Measurement of synovial tumor necrosis factor-alpha in diagnosing emergency patients with bacterial arthritis
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
- Department of Emergency and Internal Medicine, Cheng-Ching General Hospital, Taiwan
Correspondence
- Address reprint requests to Dr Jeng, Department of Emergency and Internal Medicine, Cheng-Ching General Hospital, Taichung, Taiwan, ROC 1996-06-20.
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
- Department of Emergency and Internal Medicine, Cheng-Ching General Hospital, Taiwan
Correspondence
- Address reprint requests to Dr Jeng, Department of Emergency and Internal Medicine, Cheng-Ching General Hospital, Taichung, Taiwan, ROC 1996-06-20.
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- Department of Internal Medicine, Chung Shan Medical and Dental College Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- Department of Emergency and Internal Medicine, Lotong Poh-Ai Hospital, Taiwan
Affiliations
- Department of Family Medicine, Province Hsin-Chu Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- Department of Internal Medicine, National Cheng-Kung University Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
Affiliations
- From the Section of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
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Abstract
Because of the high morbidity and mortality in patients with bacterial arthritis, rapidly and correctly diagnosing this critical condition is a challenge to emergency clinicians. Synovial fluid samples were obtained from 75 patients with arthritis disorders who presented to an emergency service, and levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) were measured. Twenty patients with culture-proven bacterial arthritis had higher levels of synovial TNF-α than patients with osteoarthritis or with inflammatory arthritis, including gouty arthritis, rheumatoid arthritis, reactive arthritis, and lupus arthritis. There was a good sensitivity for synovial TNF-α level in diagnosing patients with bacterial arthritis. Nearly 100% of patients with bacterial arthritis had elevated synovial TNF-α levels. However, synovial IL-1β and IL-6 levels failed to discriminate bacterial arthritis from other inflammatory arthritis. Measurement of synovial TNF-α level may be useful as a diagnostic aid in emergency patients with bacterial arthritis disorders.
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