This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Topic Collections  • Immunologic Disorders  • Infectious Diseases, Other  • Diagnosis  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In their Rational Clinical Examination article, Dr Margaretten and colleagues¹ concluded that the synovial fluid white blood cell count and the corresponding percentage of polymorphonuclear cells are the most useful markers in identifying septic arthritis while waiting for the Gram stain and culture test results. Synovial fluid glucose, protein, and lactate dehydrogenase were not found to be helpful.

In the past, synovial fluid lactic acid measurement was proposed as a useful test in the rapid differentiation between septic and nonseptic arthritis. For example, in the study by Riordan et al,² lactic acid seemed to be more sensitive than Gram stain (especially if antibiotics had been administered before joint aspiration) and could be measured even when the synovial fluid was too thick for a cell count to be performed. In addition, synovial fluid lactic acid can be assessed rapidly in a blood gas analyzer and may be available . . . [Full Text of this Article]

Petros Kopterides, MD
petkop@ath.forthnet.gr
Critical Care Department
"Attikon" University Hospital
Athens, Greece

RELATED LETTER

Synovial Lactic Acid and Septic Arthritis—Reply
Mary E. Margaretten, Jeffrey Kohlwes, and Stephen Bent
JAMA. 2007;298(1):40.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Does This Adult Patient Have Septic Arthritis?
Mary E. Margaretten, Jeffrey Kohlwes, Dan Moore, and Stephen Bent
JAMA. 2007;297(13):1478-1488.
ABSTRACT | FULL TEXT