Synovial fluid tests

• Autores: Israa Al Shakarchi, Gerald Coakley
• Localización: Medicine, ISSN-e 1357-3039, Vol. 42, Nº. 4, 2014, págs. 202-204
• Idioma: inglés
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• Resumen

  • Infection, crystal arthropathies, osteoarthritis, trauma and a variety of systemic diseases can all lead to a painful, swollen peripheral joint of which septic arthritis is the most serious cause. Synovial fluid (SF) analysis is widely used to aid the diagnosis and management of both acute and chronic arthritis, and may be diagnostic in patients with bacterial infections or crystal-induced synovitis.

    Any physician competent in joint aspiration may perform native joint aspiration, whereas suspected infected prosthetic joints must be aspirated in theatre under strict asepsis. The SF should be sent to the laboratory promptly for microscopy, culture, and crystal search using polarized light microscopy.

    Ordinarily SF is viscous, clear and essentially acellular, but in diseased states components of the SF may vary in characteristic ways. Although a positive Gram stain and culture may clinch the diagnosis of septic arthritis, the absence of organisms on Gram stain or a negative subsequent synovial fluid culture does not exclude a diagnosis of septic arthritis.

    A previous systematic review of the literature has shown that although no investigation has sufficient sensitivity and specificity to confirm the diagnosis of septic arthritis in all cases, the single most useful investigation is synovial fluid microscopy and culture. All junior doctors should gain experience in joint aspiration to save delays in diagnosis.