Goodman Susan M, Mannstadt Insa, Tam Kathleen, Mehta Bella, Kochen Alejandro, Shakib Lorien, Sculco Peter, Carli Alberto, Batter Stephen, Rodriguez Jose, Bass Anne R, Blevins Jason L, Miller Andy O, Russell Linda, Donlin Laura, Nocon Allina, Figgie Mark
From the Department of Rheumatology, Hospital for Special Surgery, New York, NY.
Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY.
J Clin Rheumatol. 2024 Dec 1;30(8):309-314. doi: 10.1097/RHU.0000000000002157. Epub 2024 Oct 30.
Diagnosis of periprosthetic joint infection (PJI) in patients with inflammatory arthritis (IA) is challenging, as features of IA flares can mimic infection. We aimed to cross-sectionally determine if the optimal tests to diagnose PJI in osteoarthritis were present in patients with IA flares.
We enrolled patients from October 2020 to July 2022 in 3 groups: ( a ) PJI-total joint arthroplasty patients undergoing revision for infection, ( b ) IA Flare-IA patients with a flaring native joint, and ( c ) IA Aseptic-total joint arthroplasty patients with IA undergoing aseptic arthroplasty revision. We compared blood and synovial fluid markers between the cohorts using Kruskal-Wallis and Fisher exact tests to assess marker sensitivity and specificity.
Of 52 cases overall, 40% had rheumatoid arthritis, 20% psoriatic arthritis, and 11% osteoarthritis (in PJI group). PJI cases had higher C-reactive protein (CRP) and synovial fluid polymorphonuclear neutrophil percentage (%PMN). Alpha-defensin tested positive in 93% of PJI cases, 20% of IA Flares, and 6% of IA Aseptic ( p < 0.01). Synovial white blood cell count >3000/μL and positive alpha-defensin were highly sensitive (100%) in diagnosing infection; however, specificity was 50% for white blood cell counts and 79% for alpha-defensin. PJI diagnosis was nearly 5 times more likely with positive alpha-defensin and almost 6 times more likely with %PMNs >80. Blood markers interleukin-6, procalcitonin, and d -dimer were neither sensitive nor specific, whereas erythrocyte sedimentation rate and CRP showed 80% sensitivity, but 47% and 58% respective specificities.
Although synovial %PMNs, CRP, and alpha-defensin are sensitive tests for diagnosing PJI, they are less specific and may be positive in IA flares.
炎症性关节炎（IA）患者的人工关节周围感染（PJI）诊断具有挑战性，因为IA发作的特征可能与感染相似。我们旨在横断面确定IA发作患者是否具备诊断骨关节炎中PJI的最佳检测方法。
我们在2020年10月至2022年7月期间招募了3组患者：（a）因感染接受翻修的PJI全关节置换患者；（b）IA发作的IA患者，其天然关节发作；（c）接受无菌关节置换翻修的IA无菌全关节置换患者。我们使用Kruskal-Wallis检验和Fisher精确检验比较了队列之间的血液和滑液标志物，以评估标志物的敏感性和特异性。
在总共52例病例中，40%患有类风湿性关节炎，20%患有银屑病关节炎，11%患有骨关节炎（在PJI组中）。PJI病例的C反应蛋白（CRP）和滑液多形核中性粒细胞百分比（%PMN）较高。α-防御素在93%的PJI病例、20%的IA发作病例和6%的IA无菌病例中呈阳性（p<0.01）。滑液白细胞计数>3000/μL和α-防御素阳性在诊断感染方面具有高度敏感性（100%）；然而，白细胞计数的特异性为50%，α-防御素的特异性为79%。α-防御素阳性时，PJI诊断的可能性几乎高出5倍，%PMN>80时，PJI诊断的可能性几乎高出6倍。血液标志物白细胞介素-6、降钙素原和D-二聚体既不敏感也不特异，而红细胞沉降率和CRP的敏感性为80%，但特异性分别为47%和58%。
尽管滑液%PMN、CRP和α-防御素是诊断PJI的敏感检测方法，但它们的特异性较低，在IA发作时可能呈阳性。
