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Meta-Analysis
. 2023 May 2;62(5):1740-1756.
doi: 10.1093/rheumatology/keac606.

Assessment and diagnosis of the acute hot joint: a systematic review and meta-analysis

Mrinalini Dey  1   2 , Mariam Al-Attar  3 , Leticia Peruffo  4 , Ashley Coope  5 , Sizheng Steven Zhao  6 , Stephen Duffield  1 , Nicola Goodson  7
Affiliations
Meta-Analysis

Assessment and diagnosis of the acute hot joint: a systematic review and meta-analysis

Mrinalini Dey et al. Rheumatology (Oxford). .

Abstract

Objectives: Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential for avoiding unnecessary antibiotics and hospital admissions. We evaluated the utility of synovial fluid (SF) and serum tests in differentiating causes of acute hot joints.

Methods: We performed a systematic literature review of diagnostic testing for acute hot joints. Articles were included if studying ≥1 serum or SF test(s) for an acute hot joint, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. The following were recorded for each test, threshold and diagnosis: sensitivity, specificity, positive/negative predictive values and likelihood ratios. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity, and areas under the curves.

Results: A total of 8443 articles were identified, and 49 were ultimately included. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most had been tested at multiple diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and thresholds, meta-analysis was possible for only eight SF tests, all differentiating septic from non-septic joints. Of these, leucocyte esterase had the highest pooled sensitivity [0.94 (0.70, 0.99)] with good pooled specificity [0.74 (0.67, 0.81)].

Conclusion: Our review demonstrates many single tests, individually with diagnostic utility but suboptimal accuracy for exclusion of native joint infection. A combination of several tests with or without a stratification score is required for optimizing rapid assessment of the hot joint.

Keywords: biomarker; crystal arthritis; gout; hot joint; infectious arthritis; point-of-care testing; septic arthritis; synovial fluid.

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Figures

Figure 1.
Figure 1.
PRISMA flowchart of included papers
Figure 2.
Figure 2.
Pooled sensitivity, specificity and areas under curves (AUCs) for eligible SF tests (for differentiating septic from non-septic arthritis) included in meta-analyses
See this image and copyright information in PMC

References

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