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1.
An experimental model of acute staphylococcal septic arthritis in chickens was used to study the effect of different therapeutic regimens of the antibiotic cloxacillin on the natural history of the disease. Three different therapeutic regimens were used in order to assess the effect of increasing the frequency and of delaying the commencement of administration. The results were assessed by measurement of animal growth rate, clinical condition, bacterial and leukocyte counts in synovial fluid, and histological appearance. An inadequate dosage regimen (a single daily dose) prevented spread of bacteria but did not control abscesses. Delay in commencing treatment permitted persistence and spread of abscesses with destruction of the secondary (epiphyseal) ossification center and even transphyseal spread into metaphyseal bone. Repair by fibroblasts was mainly seen in articular and epiphyseal cartilage but was not seen in the epiphyseal ossification center during the duration of the experiments (up to 18 days). Synovial fluid sampling with measurement of leukocyte and bacterial concentrations appears to be a useful guide to the effectiveness of treatment, because the numbers of cells correlate with the pathological process. 相似文献
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Chi-Chou Tseng Chung-Da Wu Wei-Ting Lin Huan-Tee Chan Po-Yih Chen 《Formosan Journal of Musculoskeletal Disorders》2013,4(2):51-52
Septic arthritis caused by Gram-negative bacteria is uncommon. However, Klebsiella pneumoniae is one of the most common pathogens in Taiwan in several clinical entities, including severe community-acquired pneumonia, community-acquired lung abscess, empyema, necrotizing fasciitis, and liver abscess. However, the research focusing on septic arthritis caused by K. pneumoniae is only limited. Herein, we described three cases of K. pneumoniae-associated septic arthritis. Two of them had underlying diabetes mellitus, and one of them was caused by extended beta-lactamase–producing K. pneumoniae. All outcomes were favorable under appropriate management, which included antibiotic treatment or drainage. 相似文献
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Septic arthritis due to fungal infection is uncommon, but when it does occur it can have a devastating effect. Scedosporium prolificans is an emerging fungal pathogen that appears to have a predilection for bone and cartilaginous surfaces. This fungus is resistant to most commonly prescribed antifungal agents. We report the successful treatment of Scedosporium prolificans septic arthritis with a combination of surgery and new antifungal agents. 相似文献
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An experimental model of acute septic arthritis is described, utilizing the injection of S. aureus into chicken hock joints. The course of the infection was monitored over a 14-day period by measurement of chicken growth rate, histopathology of the joint, number of bacteria, and number and type of leukocytes in the synovial fluid. Bacterial numbers decreased initially then increased rapidly over the first 24 h. Leukocyte counts rose sharply, starting between 60 and 90 min after injection. Gross destruction of articular cartilage was observed at 4 days, and appeared to be initiated by the adherence of the staphylococci to the cartilage surface followed by their penetration and invasion of vascular tunnels in the epiphyseal cartilage. Extensive (but focal) erosion of the articular surface was evident by 14 days. 相似文献
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A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint. 相似文献
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目的观察持续冲洗结合负压封闭引流(VSD)治疗儿童急性化脓性关节炎临床疗效。方法将血培养阳性的急性化脓性关节炎患儿按治疗方法分为观察组(持续冲洗结合VSD,22例)和对照组(传统冲洗,24例),对两组的住院时间、体温恢复正常时间、换药次数、治疗次数进行比较。结果观察组随访6个月~2年,对照组随访1~5年。观察组并发症明显低于对照组,两组比较差异有统计学意义(P0.05)。住院时间、体温恢复正常时间、换药次数、治疗次数观察组均优于对照组,差异均有统计学意义(P0.05)。结论持续冲洗结合VSD治疗儿童急性化脓性关节炎效果理想,可以缩短康复时间、减少换药及治疗次数。 相似文献
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Cornelia M. Donders Anne J. Spaans Johannes H. J. M. Bessems Christiaan J. A. van Bergen 《Journal of children's orthopaedics》2021,15(1):48
PurposeSeptic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children.MethodsThe electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsOut of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. ConclusionIncluded studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae.Level of evidenceIV 相似文献
9.
