Concomitant Septic Arthritis in Crystal Monoarthritis
Bibliographic record
Abstract
OBJECTIVE: In acute monoarthritis, the presence of crystals in synovial fluid may lead to a diagnosis of crystal arthritis (CA) before septic arthritis (SA) can be excluded by culture. We aimed to identify the frequency of coexistence of CA with SA and to compare these with regard to synovial fluid microscopy, C-reactive protein (CRP), and blood culture. METHODS: We examined 1612 synovial aspirates from 2004 to 2009 retrospectively. Of these, 104 patients with clinically significant SA were identified. These were compared to 295 patients with isolated CA. RESULTS: Five percent of joints with CA had concomitant infection. A high synovial white blood cell (WBC) count and elevated CRP (> 100 mg/l) were predictive of concomitant SA with a sensitivity of 86.4%, specificity of 48.3% and 54.6%, and negative predictive values of 98.5% and 98.7%, respectively. In patients with SA who had a blood culture, 42.5% were positive with a matching organism. SA of the shoulder had a 90% rate of bacteremia. CONCLUSION: Crystals alone in synovial fluid from acute monoarthritis cannot exclude SA, as CA and SA frequently coexist. High WBC counts and elevated CRP are common to both SA and CA. Blood cultures should be collected and septic arthritis considered, even when crystals are present, particularly if the shoulder is affected. The exception is when Gram stain is negative and the CRP is < 100 mg/l and joint WBC count is < 10,000/μl. In these circumstances it is very unlikely that there will be concomitant SA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".