, MC 3079, Chicago, IL, 60637, USA
| | - Tony Da Lomba
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Rahul Dadwani
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - James Dahm
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL, USA
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12
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Turner EHG, Lang MDH, Spiker AM. A narrative review of the last decade's literature on the diagnostic accuracy of septic arthritis of the native joint. J Exp Orthop 2021; 8:3. [PMID: 33423115 PMCID: PMC7797010 DOI: 10.1186/s40634-020-00315-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/25/2020] [Indexed: 12/28/2022] Open
Abstract
While septic arthritis can be a straightforward diagnosis, there are many cases when the diagnosis is difficult to make. The aim of this study was to review the last decade’s literature on the diagnosis of septic arthritis of the native joint in adults and summarize that data in an easy to follow algorithm to clarify how the last decade’s data may be applied to the diagnosis of septic arthritis. A search of PubMed and CINAHL databases was performed to identify studies that compared results diagnostic tests for septic arthritis. We cross referenced this search with searches of additional databases (including Cochrane Library and Scopus) to confirm similar search results. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used by two independent reviewers to determine study quality and risk of bias. After applying inclusion and exclusion criteria to the initial search, 15 papers total were included for analysis. All 15 papers were of high quality methodology as determined by the QUADAS tool. There were 26 different diagnostics tests used across the 15 papers included for review. Three of those diagnostic tests had specificity and sensitivity greater than 80%. Eight tests had a positive likelihood ratio of ≥10. Three tests had a negative likelihood ratio < 0.1, indicating that they may help to rule out septic arthritis. A flowchart was created to summarize the findings of our review, so that physicians may reference this visual in making the appropriate diagnosis when the commonly held standards of cell count, gram stain, and culture aren’t enough to make the diagnosis.
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Affiliation(s)
- Elizabeth H G Turner
- Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, UW Health at The American Center, 4602 Eastpark Blvd., Madison, WI, 53718, USA
| | - Mc Daniel H Lang
- Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, UW Health at The American Center, 4602 Eastpark Blvd., Madison, WI, 53718, USA
| | - Andrea M Spiker
- Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, UW Health at The American Center, 4602 Eastpark Blvd., Madison, WI, 53718, USA.
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Berthoud O, Coiffier G, Albert JD, Gougeon-Jolivet A, Goussault C, Bendavid C, Guggenbuhl P. Performance of a new rapid diagnostic test the lactate/glucose ratio of synovial fluid for the diagnosis of septic arthritis. Joint Bone Spine 2020; 87:343-350. [PMID: 32234547 DOI: 10.1016/j.jbspin.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of the synovial lactate, glucose and lactate/glucose ratio assay for the diagnosis of septic arthritis. METHODS In this monocentric cross-sectional study, synovial fluids were prospectively obtained from patients with acute joint effusion (<30 days) on native joint. Septic arthritis was defined using Newman's criteria. To evaluate diagnostic performance, Receiver Operating Characteristic (ROC) curves with Area under the curve (AUC), Sensitivities (Se), Specificities (Sp), LR+ their 95% confidence intervals were calculated. Synovial fluid cultures with gram staining, crystal analyses, synovial fluid white blood cell counts (WBC), lactate and glucose assays were performed. RESULTS A total of 233 synovial fluids were included. 25 patients had septic arthritis and 208 had non-septic arthritis (104 crystal-induced arthritis, 15 RA, 8 SpA, 6 reactive arthritis, and 75 acute arthritis of undifferentiated origin). Synovial lactate/glucose ratio performed higher than the synovial lactate or glucose assay separately (AUC: 0.859 [0.772-0.945]). Best synovial lactate/glucose ratio threshold to differentiate septic arthritis from non-septic arthritis was 5 Se 52% [0.34-0.7], Sp 98.1% [0.95-0.99], LR+ 27.0[9.50-76.00]). CONCLUSION The diagnostic performance of synovial lactate/glucose allows septic arthritis to be effectively and very quickly distinguished from other types of arthritis.