Septic arthritis is an orthopedic emergency that can lead to significant morbidity and mortality. Polyarticular involvement is a relatively rare phenomenon occurring primarily in high-risk patients. In this article, we report the rare case of a patient with rheumatoid arthritis presenting with an acute episode of septic arthritis involving most of the joints of the body. Surprisingly, his bilateral total hip arthroplasties were completely unaffected. Unusual polyarticular presentations of septic arthritis, though rare, must still be considered within the differential diagnosis by all healthcare providers when treating certain high-risk groups. 相似文献
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《Joint, bone, spine : revue du rhumatisme》2023,90(3):105510
ObjectiveTo determine the risks and clinical significance of tocilizumab (TCZ)-related neutropenia, in real-world settings, for patients with rheumatoid arthritis (RA).MethodsMedical records of RA patients treated with TCZ at a tertiary referral hospital in South Korea were collected. Infectious complications were defined as cases confirmed by clinical diagnosis and treated with antibiotics.ResultsA total of 277 RA patients with TCZ treatment (intravenous: 152 [54.9%], subcutaneous: 125 [45.1%]) were included in our study. During the observational period, 22 (7%) patients experienced grade 3 neutropenia. No patients discontinued TCZ due to neutropenia, while the dosage of conventional synthetic DMARD (csDMARD) was either reduced or discontinued for 8 patients. Patients, who experienced neutropenia while using csDMARD, had a higher risk for grade 3/4 neutropenia during TCZ treatment (hazard ratio [HR]: 3.120, 95% CI: 1.189–8.189, P = 0.021). Among infections, pulmonary infections were the most common (10.35 per 100 patient-years). Age over 60 years (HR: 2.133, 95% CI: 1.118–4.071, P = 0.022) and the presence of extra-articular manifestations (adjusted HR: 11.096, 95% CI: 5.353–22.999, P < 0.001), but not neutropenia (adjusted HR: 1.263, 95% CI: 0.269–5.945, P = 0.77), were risk factors for infections during TCZ treatment.ConclusionApproximately 7% of RA patients treated with TCZ developed grade 3 neutropenia. The previous history of neutropenia during csDMARD was a risk factor for TCZ-related neutropenia. Age and extra-articular manifestations, but not neutropenia, were risk factors for infection during TCZ treatment, suggesting that TCZ treatment can be maintained in the presence of neutropenia unless infection occurs. 相似文献
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Lumbar fusion outcomes in patients with rheumatoid arthritis 总被引:1,自引:1,他引:0
Charles H. CrawfordIII Leah Y. Carreon Mladen Djurasovic Steven D. Glassman 《European spine journal》2008,17(6):822-825
Although outcomes after cervical fusion in rheumatoid arthritis (RA) patients are widely published, outcomes of lumbar fusion
in RA patients has not been reported. Ninteen patients with RA, identified using ICD-9 and CPT codes, who underwent instrumented
posterolateral lumbar fusion were matched for age, gender, smoking status, date, and level of surgery to a contemporaneous
non-RA group. Medical records and radiographs were reviewed by the primary author who had no role in the treatment of these
patients. The average age was 64 years in the RA group and 65 years in the non-RA group. The male to female ratio was 2:17
and 1:18, respectively. There were three smokers and two diabetics in each group. An average of 1.5 levels was fused in each
group. Average follow-up was 24 and 27 months, respectively. In the RA group, 15 patients were taking DMARDs with 7 of those
also taking oral steroids; 4 patients were taking NSAIDs only. There were seven complications (37%) in the RA group versus
four (21%) in the non-RA group; wound infections in three patients (16%) in the RA group versus one (5%) in the non-RA group;
and non-union in two patients (11%) in the RA group versus three (16%) in the non-RA group. Clinical outcomes were similar
between the two groups with 74% of patients achieving good to excellent results in the RA group compared to 63% in the non-RA
group (p = 0.692). Surgeons and their RA patients who undergo an instrumented lumbar fusion can expect a slightly higher complication
rate than patients without RA which may be related to osteopenia and immunosuppression. 相似文献
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类风湿关节炎和骨质疏松在我国都属于常见病和多发病,而二者之间又有着非常重要的联系。但是目前临床上还没有一个广泛应用的药物可以同时对两者都产生很好的治疗效果。为了进一步了解骨质疏松和类风湿关节炎的关系,将来能够找到更好的治疗药物,笔者从流行病学、发病机制以及治疗方法等方面分别进行了论述。 相似文献
