Friday, 23 Mar 2018

You are here

Concomitant Septic Arthritis and Crystalline Arthropathy

I joined a poster tour this morning on the topic of infections and was intrigued by an abstract titled, Coexistence of septic and crystal-induced arthritis: a diagnostic challenge (#0560, Y Garcia-Mira, et al).

The authors sought to describe the characteristics of patients with concurrent septic and crystal arthritis through a retrospective analysis of patients with the concomitant diagnoses between 1985-2015 at a university hospital in Spain.  

Out of 123 patients with septic arthritis, 20.3% (25) had concurrent crystalline arthritis. All patients had positive bacterial culture (blood and/or synovial fluid) and crystals in synovial fluid. The majority (68%) were males and average age was 67 years. Risk factors identified were diabetes in 24%, use of diuretics in 24%, and CKD in 16% including 2 on dialysis and 4 with history of kidney transplant. There was a delay to diagnosis on average of 14 days and the most commonly affected joint was the knee followed by the foot and hip.

As far as types of crystalline arthropathy, 60% had MUS, 20% CPPD and 8% hydroxyapatite. 32% had positive gram stain and 88% had positive synovial fluid culture. Blood cultures were positive in 32%. Surgical debridement was done in 32% and mortalitiy was 8%.

I found the 20% incidence of concurrent septic arthritis and crystal disease to be quite high, but nonetheless this is something to consider especially in elderly males with certain co-morbidities, and reminds us that synovial fluid should always be examined for crystals and infection.  

Add new comment

More Like This

The RheumNow Week in Review - 23 March 2018

Dr. Jack Cush reviews the highlights from the news, journals and major meetings. New announcements and approval from the FDA; novel associations between ANCA vasculitis and thyroid disease; flare rates after arthroplasty; and pregnancy outcomes for men and women.

MMWR: Arthritis Prevalence Increases and Varies Widely

MMWR reports that In 2015, the number of adults with arthritis continued to increase; with marked geographic variability in arthritis estimates with gaps in arthritis management.

The CDC estimates that physician-diagnosed arthritis affects 54 million of adults in the United States with an annual cost of approximately $300 billion annually.

The RheumNow Week in Review - 16 March 2018

Dr. Jack Cush reviews the highlights from the news, journals and major meetings. Bigtime rheumatologic lessons with tales from intestinal crypts, the friendly skies & the hips of hockey players. Also the microbiome and lupus, benefits of ENT findings with GPA and rare risk of opportunistic infections with biologics.

The RheumNow Week in Review - 9 March 2018

Dr. Jack Cush reviews highlights, news and recent research published this past week on This week's report includes news on new regulatory changes, new indication for tofacitinib, the rise and deficits of opioids and the benefits of fish and bariatric surgery.

ACR Responds to Association Health Plans Proposed Rule

In comments submitted today to the US Department of Labor in response to its Association Health Plans (AHP) proposed rule, the American College of Rheumatology urged Administration officials to protect essential health benefits and other consumer protections that make it possible for individuals living with rheumatic diseases to access comprehensive and affordable healthcare.