Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department

AbstractTo assess the diagnostic value of ultrasound-guided (US-guided) synovial biopsy in routine clinical practice in cases of acute and chronic arthritis. A retrospective, single-center study of US-guided synovial biopsies between 2003 and 2013. The clinical, laboratory, radiographic, synovial fluid, and histological and bacteriological results of synovial biopsies were analyzed. Arthritis was classified according to disease duration<  6 weeks (AA) or ≥ 6 weeks (CA). Synovial biopsy success rate was defined by the rate of capsular and/or synovial tissue analyzed. The diagnostic efficiency was defined by synovial biopsy success rate multiplied by the clinical utility (validation of a diagnostic hypothesis leading to a spec ific therapy). One hundred seventy-six US-guided synovial biopsies (51 AA and 125 CA) were analyzed. Synovial biopsy success rate was 82.4%. The diagnostic efficiency was 19.9%. Among the acute arthritis cases, 11 were septic. Only three patients had a positive biopsy culture while the synovial flui d puncture was of insufficient quantity to allow bacteriological analysis. The perivascular infiltration of neutrophils (PMN) had a sensitivity of 81.8%, a specificity of 84.2%, and a positive likelihood ratio of 5.2 for the septic arthritis diagnosis. Among the chronic arthritis cases, no case of p yogenic septic arthritis was found. No histological lesions, examined separately, were specific to a type of chronic inflammatory joint disease. US-guid...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research