title: Measurement of synovial tumor necrosis factor-alpha in diagnosing emergency patients with bacterial arthritis.
abstract: Because of the high morbidity and mortality in patients with bacterial arthritis, rapidly and correctly diagnosing this critical condition is a challenge to emergency clinicians. Synovial fluid samples were obtained from 75 patients with arthritis disorders who presented to an emergency service, and levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) were measured. Twenty patients with culture-proven bacterial arthritis had higher levels of synovial TNF-alpha than patients with osteoarthritis or with inflammatory arthritis, including gouty arthritis, rheumatoid arthritis, reactive arthritis, and lupus arthritis. There was a good sensitivity for synovial TNF-alpha level in diagnosing patients with bacterial arthritis. Nearly 100% of patients with bacterial arthritis had elevated synovial TNF-alpha levels. However, synovial IL-1 beta and IL-6 levels failed to discriminate bacterial arthritis from other inflammatory arthritis. Measurement of synovial TNF-alpha level may be useful as a diagnostic aid in emergency patients with bacterial arthritis disorders.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, ROC.
authors.forename: G W
authors.initials: GW
authors.lastname: Jeng
authors.forename: C R
authors.initials: CR
authors.lastname: Wang
authors.forename: S T
authors.initials: ST
authors.lastname: Liu
authors.forename: C C
authors.initials: CC
authors.lastname: Su
authors.forename: R T
authors.initials: RT
authors.lastname: Tsai
authors.forename: T S
authors.initials: TS
authors.lastname: Yeh
authors.forename: C L
authors.initials: CL
authors.lastname: Wen
authors.forename: Y Q
authors.initials: YQ
authors.lastname: Wu
authors.forename: C Y
authors.initials: CY
authors.lastname: Lin
authors.forename: G L
authors.initials: GL
authors.lastname: Lee
authors.forename: M Y
authors.initials: MY
authors.lastname: Chen
authors.forename: M F
authors.initials: MF
authors.lastname: Liu
authors.forename: C Y
authors.initials: CY
authors.lastname: Chuang
authors.forename: C Y
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001168:Arthritis / Q000378:metabolism; D015210:Arthritis, Gouty / Q000378:metabolism; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000378:metabolism; D016918:Arthritis, Reactive / Q000378:metabolism; D001172:Arthritis, Rheumatoid / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D004636:Emergency Service, Hospital; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000378:metabolism; D016908:Gram-Positive Bacterial Infections / Q000378:metabolism; D006801:Humans; D007375:Interleukin-1 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D008180:Lupus Erythematosus, Systemic / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000378:metabolism; D012680:Sensitivity and Specificity; D013582:Synovial Fluid / Q000737:chemistry*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D015415:Biomarkers; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha