Lee Byung Hoon, Na Young Gon, Ham Seong Hyup, Jin Mirim, Kim Yoon Tae, Kim Kyung-Ok, Sim Jae Ang
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, 21565, Republic of Korea.
Department of Microbiology, College of Medicine, Gachon University, Incheon, Korea.
Knee Surg Relat Res. 2024 Sep 16;36(1):27. doi: 10.1186/s43019-024-00229-2.
To evaluate the diagnostic characteristics of tryptophanyl tRNA synthetase (WRS) for the diagnosis of septic arthritis of the knee joint and to determine whether it is a reliable and sensitive synovial biomarker for discriminating septic arthritis from other types of arthritis.
Patients joint effusions for which septic arthritis was suspected were prospectively recruited between January 2019 and September 2020. A total of 9 patients had septic arthritis, 6 had acute gout attack, 1 had an acute flare of chronic rheumatic arthritis, and 46 had pseudogout or reactive arthropathy. Traditional inflammatory markers were measured, and their diagnostic abilities were compared. Neutrophil count, C-reactive protein (CRP) level, WRS, and human neutrophil α-defensin levels were assessed in the synovial fluids. Demographic parameters and biomarkers with a P < 0.05 in differentiating septic from nonseptic arthritis were included in a multivariable model. A multivariable logistic regression with a stepwise selection was performed to build the final combined model. Receiver operating characteristic curves were used to establish optimal thresholds for the diagnosis of septic arthritis of the knee joint, and the area under the curve was calculated to determine the overall accuracy of these tests compared with patients with nonseptic inflammatory arthritis.
Patients with septic arthritis were more likely to display higher serum WBC and CRP levels, synovial neutrophil counts, and levels of two synovial biomarkers, including WRS and α-defensin. WRS showed the highest specificity (87.5%) and sensitivity (83.3%) with α-defensin among the three synovial biomarkers.
Synovial fluid WRS is a relevant biomarker in discriminating septic arthritis from other inflammatory arthritis and should be tested in an independent cohort.
prospective observational study, III.
评估色氨酰tRNA合成酶（WRS）对膝关节化脓性关节炎诊断的特征，并确定其是否为区分化脓性关节炎与其他类型关节炎的可靠且敏感的滑膜生物标志物。
前瞻性招募2019年1月至2020年9月间疑似化脓性关节炎的患者关节积液。共有9例患者患有化脓性关节炎，6例有急性痛风发作，1例有慢性风湿性关节炎急性发作，46例有假性痛风或反应性关节炎。检测传统炎症标志物并比较其诊断能力。在滑液中评估中性粒细胞计数、C反应蛋白（CRP）水平、WRS和人中性粒细胞α-防御素水平。将在区分化脓性与非化脓性关节炎中P < 0.05的人口统计学参数和生物标志物纳入多变量模型。进行逐步选择的多变量逻辑回归以建立最终的联合模型。使用受试者工作特征曲线确定膝关节化脓性关节炎诊断的最佳阈值，并计算曲线下面积以确定与非化脓性炎症性关节炎患者相比这些检测的总体准确性。
化脓性关节炎患者更可能表现出更高的血清白细胞和CRP水平、滑膜中性粒细胞计数以及两种滑膜生物标志物（包括WRS和α-防御素）的水平。在三种滑膜生物标志物中，WRS与α-防御素联合显示出最高的特异性（87.5%）和敏感性（83.3%）。
滑液WRS是区分化脓性关节炎与其他炎症性关节炎的相关生物标志物，应在独立队列中进行检测。
前瞻性观察性研究，III级。
