Semi-quantitative reagent strip analysis of leukocyte esterase and glucose in synovial fluid as bioindicators for rapid diagnosing bacterial arthritis

Abstract

Aim: To evaluate the diagnostic performance of synovial leukocyte esterase (LE) and glucose reagent strip tests in differentiating septic arthritis from inflammatory arthritis.

Methods: All aspirates were evaluated by culturing, gram staining, and analyzing the cell count and the polymorphonuclear cell percentage. We interpreted all LE and glucose results by semi-quantitative visual assessments. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated.

Results:  While LE positivity was more common in the septic arthritis group, glucose levels were found to be significantly lower. As bioindicators; levels of synovial LE, synovial glucose and combined levels of LE and glucose were found to have significantly different ROC areas in discriminating septic arthritis patients from aseptic arthritis patients.

 Conclusions: The test can be used as a valuable and inexpensive assessment tool for patients to quickly perform the differential diagnosis of septic arthritis in primary care or emergency settings. However, LE and glucose strip test results should not be viewed as an independent test. Rather, the results should be assessed as auxiliary test results that facilitate the diagnosis of septic changes in body fluids.