小结
定义
病史和体格检查
关键诊断因素
- 关节发热、肿胀、疼痛、活动受限
- 急性表现
其他诊断因素
- 发热
- 大关节
- 单关节
- 假体关节
- 症状活动度
- 性活动
- 游走性红斑
- 危险因素
危险因素
- 潜在关节病
- 假体关节
- 年龄
- 免疫抑制
- 接触传播
- 蜱虫暴露
- 先前关节内皮质类固醇注射
- 近期关节手术
- 低等社会经济状况
诊断性检查
首要检查
- 滑膜液显微镜检查、革兰染色和偏光显微镜检查
- 滑膜液培养和药敏试验
- 滑液白细胞计数
- 血培养和药敏试验
- 白细胞计数
- 红细胞沉降率 (ESR)
- C 反应蛋白 (CRP)
- 尿素和电解质
- 肝功能检查 (LFT)
- X 线平片
- 超声
需考虑的检查
- 降钙素原 (PCT)
- 磁共振成像 (MRI)
- 滑膜液聚合酶链反应（PCR）
- 采集拭子进行显微镜检查、培养和药敏试验
- 尿液试纸检测、显微镜检查、培养和药敏试验
- 酶联免疫吸附试验 (ELISA)
- 滑膜活检
新兴检查
- 钙卫蛋白
治疗流程
任何关节内的疑似感染：累及全身
人工关节的疑似感染：未累及全身
自体关节的疑似感染：未累及全身
任何关节的确诊感染：累及全身
人工关节的确诊感染：未累及全身
自体关节内的确诊感染：未累及全身
自体关节未经确诊的临床疑似感染：未累及全身
撰稿人
专家顾问
Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, DipIMC RSEd
Consultant in Emergency Medicine
Royal London Hospital
Consultant in Physician Response Unit
Barts Health NHS Trust/London Air Ambulance
London
UK
利益声明
AA declares that he has no competing interests.
鸣谢
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors to this, whose work is retained in parts of the content:
Gerald Coakley PhD, FRCP
Consultant Rheumatologist
Queen Elizabeth Hospital
London
UK
GC is an author of a reference cited in this topic.
Catherine J. Mathews MSc, FRCP
Consultant Rheumatologist
Queen Elizabeth Hospital
London
UK
CJM is an author of a reference cited in this topic.
Johann Grundlingh
Emergency Medicine Consultant
Royal London Hospital
Barts Health NHS Trust
Honorary senior lecturer
Queen Mary University
London
UK
JG declares that he has no competing interests.
Theodore Young
CT1 anaesthetics
Anaesthetic Department
Peterborough City Hospital
Peterborough
UK
TY declares that he has no competing interests.
同行评议者
Catherine J. Mathews, MSc, FRCP
Consultant Rheumatologist
Lewisham and Greenwich NHS Trust
London
UK
利益声明
CJM is an author of references cited in this topic.
编辑
Celia Pincus
Section Editor, BMJ Best Practice
利益声明
CP declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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