The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Michael Doherty - One of the best experts on this subject based on the ideXlab platform.
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Gout – a guide for the general and acute physicians
Clinical medicine (London England), 2017Co-Authors: Abhishek Abhishek, Edward Roddy, Michael DohertyAbstract:Gout is the most prevalent inflammatory arthritis and affects 2.5% of the general population in the UK. It is also the only arthritis that has the potential to be cured with safe, inexpensive and well tolerated urate-lowering treatments, which reduce serum uric acid by either inhibiting xanthine oxidase - eg allopurinol, febuxostat - or by increasing the renal excretion of uric acid. Of these, xanthine oxidase inhibitors are used first line and are effective in 'curing' gout in the vast majority of patients. Gout can be diagnosed on clinical grounds in those with typical podagra. However, in those with involvement of other Joints, Joint Aspiration is recommended to demonstrate monosodium urate crystals and exclude other causes of acute arthritis, such as septic arthritis. However, a clinical diagnosis of gout can be made if Joint Aspiration is not feasible. This review summarises the current understanding of the pathophysiology, clinical presentation, investigations and treatment of gout.
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Treatment of calcium pyrophosphate deposition
Oxford Medicine Online, 2016Co-Authors: Abhishek Abhishek, Michael DohertyAbstract:The treatment of calcium pyrophosphate crystal deposition (CPPD) is mainly symptomatic. Acute calcium pyrophosphate (CPP) crystal synovitis should be treated with rest, local application of ice packs, Joint Aspiration, and/or intra-articular corticosteroid injection (once Joint sepsis has been excluded). Oral colchicine or prednisolone may be used if Joint Aspiration and/or injection are not feasible. Anti-inflammatory agents (with proton pump inhibitors) may be used but in general these should be avoided as most patients with acute CPP crystal arthritis are elderly, and at a high risk of gastrointestinal and renal complication of non-steroidal anti-inflammatory drug (NSAIDs). Principles of management of CPPD with osteoarthritis (OA) are identical to those for isolated OA. However, patients may have more inflammatory signs and symptoms and periodic Joint Aspiration and corticosteroid injection may be required more often than in isolated OA. Oral NSAIDs (with gastro-protection), colchicine, low-dose corticosteroids, hydroxychloroquine, and radiosynovectomy have been suggested as options for the treatment of chronic CPP crystal arthritis. There is growing interest in use of anti-interleukin-1 agents for acute or chronic CPP crystal arthritis but the efficacy of these agents has not been formally studied, and their use should be considered on an individual basis.
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Joint Aspiration and injection and synovial fluid analysis
Best Practice & Research: Clinical Rheumatology, 2009Co-Authors: Philip Courtney, Michael DohertyAbstract:Joint Aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of Joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of Aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected Joints. The knee is the most common site to require Aspiration, although any non-axial Joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of Joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing Joint inflammation is associated with increased SF volume, reduced viscosity, increasing turbidity and cell count, and increasing ratio of polymorphonuclear: mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed Joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis.
Lars Frommelt - One of the best experts on this subject based on the ideXlab platform.
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Algorithm to Diagnose Delayed and Late PJI: Role of Joint Aspiration
Advances in experimental medicine and biology, 2016Co-Authors: Olivier Borens, Lars Frommelt, Pablo S. Corona, Stergios Lazarinis, Michael Richard Reed, Carlo Luca RomanòAbstract:Total Joint Arthroplasty (TJA) continues to gain acceptance as the standard of care for the treatment of severe degenerative Joint disease, and is considered one of the most successful surgical interventions in the history of medicine. A devastating complication after TJA is infection. Periprosthetic Joint infection (PJI), represents one of the major causes of failure and remains a significant challenge facing orthopaedics today. PJI usually requires additional surgery including revision of the implants, fusion or amputations causing tremendous patient suffering but also a heavy health economics burden. PJI is at the origin of around 20–25 % of total knee arthroplasty (Bozic et al. 2010; de Gorter et al. 2015; Sundberg et al. 2015) and 12–15 % of total hip arthroplasty (Bozic et al. 2009; Garellick et al. 2014; de Gorter et al. 2015) failures.
