Additionally, more complex testing techniques are also presented as is appropriate to the specific fluid type. In the latter case, the training of the observer is likely to be a determinant of the results. Each patients diagnosis was established independently of synovial. Rheumatologists have extensive training in synovial fluid crystal analysis and this rapid and costeffective clinical tool should be available to all practicing rheumatologists. Fernandes synovium is essentially a living ultrafiltration membrane with fenestrated capillaries just below an intimal surface that contains wide intercellular gaps, but unlike true membranes, has no epithelial cells and no basement membrane. Correlated with clinical information to arrive at a diagnosis. To determine which synovial fluid tests are most useful, we prospectively analyzed the synovial fluid test results of 100 consecutive patients undergoing diagnostic arthrocentesis. To obtain free cmecmle credits click on earn ce credits under continuing education on the left side of. Dec 01, 2017 the diagnostic standard for acute gout is joint aspiration with synovial fluid analysis for monosodium urate crystals. Synovial fluid analysis definition of synovial fluid.
Learn indepth information on synovial fluid analysis of knee joint, on why the laboratory test is performed, specimen collected, the significance. Identification of crystals in synovial fluid annals of the. Synovial fluid may be collected by syringe in a procedure termed arthrocentesis, also known as joint aspiration categories of joint effusions results of synovial fluid analysis can be used to categorize the fluid as noninflammatory, inflammatory, septic, or hemorrhagic based upon the clinical and laboratory analysis 11. The diagnostic standard for acute gout is joint aspiration with synovial fluid analysis for monosodium urate crystals. Request pdf synovial fluid analysis asa prompt and accurate diagnosis of a painful, swollen joint is imperative, primarily in the case of a septic joint, as delayed therapy may. Synovial fluid is an ultrafiltrate of serum and alternations in its composition are a direct reflection of the synovial structure. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. The remaining chapters cover specific body fluid types and their unique features. A structured approach to joint fluid interpretation synovial fluid analysis, including some clinical case scenarios to put your knowledge to the test. The vmdl provides indepth laboratory diagnostic support to veterinary practitioners, livestock and poultry industry interests, companion animal interests, wildlife conservationists, scientists utilizing animals in their research throughout the university, state and. Learn synovial fluid analysis with free interactive flashcards.
For full access to this pdf, sign in to an existing account, or purchase an annual. Synovial fluid analysis in the diagnosis of joint disease. The chemical analysis and microbiology sections of the. Vi the asssociation of clinical biochemists in ireland the biochemistry of body fluids. Synovial fluid analysis for crystals is a simple procedure allowing immediate and definite diagnosis of gout and cppd arthritis when clinics are fitted with a proper microscope and the. Each patients diagnosis was established independently of synovial fluid laboratory test results. Synovial fluid analysis is also known as joint fluid analysis. Synovial white cell counts 50,000 cellsmm 3 in children were not uncommon. Synovial fluid analysis for crystals is generally considered the gold standard. Diseases and conditions affecting one or more joints and the synovial fluid can be divided into four main categories. Synovial fluid analysis is helpful for determining the underlying cause of arthritis, particularly for septic or crystalinduced arthritis.
Synovial fluid in sarcoid arthritis annals of internal. Jul 11, 2017 a synovial fluid analysis is performed when pain, inflammation, or swelling occurs in a joint, or when theres an accumulation of fluid with an unknown cause. Infectious diseases those caused by bacteria, fungi, or viruses. Sfa is commonly performed on younger pts to detect infectioneg. Synovial fluid analysis consists of a group of tests that detect changes in synovial fluid that may indicate the presence of diseases that affect joint structure and function. The joint is enclosed in a fibrous joint capsule lined by the synovial membrane.
The principal cellular constituents are polymorphonuclear neutrophils and mononuclear cells, including lymphoid dendritic cells the leukocyte count does not always correlate with the degree of clinical activity. Synovial fluid analysis for diagnosis of amyloid arthropathy. With its egg whitelike consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Bloody 2 or purulent 3 synovial fluid and leukocyte counts of 26 000 and 1020mm 3 with neutrophil preponderance 1, 4 were reported in sarcoid arthritis of more than a years duration. For example, in one study four samples of different synovial fluid were sent to 25 laboratories for analysis and crystal identification, and a sensitivity of 78% for the detection of msu crystals and only 12% for cppd crystals was obtained. Five papers about synovial lining histology and six papers about the lubricating properties of the fluids were identified. The synovial fluid wbc counts were significantly higher in children.
Hunder to detect the presence of amyloid, we studied synovial fluid samples from 7 patients who had biopsy proven amyloidosis and clinical arthropathy and from 98 patients who had other forms of arthritis. Synovial fluid is normally a thick, strawcolored liquid found. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf. The mean cell count for children was 49,924 cellsmm 3 range 2,5009,740, while the mean adult cell count was 12,396 cellsmm 3 range 1,70030,000. The tests help diagnose and treat jointrelated problems. We believe that the catalog of proteins generated in this study will further enhance our knowledge regarding the pathophysiology of osteoarthritis and should assist in identifying better biomarkers for early diagnosis. The american college of rheumatology firmly recommends the designation of. Normally the synovial fluid will form a string, approximately around 46 cm before it breaks. The presence of uric acid crystals in the synovial fluid indicates gout. Synovial fluid interpretation normal noninflammatory arthritis inflammatory arthritis septic arthritis appearance clear clearyellow clearcloudy yellow opaque white cells x106l or cumm extremely high 50,000 neutrophils low 75% additional tests culture. Proper eval uation of csf depends on knowing which tests to order, normal ranges for the patients age. The lack of consistency in synovial fluid analysis could be explained either by the inability of the technique to give good quality results, or by observer misinterpretation, as crystal identification requires subjective interpretation. A sample of synovial fluid is needed for this test. Others have noted high synovial fluid white cell counts in pediatric lyme arthritis 24, 9, 10, 14.
