Citation: BMJ Case Reports. 2019, 12(5), e228597
Author: Goldsmith L, Barlow M, Evans PJ, Srinivas-Shankar U
Abstract: A 55-year-old man with poorly controlled type 1 diabetes with microvascular and macrovascular complications presented with a 1-week history of painful erythematous swelling on the dorsum of the left foot with two areas of foot ulceration. Inflammatory markers were raised. MRI of the left foot revealed a soft tissue swelling on the dorsum of the left foot, marrow oedema and destruction of several small joints of the foot, indicating osteomyelitis and Charcot neuroarthropathy (CN). The soft tissue swelling on the dorsum of the left foot was debrided; per-operatively bone destruction of base of the fifth metatarsal was found. The patient received intravenous antibiotics for 6 weeks. The clinical features of CN including erythema, oedema and elevated temperature of the left foot settled with off-loading the foot in an air cast walker after 6 months. Our case highlights the need to recognise CN in an acutely inflamed foot of diabetic patients with neuropathy, even when other conditions like soft tissue infection and osteomyelitis can explain the clinical features.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: bone and joint infections; diabetes; orthopaedics; peripheral nerve disease
Link to PubMed record
Thursday, 16 May 2019
Tuesday, 14 May 2019
WUTH publication: Evaluation of Radiation Exposure During Sentinel Lymph Node Biopsy in Breast Cancer: A Retrospective Study
Citation: World Journal of Surgery. 2019, 43(9), 2250-53
Author: Burrah R, James K, Poonawala S
Abstract: INTRODUCTION: Sentinel node biopsy (SNB) is the standard of care for nodal staging in breast cancer. Currently, radioisotope-guided SNB is the standard technique. We have undertaken this study to analyse radiation exposure during SNB for breast cancer over a significant period of time.
METHODS: The study was conducted over a period of 41 months and included 183 patients. The radioisotope was usually administered the day preceding the surgery at a dose of 40 MBq (±10%), and a lower dose of 20 MBq (±10%) was given if injected on the day of surgery. The radiation exposure was measured by dosimeters worn by the surgeon and surgical assistant.
RESULTS: The surgical procedures performed were mastectomy and SNB (56 patients), wide local excision and SNB (109 patients), and SNB alone (18 patients). The median time interval between the injection and surgery was 19.3 h, and median duration of surgery 93 min. The annual exposure for the surgeon was 0.125 mSv (range 0.01-0.03 mSv) and for the assistant was 0.265 (range 0.01-0.13 mSv).
CONCLUSION: Contrary to other studies, we found the radiation exposure in the assistant was higher than that in the surgeon and we think this is because the assistant is positioned closer to the injection site during the procedure. However, the cumulative levels of radiation with SNB were very low and significantly below the permissible limits. The timing of injection, type of breast surgery and duration of procedure did not affect the levels of radiation exposure.
Link to PubMed record
Author: Burrah R, James K, Poonawala S
Abstract: INTRODUCTION: Sentinel node biopsy (SNB) is the standard of care for nodal staging in breast cancer. Currently, radioisotope-guided SNB is the standard technique. We have undertaken this study to analyse radiation exposure during SNB for breast cancer over a significant period of time.
METHODS: The study was conducted over a period of 41 months and included 183 patients. The radioisotope was usually administered the day preceding the surgery at a dose of 40 MBq (±10%), and a lower dose of 20 MBq (±10%) was given if injected on the day of surgery. The radiation exposure was measured by dosimeters worn by the surgeon and surgical assistant.
RESULTS: The surgical procedures performed were mastectomy and SNB (56 patients), wide local excision and SNB (109 patients), and SNB alone (18 patients). The median time interval between the injection and surgery was 19.3 h, and median duration of surgery 93 min. The annual exposure for the surgeon was 0.125 mSv (range 0.01-0.03 mSv) and for the assistant was 0.265 (range 0.01-0.13 mSv).
CONCLUSION: Contrary to other studies, we found the radiation exposure in the assistant was higher than that in the surgeon and we think this is because the assistant is positioned closer to the injection site during the procedure. However, the cumulative levels of radiation with SNB were very low and significantly below the permissible limits. The timing of injection, type of breast surgery and duration of procedure did not affect the levels of radiation exposure.
