{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:10:03Z","timestamp":1756293003330,"version":"3.44.0"},"reference-count":6,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,17]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>In traditional teaching, synovial fluid cell counts over 50 000\/mm<jats:sup>3<\/jats:sup> are in keeping with septic or crystalline arthritis. We report a patient with adult-onset Still\u2019s disease (AOSD) and associated inflammatory arthritis whose synovial fluid cell count was over 80 000\/mm<jats:sup>3<\/jats:sup>. This is the highest level reported in the literature, demonstrating that in the appropriate clinical context, markedly elevated synovial cell count levels over 50 000\/mm<jats:sup>3<\/jats:sup> can be caused by inflammatory conditions like AOSD. Recognition of this is crucial to avoid inappropriate antibiotics and procedures while also ensuring correct immunosuppressive treatments are offered in a timely manner.<\/jats:p>","DOI":"10.1136\/bcr-2021-243889","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T12:34:08Z","timestamp":1629808448000},"page":"e243889","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Synovial fluid cell count of 84 930\/mm<sup>3<\/sup> in adult-onset Still\u2019s disease"],"prefix":"10.1136","volume":"14","author":[{"given":"Carter","family":"Winberg","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim","family":"Ladak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,24]]},"reference":[{"key":"2025082703303156000_14.8.e243889.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.13.1478"},{"key":"2025082703303156000_14.8.e243889.2","first-page":"424","article-title":"Preliminary criteria for classification of adult still's disease","volume":"19","author":"Yamaguchi","year":"1992","journal-title":"J Rheumatol"},{"key":"2025082703303156000_14.8.e243889.3","first-page":"495","article-title":"Comparative study of 6 types of criteria in adult still's disease","volume":"23","author":"Masson","year":"1996","journal-title":"J Rheumatol"},{"key":"2025082703303156000_14.8.e243889.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-216655"},{"key":"2025082703303156000_14.8.e243889.5","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199103000-00004"},{"key":"2025082703303156000_14.8.e243889.6","doi-asserted-by":"crossref","first-page":"171","DOI":"10.5792\/ksrr.2011.23.3.171","article-title":"A case of adult onset still's disease misdiagnosed as septic arthritis","volume":"23","author":"Song","year":"2011","journal-title":"Knee Surg Relat Res"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243889","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:30:37Z","timestamp":1756290637000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243889"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":6,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,24]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-243889"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243889","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}