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Dey M, Al-Attar M, Peruffo L, Coope A, Zhao SS, Duffield S, Goodson N. Assessment and diagnosis of the acute hot joint: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:1740-1756. [PMID: 36264140 PMCID: PMC10152293 DOI: 10.1093/rheumatology/keac606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential for avoiding unnecessary antibiotics and hospital admissions. We evaluated the utility of synovial fluid (SF) and serum tests in differentiating causes of acute hot joints. METHODS We performed a systematic literature review of diagnostic testing for acute hot joints. Articles were included if studying ≥1 serum or SF test(s) for an acute hot joint, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. The following were recorded for each test, threshold and diagnosis: sensitivity, specificity, positive/negative predictive values and likelihood ratios. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity, and areas under the curves. RESULTS A total of 8443 articles were identified, and 49 were ultimately included. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most had been tested at multiple diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and thresholds, meta-analysis was possible for only eight SF tests, all differentiating septic from non-septic joints. Of these, leucocyte esterase had the highest pooled sensitivity [0.94 (0.70, 0.99)] with good pooled specificity [0.74 (0.67, 0.81)]. CONCLUSION Our review demonstrates many single tests, individually with diagnostic utility but suboptimal accuracy for exclusion of native joint infection. A combination of several tests with or without a stratification score is required for optimizing rapid assessment of the hot joint.
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Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Rheumatology, Queen Elizabeth Hospital, London, UK
| | | | - Leticia Peruffo
- School of Medicine, Federal University of Parana, Curitiba, Brazil
| | - Ashley Coope
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sizheng Steven Zhao
- Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Stephen Duffield
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Nicola Goodson
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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2
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Liu D, Xiao WF, Li YS. The Diagnostic and Prognostic Value of Synovial Fluid Analysis in Joint Diseases. Methods Mol Biol 2023; 2695:295-308. [PMID: 37450127 DOI: 10.1007/978-1-0716-3346-5_20] [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] [Indexed: 07/18/2023]
Abstract
Liquid biopsy is an emergent test method for the diagnosis and prognosis in the clinic. Joint fluid, also known as synovial fluid, contains a variety of bioactive constituents that can be selectively detected and further evaluated in a convenient fashion. Therefore, synovial fluid analysis functions as a specific form of liquid biopsy and plays a vital role in numerous joint diseases. In spite of the component analysis of aspirated synovial fluid beingconsidered as the gold standard for diagnosis of joint infections, biopsy of joint fluid benefits the initial diagnosis and long-term prognosis of degenerative, inflammatory, autoimmune, traumatic, congenital, and even neoplastic joint diseases. The convenience and accuracy for disease evaluation are significantly elevated as a result of the combination of synovial fluid analysis and other novel clinical technologies. In this review, we shed light on the latent role of synovial fluid in the diagnosis and prognosis of articular diseases and proposed future prospects for relevant research in this field.
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Affiliation(s)
- Di Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wen-Feng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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3
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Kwon H, Yu KE, Cahill SV, Alder KD, Dussik CM, Kim S, Sharma L, Back J, Oh I, Lee FY. Concurrent targeting of glycolysis in bacteria and host cell inflammation in septic arthritis. EMBO Mol Med 2022; 14:e15284. [PMID: 36354099 PMCID: PMC9728052 DOI: 10.15252/emmm.202115284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Intracellular infiltration of bacteria into host cells complicates medical and surgical treatment of bacterial joint infections. Unlike soft tissue infections, septic arthritis and infection-associated inflammation destroy cartilage that does not regenerate once damaged. Herein, we show that glycolytic pathways are shared by methicillin-resistant Staphylococcus aureus (MRSA) proliferation and host inflammatory machinery in septic arthritis. MRSA readily penetrates host cells and induces proinflammatory cascades that persist after conventional antibiotic treatment. The glycolysis-targeting drug dimethyl fumarate (DMF) showed both bacteriostatic and anti-inflammatory effects by hindering the proliferation of intracellular MRSA and dampening excessive intraarticular inflammation. Combinatorial treatment with DMF and vancomycin further reduced the proliferation and re-emergence of intracellular MRSA. Combinatorial adjuvant administration of DMF with antibiotics alleviated clinical symptoms of septic arthritis by suppressing bacterial burden and curbing inflammation to protect cartilage and bone. Our results provide mechanistic insight into the regulation of glycolysis in the context of infection and host inflammation toward development of a novel therapeutic paradigm to ameliorate joint bioburden and destruction in septic arthritis.
