The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Septic or Lyme Hip Arthritis? Rapid Lyme Diagnostics Could Avoid Unnecessary Treatment

Septic or Lyme Hip Arthritis? Rapid Lyme Diagnostics Could Avoid Unnecessary Treatment

April 26, 2018 • By Reuters Staff

  • Tweet
  • Email
Print-Friendly Version / Save PDF

NEW YORK (Reuters Health)—In Lyme-endemic areas, synovial fluid white blood cell (WBC) count isn’t very helpful in distinguishing septic from Lyme arthritis of the hip, a new study suggests.

You Might Also Like
  • Lyme Arthritis Treatment Protocols Critical as Lyme Disease Spreads
  • Diagnosis, Treatment Updates for Lyme Arthritis
  • More Evidence Dexamethasone Speeds Recovery in Kids with Septic Arthritis

Use of newer-generation Lyme disease diagnostics are necessary to avoid the “under- and overdiagnosis of Lyme arthritis at the time that initial management decisions must be made,” Dr. Lise Nigrovic from Boston Children’s Hospital and colleagues write in Pediatrics, online April 18.1

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Surgical drainage is needed in patients with septic arthritis of the hip, but these patients can be hard to distinguish from patients with Lyme arthritis. And, until now, the ability of synovial fluid WBC counts to help discriminate between septic and Lyme arthritis of the hip has not been tested, the researchers say.

Dr. Nigrovic and colleagues took a look back at 238 patients aged 21 and younger with monoarticular hip arthritis and a synovial-fluid culture obtained at emergency departments in Lyme-endemic areas. Twenty-six (11%) had septic arthritis, 32 (13%) had Lyme arthritis and 180 (76%) had other arthritis.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

The researchers defined septic arthritis as a positive synovial-fluid culture result or synovial-fluid pleocytosis (WBC count 50,000 cells/mcL or greater) and Lyme arthritis as positive two-tiered Lyme disease serology results and negative synovial-fluid bacterial culture results.

They found that patients with septic arthritis had higher median synovial-fluid WBC counts (126,130 cells/mcL) than patients with Lyme arthritis (53,955 cells/mcL) or other inflammatory arthritis.

Of note, say the researchers, more than half of patients with Lyme arthritis (18 patients, 56%) had synovial fluid WBC counts greater than or equal to 50,000 cells/mcL. Thirteen of 94 patients who underwent surgical drainage were later diagnosed with Lyme arthritis.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

“Although septic arthritis of the hip is an orthopedic emergency requiring immediate operative intervention as well as parenteral antibiotics, patients with other types of hip arthritis, including Lyme arthritis and transient synovitis, do not require their potentially dangerous interventions,” Dr. Nigrovic and colleagues note in their article.

In this study, they say, “Commonly used synovial fluid WBC count cut-points resulted in the misclassification of a number of patients with Lyme arthritis while missing a few with septic arthritis. We suggest that clinicians should use more than just synovial fluid cell counts in isolation to decide whether to perform operative joint washout for patients with hip monoarthritis.”

“In Lyme endemic areas, a rapid and accurate diagnostic test for Lyme disease would reduce diagnostic confusion for clinicians who care for patients with hip effusions,” they add.

Pages: 1 2 | Single Page

Filed Under: Conditions Tagged With: Lyme arthritis, Lyme Disease, septic arthritis, synovial fluid

You Might Also Like:
  • Lyme Arthritis Treatment Protocols Critical as Lyme Disease Spreads
  • Diagnosis, Treatment Updates for Lyme Arthritis
  • More Evidence Dexamethasone Speeds Recovery in Kids with Septic Arthritis
  • Diagnostic Clues, Tips Useful for Differentiating RA and Lyme Disease

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)