Pavic Katrina, Pandya Jay, Sebak Sophie, Shetty Amith, Spencer David, Manolios Nicholas
Department of Rheumatology, Westmead Hospital, Sydney, New South Wales, Australia.
Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2018 Sep;48(9):1087-1095. doi: 10.1111/imj.13969.
Literature pertaining to the predictive factors for septic arthritis is limited.
The 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.
A 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.
Of 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%).
In 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.
关于化脓性关节炎预测因素的文献有限。
主要目的是研究化脓性关节炎的预测因素。次要目的是研究晶体性关节炎的预测因素，并探讨急性关节炎管理的当前做法。
进行回顾性分析。所有因诊断和管理目的接受关节穿刺的急性关节炎患者均被纳入。观察指标包括患者人口统计学特征、体格检查结果、血液和滑液分析结果以及管理情况。
在出现急性关节炎的患者中，172次关节穿刺中有24次细菌检测呈阳性（13.95%）。在172次关节穿刺中，90次晶体检测呈阳性（52.33%）。与滑液中细菌存在风险增加相关的调查变量包括脓毒症特征（P < 0.001）、关节活动范围受限（P = 0.048）、C反应蛋白升高（P < 0.001）和滑液中白细胞总数升高（P < 0.001）。在24次细菌检测呈阳性的关节穿刺中，13次血培养结果也呈阳性（54.17%）。在172次关节穿刺中，96例（55.81%）使用了抗生素。其中，41例（42.71%）在关节穿刺前使用了抗生素。
在我们的研究中，急性关节炎最常见的原因是晶体性关节病。准确的体格检查结合滑液分析在诊断化脓性关节炎中尤为重要。血培养不是关节穿刺的可靠替代方法，但仍应进行。