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Affiliation(s)
- Hyuk‐Kwon Kwon
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Kristin E Yu
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA
| | - Sean V Cahill
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryWashington University School of MedicineSt. LouisMOUSA
| | - Kareme D Alder
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA
| | - Christopher M Dussik
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopaedics and RehabilitationUniversity of RochesterRochesterNYUSA
| | - Sang‐Hun Kim
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Jungho Back
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
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4
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Han T, Cong H, Shen Y, Yu B. Recent advances in detection technologies for COVID-19. Talanta 2021; 233:122609. [PMID: 34215093 PMCID: PMC8196236 DOI: 10.1016/j.talanta.2021.122609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022]
Abstract
Corona Virus Disease 2019 (COVID-19) is a highly infectious respiratory illness that was caused by the SARS-CoV-2. It spread around the world in just a few months and became a worldwide pandemic. Quick and accurate diagnosis of infected patients is very important for controlling transmission. In addition to the commonly used Real-time reverse-transcription polymerase chain reaction (RT-PCR) detection techniques, other diagnostic techniques are also emerging endlessly. This article reviews the current diagnostic methods for COVID-19 and discusses their advantages and disadvantages. It provides an important reference for the diagnosis of COVID-19.
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Affiliation(s)
- Tingting Han
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China
| | - Hailin Cong
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China; State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, 266071, China
| | - Youqing Shen
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China
| | - Bing Yu
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China; State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, 266071, China.
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5
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Kolbeck L, Haertlé M, Graulich T, Ettinger M, Suero EM, Krettek C, Omar M. Leukocyte Esterase and Glucose Reagent Test Can Rule in and Rule out Septic Arthritis. In Vivo 2021; 35:1625-1632. [PMID: 33910845 DOI: 10.21873/invivo.12420] [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: 12/01/2020] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Septic arthritis (SA) requires rapid diagnosis and therapy to avoid joint damage. This study evaluated the diagnostic accuracy of leukocyte esterase (LE) and glucose (GLC) strip tests for diagnosing SA. PATIENTS AND METHODS Synovial fluids from 455 patients with atraumatic joint effusions were assessed prospectively over a 5-year period with LE and glucose strip tests. Results were compared to modified Newman criteria for diagnosing joint infections. Synovial fluid cultures, crystal, blood and synovial cell analyses were also performed. RESULTS Forty-one patients had SA and 252 non-SA. A positive LE reading combined with negative glucose reading could detect SA with 100% specificity, 85% sensitivity, 100% positive predictive value (PPV) and 98% negative predictive value (NPV). Positive synovial LE reading alone detected SA with 82% specificity, 95% sensitivity, 47% PPV, and 99% NPV. CONCLUSION Combined LE and glucose strip tests represent a low-cost tool for rapidly diagnosing or ruling out SA.
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Affiliation(s)
- Louisa Kolbeck
- Trauma Department, Hannover Medical School, Hannover, Germany;
| | - Marco Haertlé
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Max Ettinger
- Orthopedic Surgery Department, Hannover Medical School, Hannover, Germany
| | - Eduardo M Suero
- Department of General Trauma and Reconstructive Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Mohamed Omar
- Trauma Department, Hannover Medical School, Hannover, Germany
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Coiffier G, Berthoud O, Albert JD, Robin F, Goussault C, Gougeon-Jolivet A, Bendavid C, Guggenbuhl P. Elaboration of a new synovial predictive score of septic origin for acute arthritis on the native joint (RESAS). Rheumatology (Oxford) 2021; 60:2238-2245. [PMID: 33197255 DOI: 10.1093/rheumatology/keaa567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To establish a new predictive score for the diagnosis of septic arthritis (SA) according to different synovial fluid (SF) variables. METHODS First, we analysed the different clinical, biological and SF variables associated with the diagnosis of SA (according to the Newman's criteria) in a monocentric cohort of acute arthritis (<30 days) (n = 233) (SYNOLACTATE cohort). A new score predictive of SA (RESAS) was created using the independent discriminant variables after multivariate analysis. A value was attributed to each variable of the score according to the weighting based on their likelihood ratio for the diagnosis of SA. RESAS performance was then tested on the first cohort (internal validation) and then checked on a second independent cohort (n = 70) (external validation). RESULTS After multivariate analysis, four independent variables of the SF were included for RESAS: (i) purulent SF or white blood cells count ≥70 000/mm3; (ii) absence/presence of crystals; (iii) lactate; and (iv) glucose synovial level. RESAS ranged between -4 and +13 points. The performance of RESAS to predicted SA was excellent with area under the curve (AUC)=0.928 (0.877-0.980) in internal validation and AUC=0.986 (0.962-1.00) in external validation. For a RESAS threshold ≥+4, SA was diagnosed with Se=56.0% (0.371-0.733), Sp=98.1% (0.952-0.993), LR+=29.1 (10.4-81.6) in the first cohort and with Se=91.7% (0.646-0.985), Sp=98.3% (0.909-0.997), LR+=53.2 (7.56-373) in the second cohort. CONCLUSION RESAS is a new composite score of four SF variables with excellent performance to predicted SA in acute arthritis population.
