化膿性関節炎 診断・治療アルゴリズム
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単（少・多）関節炎の患者では、病歴・身体所見上化膿性関節炎が否定できない場合は、必ず関節穿刺を行い、細胞数・グラム染色・培養、結晶検査にて評価する。必要な培養検検体がとられていることを確認のうえで、抗菌薬を開始する。ドレナージ、リハビリも重要な要素である。
出典
1:
Septic arthritis: current diagnostic and therapeutic algorithm.
著者:
Catherine J Mathews, Gerald Coakley
雑誌名:
Curr Opin Rheumatol. 2008 Jul;20(4):457-62. doi: 10.1097/BOR.0b013e3283036975.
Abstract/Text
PURPOSE OF REVIEW:
To propose and discuss an evidence-based algorithm for the diagnosis and treatment of bacterial septic arthritis. Also, to review the recent literature on emerging management strategies and discuss the potential impact of these developments on clinical practice.
RECENT FINDINGS:
Evidence-based guidelines have recently been published to assist in the diagnosis and management of suspected and confirmed septic arthritis. All suspected septic joints should be aspirated and the synovial fluid examined by microscopy for the presence of crystals and microorganisms. There is controversy surrounding the diagnostic utility of quantifying the synovial fluid white cell count, with two recent systematic reviews reaching opposite conclusions. The emergence of multidrug resistant pathogens has led to a search for alternative antimicrobial agents such as linezolid. Studies in animals and children have suggested that corticosteroid therapy may be a useful adjunct to conventional antibiotic therapy. Research using experimental murine models of septic arthritis is also generating novel immunotherapeutic targets as potential adjuncts to antibiotic regimens.
SUMMARY:
There is a striking paucity of high-quality evidence upon which to base guidelines on the management of the hot-swollen joint. Ultimately, the diagnosis of septic arthritis rests on the opinion of a clinician experienced in the assessment of musculoskeletal disease. Future research may provide alternative investigative and treatment strategies to improve the accuracy of diagnosis as well as the outcome in this group of patients.
Curr Opin Rheumatol. 2008 Jul;20(4):457-･･･
