Artritli çocuk olguların değerlendirilmesi: 9 yıllık retrospektif çalışma
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Date
2020-06-06
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Bursa Uludağ Üniversitesi
Abstract
Bu çalışmada, kliniğimize septik artrit öntanısı ile başvuran olguların klinik ve laboratuvar bulgularının ve tedavi yanıtlarının değerlendirilmesi amaçlandı. Ocak 2010-Ocak 2019 tarihleri arasında artrit öntanısıyla yatmış olan 111 çocuk (0-18 yaş) hasta kayıtları retrospektif incelendi. Olguların klinik, laboratuvar bulgularının değerlendirilmesi, tedavi ve prognostik özelliklerinin incelenmesi planlandı. Çalışmaya alınan toplam 111 hastanın %66’sı erkek olup ortalama yaşları 91±56 (medyan 83,1-215 aralığı) ay idi. Olguların çoğunluğunu (n=62,%56) 3-10 yaş aralığındaki hastalar oluşturdu. Olguların %60’ına (n=67) septik artrit tanısı konuldu. Bu tanıyı reaktif artrit (%10), juvenil idiopatik artrit (%10), toksik/geçici sinovit (%5) ve diğer artritler takip etti. Başvuruda olguların %96’sında ağrı, %63’ünde eklem şişliği, %21’inde kızarıklık, %41’inde eklemde ısı artışı, %64’ünde hareket kısıtlılığı, %38’inde yürüyememe yakınması vardı. Sıklıkla tutulan eklemler diz (%51) ve kalçaydı (%35). Ateş yüksekliği olan olgularda septik artrit olasılığı yüksek saptandı (p=0,0001). Septik artrit dışı artritlerde ibuprofene yanıt daha fazlaydı (p=0,0001). Olguların %55’ine (n=61) ponksiyon yapıldı, %34’ü (n=38) eklem içi debridman operasyonu geçirdi. Eklem sıvı kültüründe en sık üreyen mikroorganizmalar Staphylococcus aureus ve Streptococcus pyogenes idi. Septik artrit ile septik artrit dışı olgular karşılaştırıldığında, ultrasonografi ile ölçülen efüzyon miktarı, ponksiyonla alınan sıvı miktarı septik artrit grubunda istatistiksel olarak anlamlı oranda daha fazla, CRP ve lökosit sayısı ise septik artrit grubunda daha yüksek bulundu (sırasıyla p=0,001;p=0,025;p=0,018;p=0,032). Olguların %19’unda (n=21) osteomyelit saptanıp hepsi septik artrit grubundaydı Bu çalışmada ateşi olan, lökosit sayısı >12100/mm3 , CRP>3 mg/dl üzerinde olan olgularda, ultrasonografi ile 8,5 mm ve üzerinde efüzyon ölçülen olgularda septik artrit olma olasılığı istatistiksel anlamlı bulundu. Septik artrit dışı artritlerde ibuprofen yanıtı daha fazlaydı.
The aim of this study was to evaluate the clinical and laboratory findings and treatment responses of patients with arthritis. The medical records of 111 children (0-18 years) were evaluated who were hospitalized with the diagnosis of arthritis between January 2010 and January 2019 retrospectively. The aim of this study was to evaluate the clinical and laboratory findings and to investigate the treatment and prognostic features of the patients. RESULTS: : A total of 111 patients, 66% were male and the mean age was 91±56 (median 83,1-215) months. The most of the patients (n=62,56%) were between 3-10 years of age. Septic arthritis was diagnosed in 60% (n=67) of the patients. This diagnosis was followed by reactive arthritis (10%), juvenile idiopathic arthritis (10%), toxic/transient synovitis (5%) and other arthritis. On admission, there were pain in 96%, joint swelling in 63%, redness in 21%, increased temperature of the joint in 41%, decreased range of motion in 64%, and inability to walk in 38% of the patients. The most frequently involved joints were knee (51%) and hip (35%). The possibility of septic arthritis was significantly higher in patients with high fever (p=0,0001). The response to ibuprofen was higher in non-septic arthritis (p=0,0001). Arthrocentesis was performed in 55% (n=61) of the cases and 34% (n=38) of the patients had underwent intra-articular debridement surgery. Staphylococcus aureus and Streptococcus pyogenes were the most common microorganisms growth in joint fluid culture. When septic arthritis and other arthritis cases were compared, the effusion amount, the amount of fluid taken by puncture were significantly higher and the level of CRP and leukocytes were higher in septic arthritis group (p=0,001;p=0,025;p=0,018;p=0,032,respectively). Osteomyelitis was observed in 19%(n=21) of the cases. In this study, the probability of septic arthritis was found to be statistically significant in patients with fever, leukocyte>12100/mm3, CRP>3 mg/dl, and effusion measured 8.5 mm or more by ultrasonography. Also, ibuprofen response was higher in non-septic arthritis group.
The aim of this study was to evaluate the clinical and laboratory findings and treatment responses of patients with arthritis. The medical records of 111 children (0-18 years) were evaluated who were hospitalized with the diagnosis of arthritis between January 2010 and January 2019 retrospectively. The aim of this study was to evaluate the clinical and laboratory findings and to investigate the treatment and prognostic features of the patients. RESULTS: : A total of 111 patients, 66% were male and the mean age was 91±56 (median 83,1-215) months. The most of the patients (n=62,56%) were between 3-10 years of age. Septic arthritis was diagnosed in 60% (n=67) of the patients. This diagnosis was followed by reactive arthritis (10%), juvenile idiopathic arthritis (10%), toxic/transient synovitis (5%) and other arthritis. On admission, there were pain in 96%, joint swelling in 63%, redness in 21%, increased temperature of the joint in 41%, decreased range of motion in 64%, and inability to walk in 38% of the patients. The most frequently involved joints were knee (51%) and hip (35%). The possibility of septic arthritis was significantly higher in patients with high fever (p=0,0001). The response to ibuprofen was higher in non-septic arthritis (p=0,0001). Arthrocentesis was performed in 55% (n=61) of the cases and 34% (n=38) of the patients had underwent intra-articular debridement surgery. Staphylococcus aureus and Streptococcus pyogenes were the most common microorganisms growth in joint fluid culture. When septic arthritis and other arthritis cases were compared, the effusion amount, the amount of fluid taken by puncture were significantly higher and the level of CRP and leukocytes were higher in septic arthritis group (p=0,001;p=0,025;p=0,018;p=0,032,respectively). Osteomyelitis was observed in 19%(n=21) of the cases. In this study, the probability of septic arthritis was found to be statistically significant in patients with fever, leukocyte>12100/mm3, CRP>3 mg/dl, and effusion measured 8.5 mm or more by ultrasonography. Also, ibuprofen response was higher in non-septic arthritis group.
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Keywords
Artrit, Çocukluk dönemi, Septik artrit, Arthritis, Childhood, Septic arthritis
Citation
Yeşil, E. vd. (2020). "Artritli çocuk olguların değerlendirilmesi: 9 yıllık retrospektif çalışma". Güncel Pediatri Dergisi, 18(2),140-152