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Affiliation(s)
- Olivia Berthoud
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; UMR Inserm U 1241, University of Rennes, Rennes, France
| | - Jean-David Albert
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; UMR Inserm U 1241, University of Rennes, Rennes, France
| | - Anne Gougeon-Jolivet
- UMR Inserm U 1241, University of Rennes, Rennes, France; Bacteriology Laboratory, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Claire Goussault
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Claude Bendavid
- Department of Biochemistry, Rennes University Hospital - Pontchaillou, 2, rue Henri-LeGuilloux, 35000 Rennes, France; Inserm unité mixte de recherche 991, 35043 Rennes, France
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Lapić I, Padoan A, Bozzato D, Plebani M. Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation. Am J Clin Pathol 2020; 153:14-29. [PMID: 31598629 DOI: 10.1093/ajcp/aqz142] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in acute inflammation. METHODS PubMed and Scopus were searched and eligible articles were screened for methodologic quality using the Quality Assessment of the Diagnostic Accuracy Studies-Revised. Meta-analysis with calculation of pooled sensitivity (Se), specificity (Sp), and summary area under the curve (SAUC) was performed. RESULTS Twenty-nine studies were eligible. Se and Sp were 0.78 and 0.68 (SAUC = 0.80) for ESR in orthopedic infections and 0.79 and 0.70 (SAUC = 0.81) for CRP. For the diagnosis of other various inflammatory conditions, CRP had a superior diagnostic accuracy, with a Se of 0.86, Sp of 0.67, and SAUC of 0.86 compared with a Se of 0.77, Sp of 0.59, and SAUC of 0.75 for ESR. Heterogeneity among studies was elevated. Combined use of ESR and CRP yielded higher diagnostic accuracy. CONCLUSIONS Despite observed heterogeneity among studies, ESR and CRP have a similar diagnostic accuracy in assessment of inflammation, especially in orthopedic conditions.
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Affiliation(s)
- Ivana Lapić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Andrea Padoan
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Dania Bozzato
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine–DIMED, University of Padova, Padova, Italy
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Ben-Zvi L, Sebag D, Izhaki G, Katz E, Bernfeld B. Diagnosis and Management of Infectious Arthritis in Children. Curr Infect Dis Rep 2019; 21:23. [PMID: 31144135 DOI: 10.1007/s11908-019-0678-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Septic arthritis is limb and life-threatening condition which necessitates rapid diagnosis and treatment. It is important for a medical practitioner to be familiar with this condition. This review summarizes the epidemiology, risk factors, diagnosis and differential diagnosis, complications, as well as treatment and the following-up of this condition. RECENT FINDINGS Different causative organisms require unique diagnostic and treatment approaches. Establishing the diagnosis often requires multiple diagnostic modalities, some of which are new and innovative. Differential diagnosis requires excluding non-infectious inflammatory causes, such as reactive arthritis, juvenile rheumatoid arthritis, transient synovitis, and pericapsular pyomyositis. There is no consensus regarding the nature or duration of pharmacological or surgical treatment. Treatment includes administration of appropriate antimicrobial therapy and including the use of steroids and drainage. The most common complications are osteonecrosis of the femoral head and chronic osteomyelitis. Complications of septic arthritis are mostly due to a missed diagnosis. Further studies are required to better evaluate the diagnostic and therapeutic choice.
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Affiliation(s)
- Lior Ben-Zvi
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel.