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the value of synovial biopsy Joint Aspiration and c reactive protein in the diagnosis of late peri prosthetic infection of total knee replacements
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: Bernd Fink, C Makowiak, Martin Fuerst, Irina Berger, Peter H Schafer, Lars FrommeltAbstract:We analysed the serum C-reactive protein level, synovial fluid obtained by Joint Aspiration and five synovial biopsies from 145 knee replacements prior to revision to assess the value of these parameters in diagnosing late peri-prosthetic infection. Five further synovial biopsies were used for histological analysis. Samples were also obtained during the revision and incubated and analysed in an identical manner for 14 days. A total of 40 total knee replacements were found to be infected (prevalence 27.6%). The Aspiration technique had a sensitivity of 72.5% (95% confidence interval (CI) 58.7 to 86.3), a specificity of 95.2% (95% CI 91.2 to 99.2), a positive predictive value of 85.3% (95% CI 73.4 to 100), a negative predictive value of 90.1% (95% CI 84.5 to 95.7) and an accuracy of 89%. The biopsy technique had a sensitivity of 100%, a specificity of 98.1% (95% CI 95.5 to 100), a positive predictive value of 95.2% (95% CI 88.8 to 100), a negative predictive value of 100% and an accuracy of 98.6%. C-reactive protein with a cut-off-point of 13.5 mg/l had a sensitivity of 72.5% (95% CI 58.7 to 86.3), a specificity of 80.9% (95% CI 73.4 to 88.4), a positive predictive value of 59.2% (95% CI 45.4 to 73.0), a negative predictive value of 88.5% (95% 81.0 to 96.0 CI) and an accuracy of 78.1%. We found that biopsy was superior to Joint Aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.
Philip Courtney - One of the best experts on this subject based on the ideXlab platform.
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Joint Aspiration and injection and synovial fluid analysis
Best Practice & Research: Clinical Rheumatology, 2009Co-Authors: Philip Courtney, Michael DohertyAbstract:Joint Aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of Joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of Aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected Joints. The knee is the most common site to require Aspiration, although any non-axial Joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of Joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing Joint inflammation is associated with increased SF volume, reduced viscosity, increasing turbidity and cell count, and increasing ratio of polymorphonuclear: mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed Joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis.
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Joint Aspiration and injection
Best Practice & Research: Clinical Rheumatology, 2005Co-Authors: Philip Courtney, U Michael K DohertyAbstract:Joint Aspiration/injection is an invaluable procedure for the diagnosis and treatment of Joint disease. The knee is the commonest site to require Aspiration although any non-axial Joint is accessible for obtaining synovial fluid. Septic arthritis and crystal arthritis can be readily diagnosed by aspirating synovial fluid. Intra-articular injection of long-acting insoluble corticosteroids produces rapid resolution of inflammation in most injected Joints and is a well established procedure in rheumatological practice. The technique involves only a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used it is a safe procedure. This chapter addresses the indications, technical principals, expected benefits and risks of intra-articular corticosteroid injection. The use of other intra-articular injections including osmic acid, radioisotopes and hyaluronic acid, which are less universally utilised than intra-articular corticosteroid, will also be addressed.
Isabel Spriet - One of the best experts on this subject based on the ideXlab platform.
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preoperative Joint Aspiration culture results and causative pathogens in total hip and knee prosthesis infections mind the gap
Acta Clinica Belgica, 2020Co-Authors: Peter Declercq, J Neyt, Melissa Depypere, Stefanie Goris, Eric Van Wijngaerden, Jan Verhaegen, Joost Wauters, Isabel SprietAbstract:In prosthetic Joint infections (PJIs), there is no consensus about the utility of the preoperative Joint Aspiration culture to guide antimicrobial treatment. The main objective of this retrospectiv...
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AGREEMENT BETWEEN PRE-OPERATIVE Joint Aspiration RESULTS AND CAUSATIVE PATHOGENS IN PATIENTS WITH PROSTHETIC HIP AND KNEE INFECTIONS TREATED WITH A TWO-STAGE REVISION
2018Co-Authors: Peter Declercq, J Neyt, Stefanie Goris, Joost Wauters, Isabel SprietAbstract:AimPreoperative Joint Aspiration cultures (PJACs) are of great value in diagnosing prosthetic Joint infections (PJIs). Studies investigating the predictive value of PJACs to identify causative path...
