Measurement of synovial tumor necrosis factor-alpha in diagnosing emergency patients with bacterial arthritis.
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.
Jeng
G W
GW
Department of Internal Medicine, National Taiwan University Hospital, ROC.
Wang
C R
CR
Liu
S T
ST
Su
C C
CC
Tsai
R T
RT
Yeh
T S
TS
Wen
C L
CL
Wu
Y Q
YQ
Lin
C Y
CY
Lee
G L
GL
Chen
M Y
MY
Liu
M F
MF
Chuang
C Y
CY
Chen
C Y
CY
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*
D015415:Biomarkers; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha