Acute arthritis: predictive factors and current practice in the approach to diagnosis and management across two hospitals in Sydney

Internal Medicine Journal - Tập 48 Số 9 - Trang 1087-1095 - 2018
Katrina Pavic1,2, Jay Pandya3, Sophie Sebak2, Amith Shetty4, David Spencer1,2, Nicholas Manolios1,2
1Department of Rheumatology, Westmead Hospital, Sydney, New South Wales, Australia
2Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
3Department of Orthopaedic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
4Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia

Tóm tắt

AbstractBackgroundLiterature pertaining to the predictive factors for septic arthritis is limited.AimsThe primary objective was to investigate the predictive factors for septic arthritis. The secondary objectives were to investigate the predictive factors for crystal arthritis and to explore current practices in the management of acute arthritis.MethodsA retrospective analysis was undertaken. All patients with an acute arthritis who underwent a joint aspiration for diagnostic and management purposes were considered for inclusion. The outcome measures were patient demographics, findings on physical examination, findings on blood and synovial fluid analysis and management.ResultsOf the patients who presented with an acute arthritis, 24 of the 172 joint aspirations undertaken were positive for bacteria (13.95%). Of the 172 joint aspirations, 90 were positive for crystals (52.33%). Investigated variables associated with increased risk for the presence of bacteria on synovial fluid included features of sepsis (P < 0.001), joint‐restricted range of motion (P = 0.048), elevated C‐reactive protein (P < 0.001) and elevated total leukocyte count on synovial fluid (P < 0.001). Of the 24 joint aspirations that were positive for bacteria, 13 had associated positive blood cultures (54.17%). Of the 172 joint aspirations, antibiotics were administered in 96 cases (55.81%). Of these, antibiotics were administered prior to joint aspiration in 41 cases (42.71%).ConclusionsIn our study, the most common cause of acute arthritis was crystal arthropathy. An accurate physical examination in conjunction with synovial fluid analysis is of particular importance in diagnosing septic arthritis. Blood cultures are not a reliable substitute for joint aspiration but should nevertheless be undertaken.

Từ khóa


Tài liệu tham khảo

10.1111/j.1553-2712.2011.01121.x

10.1503/cmaj.080183

Visser S, 2009, Septic until proven otherwise: approach to and treatment of the septic joint in adult patients, Can Fam Physician, 55, 374

10.1111/j.1469-0691.2006.01366.x

Mathews C, 2007, Management of septic arthritis: a systematic review, Ann Rheum Dis, 66, 440

10.3928/01477447-20140124-09

10.1136/jcp.2006.043950

10.1093/jac/dkl295

10.1016/j.reuma.2009.12.010

Horowitz D, 2011, Approach to septic arthritis, Am Fam Physician, 84, 653

10.2214/AJR.10.6273

10.1136/emj.2006.037929

Clinical Excellence Commission, 2013, Adult sepsis pathway Version 2

10.1136/emj.16.5.355

10.1093/rheumatology/keg297

10.1308/003588412X13171221591015

10.5694/mja15.00657

Thông tin
Thông tin xuất bản

Internal Medicine Journal

Tập 48 Số 9

1087-1095

Thông tin tác giả