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Seunghwan Shin Eun Hye Park Eun Ha Kang Yun Jong Lee Yeong Wook Song You-Jung Ha 《Joint, bone, spine : revue du rhumatisme》2021,88(3):105124
ObjectiveRheumatoid arthritis (RA) is more prevalent in women, but sex differences remain incompletely understood. This study aimed to elucidate sex differences in clinical characteristics and their potential impact on clinical outcomes in a large Korean cohort of patients with RA.MethodsIn total, 5376 RA patients from the KORean Observational study Network for Arthritis (KORONA) database were examined at baseline and for 3 consecutive years using the disease activity score 28 (DAS28), health assessment questionnaire (HAQ), and patient-reported outcomes (PROs). Within a subgroup with active disease (DAS28 ≥ 3.2) at baseline, sex impacts on clinical outcome during follow-up were analyzed using generalized estimating equation (GEE) models. The factors related to achieving clinical remission were analyzed using Cox-proportional hazard regression.ResultsAt baseline, women (n = 4574) were younger and had more erosive disease and longer disease duration than men (n = 802) with higher scores in DAS28, HAQ, and PROs. The prevalence of interstitial lung disease, cardiovascular disease, and diabetes in men was higher than that of women. In a RA subgroup with active disease at baseline, GEE analyses demonstrated that women RA significantly influenced the rate of change of DAS28 over time. In that group, men are associated with achieving DAS28 sustained remission and point remission.ConclusionsWomen with RA in Korea report higher levels of disease activity and PROs compared to men, whereas most comorbidities were more prevalent in men. The longitudinal change in disease activity and the rate of achieving clinical remission were found to be worse in women with RA. 相似文献
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Tim Lögters Adnana Paunel‐Görgülü Christoph Zilkens Jens Altrichter Martin Scholz Simon Thelen Rüdiger Krauspe Stefan Margraf Teresa Jeri Joachim Windolf Marcus Jäger 《Journal of orthopaedic research》2009,27(11):1401-1407
The release of “neutrophil extracellular traps” (NETs) has been identified as a novel immune response in innate immunity. NETs are composed of neutrophil‐derived circulating free DNA (cf‐DNA) and neutrophil cytoplasm‐derived proteins such as proteases. In this study, we analyzed the putative diagnostic value of synovial cf‐DNA/NETs for identification of septic arthritis. Forty‐two patients with a joint effusion who had undergone arthrocentesis were included. From synovial fluid, cf‐DNA/NETs (j‐cf‐DNA) levels were directly quantified. Diagnostic value of j‐cf‐DNA was compared with white blood cells (WBC), synovial white blood cells (j‐WBC), C‐reactive protein (CRP), j‐IL‐6, j‐TNF alpha, j‐IL‐1 beta, and myeloperoxidase (j‐MPO). Sensitivity, specificity, positive and negative predictive value, as well as ROC‐curves for each parameter were calculated. Synovial fluid cf‐DNA/NETs values from patients with septic arthritis (3,286 ± 386 ng/ml, n = 9) were significantly increased compared to patients with noninfectious joint inflammation (1,040 ± 208 ng/ml, n = 17) or osteoarthritis (278 ± 34 ng/ml, n = 16, p < 0.01). In conjunction with j‐cf‐DNA, j‐IL‐6 and j‐IL‐1 beta were significantly elevated (p < 0.01), but WBC, CRP, and j‐WBC were not. At a cut‐off of 300 ng/ml, j‐cf‐DNA had a sensitivity of 0.89, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.97. Receiver operation curves revealed largest areas under the curve for cf‐DNA/NETs (0.933) and j‐IL‐6 (0.951). cf‐DNA/NETs seem to be a valuable additional marker for the diagnosis of septic arthritis or periprosthetic infections. However, this result should be confirmed in a large clinical trial. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1401–1407, 2009 相似文献
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Obayashi M Uzu T Harada T Yamato M Takahara K Yamauchi A 《Clinical and experimental nephrology》2003,7(4):275-278