Link to PubMed record
Wednesday, 8 May 2019
WUTH publication: Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review
Citation: BMJ Open. 2019, 9(5), e022105
Author: Trubey R, Huang C, Lugg-Widger FV, Hood K, Allen D, Edwards D, Lacy D, Lloyd A, Mann M, Mason B, Oliver A, Roland D, Sefton G, Skone R, Thomas-Jones E, Tume LN, Powell C
Abstract: OBJECTIVE: To assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children.
DESIGN: Systematic review.
DATA SOURCES: British Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018.
ELIGIBILITY CRITERIA: We included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0-18 years), where adverse outcome metrics were reported. Several study designs were considered.
DATA EXTRACTION AND SYNTHESIS: Data extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale.
RESULTS: 36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration.
CONCLUSION: There are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base.
PROSPERO REGISTRATION NUMBER: CRD42015015326.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
KEYWORDS: PEWS; children; clinical deterioration; early warning scores; systematic review; track and trigger scores
Link to PubMed record
Author: Trubey R, Huang C, Lugg-Widger FV, Hood K, Allen D, Edwards D, Lacy D, Lloyd A, Mann M, Mason B, Oliver A, Roland D, Sefton G, Skone R, Thomas-Jones E, Tume LN, Powell C
Abstract: OBJECTIVE: To assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children.
DESIGN: Systematic review.
DATA SOURCES: British Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018.
ELIGIBILITY CRITERIA: We included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0-18 years), where adverse outcome metrics were reported. Several study designs were considered.
DATA EXTRACTION AND SYNTHESIS: Data extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale.
RESULTS: 36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration.
CONCLUSION: There are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base.
PROSPERO REGISTRATION NUMBER: CRD42015015326.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
KEYWORDS: PEWS; children; clinical deterioration; early warning scores; systematic review; track and trigger scores
Link to PubMed record
Friday, 26 April 2019
WUTH publication: Developments in Transduction, Connectivity and AI/Machine Learning for Point-of-Care Testing
Citation: Sensors. 2019, 19(8), pii: E1917
Author: O'Sullivan S, Ali Z, Jiang X, Abdolvand R, Ünlü MS, Silva HPD, Baca JT, Kim B, Scott S, Sajid MI, Moradian S, Mansoorzare H, Holzinger A
Abstract: We review some emerging trends in transduction, connectivity and data analytics for Point-of-Care Testing (POCT) of infectious and non-communicable diseases. The patient need for POCT is described along with developments in portable diagnostics, specifically in respect of Lab-on-chip and microfluidic systems. We describe some novel electrochemical and photonic systems and the use of mobile phones in terms of hardware components and device connectivity for POCT. Developments in data analytics that are applicable for POCT are described with an overview of data structures and recent AI/Machine learning trends. The most important methodologies of machine learning, including deep learning methods, are summarised. The potential value of trends within POCT systems for clinical diagnostics within Lower Middle Income Countries (LMICs) and the Least Developed Countries (LDCs) are highlighted.
KEYWORDS: POCT; artificial intelligence; deep learning; microfluidics; mobile phone; photonics
Link to PubMed record
Author: O'Sullivan S, Ali Z, Jiang X, Abdolvand R, Ünlü MS, Silva HPD, Baca JT, Kim B, Scott S, Sajid MI, Moradian S, Mansoorzare H, Holzinger A
Abstract: We review some emerging trends in transduction, connectivity and data analytics for Point-of-Care Testing (POCT) of infectious and non-communicable diseases. The patient need for POCT is described along with developments in portable diagnostics, specifically in respect of Lab-on-chip and microfluidic systems. We describe some novel electrochemical and photonic systems and the use of mobile phones in terms of hardware components and device connectivity for POCT. Developments in data analytics that are applicable for POCT are described with an overview of data structures and recent AI/Machine learning trends. The most important methodologies of machine learning, including deep learning methods, are summarised. The potential value of trends within POCT systems for clinical diagnostics within Lower Middle Income Countries (LMICs) and the Least Developed Countries (LDCs) are highlighted.
