Contrasting the Clinical Presentation and Prevalence of Septic, Reactive, and Crystal Arthritis in Patients With Hematologic and Solid Malignancies

Background The development of septic arthritis requires rapid identification and treatment to prevent serious and irreversible complications in cancer patients. This is further emphasized by the fact that many cancer patients are immunocompromised either through the nature of their disease or through their treatment. Septic arthritis, crystal-induced arthritis (CIA), and reactive arthritis (RA) all present in a similar fashion with erythematous, edematous, painful joints. Methods A retrospective review was performed using data compiled from patient charts at the Moffitt Cancer Center between the dates of January 1, 2010, and February 22, 2018. Of the original 56 patients who had joint aspirations, 45 met the inclusion criteria of also having either a solid or hematologic malignancy. Results Analysis of the study population suggests that septic arthritis or CIA is significantly less common compared with RA in cancer patients. In addition, the development of septic arthritis is strongly associated with both prosthetic joints and nearby malignancies. Calcium pyrophosphate crystal-induced and monosodium urate CIA presents similar to septic arthritis. Lastly, synovial fluid analysis distinguishes the etiologies of arthritis more accurately compared with serum analysis. Conclusions The data collected in the study support the conclusion that oncology patients presenting with an inflamed joint are more likely to have RA and unlikely to have septic arthritis unless associated with a prosthesis or nearby malignancy. Reactive arthritis is most common and readily resolves with chemotherapy and anti-inflammatory therapy with no joint destruction and rarely recurs. Lastly, synovial fluid analysis is necessary to diagnose and/or rule out specific arthritis causes. Correspondence to: John N. Greene, MD, Infectious Diseases and Hospital Epidemiologist, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612-9497. E-mail: John.Greene@moffitt.org. The authors of this paper have no funding or financial conflicts of interests to disclose. None of the authors have any financial ties with an organization with a financial stake in the research conducted. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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