Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
response to letter by William Sargent
- Siu Fai Li (25 October 2007)
-
Gold Standard
- William Sargent (20 September 2007)
-
response to Dr. Yasin's letter
- Siu Fai Li (11 May 2007)
-
Diagnosing difficulties in Septic Arthritis
- Dr Athar Yasin (27 February 2007)
|
|
|||
|
Siu Fai Li, MD Jacobi Medical Center
Send letter to journal:
siuf{at}verizon.net Siu Fai Li
|
We agree that the diagnosis of septic arthritis in the operating room is vulnerable to subjective intrepretation. There was one patient in our study whose diagnosis of septic arthritis was made based on operative findings alone (i.e. without a positive arthrocentesis culture). The operative findings were described as "pus", and we believe that supports the diagnosis of septic arthritis. The patient had been on a course of antibiotics prior to presentation, which may explain the negative microbiologic studies. |
|||
|
|
|||
|
William Sargent, SpR Emergency Medicine Aberdeen Royal Infirmary
Send letter to journal:
williamsargent{at}nhs.net William Sargent
|
Are 'operative findings' a gold standard for diagnosis of a septic joint? Discussion of interpretation of synovial fluid in Roberts: Clinical Procedures in Emergency Medicine, 4th ed, suggests that gout, pseudogout and other arthritides can give turbid fluid. This clearly has a major impact on interpretation of the data. |
|||
|
|
|||
|
Siu Fai Li, MD Jacobi Medical Center Bronx, NY, U.S.A.
Send letter to journal:
siuf{at}verizon.net Siu Fai Li
|
Dear Editor, We agree with Dr. Yasin's comment concerning clinical judgment in septic arthritis; it is most important in the assessment of a potentially septic joint, and should not be discounted in the light of "negative" ancillary tests. However, we would like to caution against the use of numerical cut-offs for "positive" and "negative" jWBC. There is considerable overlap in jWBC counts between patients with septic arthritis and those without; some patients with crystal- associated arthritis will have jWBC > 100,000 cells/ml, and some patients with septic arthritis will have jWBC < 50,000 cells/ml. Septic arthritis is a high risk diagnosis, and if a cut-off is to be utilized, it may be advisable to sacrifice specificity for sensitivity. Based on our data, a jWBC count of 17,500 cells/ml maximized sensitivity and specificity, but neither was perfect. Siu Fai Li, MD |
|||
|
|
|||
|
Dr Athar Yasin, SHO Trauma & Orthopaedics Medway NHS Trust, Kent, UK
Send letter to journal:
ays_athar{at}yahoo.co.uk Dr Athar Yasin
|
Dear Editor, I have read the recent article "Diagnostic utility of laboratory tests in septic arthritis" by S F Li et.al. Septic arthritis is one of the few Orthopaedic emergencies which can be potentially life threatening and requires urgent operative management. It is crucial to rule-out this condition in a patient presenting with monoarticular arthritis, and the gold-standard is aspiration and microscopic examination of the joint fluid aspirate. The authors have provided evidence that suggests that joint aspirate WBC is the most sensitive and specific test for diagnosing the condition accurately(1). The cell count of > 100,000 cells/ml is always diagnostic of pyogenic arthritis. Between 50,000 and 100,000 cells/ml, one may find pyogenic arthritis but there may be also a few cases of rheumatoid arthritis, psoriatic rheumatism, gout and pseudo-gout in this range(2). This is all possible when the joint aspirate is positive but if the joint aspirate is negative or what we call as "dry tap" it becomes increasingly difficult to diagnose the condition especially in smaller joints where the expertise is required for joint aspirate. In most of these circumstances the specialist has to rely on his clinical judgement. References: 1. S F Li et al Diagnostic utility of laboratory tests in septic arthritis Emerg Med J 2007; 24: 75-77 2.Lemaire V et al. Results of the cytological examination of the synovial fluid in various arthropathies. Rev Rhum Mal Osteoartic. 1981 Mar;48(3):229-34 |
|||