It usually involves an initial basic set of tests and may include some followup tests depending on the results of the first set of tests, the patients symptoms, and the. Each of the joints in the human body contains synovial fluid. Gross synovial fluid analysis in the differential diagnosis of joint effusion. Synovial fluid analysis is a group of tests that examine joint synovial fluid. An overview of synovial fluid analysis in the native joint is.
Reliability of identification depends on training and experience of examiners and on the quality and proper maintenance of the microscope. The smooth articular cartilage and synovial fluid reduce friction. Normal synovial fluid is clear, slightly yellow, and completely free of particulate. The vmdl is a fullservice laboratory accredited by the american association of veterinary laboratory diagnosticians aavld. Synovial fluid is usually a group ii or inflammatory fluid table 7. Jan 26, 2007 synovial fluid sf analysis has been widely recommended as a crucial aid in the evaluation of patients with arthritis and joint effusions.
Microscopic analysis of synovial perfect diagnostic. Synovial fluid analysis laboratory medicine oxford. Synovial fluid definition of synovial fluid by medical. Gross characteristicscolor, clarity, volume, and viscosityare immediately examined after collection. The white cell count, differential count, cultures, gram stain, and crystal search using polarized light microscopy are the most useful studies. Mucin clot was normal in two instances 4, and absence of crystals was noted in two patients 1, 2. It would be most unfortunate if these tests were to fall into disuse solely because clinicians have no confidence in the results, when straightforward steps could be taken to improve this situation.
The synovial fluid is expressed into the test tube from the tip of the syringe, one drop at a time. Some of these, particularly monosodium urate monohydrate msum and calcium pyrophosphate dihydrate cppd crystals, are pathogenic. Synovial fluid, also called synovia, is a viscous, nonnewtonian fluid found in the cavities of synovial joints. Proteomic analysis of human osteoarthritis synovial fluid. Thus, the fluid is usually classified as being noninflammatory degenerative joint disease or trauma or inflammatory, based on the nucleated cell count, total protein, viscosity, types of cells and appearance of cells in the fluid see algorithm.
Synovial fluid analysis is the cornerstone of the diagnosis of many rheumatic diseases, and correct handling and interpretation of the fluid is crucial. Pdf gross synovial fluid analysis in the differential. The cells making up the reformed synovial lining, as well as the lining of interface membranes, were similar to the typical. It is a viscous, mucinous substance that lubricates most joints. A synovial fluid analysis is performed when pain, inflammation, or swelling occurs in a joint, or when theres an accumulation of fluid with an unknown cause. Characteristics of synovial fluid in sarcoid arthritis have not been well defined 1. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.
The synovial membrane contains specialized cells called synoviocytes. Joint fluid interpretation synovial fluid analysis. New chapters have been added, including a chapter on urine and specialized body fluids. Apr 01, 20 synovial fluid may be collected by syringe in a procedure termed arthrocentesis, also known as joint aspiration categories of joint effusions results of synovial fluid analysis can be used to categorize the fluid as noninflammatory, inflammatory, septic, or hemorrhagic based upon the clinical and laboratory analysis 11. The synovial fluid crystal assay is extremely important diagnostically. Synovial fluids can contain a number of crystals and other particulate matter. It can change clinically suspected diagnoses and can change treatment 2 but it does have limitations. A specially trained lab technician will prepare a synovial fluid sample and examine it under a microscope for crystals, white blood cell count, microorganisms, and possible unusual traits. Synovial fluid analysis may be ordered to help diagnose the cause of joint inflammation, pain, swelling, and fluid accumulation. Choose from 500 different sets of synovial fluid analysis flashcards on quizlet. Monosodium urate crystals are diagnostic for gout, and will appear needle shaped and have negative birefringence blue color 9. The patient with an acutely painful joint that you tap may or may not have a history of gout or pseudogout, but either way the synovial fluid analysis will investigate for crystals. Unfortunately, synovial fluid analysis rarely is specific for an underlying cause. We present an indepth analysis of the synovial fluid proteome from patients with osteoarthritis.
Educational commentary is provided through our affiliation with the american society for clinical pathology ascp. Diagnosis through synovial fluid analysis arthritishealth. Synovial fluid analysis laboratory medicine oxford academic. Despite the importance of this procedure, only a few textbooks and articles have been devoted to this subject.
979 1385 1332 1007 1085 161 228 1025 507 1118 471 1153 596 604 950 449 132 442 936 1226 772 648 768 307 655 1486 495 1201 1104 692 1254 1074 1373 3