| | - Diklah Sebag
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Izhaki
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Eldad Katz
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Benjamin Bernfeld
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
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16
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Value of serum procalcitonin for the diagnosis of bacterial septic arthritis in daily practice in rheumatology. Clin Rheumatol 2019; 38:2265-2273. [PMID: 30989408 DOI: 10.1007/s10067-019-04542-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION/OBJECTIVES Septic arthritis is a diagnostic and therapeutic emergency because of a high morbidity and mortality. Nevertheless, the etiologic diagnosis is often difficult. The aim of our study was to determine if serum procalcitonin was a discriminatory biomarker in case of arthritis of undetermined etiology. METHOD Patients were separated in five groups: gouty arthritis, calcium pyrophosphate deposition arthritis, osteoarthritis or post-traumatic arthritis ("mechanical" arthritis), chronic inflammatory rheumatic arthritis, and septic arthritis. Levels of serum white blood cells, C-reactive protein and procalcitonin were measured. RESULTS Ninety-eight patients were included: 18 in the "gout" group, 26 in the "calcium pyrophosphate deposition arthritis" group, 16 in the mechanical group, 18 in the "chronic inflammatory rheumatic" group, and 20 in the "sepsis" group. The area under the receiver operating characteristic curve of white blood cells, C-reactive protein, and procalcitonin levels to diagnose a septic arthritis were 0.69 (IC95% 0.55-0.83), 0.82 (IC95% 0.73-0.91), and 0.87 (IC95% 0.76-0.98) respectively. For a cutoff of 0.5 ng/ml, procalcitonin sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 65%, 91%, 65%, 91%, 7.2, and 0.4, respectively. Serum C-reactive protein and procalcitonin levels were correlated, were not different in sepsis or gout groups, and were higher in non-septic arthritis with poly-arthritis than with mono-arthritis (p < 0.05). CONCLUSIONS Serum procalcitonin is a useful biomarker in arthritis management with diagnosis performances higher than those of other biomarkers (white blood cells, C-reactive protein).Key Points• Diagnostic performances of serum procalcitonin level in septic arthritis are higher than those of serum C-reactive protein or white blood cells levels.• Serum procalcitonin levels are not different in septic arthritis or gouty arthritis.• Serum procalcitonin levels are higher in non-septic arthritis with poly-arthritis than with mono-arthritis.
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17
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Zhang J, Zhao C, Wu T, Su J, Wu X, Liu J, Zhu J, Zhou B. Procalcitonin may not be a differential diagnostic marker for bacterial infection in febrile patients with chronic gouty arthritis. J Int Med Res 2018; 46:4197-4206. [PMID: 30111212 PMCID: PMC6166349 DOI: 10.1177/0300060518791093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/05/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to examine the diagnostic value of serum procalcitonin (PCT) levels for identifying bacterial infection in febrile patients with chronic gouty arthritis. Methods Sixty-six febrile patients with chronic gouty arthritis were divided into non-bacterial infection (n = 45) and bacterial infection groups (n = 21). PCT levels were measured by an immunoassay. Other laboratory parameters, including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), and the neutrophil ratio were extracted from medical records. Receiver-operating characteristic curves were used to evaluate diagnostic values and accuracy. Results Serum PCT levels, the ESR, CRP levels, WBC count, and neutrophil ratio were not different between the groups. To assess the ability of PCT to discriminate bacterial infection in febrile patients with chronic gouty arthritis (cut-off value: 0.5 ng/mL), the sensitivity and specificity of PCT were 22.2% and 61.5%, respectively. The area under the curve (AUC) of serum PCT levels was 0.526. The AUCs of related inflammatory indicators were 0.530 for the ESR, 0.635 for CRP, 0.577 for the WBC count, and 0.712 for the neutrophil ratio. Conclusion Serum PCT levels may not be a good biomarker for bacterial infection in febrile patients with chronic gouty arthritis.
