Usefulness of synovial fluid analysis in the evaluation of joint effusions. Use of threshold analysis and likelihood ratios to assess a diagnostic test

Eisenberg, J. M.

doi:10.1001/archinte.144.4.715

Cited by 16 publications

(21 citation statements)

References 1 publication

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“…The derived therapeutic thresholds were consistent with recommended medical practice, for example, with a lower threshold for possible septic arthritis (20%) than for possible gout (65%). 6 Findings of the present study suggest that 83.3% patients of osteoarthritis had ESR 20 mm/hr moreover Serum RF and CRP were positive in 8.3% and 13.3% respectively. These findings correlate well with suggestion by Sipe that there is a modest rise in ESR and the concentration of CRP are elevated in osteoarthritis but to a lesser extent than rheumatoid arthritis.…”

Section: Resultsmentioning

confidence: 44%

Study of inflammatory markers in idiopathic osteoarthritis of knee

et al. 2016

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Background: The aim of the present study was to analyse inflammatory markers in idiopathic osteoarthritis of knee and to formulate reliable disease markers in the diagnosis and prognosis of the disease.Methods: This prospective study was conducted for 2 years in a tertiary care center in 60 patients with idiopathic osteoarthritis of knee and compared them with 60 controls that had no signs of osteoarthritis.Results: The hematological markers to study inflammatory basis of idiopathic osteoarthritis of knee suggested that ESR (erythrocyte sedimentation rate) was more than 20 mm/hour in 83.3%. Serum rheumatoid factor (RF) and CRP (C-reactive protein) was positive in 8.3% and 13.3% patients respectively. Antinuclear antibody (ANA) was positive in 2 (3.3%) patients and negative in 58 (96.7%) patients. Synovial fluid analysis was done in 44 patients with RF positivity in only 1 patient. The control group has ESR less than 30 mm/hour and CRP was (<3 µg/ml). In the control group RF and ANA were similar to the normal population.Conclusions: Synovial fluid analysis is of value to rule out crystal arthropathies and pyogenic arthritis. The study indicates that ESR, CRP and RF collectively can serve as surrogate markers in idiopathic osteoarthritis of knee. Further studies need to be done to formulate reliable disease markers in idiopathic osteoarthritis of knee.

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Section: Resultsmentioning

confidence: 44%

Study of inflammatory markers in idiopathic osteoarthritis of knee

et al. 2016

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“…3 4 It was subsequently shown that detection of crystals in SF may change clinical diagnosis and treatment. 5 Moreover, analysis of aspirated joint fluid is regarded as the key to the diagnosis of infectious arthritis. The analysis of SF is recommended by textbooks and publications as an important aid to diagnosis.…”

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confidence: 99%

The value of synovial fluid assays in the diagnosis of joint disease: a literature survey

Swan

Amer²,

Dieppe³

2002

Annals of the Rheumatic Diseases

264

160

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Objective: To carry out a critical appraisal of the literature in an attempt to assess the current value of synovial fluid (SF) analysis in the diagnosis of joint disease. Methods: A literature search was undertaken using the Medline, Biomed, Bids, Pubmed, and Embase electronic databases using the keywords: synovial fluid (SF) analysis, SF crystals, joint sepsis, acute arthritis, and SF cell counts, cytology, biomarkers, and microbiology. Results: Publications fell into three main categories. Firstly, reports assessing the value of the three traditional assays (microbiology, white blood cell counts, and microscopy for pathogenic crystals). For these quality control evidence was found to be sparse, and tests for sensitivity, specificity, and reliability showed worrying variations. These poor standards in SF analysis may be due to lack of inclusion of some tests within routine pathology services. Secondly, claims for the usefulness of "new" assays (cytology and biochemical markers). For cytology, the supporting evidence was mainly anecdotal and there were no reports on specificity, sensitivity, and reliability. Interpretation difficulties are a major hindrance to the clinical use of biochemical assays, which remain primarily research tools. Finally, work on the diagnostic value of SF analysis in general. The appraisal confirmed that SF analysis remains of major diagnostic value in acute arthritis, where septic arthritis or crystal arthropathy is suspected, and in intercritical gout. Conclusions: Given the importance of SF tests, rationalisation of their use, together with improved quality control, should be immediate priorities. Further investigation is recommended into the contribution of SF inspection and white cell counts to diagnosis, as well as of the specificity and sensitivity of SF microbiological assays, crystal identification, and cytology.

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“…28 In some clinical laboratories, SF differential counts are omitted when total cell counts are less than 1,000/ mm ' . 3,28,29 In a recent publication regarding TS staining in "noninflammatory" fluids with less than 2,000 cells Lymphocytes and fibrin strands in the synovial fluid of a patient with seronegative spondyloarthropathy (cresyl violet and methylene blue X 1000).…”

Section: Discussionmentioning

confidence: 99%

Supravital staining of synovial fluid with testsimplets

Reginato¹,

Maldonado

Falasca

et al. 1992

Diagnostic Cytopathology

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We explored the use of Testsimplet (TS) After the history and physical examination, synovial fluid (SF) analysis ranks as the most simple diagnostic procedure for the evaluation ofjoint diseases. In many patients with septic arthritis and crystal-associated arthritis, a few drops of SF often yield a rapid and definitive diagnosis. In other rheumatic diseases, SF analysis provides useful information about the intensity of the inflammatory process and helps to narrow the differential diagnosis to conditions associated with either "inflammatory" or "noninflammatory" fluids.Differentiation of inflammatory cells is usually performed in air-fixed Wright-stained preparations and oc- casionally with the Papanicolaou stain. Wright stains of "noninflammatory" SF preparations are difficult to read when few cells are present or when the fluid is very viscous. Early reports suggested that supravital staining of fresh synovial fluid preparations using neutral red and Janus green were helpful in differentiating mononuclear cells in noninflammatory fluids. 6,7 We and others have been unable to corroborate these findings. 3,8 Supravital staining with cresyl violet and methylene blue is performed easily with precoated, dry glass slides containing these dyes (Testsimplet TM, Boehringer, Mannhein, Germany). 9-11 We report our experience with Testsimplet (TS) in the synovial fluid analysis of 159 patients with various rheumatic diseases. TS provided a rapid and reproducible method of SF supravital staining and allowed better visualization of Reiter cells, synovial cells, cartilage fragments, fat droplets, fibrin, monosodium urate, and calcium pyrophosphate dihydrate crystals than fixed, dried Wright-stained preparations. Calcium pyrophosphate and monosodium urate crystals were well preserved for simultaneous examination under compensated polarized light. Materials and MethodsTS was performed by placing a drop of SF on the center of the commercially available glass slide already containing the dried stains. The slide was covered with a glass cover slip and examined after 10-15 min9-l2 The differential cell count and the search for crystals under compensated polarized light with TS staining were compared with simultaneous same-patient control samples obtained with dry-fixed Wright-stained preparations and unstained synovial fluid fresh preparations, respectively.Routine SF analysis included a fresh preparation observed under regular and compensated polarized light, total cell count, and differential cell count in a dried, fixed Wright-stained preparation. These studies were performed on SF from 159 patients between 1988 and 1990 0

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Usefulness of synovial fluid analysis in the evaluation of joint effusions. Use of threshold analysis and likelihood ratios to assess a diagnostic test

Cited by 16 publications

References 1 publication

Study of inflammatory markers in idiopathic osteoarthritis of knee

Study of inflammatory markers in idiopathic osteoarthritis of knee

The value of synovial fluid assays in the diagnosis of joint disease: a literature survey

Supravital staining of synovial fluid with testsimplets

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