Background Bucillamine, a disease-modifying antirheumatic drug widely prescribed in Japan, is reported to be a cause of proteinuria. However, to date, the clinical course of the nephropathy associated with the use of bucillamine has not been described in detail.Methods We analyzed renal biopsy findings from 10 patients with rheumatoid arthritis and concomitant bucillamine-induced nephropathy. Each patient was followed up until proteinuria had resolved.Results Proteinuria appeared 2–11 months after the initiation of the treatment with bucillamine. Nine patients, who stopped bucillamine treatment immediately (within 3 months) after the onset of proteinuria, were diagnosed as having stage I membranous nephropathy. Only one patient, who used bucillamine for 9.5 months after the onset of proteinuria, was diagnosed as having stage II membranous nephropathy. In all patients with stage I membranous nephropathy, the proteinuria disappeared within 7 months after they stopped bucillamine treatment. On the other hand, in the patient with stage II membranous nephropathy, the proteinuria persisted for 14 months after the use of bucillamine was stopped. In all the patients, the proteinuria resolved completely without deterioration of renal function. None of the patients has experienced recurrence of proteinuria.Conclusions In patients with proteinuria induced by treatment with bucillamine, membranous nephropathy is the most common disorder. Immediate withdrawal of bucillamine results in prompt and complete resolution of proteinuria without deterioration of renal function. 相似文献
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Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, with a 0.5% worldwide prevalence. The cause of RA remains unknown, however both genetic and environmental factors may contribute to its development. Among these is the Epstein-Barr virus (EBV). Here, we discuss several aspects of the close relationship between EBV and RA. Patients with RA have impaired control of EBV infection. Indeed, they have high titres of antibodies against EBV antigens. Their peripheral blood T lymphocytes are less efficient at controlling the outgrowth of EBV-infected B cells. RA patients have more EBV-infected B cells than normal controls, leading to a 10-fold systemic EBV overload. Post-transplant lymphoproliferative disorder (PTLPD) is a polyclonal EBV-positive B lymphocyte proliferation, which can evolve into an EBV-positive B cell lymphoma. RA patients also have an increased risk of developing EBV-associated lymphoproliferative disorder (LPD). Hence the need to monitor EBV load when treating RA patients with immunosuppressors. EBV, a widespread virus, highly recognized by antibodies but never eliminated, is an ideal candidate to trigger chronic immune complex disease. Anti-EBV antibody responses should be considered as one of the chronic autoantibody responses linked to the development of RA, in the same way as anti-citrullinated protein antibodies. 相似文献
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Aimto evaluate the role of preoperative magnetic resonance imaging (MRI) in assessing patients with a history of quiescent hip septic arthritis undergoing total hip arthroplasty.Materials and methodsretrospective consecutive study of patients with previous history of septic arthritis who underwent MRI scans of their hips prior to primary hip arthroplasty surgery and who also had minimum 2 years follow up postoperatively. Detailed radiographic examinations were obtained, demographic and microbiological data collected. The primary outcome measure was whether a preoperative MRI scan had influenced the surgical decision-making and planning. Rate of recurrence of infection and complications was also collected at final follow up.Resultssixteen patients with quiescent hip septic arthritis were included. There were 4 males and 12 females with average age at time of primary hip arthroplasty 51.7 years (range 22–75). Five patients had childhood septic arthritis with no documented microbiology data. Eleven patients had adult onset septic arthritis. In patients with childhood septic arthritis the MRI findings were similar to those with degenerative joint disease and had no added value to the routine surgical work up. MRIs of patients with adult onset septic arthritis showed persistent findings of effusion, marrow oedema and soft tissue oedema and had no added value to the surgical planning. All but one underwent single stage total hip arthroplasty. At final follow up, with average 4.6 years (range 2–8), none had a recurrence of infection.ConclusionIn our experience, preoperative MRI scans did not influence the surgical decision making and are not recommended for routine practice in the surgical work up of quiescent septic arthritis prior to total hip arthroplasty. 相似文献
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Chi-Chou Tseng Chung-Da Wu Shun-Chien Cheng Wei-Ting Lin Huan-Tee Chan Po-Yih Chen 《Formosan Journal of Musculoskeletal Disorders》2013,4(2):53-55
Septic arthritis caused by Aeromonas hydrophila is a rare clinical entity in common practice. Herein, we describe one case of A. hydrophila-associated septic knee after a traumatic injury. The clinical condition gradually improved after appropriate antibiotic and surgical debridement. 相似文献