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Affiliation(s)
- Jing Zhang
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
| | - Cheng Zhao
- Department of Rheumatology and Immunology, the Affiliated Drum
Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Tong Wu
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
| | - Jiang Su
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
| | - Xiaodan Wu
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
| | - Jian Liu
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
| | - Jing Zhu
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
| | - Bin Zhou
- Department of Rheumatology and Immunology, Sichuan Academy of
Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,
China
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18
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Boff D, Crijns H, Teixeira MM, Amaral FA, Proost P. Neutrophils: Beneficial and Harmful Cells in Septic Arthritis. Int J Mol Sci 2018; 19:E468. [PMID: 29401737 PMCID: PMC5855690 DOI: 10.3390/ijms19020468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Septic arthritis is an inflammatory joint disease that is induced by pathogens such as Staphylococcus aureus. Infection of the joint triggers an acute inflammatory response directed by inflammatory mediators including microbial danger signals and cytokines and is accompanied by an influx of leukocytes. The recruitment of these inflammatory cells depends on gradients of chemoattractants including formylated peptides from the infectious agent or dying cells, host-derived leukotrienes, complement proteins and chemokines. Neutrophils are of major importance and play a dual role in the pathogenesis of septic arthritis. On the one hand, these leukocytes are indispensable in the first-line defense to kill invading pathogens in the early stage of disease. However, on the other hand, neutrophils act as mediators of tissue destruction. Since the elimination of inflammatory neutrophils from the site of inflammation is a prerequisite for resolution of the acute inflammatory response, the prolonged stay of these leukocytes at the inflammatory site can lead to irreversible damage to the infected joint, which is known as an important complication in septic arthritis patients. Thus, timely reduction of the recruitment of inflammatory neutrophils to infected joints may be an efficient therapy to reduce tissue damage in septic arthritis.
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Affiliation(s)
- Daiane Boff
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| | - Helena Crijns
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| | - Mauro M Teixeira
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Flavio A Amaral
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Paul Proost
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
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Alvand A, Rezapoor M, Parvizi J. The Role of Biomarkers for the Diagnosis of Implant-Related Infections in Orthopaedics and Trauma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 971:69-79. [PMID: 28243953 DOI: 10.1007/5584_2017_11] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diagnosis of implant-related (periprosthetic joint) infections poses a major challenge to infection disease physicians and orthopaedic surgeons. Conventional diagnostic tests continue to suffer from issues of accuracy and feasibility. Biomarkers are used throughout medicine for diagnostic and prognostic purposes, as they are able to objectively determine the presence of a disease or a biological state. There is increasing evidence to support the measurement of specific biomarkers in serum and/or synovial fluid of patients with suspected periprosthetic joint infections. Promising serum biomarkers include interleukin (IL)-4, IL-6, tumour necrosis factor (TNF)-α, procalcitonin, soluble intercellular adhesion molecule 1 (sICAM-1), and D-dimer. In addition to c-reactive protein and leucocyte esterase, promising biomarkers that can be measured in synovial fluid include antimicrobial proteins such as human β-defensin (HBD)-2 and human β-defensin (HBD)-3, and cathelicidin LL-37, as well as several interleukins such as IL-1β, IL-6, IL-8, IL-17, TNF- α, interferon-δ, and vascular endothelial growth factor.
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Affiliation(s)
- Abtin Alvand
- The Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Maryam Rezapoor
- The Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Javad Parvizi
- The Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
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Zhao J, Zhang S, Zhang L, Dong X, Li J, Wang Y, Yao Y. Serum procalcitonin levels as a diagnostic marker for septic arthritis: A meta-analysis. Am J Emerg Med 2017. [PMID: 28623003 DOI: 10.1016/j.ajem.2017.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the value of serum procalcitonin (PCT) levels as a diagnostic marker for septic arthritis (SA) via meta-analysis. METHODS We searched PubMed, Embase and the Cochrane Library, as well as the reference lists of relevant articles, for studies published up to May 21, 2015 and did not impose language restrictions. We selected original studies reporting the usefulness of PCT or C-reactive protein (CRP) as a diagnostic marker for SA. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Prespecified subgroup analyses and meta-regression analyses were also performed. RESULTS This meta-analysis comprised 10 studies including 838 patients. The overall sensitivity of serum PCT levels for the diagnosis of SA in these studies was 0.54 (95% CI, 0.41-0.66), and the specificity of PCT was 0.95 (95% CI, 0.87-0.98). The positive likelihood ratio (LR) was 10.97 (95% CI, 4.65-25.89); the negative LR was 0.49 (95% CI, 0.38-0.62); and the area under ROC curve (AUROC) was 0.82 (95% CI, 0.78-0.85). Six studies also examined the usefulness of CRP levels as a marker for the diagnosis of SA. The sensitivity and specificity of CRP were 0.45 (95% CI, 0.35-0.55) and 0.079 (95% CI, 0.0.021-0.25), respectively, and the positive LR, negative LR and AUROC curve were 0.48 (95% CI, 0.39-0.61), 6.79 (95% CI, 2.04-23.81), and 0.30 (95% CI, 0.26-0.34), respectively. CONCLUSION PCT is more valuable than CRP for distinguishing SA from non-SA.
