Do drop-in. World Arthritis Day

World_arthritis_day_posterDo you know … ?

  • the symptoms for rheumatoid arthritis
  • how to stay healthy and active
  • how to find quality information on the web

Staff and students are invited to ‘drop-in’ the Staff Library, 2nd Floor, New Alderley House, next Tuesday 14 October between 10:00-4:00pm as part of World Arthritis Day. There will be information and light refreshments available plus staff on hand who would be happy to help you research this complex and painful disease.

NICE guidance – updates

Keeping you up-to-datenice 1

Guidance by topic: the following guidance topics matching your health area preferences have been published or updated

 

Singhal, R, et al: Journal of Bone and Joint Surgery: Septic arthritis vs transient synovitis in children

Septic arthritis vs transient synovitis in children: a tertiary healthcare centre study  by R Singhal of MDGH and D PerryFN KhanD CohenHL StevensonLA JamesJS Sampath and CE Bruce

Background Establishing the diagnosis in a child presenting with an atraumatic limp can be challenging. There is particular difficulty distinguishing septic arthritis (SA) from transient synovitis (TS) and consequently clinical prediction algorithms have been devised to differentiate the conditions using the presence of fever, raised erythrocyte sedimentation rate (ESR), raised white cell count (WCC) and inability to weight bear. Within Europe measurement of the ESR has largely been replaced with assessment of C-reactive protein (CRP) as an acute phase protein. We have evaluated the utility of including CRP in a clinical prediction algorithm to distinguish TS from SA.

Method  All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5 degrees C. The definition of SA was based upon microscopy and culture of the joint fluid collected at arthrotomy.

Results 311 hips were included within the study. Of these 282 were considered to have transient synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. An algorithm that indicated a diagnosis of SA in individuals who could not weight-bear and who had a CRP >20mg/L correctly classified SA in 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis.