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Synovial fluid analysis.

Eliseo Pascual1, Vega Jovaní

  • 1Rheumatology Section, Hospital General Universitario de Alicante, Calle Maestro Alonso 109, Alicante 03010, Spain. pascual_eli@gva.es

Best Practice & Research. Clinical Rheumatology
|June 9, 2005
PubMed
Summary

Analyzing synovial fluid (SF) aids in diagnosing joint conditions. Gross appearance, white cell count, crystal identification (monosodium urate, calcium pyrophosphate dihydrate), and microbiological studies are key for accurate diagnosis.

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Area of Science:

  • Rheumatology
  • Orthopedics
  • Clinical Pathology

Background:

  • Synovial fluid (SF) analysis is crucial for diagnosing various joint conditions.
  • The gross appearance and cellularity of SF offer initial diagnostic clues.
  • Distinguishing between inflammatory, non-inflammatory, and septic joint effusions can be challenging.

Purpose of the Study:

  • To review the diagnostic utility of synovial fluid analyses.
  • To provide guidance on interpreting SF findings for differential diagnosis.
  • To highlight methods for identifying crystals and pathogens in SF.

Main Methods:

  • Gross examination of synovial fluid.
  • White blood cell counting and differential analysis.
  • Polarized light microscopy for crystal detection (monosodium urate and calcium pyrophosphate dihydrate).
  • Microbiological studies for infectious agents.

Main Results:

  • Fluid transparency correlates with inflammation level; turbidity indicates inflammation.
  • Septic joints typically yield turbid to purulent fluid, but exceptions exist.
  • Crystal identification (MSU, CPPD) is definitive for gout and CPPD crystal arthropathy.
  • CPPD crystals can be difficult to detect due to low birefringence.

Conclusions:

  • Synovial fluid analysis, combining gross appearance, cell counts, crystal identification, and microbiology, is essential for accurate joint disease diagnosis.
  • Careful interpretation within the clinical context is necessary for SF parameters.
  • Specific techniques are required for optimal detection of crystals like CPPD.

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