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Affiliation(s)
- Jingyi Zhao
- Department of Functional Center, Chengde Medical College, Chengde 067000, China
| | - Shufeng Zhang
- Institute of Chinese Materia Medica, Chengde Medical College, Chengde 067000, China
| | - Lei Zhang
- Department of Community Nursing, Chengde Medical College, Chengde 067000, China
| | - Xianhui Dong
- School of Basic Medicine, Hebei University of Tranditional Chinese Medicine, Shijiazhuang 050200, China
| | - Jianhui Li
- Department of Preventive Medicine, Chengde Medical College, Chengde 067000, China
| | - Ying Wang
- Department of Pharmacy, Affiliated Hospital of Chengde Medical College, Chengde 067000, China
| | - Yinhui Yao
- Department of Pharmacy, Affiliated Hospital of Chengde Medical College, Chengde 067000, China.
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Omar M, Reichling M, Liodakis E, Ettinger M, Guenther D, Decker S, Krettek C, Suero EM, Mommsen P. Rapid exclusion of bacterial arthritis using a glucometer. Clin Rheumatol 2016; 36:591-598. [PMID: 27071629 DOI: 10.1007/s10067-016-3255-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
Abstract
Bacterial arthritis is a medical emergency. However, prompt diagnosis and differentiation from non-infectious diseases are challenging. As bacterial metabolism leads to glucose reduction, measurement of synovial fluid glucose seems to be a promising diagnostic approach. The purpose of this study was to determine whether synovial fluid glucose levels could be accurately measured by using a glucometer and to evaluate its diagnostic accuracy in diagnosing bacterial arthritis compared to currently available markers. In a prospective diagnostic study, 102 consecutive patients with atraumatic joint effusion were included. Synovial fluid glucose concentrations were determined using both glucometer and automated analyzer respectively. Synovial fluid culture, crystal analysis, and synovial cell analysis were performed. Blood samples were taken for blood cultures, analyses of serum infection markers, and serum glucose. There was a high correlation between synovial fluid glucose measured by the glucometer and the automated analyzer (r 2 = 0.92). According to the receiver operating characteristic curve, a threshold of 1.4 mmol/l had a sensitivity of 100 % (95 % CI 78.2-100 %), a specificity of 92.0 % (95 % CI 84.1-96.7 %), a positive predictive value of 68.2 % (95 % CI 45.1-86.1 %), and a negative predictive value of 100 % (95 % CI 95.5-100 %). These results suggest that synovial fluid glucose concentrations could be reliably measured using a glucometer. Due to its simplicity, this test has the potential to be an adjunct in the diagnostic cascade of bacterial arthritis.