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Affiliation(s)
| | | | | | - François Robin
- Rheumatology Department, CHU Rennes.,U1241, CIMIAD Unit, INSERM
| | | | | | - Claude Bendavid
- U1241, CIMIAD Unit, INSERM.,Biochemistry Department, CHU Rennes, University of Rennes 1, Rennes, France
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7
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Schnelle Diagnose der septischen Arthritis. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1274-4375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bei septischer Arthritis kann die Abgrenzung von anderen Formen der
akuten entzündlichen Arthritis schwierig sein. Bisher dienen
zeitaufwendige Synovialflüssigkeitskulturen zur Identifizierung
eines Erregers. Der Nachweis einer bakteriellen Infektion könnte
jedoch schneller durch Bestimmung des bakteriellen Glukoseverbrauchs
bzw. der Laktatproduktion erfolgen. Diese Arbeit untersucht, ob die
Messung dieser Parameter im Synovium als Biomarker zur Diagnose der
septischen Arthritis geeignet ist.
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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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9
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Robin F, Berthoud O, Albert JD, Cadiou S, Gougeon-Jolivet A, Bendavid C, Guggenbuhl P, Coiffier G. External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients. Clin Rheumatol 2020; 40:1983-1988. [PMID: 33113024 DOI: 10.1007/s10067-020-05382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the performance of the Gout-calculator in a cohort of consecutive acute arthritis affecting large and intermediate joints (without an attack on hallux or midfoot joints). METHODS A retrospective study. Gout-calculator data were collected in medical records of patients included in the prospective consecutive cohort of acute arthritis called SYNOLACTATE. The diagnosis of gout was defined by the presence of sodium urate crystals in synovial fluid. The diagnostic performance of the Gout-calculator was studied by performing an ROC curve with the calculation of its AUC (95% CI) as well as the calculation of Sensitivity (Se), Specificity (Sp), and positive likelihood ratio (LR+). RESULTS 170 patients with acute arthritis were included. Variables associated with the diagnosis of gout were as follows: serum uric acid > 350 μmol/L (OR 5.52 (2.52-12.1), p < 0.001), joint redness (OR 5.08 (1.85-14.0), p = 0.001), previous patient-reported arthritis attack (OR 4.04 (1.92-8.49), p < 0.001), male (OR 3.00 (1.17-7.69), p = 0.02), hypertension or cardiovascular disease (OR 2.33 (1.07-5.06), p = 0.03). The median (IQR) of Gout-calculator was significantly higher in gouty arthritis (7.0 [5.5-8.1]) than in associated-CPP acute arthritis (4.0 [2.0-5.8]), septic arthritis (3.0 [2.0-5.1]), or others arthritis (3.5 [2.0-5.5]). The AUC was 0.833 (0.768-0.897) with for the threshold ≥ 8, a Se at 27.5% (0.161-0.428), Sp 97.7% (0.934-0.992), and LR+ 11.9 (3.5-40). CONCLUSION Despite diagnostic performances close to those published, the use of the Gout-calculator is not sufficient for the diagnosis of gout or to exclude the differential diagnosis of septic arthritis in the SYNOLACTATE cohort. KEY POINTS • For a Gout-calculator threshold of ≤ 4, Sensitivity is 92.5%, Specificity 50.8% and LR- 0.15 to the gout diagnosis. • For a Gout-calculator threshold of > = 8, Sensitivity is 27.5%, Specificity 97.7% and LR+ 11.9 to the gout diagnosis. • In a population of acute arthritis affecting large joints, Gout-calculator is not sufficient to discriminate between gouty arthritis and septic arthritis.
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Affiliation(s)
- F Robin
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
| | - O Berthoud
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - J D Albert
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
| | - S Cadiou
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - A 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
| | - C Bendavid
- UMR INSERM U 1241, University of Rennes, Rennes, France.,Department of Biochemistry, Rennes University Hospital - Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - P Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, Groupe Territorial Hospitalier Rance-Emeraude Dinan Hospital, 74 boulevard Chateaubriand, 22100, Dinan, France.
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