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AGREEMENT BETWEEN PRE-OPERATIVE Joint Aspiration RESULTS AND CAUSATIVE PATHOGENS IN PATIENTS WITH PROSTHETIC HIP AND KNEE INFECTIONS TREATED WITH A TWO-STAGE REVISION
Journal of Bone and Joint Surgery-british Volume, 2016Co-Authors: Peter Declercq, J Neyt, Stefanie Goris, Joost Wauters, Isabel SprietAbstract:Aim Preoperative Joint Aspiration cultures (PJACs) are of great value in diagnosing prosthetic Joint infections (PJIs). Studies investigating the predictive value of PJACs to identify causative pathogens in PJI, which is off course relevant for the correct initiation of antimicrobial treatment, are limited. The objective of this study was to investigate whether the PJACs are in agreement with causative pathogens in PJIs. Method A retrospective monocentric study was conducted at the 40-bed orthopedics department of a tertiary centre. Medical files of patients with proven prosthetic knee or hip infection with PJACs from maximum 6 months prior to the first stage of a two-stage revision admitted between March 2010 and December 2014 were evaluated. A proven PJI was defined as at least two positive preoperative or intraoperative cultures, the presence of purulent synovial fluid or purulence at the implant site or surrounding the prosthesis without other identifiable causes, the presence of acute inflammation upon histopathological examination of the periprosthetic tissue at the time of surgery or the presence of a sinus tract communicating with the prosthesis. In order to identify the causative pathogen(s) per patient, a multidisciplinary team, consisting out of a microbiologist, a septic orthopedic surgeon, two infectious diseases specialists and two clinical pharmacists, assessed the relevance of pathogens cultured in the PJACs and intraoperative deep samples based on the current 2012 IDSA guidelines. Per patient, agreement of PJACs corresponding to the retained causative pathogen(s) was investigated in two ways: 1) on species level and 2) on Gram stain or fungi level. Results Forty-six patients (66 ± 10 years; 26 males; 23 knee and 23 hip; 25 first revisions and 21 with multiple revisions) were included. PJACs remained sterile in seven patients. In 25 of 46 patients (54%) there was agreement in terms of causative pathogen species. In 39 of 46 patients (85%), there was agreement in terms of Gram staining or fungi results. In the other 7 patients, PJACs remained sterile, but with positive intraoperative culture results. Conclusions Only half of PJAC results corresponded to the retained causative pathogens. Therefore, PJACs should not be used to initiate directed antimicrobial therapy; directed therapy should only be instituted when also intraoperatieve cultures are known. Initially, a (combination of) broad spectrum agent(s) should be preferred. Also preliminary narrowing of the spectrum can be implemented based on the Gram staining or fungi results of PJACs, as was seen in our study.
Nicola Dalbeth - One of the best experts on this subject based on the ideXlab platform.
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the effects of Joint Aspiration and intra articular corticosteroid injection on flexion reflex excitability quadriceps strength and pain in individuals with knee synovitis a prospective observational study
Arthritis Research & Therapy, 2015Co-Authors: David A Rice, Peter J Mcnair, Gwyn N Lewis, Nicola DalbethAbstract:Introduction: Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of Joint Aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis. Methods: Sixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee Joint Aspiration alone and 5 ± 2 and 15 ± 2 days after knee Joint Aspiration and the injection of 40 mg of methylprednisolone acetate. Results: Compared to baseline, knee pain was significantly reduced 5 (p =0 .001) and 15 days (p =0 .009) post intervention. Flexion reflex threshold increased immediately after Joint Aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after Joint Aspiration (p =0 .004) and 5 (p = 0.001) and 15 days (p <0.001) post intervention. Conclusions: The findings from this study suggest that altered sensory output from an inflamed Joint may increase flexion reflex excitability in humans, as has previously been shown in animals. Joint Aspiration and corticosteroid injection may be a clinically useful intervention to reverse quadriceps muscle weakness in individuals with knee synovitis.
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The effects of Joint Aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study.
Arthritis research & therapy, 2015Co-Authors: David A Rice, Peter J Mcnair, Gwyn N Lewis, Nicola DalbethAbstract:Introduction: Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of Joint Aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis. Methods: Sixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee Joint Aspiration alone and 5 ± 2 and 15 ± 2 days after knee Joint Aspiration and the injection of 40 mg of methylprednisolone acetate. Results: Compared to baseline, knee pain was significantly reduced 5 (p =0 .001) and 15 days (p =0 .009) post intervention. Flexion reflex threshold increased immediately after Joint Aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after Joint Aspiration (p =0 .004) and 5 (p = 0.001) and 15 days (p
