A 3-Day Delay in Synovial Fluid Crystal Identification Did Not Hinder the Reliable Detection of Monosodium Urate and Calcium Pyrophosphate Crystals

Tausche, Anne‐Kathrin; Gehrisch, S.; Panzner, Ines; Winzer, Maria; Range, Ursula; Bornstein, Stefan R.; Siegert, Gabriele; Wunderlich, Carsten; Aringer, Martin

doi:10.1097/rhu.0b013e31829cde53

Cited by 22 publications

(31 citation statements)

References 22 publications

(22 reference statements)

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“…Tausche et al assessed the detectability of MSU and CPP crystals in 75 SF samples over a period of 3 days and showed that the crystal counts nor pH appeared dependent on whether the samples were sent in native (plain, sterile tubes) or anticoagulated tubes with EDTA. Also, neither significant cell decay between day 0 and 3 was evident nor secondary formation of crystals in EDTA-treated samples was observed [17]. Another study on 100 SF samples showed that the white blood cell (WBC) counts, performed after preserving SF for 24 and 48 h in EDTA tubes at 4°C, were very close to the values obtained just after arthrocentesis [16].…”

Section: Discussionmentioning

confidence: 89%

“…As far as we could find, there were no more recent studies on the subject. Based on the limited available evidence, EDTA preservation for several days seems comparable with instantaneous performed polarized light microscopy [14,16,17]. Thirdly, we used a conventional laboratory centrifuge, in contrast to other studies which used cytocentrifuges [6,7,9,10,[23][24][25][26].…”

Section: Discussionmentioning

confidence: 97%

“…In vitro studies suggest that a reduction of even 2°C is sufficient to lower the solubility point [19]. Although, our preservation method, in a refrigerator at 4°C, is supported by a handful of small studies which assessed the impact of storage handling on crystals recognition [6,[12][13][14][15][16][17]. Synovial fluids were maintained for at least 48 h without morphological change.…”

Section: Discussionmentioning

confidence: 99%

“…Both tubes, filled with 1 ml of SF, were stored in a refrigerator at 4°C awaiting microscopy [6,[12][13][14][15][16][17]. SF smears were microscopically examined before and after centrifugation, as soon as possible, within 5 days as target:…”

Section: Handling Procedures Of Sf Samples and Preparation Of Smearsmentioning

confidence: 99%

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The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection

et al. 2017

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The aim of the study was to assess the added value of synovial fluid (SF) centrifugation for microscopic monosodium urate (MSU) and calcium pyrophosphate (CPP) crystal detection in patients with arthritis. This is a prospective observational study using SF samples from joints of patients undergoing joint arthrocentesis. Two blinded observers assessed the SF smears by polarized light microscopy for the presence of crystals before as well as after centrifugation. SF samples were collected from 98 patients with arthritis. After exclusion, 87 samples were eligible for inclusion. Of each sample, 2 smears before and after centrifugation were prepared and microscopically examined, resulting in 348 smears per observer. Observer 1 identified MSU crystals in 18.4% and CPP in 9.2% of the smears before as well as after centrifugation. No extra MSU crystal-positive smears were identified after centrifugation. However, centrifugation yielded 4 additional CPP crystal-positive smears. Observer 2 identified MSU crystals in 15.5% and CPP crystals in 6.3% of the smears before as well as after centrifugation. Centrifugation yielded 2 additional MSU crystal-positive smears and 4 CPP crystal-positive smears. Monosodium urate crystals were well recognized without centrifugation. Centrifugation of SF had limited additional value for increasing the amount of MSU-positive smears. However, CPP crystals were identified in a higher number of smears after centrifugation than before. Therefore, centrifugation may be of additional value in selected patients with suspected calcium pyrophosphate deposition disease and to a lesser extent for gout.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Handling Procedures Of Sf Samples and Preparation Of Smearsmentioning

confidence: 99%

See 2 more Smart Citations

The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection

et al. 2017

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“…Moreover, mucin clot test, joint aspirate Gram stain test, and (in patients with monoarthritis) monosodium urate and calcium pyrophosphate examination using polarized microscopy are also known to be useful. 7 Further, high-tech and costly culture antibiogram or polymerase chain reaction (PCR) tests are also helpful but costly tests. 8 Recently neutrophil-to-lymphocyte ratio (NLR) -the level of neutrophil reflecting the severity of inflammation and lymphocyte count increasing after physiological stress -has been gaining popularity, which was, along with other inflammatory markers, commonly accepted as an accurate marker of the inflammatory status.…”