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Affiliation(s)
- Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Moritz Reichling
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Max Ettinger
- Orthopedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Daniel Guenther
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sebastian Decker
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Eduardo M Suero
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Philipp Mommsen
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Colavite PM, Ishikawa LLW, Zorzella-Pezavento SFG, Oliveira LRCD, França TGD, da Rosa LC, Chiuso-Minicucci F, Vieira AE, Francisconi CF, da Cunha MDLRDS, Garlet GP, Sartori A. Cloxacillin control of experimental arthritis induced by SEC(+) Staphylococcus aureus is associated with downmodulation of local and systemic cytokines. Cell Microbiol 2015; 18:998-1008. [PMID: 26695535 DOI: 10.1111/cmi.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 11/23/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Abstract
Staphylococcus aureus is the most common agent of septic arthritis (SA) that is a severe, rapidly progressive and erosive disease. In this work we investigated the clinical, histopathological and immunological characteristics of the SA triggered by an enterotoxin C producer S. aureus strain. The effect of a β-lactamic antibiotic over disease evolution and cytokine production was also evaluated. After confirmation that ATCC 19095 SEC(+) strain preserved its ability to produce enterotoxin C, this bacteria was used to infect C57BL/6 male mice. Body weight, clinical score and disease prevalence were daily evaluated during 14 days. Cytokine production by splenocytes, cytokine mRNA expression in arthritic lesions, transcription factors mRNA expression in inguinal lymph nodes and histopathological analysis were performed 7 and 14 days after infection. ATCC 19095 SEC(+) strain caused a severe arthritis characterized by weight loss, high clinical scores and a 100% disease prevalence. Histopathological analysis revealed inflammation, pannus formation and bone erosion. Arthritis aggravation was associated with elevated production of pro-inflammatory cytokines, higher local mRNA expression of these cytokines and also higher mRNA expression of T-bet, ROR-γ and GATA-3. Disease control by cloxacillin was associated with decreased production of pro-inflammatory cytokines but not of IL-10. These findings indicate that the ATCC 19095 SEC(+) strain is able to initiate a severe septic arthritis in mice associated with elevated cytokine production that can be, however, controlled by cloxacillin.
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Affiliation(s)
- Priscila Maria Colavite
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Larissa Lumi Watanabe Ishikawa
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - Larissa Ragozo Cardoso de Oliveira
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Thaís Graziela Donegá França
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Larissa Camargo da Rosa
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Fernanda Chiuso-Minicucci
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Andreia Espíndola Vieira
- Department of Biological Sciences, School of Dentistry of Bauru, São Paulo University-FOB/USP, Bauru, São Paulo, Brazil
| | - Carolina Fávaro Francisconi
- Department of Biological Sciences, School of Dentistry of Bauru, São Paulo University-FOB/USP, Bauru, São Paulo, Brazil
| | | | - Gustavo Pompermaier Garlet
- Department of Biological Sciences, School of Dentistry of Bauru, São Paulo University-FOB/USP, Bauru, São Paulo, Brazil
| | - Alexandrina Sartori
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
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Liu W, Sigdel KR, Wang Y, Su Q, Huang Y, Zhang YL, Chen J, Duan L, Shi G. High Level Serum Procalcitonin Associated Gouty Arthritis Susceptibility: From a Southern Chinese Han Population. PLoS One 2015; 10:e0132855. [PMID: 26182343 PMCID: PMC4504503 DOI: 10.1371/journal.pone.0132855] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/19/2015] [Indexed: 12/25/2022] Open
Abstract
Objectives To study the serum Procalcitonin (PCT) level in inflammatory arthritis including gouty arthritis (GA), Rheumatoid arthritis (RA), and ankylosing spondylitis (AS) without any evidence of infection were evaluated the possible discriminative role of PCT in gouty arthritis susceptibility in southern Chinese Han Population. Material and Methods From Feb, 2012 to Feb, 2015, 51 patients with GA, 37 patients with RA, 41 patients with AS and 33 healthy control were enrolled in this study with no evidence of infections. The serum level of PCT (normal range < 0.05 ng/ml) was measured by electrochemiluminescence immunoassay (ECLIA). Disease activity was determined by scores of VAS (4.07 ± 1.15), DAS28 (4.97 ± 1.12), and ASDAS (2.97 ± 0.81) in GA, RA and AS groups respectively. Other laboratory parameters such as, serum creatinine (CRE), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), uric acid (UA) and white blood cells (WBC) were extracted from medical record system. Results Serum PCT level was predominantly higher in gouty arthritis than in RA and AS patients, especially in the GA patients with tophi. PCT was significantly positively correlated with VAS, CRP and ESR in gouty arthritis and CRP in AS. PCT also had positive correlation-ship with ESR, DAS28 and ASDAS in RA and AS patients respectively, but significant differences were not observed. Conclusions These data suggested that PCT is not solely a biomarker for infection, but also an indicator in inflammatory arthritis, especially in gouty arthritis.
