Document Detail


Role of Newman's classification in predicting outcomes in patients with crystal arthritis.
MedLine Citation:
PMID:  22218914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The aim of the study was to evaluate the utility of Newman's classification in predicting outcomes in patients presenting with crystal arthritis.
METHODS: Between January and December 2009, all patients who presented to our institution with acute crystal arthritis and were investigated with microbiological assessment of their synovial fluid were included in the study. Patients were divided into two groups depending on the fulfilment of Newman's criteria for culture-negative septic arthritis. Group 1 included patients that fulfilled Newman's B criteria. Group 2 included patients that fulfilled Newman's C criteria. A database looking at the demographics, mode of presentation, investigations, treatment and outcomes was then established and the results compared between the two groups.
RESULTS: A total of 58 patients were identified (group 1: n = 13; group 2: n = 45). The average age was 71 years (range 33-96). The joint most commonly involved was the knee followed by the wrist. Clinical findings at presentation were comparable in both groups; however, WBC and C-reactive protein (CRP) were more likely to be raised in group 1. Although most patients in group 1 were treated with antibiotics (62%) there was still a higher rate of morbidity, greater use of supportive therapy and a longer hospital stay (22.3 days, SD 17.4) in comparison with group 2, where most patients were treated by observation only (76%, mean hospital stay 3.5 days, SD ± 4.4). The difference in length of hospital stay was statistically significant (p < 0.0001).
CONCLUSIONS: Newman's criteria are a good indicator for prognosis in patients with crystal arthritis. However, the presence of crystals in an acutely inflamed joint does not exclude the need for supportive therapy and long hospital stay even in the absence of positive synovial fluid culture.
Authors:
Ihab Hujazi; Graeme Ambler; Arvind Arora; Vikas Khanduja
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2012-01-05
Journal Detail:
Title:  International orthopaedics     Volume:  36     ISSN:  1432-5195     ISO Abbreviation:  Int Orthop     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-16     Completed Date:  2012-09-20     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  7705431     Medline TA:  Int Orthop     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1287-90     Citation Subset:  IM    
Affiliation:
Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use
Calcium Pyrophosphate / metabolism
Chondrocalcinosis / classification,  diagnosis*,  metabolism,  therapy
Crystallization
Debridement
Female
Humans
Joints / metabolism,  pathology*,  surgery
Male
Middle Aged
Periarthritis / classification,  diagnosis*,  metabolism,  therapy
Predictive Value of Tests
Prognosis
Treatment Outcome
Uric Acid / metabolism
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 10086-45-0/Calcium Pyrophosphate; 69-93-2/Uric Acid
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