Since gout can precipitate olecranon bursitis, should I routinely order a crystal analysis for patients who present with this bursitis?
The differential diagnosis of acute olecranon bursitis includes infection and crystal-induced disease. The key test to order is culture and sensitivity; however, a crystal analysis is also important. I would order both tests for patients who present with acute olecranon bursitis because gout and infection can coexist. The most common organism found in this setting is Staphylococcus aureus.
If aspiration is not possible, empiric antibiotic therapy for staphylococcal
bursitis with careful follow-up is a reasonable management strategy.
—Michael H. Weisman, MD
Director, Division of Rheumatology
Cedars-Sinai Medical Center
Professor of Medicine
University of California, Los Angeles