KEYWORDS: POCT; artificial intelligence; deep learning; microfluidics; mobile phone; photonics
Link to PubMed record
Wednesday, 10 April 2019
Release your potential this Spring!
| Is writing a joy? Do you find it hard to get going? Do you find yourself out of balance and pulled in different directions? Would you benefit from more confidence in your research experience? Due to the success of the previous workshop earlier this year, NHS R&D North West are offering another opportunity to enhance your research experience through coaching with Will Medd. Write here, right now: coaching writing workshop - 23rd April 2019, 9.30am-5pm, Federation House, Manchester Our coaching approach is tailored to the full experience of being a researcher, improving your professional and personal impact. This workshop is a full day event from 9.30am - 5pm, held at Federation House in Manchester City Centre. It is a £45 + VAT to attend for NHS Staff (50% is funded by Health Education England). For non-NHS staff, it is £90 + vat to attend. A purchase order number will be required upon booking to secure your place |
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Monday, 8 April 2019
WUTH publication: Localised bullous pemphigoid overlying knee arthroplasty: a diagnostic challenge
Citation: BMJ Case Reports. 2019, 12(4), e227440
Author: Truss A, Papalexandris S, Gardner S, Harvey R
Abstract: An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection was identified and treated. The blistering responded well to superpotent topical steroids and local care.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: dermatology; joint interposition; orthopaedics
Link to PubMed record
Author: Truss A, Papalexandris S, Gardner S, Harvey R
Abstract: An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection was identified and treated. The blistering responded well to superpotent topical steroids and local care.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: dermatology; joint interposition; orthopaedics
Link to PubMed record
Monday, 11 March 2019
WUTH publication: The shift to integrated care in the NHS: implications of the new care models for dentistry
Citation: British Dental Journal. 2019, 226(5), 319-322
Author: Willcocks S, Willcocks E
Abstract: This article explores the implications for dentistry of the policy of integration and collaboration in health and social care. In particular, it explores the advantages and disadvantages for dentistry of involvement in one of the new integrated care models currently being piloted, and the barriers and enabling factors that may need to be addressed if dentistry is to become involved. We argue that the advantages may outweigh the disadvantages and such involvement may be necessary at least in the longer term, otherwise there is a risk of missed opportunities and the possibility of dentistry being left out of major policy decisions affecting health and social care. However, such involvement of dentistry would require a considerable change to its current form and organisation. Any involvement will require the commitment and agreement of the dental profession, and its active engagement in the decision making process.
Link to PubMed record
Author: Willcocks S, Willcocks E
Abstract: This article explores the implications for dentistry of the policy of integration and collaboration in health and social care. In particular, it explores the advantages and disadvantages for dentistry of involvement in one of the new integrated care models currently being piloted, and the barriers and enabling factors that may need to be addressed if dentistry is to become involved. We argue that the advantages may outweigh the disadvantages and such involvement may be necessary at least in the longer term, otherwise there is a risk of missed opportunities and the possibility of dentistry being left out of major policy decisions affecting health and social care. However, such involvement of dentistry would require a considerable change to its current form and organisation. Any involvement will require the commitment and agreement of the dental profession, and its active engagement in the decision making process.
Link to PubMed record
Thursday, 7 March 2019
WUTH publication: The cost of diagnostic uncertainty: a prospective economic analysis of febrile children attending an NHS emergency department
Citation: BMC Medicine. 2019, 17(1), 48
Author: Leigh S, Grant A, Murray N, Faragher B, Desai H, Dolan S, Cabdi N, Murray JB, Rejaei Y, Stewart S, Edwardson K, Dean J, Mehta B, Yeung S, Coenen F, Niessen LW, Carrol ED
Abstract: BACKGROUND: Paediatric fever is a common cause of emergency department (ED) attendance. A lack of prompt and definitive diagnostics makes it difficult to distinguish viral from potentially life-threatening bacterial causes, necessitating a cautious approach. This may result in extended periods of observation, additional radiography, and the precautionary use of antibiotics (ABs) prior to evidence of bacterial foci. This study examines resource use, service costs, and health outcomes.
METHODS: We studied an all-year prospective, comprehensive, and representative cohort of 6518 febrile children (aged < 16 years), attending Alder Hey Children's Hospital, an NHS-affiliated paediatric care provider in the North West of England, over a 1-year period. Performing a time-driven and activity-based micro-costing, we estimated the economic impact of managing paediatric febrile illness, with focus on nurse/clinician time, investigations, radiography, and inpatient stay. Using bootstrapped generalised linear modelling (GLM, gamma, log), we identified the patient and healthcare provider characteristics associated with increased resource use, applying retrospective case-note identification to determine rates of potentially avoidable AB prescribing.
