Point-of-care testing of serum and synovial fluid in acute hot joints
Research type
Research Study
Full title
Assessing the utility of point-of-care testing of serum and synovial fluid and metabolomics to discriminate septic from non-septic monoarthritis in the acute hot joint presentation
IRAS ID
261956
Contact name
Nicola Goodson
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
5 years, 0 months, 1 days
Research summary
The presentation of an acute hot joint is common in acute clinical settings, such as accident and emergency (A&E) departments. It can be due to many causes, the most common being gout or pseudogout, in which crystals are deposited within the joint. However, the most serious presentation is septic arthritis (joint infection), which can destroy the cartilage lining the joint surfaces within days of onset.
Discrimination of septic arthritis from other causes is difficult; all can present clinically with fever, joint swelling, pain, and stiffness. It is important to efficiently distinguish septic arthritis from other causes of an acute hot joint.
Prompt aspiration of joint synovial fluid (SF), with microscopy and culture tests, are essential for diagnosis. However, these tests can take hours to perform, with none available at point-of-care. Patients therefore start antibiotics without indication and are often admitted to hospital whilst results are awaited. This costs time and money in unnecessary antibiotic exposure and hospital admission, at £222.00-£400.00/day.This demonstrates the need for a reliable, accurate, and cost-effective method by which to safely exclude septic arthritis in the acute clinical setting. This has potential applications in first-world emergency departments, as well as in resource-poor third world settings.
Here, we propose a study to investigate the use of biomarkers in the diagnosis of septic arthritis. In the first instance, we shall be testing the utility of SF pH and glucose as markers of joint infection, as well as correlations between serum and SF pro-calcitonin as a marker of infection. We shall then undertake metabolomics analyses on septic and non-septic SF, blood and urine samples, in order to uncover further biomarkers which may aid differentiation between the two clinical states. Our long-term aim is to harness these results in the development of a bedside test for septic arthritis.
REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
19/NW/0594
Date of REC Opinion
7 Oct 2019
REC opinion
Further Information Favourable Opinion