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MESH Headings
- Adult
- Aged
- Arthritis, Gouty/blood
- Arthritis, Gouty/diagnosis
- Arthritis, Gouty/ethnology
- Arthritis, Gouty/pathology
- Arthritis, Rheumatoid/blood
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/ethnology
- Arthritis, Rheumatoid/pathology
- Asian People
- Biomarkers/blood
- Blood Sedimentation
- C-Reactive Protein/metabolism
- Calcitonin/blood
- Calcitonin Gene-Related Peptide
- Case-Control Studies
- Creatinine/blood
- Disease Susceptibility
- Female
- Humans
- Leukocyte Count
- Male
- Middle Aged
- Protein Precursors/blood
- Severity of Illness Index
- Spondylitis, Ankylosing/blood
- Spondylitis, Ankylosing/diagnosis
- Spondylitis, Ankylosing/ethnology
- Spondylitis, Ankylosing/pathology
- Uric Acid/blood
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Affiliation(s)
- Wen Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Keshav Raj Sigdel
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Ying Wang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Qun Su
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yan Huang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yan Lin Zhang
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jie Chen
- Department of Immunology, College of Medicine, Xiamen University, Fujian, China
| | - Lihua Duan
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
- * E-mail: (LHD); (GXS)
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
- * E-mail: (LHD); (GXS)
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24
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Septic arthritis in immunocompetent and immunosuppressed hosts. Best Pract Res Clin Rheumatol 2015; 29:275-89. [PMID: 26362744 DOI: 10.1016/j.berh.2015.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/08/2015] [Indexed: 12/12/2022]
Abstract
Septic arthritis has long been considered an orthopedic emergency. Historically, Neisseria gonorrhoeae and Staphylococcus aureus have been the most common causes of septic arthritis worldwide but in the modern era of biological therapy and extensive use of prosthetic joint replacements, the spectrum of microbiological causes of septic arthritis has widened considerably. There are also new approaches to diagnosis but therapy remains a challenge, with a need for careful consideration of a combined medical and surgical approach in most cases.
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25
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Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis. CAN J EMERG MED 2015; 17:403-10. [PMID: 25819038 DOI: 10.1017/cem.2014.56] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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 (p50,000/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 crystal-induced 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/mm3 (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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26
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Klatte TO, Lehmann W, Rueger JM. [Primary meningococcal infection of the knee. A rare cause of septic arthritis]. Unfallchirurg 2015; 118:885-9. [PMID: 25648871 DOI: 10.1007/s00113-014-2716-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article presents a case of primary septic arthritis of the knee due to serogroup C Neisseria meningitidis. A 19-year-old female presented to the emergency department with a painless but swollen knee joint which had started 2 days previously and fever (38 °C). The patient reported that she suddenly felt unwell 3 days ago and developed a rush at the same time which had almost disappeared when arrived at the emergency department. The patient was admitted to hospital and an antibiotic therapy was started with sulbactam and ampicillin. Initially, incubation of synovial fluid over the next 3 days did not result in detection of any pathogens; therefore, a reactive arthritis was assumed until Neisseria meningitidis was detected in cultures of the synovial fluid. Therapy was then switched to antibiotic therapy with ceftriaxon and arthroscopic irrigation was performed. The patient quickly recovered and was discharged from hospital after 14 days. This case example shows the difficulties of the clinical and microbiological diagnostics of a primary septic meningococcal arthritis; however, the treatment is relatively easy and mostly successful compared to other forms of bacterial joint infection.
