title: Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis.
abstract: OBJECTIVE
  To determine the sensitivity and specificity of clinical and laboratory signs for the diagnosis of septic arthritis (SA). Patients and methods This prospective study included all adult patients with suspected SA seen in the emergency department or rheumatology department at the University Hospital, Clermont-Ferrand, France, over a period of 18 months.
  
  
  RESULTS
  In total, 105 patients with suspected SA were included, 38 (36%) presenting with SA (29 [28%] with bacteriologically documented SA). In the univariate analysis, chills (p=0.015), gradual onset (p=0.04), local redness (p=0.01), as well as an entry site for infection (p=0.01) were most often identified in SA. A history of crystal-induced arthritis (p=0.004) was more frequent in non-SA cases. An erythrocyte sedimentation rate (ESR)>50 mm (p=0.005), a C-reactive protein (CRP) level >100 mg/L (p=0.019), and radiological signs suggestive of SA (p=0.001) were more frequent in the SA cases. Synovial fluid appearance: purulent (p50,000/μL (p < 0.001), differentiated between SA and non-SA. In multivariate analysis, only chills (odds ration [OR]=4.7, 95% confidence interval [CI] 1.3-17.1), a history of crystal-induced arthritis (OR=0.09, 95% CI 0.01-0.9), purulent appearance of the joint fluid (OR=8.4, 95% CI 2.4-28.5), synovial WBC count >50,000/mm3 (OR=6.8, 95% CI 1.3-36), and radiological findings (OR=7.1, 95% CI 13-37.9) remained significant.
  
  
  CONCLUSIONS
  No clinical sign or laboratory test (excluding bacteriological test), taken alone, is conclusive for the differentiation between SA and non-SA, but the association of several signs, notably chills, history of crystal-induced arthritis, radiological findings, and the appearance and cellularity of joint fluid may be suggestive.
authors.affiliation: *Rheumatology Department,Clermont-Ferrand,France.
authors.forename: Marion
authors.initials: M
authors.lastname: Couderc
authors.affiliation: †Biostatistics Unit,DRCI,Clermont-Ferrand,France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: *Rheumatology Department,Clermont-Ferrand,France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mathieu
authors.affiliation: ‡Emergency Department,Clermont-Ferrand,France.
authors.forename: Jeannot
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: §Infectious Diseases Department,Clermont-Ferrand,France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesens
authors.affiliation: ¶Bacteriological Laboratory,University Hospital,Clermont-Ferrand,France.
authors.forename: Richard
authors.initials: R
authors.lastname: Bonnet
authors.affiliation: *Rheumatology Department,Clermont-Ferrand,France.
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.affiliation: *Rheumatology Department,Clermont-Ferrand,France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Dubost
mesh_terms: D000328:Adult; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013582:Synovial Fluid / Q000378:metabolism*; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein
keywords: acute arthritis; diagnosis; microcrystal-induced arthritis; septic arthritis