Original ArticleCoexistence of septic and crystal-induced arthritis: A diagnostic challenge. A report of 25 casesCoexistencia de artritis séptica y microcristalina: un reto diagnóstico. A propósito de 25 casos☆
Introduction
Septic arthritis is considered a medical emergency due to the rapid anatomical and functional impairment it causes to the affected joint. Arthropathy due to deposition of crystals is a risk factor for its onset. If both occur simultaneously, crystal-induced arthritis can mask a diagnosis of infection, and result in a delay in starting antibiotic treatment. Therefore microbiological study of synovial fluid (Gram staining and cultures) is essential for all episodes of acute arthritis, even if the presence of crystals is detected in the fluid. Although it is not a common situation in clinical practice, the possibility of infection should be considered in all cases of crystal-induced arthritis.
The objective of this paper was to assess the characteristics of patients attended in our hospital with concomitant septic and crystal-induced arthritis. In the Spanish-speaking literature there are 7 case reports,1, 2, 3, 4, 5, 6, 7 but no published series. We only found 2 case series in the English-speaking medical literature,8, 9 which justifies this study.
Section snippets
Patients and method
We performed a retrospective analysis of septic and crystal-induced arthritis cases registered in a rheumatology section, in the setting of a university hospital covering a referral population of around 850,000 inhabitants.
An analysis was made of all the infectious arthritis cases (code IVA of the ACR classification)10 gathered in the service registry from 1985 to 2015 (database with coding of diagnoses). For the purposes of the study we chose the cases with germs in the synovial fluid study
Results
Between 1985 and December 2015, 25 patients with concomitant crystal-induced and septic arthritis were registered in the rheumatology section of the University Hospital Germans Trias i Pujol of Badalona. The distribution by sex was 17 males and 8 females, with a mean ± standard deviation (interval) of age of 67 ± 14 (36–89) years. The mean ± standard deviation (interval) of time between onset of symptoms and diagnosis was 14 ± 13 (1–45) days (data available for 14 patients). The knee was the most
Discussion
Differential diagnosis of septic or crystal-induced arthritis is generally simple; however, it can become complicated when both entities present at the same time, which rarely occurs. Both patients with septic arthritis and those who develop crystal-induced arthritis can manifest fever, pain, rubor and joint swelling, therefore it is essential to perform an arthrocentesis with microbiological study of synovial fluid to establish a precise diagnosis. Regardless of whether or not the leucocyte
Conflict of interests
The authors have no conflict of interest to declare.
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Please cite this article as: Prior-Español Á, García-Mira Y, Mínguez S, Martínez-Morillo M, Gifre L, Mateo L. Coexistencia de artritis séptica y microcristalina: un reto diagnóstico. A propósito de 25 casos. Reumatol Clin. 2019;15:e81–e85.