RESULTS: Infants aged less than 3 months incurred significantly higher resource use than any other age group, at £1000.28 [95% CI £82.39-£2993.37] per child, (p < 0.001), while lesser experienced doctors exhibited 3.2-fold [95% CI 2.0-5.1-fold] higher resource use than consultants (p < 0.001). Approximately 32.4% of febrile children received antibiotics, and 7.1% were diagnosed with bacterial infections. Children with viral illnesses for whom antibiotic prescription was potentially avoidable incurred 9.9-fold [95% CI 6.5-13.2-fold] cost increases compared to those not receiving antibiotics, equal to an additional £1352.10 per child, predominantly resulting from a 53.9-h increase in observation and inpatient stay (57.1 vs. 3.2 h). Bootstrapped GLM suggested that infants aged below 3 months and those prompting a respiratory rate 'red flag', treatment by lesser experienced doctors, and Manchester Triage System (MTS) yellow or higher were statistically significant predictors of higher resource use in 100% of bootstrap simulations.
CONCLUSION: The economic impact of diagnostic uncertainty when managing paediatric febrile illness is significant, and the precautionary use of antibiotics is strongly associated with increased costs. The use of ED resources is highest among infants (aged less than 3 months) and those infants managed by lesser experienced doctors, independent of clinical severity. Diagnostic advances which could increase confidence to withhold antibiotics may yield considerable efficiency gains in these groups, where the perceived risks of failing to identify potentially life-threatening bacterial infections are greatest.
KEYWORDS: Antibiotics; Children; Cost of illness; Febrile; Fever; Health economics; Pyrexia; United Kingdom
Link to PubMed record
Author: Leigh S, Grant A, Murray N, Faragher B, Desai H, Dolan S, Cabdi N, Murray JB, Rejaei Y, Stewart S, Edwardson K, Dean J, Mehta B, Yeung S, Coenen F, Niessen LW, Carrol ED
Abstract: BACKGROUND: Paediatric fever is a common cause of emergency department (ED) attendance. A lack of prompt and definitive diagnostics makes it difficult to distinguish viral from potentially life-threatening bacterial causes, necessitating a cautious approach. This may result in extended periods of observation, additional radiography, and the precautionary use of antibiotics (ABs) prior to evidence of bacterial foci. This study examines resource use, service costs, and health outcomes.
METHODS: We studied an all-year prospective, comprehensive, and representative cohort of 6518 febrile children (aged < 16 years), attending Alder Hey Children's Hospital, an NHS-affiliated paediatric care provider in the North West of England, over a 1-year period. Performing a time-driven and activity-based micro-costing, we estimated the economic impact of managing paediatric febrile illness, with focus on nurse/clinician time, investigations, radiography, and inpatient stay. Using bootstrapped generalised linear modelling (GLM, gamma, log), we identified the patient and healthcare provider characteristics associated with increased resource use, applying retrospective case-note identification to determine rates of potentially avoidable AB prescribing.
RESULTS: Infants aged less than 3 months incurred significantly higher resource use than any other age group, at £1000.28 [95% CI £82.39-£2993.37] per child, (p < 0.001), while lesser experienced doctors exhibited 3.2-fold [95% CI 2.0-5.1-fold] higher resource use than consultants (p < 0.001). Approximately 32.4% of febrile children received antibiotics, and 7.1% were diagnosed with bacterial infections. Children with viral illnesses for whom antibiotic prescription was potentially avoidable incurred 9.9-fold [95% CI 6.5-13.2-fold] cost increases compared to those not receiving antibiotics, equal to an additional £1352.10 per child, predominantly resulting from a 53.9-h increase in observation and inpatient stay (57.1 vs. 3.2 h). Bootstrapped GLM suggested that infants aged below 3 months and those prompting a respiratory rate 'red flag', treatment by lesser experienced doctors, and Manchester Triage System (MTS) yellow or higher were statistically significant predictors of higher resource use in 100% of bootstrap simulations.
