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THU0435 Performance of the Usual Clinical and Biological Signs for the Diagnosis of Septic Arthritis
  1. M. Couderc1,
  2. S. Mathieu1,
  3. B. Pereira2,
  4. J. Schmidt3,
  5. O. Lesens4,
  6. R. Bonnet5,
  7. F. Al juhani1,
  8. M. Vayssade1,
  9. B. Glace1,
  10. A. Tournadre1,
  11. S. Malochet-guinamant1,
  12. M. Soubrier1,
  13. J.-J. Dubost1
  1. 1Rheumatology
  2. 2DRCI
  3. 3Emergency
  4. 4Infectious Disease
  5. 5Bacteriological Laboratory, Clermont Ferrand Universitary Hospital, Clermont-Ferrand, France

Abstract

Objectives To study the sensibility (Se) and specificity (Sp) of clinical and biological signs for the diagnosis of septic arthritis (SA).

Methods This prospective study included all adult patients with a suspicion of SA seen in the emergency department or rheumatology service at the University Hospital of Clermont-Ferrand during a period of 18 months. The sensibility and specificity of the clinical and biological signs for the diagnosis of SA were calculated. A univariate analysis followed by a logistic regression analysis for SA diagnosis was conducted.

Results In total, 105 patients with a suspected SA were included, 38 (36%) presenting with SA (29 with a bacteriologically documented SA). In univariate analysis, chills (Se 39%; Sp 82%, p=0.015) but not fever (Se 53%; Sp 53%, p=0.6), a slow onset duration (Se 54%; Sp 72%, p=0.04), local redness (Se 53%, Sp 72%, p=0.01), as well as an infection entry-site (Se 7%; Sp 54%, p=0.01) were found most often in the SA cases. Microcrystalline antecedents (Se 5%, Sp 72%, 95% CI 0-0.6) and involvement of the knee were more frequent in non-septic arthritis (non-SA) cases. An erythrocyte sedimentation rate (ESR) >50 mm (Se 72%; Sp 60%, p=0.005), a C-reactive protein level >100mg/L (Se 58%; Sp 66%, p=0.019) and, above all, suggestive radiological signs (Se 30%; Sp 95%, p=0.001) were more frequent in the SA cases. The clear (Se 0; Sp 81%, p=0.007) and purulent (Se 57%, Sp 88, p<0.001) aspect of synovial fluid allowed for the differentiation between SA and non-SA, as well as the synovial fluid white blood cell (WBC)>50000/μL (Se 57%; Sp 82%, p<0.001) and percentage of polymorphonuclear >90% (Se 42%; Sp 82%, p=0.02), but not the presence of microcrystals (Se 24%, Sp 58% p=0.09). In multivariate analysis, only chills (OR=4.1, 95% CI: 1.4-12.2), microcrystalline antecedents (OR=0.08, 95% CI: 0.01-0.5), and radiological signs (OR=11, 95% CI: 2.4-50.1) remained significant. The parameters chills, microcrystalline antecedents, infection entry-site, risk factors for SA, the aspect and cellularity of synovial fluid, and radiological signs permitted the elaboration of two logistic regression models for the diagnosis of SA (AUC: 0.85 and 0.87).

Conclusions No clinical or biological (excluding bacteriological) sign, taken alone, is conclusive for the differentiation between SA and non-SA pathology, but the association of several signs, notably chills, microcrystalline antecedents, radiological signs of SA, and the aspect and cellularity of joint liquid may be conclusive.

Disclosure of Interest None Declared

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