Measurement of synovial tumor necrosis factor-alpha in diagnosing emergency patients with bacterial arthritis

Am J Emerg Med. 1997 Nov;15(7):626-9. doi: 10.1016/s0735-6757(97)90173-x.


Because of the high morbidity and mortality in patients with bacterial arthritis, rapidly and correctly diagnosing this critical condition is a challenge to emergency clinicians. Synovial fluid samples were obtained from 75 patients with arthritis disorders who presented to an emergency service, and levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) were measured. Twenty patients with culture-proven bacterial arthritis had higher levels of synovial TNF-alpha than patients with osteoarthritis or with inflammatory arthritis, including gouty arthritis, rheumatoid arthritis, reactive arthritis, and lupus arthritis. There was a good sensitivity for synovial TNF-alpha level in diagnosing patients with bacterial arthritis. Nearly 100% of patients with bacterial arthritis had elevated synovial TNF-alpha levels. However, synovial IL-1 beta and IL-6 levels failed to discriminate bacterial arthritis from other inflammatory arthritis. Measurement of synovial TNF-alpha level may be useful as a diagnostic aid in emergency patients with bacterial arthritis disorders.

MeSH terms

  • Adult
  • Aged
  • Arthritis / metabolism
  • Arthritis, Gouty / metabolism
  • Arthritis, Infectious / diagnosis*
  • Arthritis, Infectious / metabolism
  • Arthritis, Reactive / metabolism
  • Arthritis, Rheumatoid / metabolism
  • Biomarkers / analysis
  • Emergency Service, Hospital
  • Female
  • Gram-Negative Bacterial Infections / metabolism
  • Gram-Positive Bacterial Infections / metabolism
  • Humans
  • Interleukin-1 / analysis
  • Interleukin-6 / analysis
  • Lupus Erythematosus, Systemic / metabolism
  • Male
  • Middle Aged
  • Osteoarthritis / metabolism
  • Sensitivity and Specificity
  • Synovial Fluid / chemistry*
  • Tumor Necrosis Factor-alpha / analysis*


  • Biomarkers
  • Interleukin-1
  • Interleukin-6
  • Tumor Necrosis Factor-alpha