Synovial fluid lactate levels in septic and non-septic arthritides

Lactate concentration was studied in 383 synovial fluid specimens from patients with various arthritides. The highest concentrations of lactate occurred in non-gonococcal septic synovial fluids. High values were recorded in seropositive rheumatoid arthritis and crystal-induced arthritides, medium values in synovial fluids from seronegative rheumatoid arthritis, seronegative spondylarthritides, gonococcal arthritis and haemarthrosis, and the lowest values in aspirates from osteoarthrotic joints. There was a positive correlation between synovial pH and lactic acid concentration. These data suggest that determination of lactate in synovial fluid can be valuable in the rapid exclusion of septic arthritis. Its value for differentiating between other inflammatory arthritides is discussed.