Early differential diagnosis of acute arthritides.

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20 case with severe acute inflammatory arthritides were evaluated on the initial differential diagnosis.Final diagnoses of these 20 cases were suppurative arthritis (12 cases), crystal deposition disease (including highly suspected cases) (6 cases), unknown etiology (2 cases), and one case which showed difficulty in differentiation between supputative arthritis and crystal deposition disease. Whether findings of any diagnostic value may exist or not was discussed on the early diagnosis of these 20 cases.Clinical manifestations showed no difference between 9 cases with suppurative arthritides (excluding 3 infant cases) and 6 cases with crystal deposition disease. White cell counts were abnormally high in many cases with the former. CRP showed no difference. ESR elevation was noted in the latter group. Mean age was 66 in the former and 70 in the letter.Incidence of crystal induced arthritis was none under the age of 70. However, approximately half of the cases over 70 years old were showed crystal induced arthritis.Microscopic examination of synovial fluid and of gram-stained preparation are at-most important in the early differential diagnosis of acute arthritides. Crystal deposition disease is established if crystals were recognized and suppurative arthritis is evident if bacteria were found in the synovial fluid. Caution should be made because complications by both are not infrequent.Considering the above mentioned discussion, the treatment schedule may be as follows. In cases of over 70 years old with acute arthritis, irrigation is the only option and antibiotics may be reserved for 24hrs. In cases under 60 years and in infants in particular, antibiotic prescription and distension-irrigation should be done as rapidly as possible.
西日本整形・災害外科学会の論文

Early differential diagnosis of acute arthritides.

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