Abstract

Whether the levels of procalcitonin (PCT) in the serum and synovial fluid are effective indicators for distinguishing septic arthritis (SA) from non-infectious arthritis remains controversial. The present study aimed to evaluate whether PCT levels in fresh serum or fresh joint fluid may be used in the differential diagnosis of SA from rheumatoid arthritis (RA), osteoarthritis (OA) and gouty arthritis (GA). From January 2012 to June 2013, 23 patients with knee SA, 21 patients with RA, 40 patients with OA and 11 patients with GA were enrolled in the current study. The levels of PCT were measured within 24 h after specimen collection at room temperature. An enzyme-linked fluorescence assay (ELFA) was used to detect the levels of PCT in the serum and synovial fluid. The correlations between the levels of PCT in the serum and synovial fluid and the arthritic patient groups were determined by the Nemenyi test. Areas under the receiver operating characteristic (ROC) curve were calculated to evaluate the accuracy of the correlations. The levels of PCT in the serum and joint fluid of the patients in the SA group were higher compared with those of the other groups (P<0.01) and there were no significant differences among the RA, OA and GA groups in these levels. A PCT level of <0.5 μg/l in the serum and synovial fluid had high specificity in the differential diagnosis of SA from RA, OA and GA. Synovial fluid PCT revealed significantly greater sensitivity than serum PCT. The accuracy of the differential diagnosis of SA by the serum levels of PCT was significantly lower than that by the synovial fluid levels of PCT. The levels of PCT in the serum and synovial fluid may be used as alternative laboratory indicators to distinguish between SA and the non-infectious types of arthritis; however, the PCT levels in fresh synovial fluid are more sensitive and accurate indicators than PCT levels in fresh serum.

Highlights

  • The incidence rate of septic arthritis (SA) has been increasing over the last few years

  • The present study aimed to evaluate whether serum or joint fluid levels of PCT may be used in the differential diagnosis of SA from rheumatoid arthritis (RA), OA and gouty arthritis (GA) using fresh serum and synovial fluid samples

  • To investigate whether serum and/or joint fluid PCT can be used in distinguishing SA from RA, OA and GA, the levels of PCT in fresh serum and synovial fluid samples of patients diagnosed with SA, RA, OA or GA were measured

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Summary

Introduction

The incidence rate of septic arthritis (SA) has been increasing over the last few years. Prior to the bacterial culture results becoming available, several other clinical tests, including X‐ray imaging [4], routine blood tests [5], erythrocyte sedimentation rate (ESR) measurements [6], synovial fluid white blood cell (WBC) count [7] and levels of CRP (C reactive protein) [8,9] may be used for SA diagnosis. None of these tests are sensitive enough to produce an accurate diagnosis and they frequently lead to misdiagnosis and/or the delay of treatment.

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