Section: Evaluation Of Neutrophil-to-lymphocyte Ratio As a Marker Of mentioning

confidence: 99%

Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in septic arthritis

et al. 2015

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Is neutrophil-to-lymphocyte ratio high in patients with septic arthritis? Septic arthritis may lead to higher rates of morbidity or even mortality if not diagnosed on time. This study was planned to answer the question that "Could neutrophil-to-lymphocyte ratio be utilized to help to diagnose septic arthritis?" The cohort of the study consisted of 39 patients diagnosed with septic arthritis. After ruling out the patients who did not meet the research's inclusion criteria, the data of 26 patients were evaluated. The control group was collected from healthy volunteers who were admitted to the internal medicine outpatient clinic for a routine medical checkup at the same period (n = 26). Complete blood count (CBC) parameters, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-tolymphocyte ratios of the septic arthritis and control groups were compared statistically. In comparison, neutrophilto-lymphocyte ratios of the septic arthritis group were significantly higher than the control group. In conclusion, neutrophil-to-lymphocyte ratio can be utilized in the emergency department or in outpatient clinics to support the diagnosis of septic arthritis.

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Agreement Among Multiple Observers on Crystal Identification by Synovial Fluid Microscopy

Bernal

Andrés

López‐Salguero

et al. 2022

Arthritis Care & Research

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Objective. Despite the fact that polarized microscopy remains the gold standard for diagnosing crystal arthritis, some uncertainties hamper full implementation in clinical practice. We undertook this study to analyze the agreement among multiple observers in crystal identification using compensated polarized microscopy, as well as to assess potential outcome modifiers.Methods. This was a cross-sectional, observational study with consecutive synovial fluid sampling. Samples were immediately analyzed when possible or kept refrigerated at 4 C. Five observers analyzed them separately, blinded to clinical data, using a compensated polarized optical microscope (400×), through 3 stages (ordinary, simple polarized, and compensated polarized light) to detect and identify crystals. They recorded the presence and type of crystal (no crystals, monosodium urate [MSU], and calcium pyrophosphate dihydrate [CPP]). Interrater agreement was measured by Cohen's kappa. Subanalyses were performed on visualization delay and cumulative expertise. Discrepancies between each stage of the microscopy and the final decision were also examined.Results. A total of 250 observations from 50 samples completed full assessment. Overall, κ = 0.74 (95% confidence interval [95% CI] 0.64-0.84), indicating good agreement. Agreement for crystal detection was κ = 0.71 (95% CI 0.59-0.82), for MSU was κ = 0.88 (95% CI 0.75-1.0), and for CPP was κ = 0.69 (95% CI 0.56-0.82). Most of the crystal identifications were already made by ordinary light. No differences between observations made before or after 24 hours (P = 0.859) or in expertise on crystal analysis (P = 0.989) were found. Observations performed under ordinary light matched the final diagnosis in 96.8% of cases (242 of 250).Conclusion. Compensated polarized microscopy remained consistent in detecting and identifying crystals in synovial fluid, even when examined among multiple observers, confirming its high utility for clinical practice.

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A 3-Day Delay in Synovial Fluid Crystal Identification Did Not Hinder the Reliable Detection of Monosodium Urate and Calcium Pyrophosphate Crystals

Cited by 22 publications

References 22 publications

The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection

The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection

Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in septic arthritis

Agreement Among Multiple Observers on Crystal Identification by Synovial Fluid Microscopy

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