European-first to trial new test to diagnose joint inflammation

Patients at the Norfolk and Norwich University Hospital have become the first in the UK to join a new clinical trial that aims to improve the speed and accuracy of diagnosing the causes of joint inflammation.

More than 200,000 knee and hip replacements take place in the UK every year with less than 1% of patients experiencing a rare but serious complication following joint replacement surgery.

A new genomic test to help diagnose and differentiate between infectious and non-infectious inflammation has been developed by Australian-based OrthoDx, which is now being trialled at NNUH in the first UK research study, and is able to cut testing times from days to hours.

The Synvichor system is a genomic PCR (polymerase chain reaction) test for rapid diagnosis of joint pain and is being tested by the Orthopaedic, Research and Development department, Rheumatology, Microbiology and Pathology teams with support from University of East Anglia (UEA) researchers.

Prof Iain McNamara, NNUH Consultant Orthopaedic Surgeon and UK Chief Investigator, said it has taken a large amount of work over 18 months to establish the research study and is the first time the system has been tested outside of Australia and is the first clinical trial to test the Synvichor. This study is likely to determine whether this new diagnostic test offers improvements in differentiating infectious from non-infectious joint pain alongside existing methods currently in use.

He said: “Many patients attend A&E, Orthopaedic or Rheumatology clinic with joint swelling and pain and one of the biggest challenges is to differentiate infectious and non-infectious causes. Both normal and replaced joints can develop swelling and pain which needs a diagnosis. To help work out the cause for the swelling and pain, the first instance, to determine if the fluid in a joint is infected, we draw some of the synovial fluid out with a needle and send to the lab to be looked at under a microscope, which is a technique that has been used for over one hundred years but it is not necessarily a reliable diagnostic test.”

“The Synvichor system is designed to give a quick and more accurate ‘yes or no’ result to show whether infection is present in the sample within three hours and uses similar technology that was used during the pandemic to test people’s saliva for Covid-19. If it is a yes, it gives us more certainty around the need for surgery. If it is a no, it helps save time and could mean that a patient does not need an admission to a hospital bed, antibiotics or surgery and can be managed by the community team.”

Prof McNamara said that the ELIJA clinical trial will involve 500 participants and Sheffield Teaching Hospital is set to join the study in the coming weeks.

The clinical trial will be open to any adult who has presented to hospital with a suspected joint infection and taking part does not require any additional tests or appointments. The first participant was recruited on 8 January.

Dr Bernard Brett, NNUH Medical Director, said: “This is an important research study that could lead to a real improvement for patients in ensuring they get the correct diagnosis and treatment more rapidly – I’m really glad to see our Orthopaedic team leading the way in joining this research study.”

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