CONCLUSION: The economic impact of diagnostic uncertainty when managing paediatric febrile illness is significant, and the precautionary use of antibiotics is strongly associated with increased costs. The use of ED resources is highest among infants (aged less than 3 months) and those infants managed by lesser experienced doctors, independent of clinical severity. Diagnostic advances which could increase confidence to withhold antibiotics may yield considerable efficiency gains in these groups, where the perceived risks of failing to identify potentially life-threatening bacterial infections are greatest.
KEYWORDS: Antibiotics; Children; Cost of illness; Febrile; Fever; Health economics; Pyrexia; United Kingdom
Link to PubMed record
Monday, 4 March 2019
WUTH publication: Pneumatosis intestinalis after fistuloclysis
Citation: Nutrition. Nutrition. 2019, 62, 18-9. Epub 2018 Dec 3
Author: Appleton N, Day N, Walsh C
Abstract: We present an unique case report of pneumatosis intestinalis after fistuloclysis.
Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.
KEYWORDS: Pneumatosis intestinalis; fistuloclysis
Link to PubMed record
Author: Appleton N, Day N, Walsh C
Abstract: We present an unique case report of pneumatosis intestinalis after fistuloclysis.
Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.
KEYWORDS: Pneumatosis intestinalis; fistuloclysis
Link to PubMed record
Monday, 4 February 2019
WUTH publication: Can C-Reactive Protein Be Used to Predict Acute Septic Arthritis in the Adult Population?
Citation: Southern Medical Journal. 2019, 112(2), 108-111
Author: Thornton L, Ormsby N, Allgar V, Thomas G
Abstract: OBJECTIVES: The objective of this study was to establish whether C-reactive protein (CRP) could be used to predict native joint septic arthritis (SA) in the adult population.
METHODS: All patients who underwent native joint aspiration in accident and emergency settings between April 2012 and September 2016 were identified from laboratory microbiology records. Patients were divided into three groups for analysis: patients with SA, patients with crystal arthropathy, and patients with normal or osteo/inflammatory arthritic joints.
RESULTS: Fifteen patients (7.9%) were deemed to have SA, 18 patients had crystal arthropathy (9.5%), and 157 patients (82.6%) were deemed to have normal or osteo/inflammatory arthritic joints. All of the patients with CRP >200 mg/L had SA. Patients with CRP 90 to 200 mg/L had a mix of crystal arthropathy and SA, and patients with CRP <90 mg/L had either normal or osteo/inflammatory arthritic joints or crystal arthropathy. The mean CRP in patients with a normal or osteo/inflammatory arthritic joint was 25 mg/L. This was compared with 100 mg/L (P ≤ 0.001) in patients with crystal arthropathy and 308 mg/L (P ≤ 0.001) in patients with SA.
CONCLUSIONS: We demonstrated CRP to be a reliable independent marker to help differentiate among SA, crystal arthropathy, and normal/arthritic joints in an adult population. No patients with CRP <90 mg/L had SA.
Link to PubMed record
Author: Thornton L, Ormsby N, Allgar V, Thomas G
Abstract: OBJECTIVES: The objective of this study was to establish whether C-reactive protein (CRP) could be used to predict native joint septic arthritis (SA) in the adult population.
METHODS: All patients who underwent native joint aspiration in accident and emergency settings between April 2012 and September 2016 were identified from laboratory microbiology records. Patients were divided into three groups for analysis: patients with SA, patients with crystal arthropathy, and patients with normal or osteo/inflammatory arthritic joints.
RESULTS: Fifteen patients (7.9%) were deemed to have SA, 18 patients had crystal arthropathy (9.5%), and 157 patients (82.6%) were deemed to have normal or osteo/inflammatory arthritic joints. All of the patients with CRP >200 mg/L had SA. Patients with CRP 90 to 200 mg/L had a mix of crystal arthropathy and SA, and patients with CRP <90 mg/L had either normal or osteo/inflammatory arthritic joints or crystal arthropathy. The mean CRP in patients with a normal or osteo/inflammatory arthritic joint was 25 mg/L. This was compared with 100 mg/L (P ≤ 0.001) in patients with crystal arthropathy and 308 mg/L (P ≤ 0.001) in patients with SA.
CONCLUSIONS: We demonstrated CRP to be a reliable independent marker to help differentiate among SA, crystal arthropathy, and normal/arthritic joints in an adult population. No patients with CRP <90 mg/L had SA.
Link to PubMed record
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