Rheumatology department, G.-Montpied Teaching Hospital, Faculty of Medicine, Clermont-Ferrand 1 University, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
Joint Bone Spine. 2012 Mar;79(2):156-9. doi: 10.1016/j.jbspin.2011.04.019. Epub 2011 Jul 5.
No microorganism is identified in 7-35% of cases of septic arthritis. The diagnosis is, therefore, only presumptive. We reviewed our cases of septic arthritis in adult native joints to determine the frequency of negative cultures, disease characteristics and the frequency of misdiagnosis of septic arthritis.
This retrospective study included all patients admitted to our department from 1979-2005 with arthritis, diagnosed and treated as septic.
No microorganism was isolated from synovial fluid or blood samples from 74 out of 398 (19%) patients with presumed septic arthritis. Patients without microorganisms were younger (54 vs 62 years), less likely to have risk factors for septic arthritis (31% vs 41%) and had lower mortality (0 vs 5%) than patients with positive cultures. Long-term outcome was known for 48 patients. A retrospective analysis of all data and long-term outcome concluded that septic arthritis was probable in 18 patients and improbable in 13. Ten of the latter developed rheumatic disease after a mean time of 6 months: rheumatoid arthritis (n=3), spondyloarthropathies (n=3), unclassified rheumatic disease (n=2), Wegener granulomatosis (n=1) and cytosteatonecrosis (n=1). Fever and signs of inflammation were more frequent and synovial fluid cell counts were higher in patients with improbable septic arthritis. Conversely, radiological signs were more common in patients with probable septic arthritis.
At least 14% of patients diagnosed with septic arthritis with negative bacteriological results subsequently develop rheumatic disease. This pseudoseptic arthritis is indistinguishable from true septic arthritis. When no microorganism is identified, the diagnosis remains presumptive and follow-up is necessary to screen for other diseases, especially rheumatic diseases.
在 7-35%的脓毒性关节炎病例中未发现微生物。因此，诊断只是推测性的。我们回顾了我们成人原发性关节脓毒性关节炎的病例，以确定阴性培养的频率、疾病特征和脓毒性关节炎误诊的频率。
这项回顾性研究包括了 1979 年至 2005 年期间因关节炎住院并被诊断和治疗为脓毒性关节炎的所有患者。
398 例疑似脓毒性关节炎患者中，有 74 例（19%）的滑膜液或血液样本中未分离出微生物。无微生物患者年龄较小（54 岁 vs 62 岁），发生脓毒性关节炎的危险因素较少（31% vs 41%），死亡率较低（0% vs 5%）。48 例患者的长期结果已知。对所有数据和长期结果的回顾性分析得出结论，18 例患者脓毒性关节炎可能性大，13 例患者脓毒性关节炎可能性小。后者中有 10 例在平均 6 个月后发展为风湿性疾病：类风湿关节炎（n=3）、脊柱关节病（n=3）、未分类风湿性疾病（n=2）、韦格纳肉芽肿（n=1）和骨化性肌炎（n=1）。可能性小的脓毒性关节炎患者发热和炎症迹象更频繁，滑膜液细胞计数更高。相反，可能性大的脓毒性关节炎患者的影像学征象更常见。
至少有 14%的诊断为阴性细菌学结果的脓毒性关节炎患者随后会发展为风湿性疾病。这种假性脓毒性关节炎与真正的脓毒性关节炎无法区分。当未发现微生物时，诊断仍然是推测性的，需要进行随访以筛查其他疾病，尤其是风湿性疾病。
