■化脓性关节炎是骨科急症。合并结晶性关节病(痛风或假性痛风)的患者难以诊断。晶体关节炎的症状学模拟脓毒性关节炎,模糊的临床诊断。关节穿刺术和滑液分析是两种病理的标准诊断测试。显微镜上的晶体可以诊断晶体关节炎,然而,它们的存在并不排除化脓性关节炎。通过阳性微生物学培养诊断化脓性关节炎。尽管化脓性关节炎与滑膜总核计数(TNC)升高有关,痛风也可能发生TNC升高。文献表明,晶体阳性关节中TNC计数>50,000个细胞应引起并发化脓性关节炎的怀疑。然而,数据是有限的。由于治疗和预后不同,需要进一步的诊断指标来帮助临床医生及时识别晶体阳性化脓性关节炎。
■回顾性确定了对尿酸单钠(MSU)和/或(CPPD)晶体呈阳性的天然关节关节穿刺术的患者。收集实验室数据,包括滑液培养,有核细胞总数(TNC),多态中性粒细胞百分比(%PMN),和晶体分析;和血清CRP,ESR,和白细胞计数(WBC)。使用Spearman相关性进行统计分析,单变量-Fischer精确和Wilcoxon检验,和多变量分析。
■442个被确定为CPPD和/或MSU晶体阳性的关节,31%是女性,69%男性。442个吸气剂中,58有积极的文化。如果滑膜TNC>50,000(比值比7.7),患者更有可能出现阳性培养。CRP>10mg/dL(OR3.2),PMN>90%(OR2.17),如果患者是女性(OR1.9),均有统计学意义,p<0.05。有55例患者因临床怀疑或革兰氏染色阳性而接受冲洗和清创,其中37例最终具有阳性培养(67%),其余18例出现阴性培养.
■结果与文献一致,TNC>50,000,值得高度怀疑并发化脓性关节炎,并应促使提供者对其他患者实验室数据进行严格评估.结果进一步表明,具有阳性晶体的患者,滑膜TNC>50,000个细胞,PMN>90%,血清CRP>10mg/dL是并发脓毒性关节炎的高风险,可能需要紧急冲洗和清创和抗生素治疗。该数据可作为开发晶体阳性化脓性关节炎的感染风险计算器的支持。证据等级:III。
UNASSIGNED: Septic arthritis is an orthopedic emergency. Diagnosis is difficult in patients with concomitant crystalline arthropathy (gout or pseudogout). The symptomatology of crystal arthritis mimics septic arthritis, clouding clinical diagnosis.
Arthrocentesis and synovial fluid analysis are the standard diagnostic tests for both pathologies. Crystals on microscopy are diagnostic of crystal arthritis, however their presence does not rule out septic arthritis. Septic arthritis is diagnosed by positive microbiology culture. Though septic arthritis is associated with elevated synovial total nucleated count (TNC), TNC elevations can also occur with gout. The literature suggests that a TNC count of > 50,000 cells in a crystal-positive joint should raise suspicion for concurrent septic arthritis, however data is limited. Further diagnostic indicators are needed to help clinicians promptly identify crystal positive septic arthritis as the treatments and prognoses are different.
UNASSIGNED: Patients were retrospectively identified who had
arthrocentesis of a native joint positive for monosodium urate (MSU) and/or (CPPD) crystals. Laboratory data was collected including synovial fluid cultures, total nucleated cell count (TNC), percent polymorphic neutrophils (%PMN), and crystal analysis; and serum CRP, ESR, and white blood cell count (WBC). Statistical analysis performed using Spearman correlation, Univariate-Fischer\'s exact and Wilcoxon tests, and multivariate analysis.
UNASSIGNED: 442 joints identified with positive CPPD and/or MSU crystals, 31% female, 69% male. Of 442 aspirates, 58 had positive cultures. Patients were more likely to have positive cultures if synovial TNC > 50,000 (odds ratio 7.7), CRP > 10 mg/dL (OR 3.2), PMN > 90% (OR 2.17), and if the patient was female (OR 1.9), all were statistically significant with p < 0.05. There were 55 patients who underwent irrigation and debridement based on clinical suspicion or a positive gram stain, 37 of these ultimately had a positive culture (67%), the remaining 18 had negative cultures.
UNASSIGNED: Results are consistent with the literature, a TNC > 50,000 warrants a high suspicion for concurrent septic arthritis and should prompt providers to critically evaluate other patient laboratory data. Results further suggests that a patient with positive crystals, synovial TNC > 50,000 cells, PMN > 90%, and serum CRP > 10mg/dL is at high risk for having a concurrent septic arthritis and may warrant urgent irrigation and debridement and antibiotic therapy. This data serves as a supporting to develop an infection risk calculator for crystal positive septic arthritis. Level of Evidence: III.