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Affiliation(s)
- T O Klatte
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - W Lehmann
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - J M Rueger
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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27
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Paosong S, Narongroeknawin P, Pakchotanon R, Asavatanabodee P, Chaiamnuay S. Serum procalcitonin as a diagnostic aid in patients with acute bacterial septic arthritis. Int J Rheum Dis 2014; 18:352-9. [DOI: 10.1111/1756-185x.12496] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Suangkanok Paosong
- Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | | | - Rattapol Pakchotanon
- Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Paijit Asavatanabodee
- Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Sumapa Chaiamnuay
- Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
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28
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Shaikh MM, Hermans LE, van Laar JM. Is serum procalcitonin measurement a useful addition to a rheumatologist's repertoire? A review of its diagnostic role in systemic inflammatory diseases and joint infections. Rheumatology (Oxford) 2014; 54:231-40. [DOI: 10.1093/rheumatology/keu416] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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29
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Chen AF, Parvizi J. Emerging Technologies for the Diagnosis of Periprosthetic Infection. JBJS Rev 2014; 2:01874474-201408000-00001. [DOI: 10.2106/jbjs.rvw.m.00121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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30
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Wang C, Zhong DA, Liao Q, Kong L, Liu A, Xiao H. Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis. Exp Ther Med 2014; 8:1075-1080. [PMID: 25187799 PMCID: PMC4151653 DOI: 10.3892/etm.2014.1870] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/17/2014] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - DA Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Qiande Liao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lingyu Kong
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ansong Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Han Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Shokrollahi MR, Noorbakhsh S, Aliakbari M, Tabatabaei A. Searching the Staphylococcal Superantigens: Enterotoxins A, B, C, and TSST1 in Synovial Fluid of Cases With Negative Culture Inflammatory Arthritis. Jundishapur J Microbiol 2014; 7:e11647. [PMID: 25368802 PMCID: PMC4216582 DOI: 10.5812/jjm.11647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 11/02/2013] [Accepted: 11/11/2013] [Indexed: 11/20/2022] Open
Abstract
Background: Accurate and rapid diagnosis of bacterial arthritis is not always possible in unvaccinated (Streptococcus pneumoniae and Haemophilus influenzae type B) children in Iran. Objectives: Searching the staphylococcal superantigen (entrotoxin A, B, C and TSST1) in synovial fluid of cases with inflammatory arthritis. Patients and Methods: This cross sectional study was implemented in the pediatric and orthopedic wards, Rasoul Akram Hospital, Tehran, Iran (2008-2010) upon synovial fluid (SF) aspirated from 66 children (five months to 16 years; mean age 11 ± 3.8 years) with monoarthritis. Staphylococcal supperantigens (enterotoxins A, B, C, TSST1) were assessed by Enzyme-linked immunosorbent assay (ELISA) in synovial fluid of cases with inflammatory arthitis. Staphylococcal superantigens compared between cases with positive and negative Staphylococcus aureus culture (P < 0.05 was significant) Results: S. aureus was the most common cause of septic arthritis. Positive S. aureus culture in SF was reported in 10.6% (7/66) of the cases. Enterotoxin A was the least common type of superantigens found even in SF negative culture; 47% of the cases had one or more staphylococcal superantigens. Enterotoxin A was the least common type in SF; there was poor agreement between positive culture for S. aureus and presence of enterotoxins B, C, and TSST1 in SF, and intermediate agreement (KAPPA Index = 0.67) for enterotoxin A. Conclusions: A possible role (%47) for staphylococcal toxins was defined even in SF negative cultures obtained from monoarthritis cases. Failure in isolation of organisms might be due to natural un-growth of microorganism in synovial fluid, and previous antibiotic usage or low technical methods. It could not be determined from the data obtained in the current investigation whether or not staphylococcal toxins (superantigens) play a pathogenic role without direct invasion of the organism. It is recommend to use complementary methods for searching the S. aureus superantigens in future studies.
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Affiliation(s)
| | - Samileh Noorbakhsh
- Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Samileh Noorbakhsh, Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166525328, Fax: +98-2166516049, E-mail:
| | - Mohammad Aliakbari
- Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran
| | - Azardokht Tabatabaei
- Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran
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Saeed K, Ahmad N, Dryden M. The value of procalcitonin measurement in localized skin and skin structure infection, diabetic foot infections, septic arthritis and osteomyelitis. Expert Rev Mol Diagn 2013; 14:47-54. [DOI: 10.1586/14737159.2014.864238] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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