A Swan1, H Amer, P Dieppe. 1. Division of Medicine, University of Bristol MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK. Angela.Swan@bristol.ac.uk
Abstract
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.
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.
Authors: C J Mathews; G Kingsley; M Field; A Jones; V C Weston; M Phillips; D Walker; G Coakley Journal: Ann Rheum Dis Date: 2007-01-12 Impact factor: 19.103
Authors: Tomas Cazenave; Victoria Martire; Anthony M Reginato; Marwin Gutierrez; Christian Alfredo Waimann; Carlos Pineda; Javier Eduardo Rosa; Santiago Ruta; Oscar Sedano-Santiago; Ana Maria Bertoli; Marcelo Audisio; Cristina Hernandez-Diaz; Lucio Ventura-Rios; Maritza Quintero; Eugenio De Miguel; Ana Laura Alvarez-Del-Castillo-Araujo; Andy Abril; Eliana Natalí Ayala-Ledesma; Edith Alarcon-Isidro; Maria Lida Santiago; Mariana Alejandra Pera; Cecilia Urquiola; Gustavo Rodriguez Gil; Lina Maria Saldarriaga Rivera; Cesar Cefferino; Mariana Benegas; Mario Enrique Diaz Cortes; Maximiliano Bravo; Diana Peiteado; Natalia Anahi Estrella; Roser Areny Micas; Jorge Saavedra Muñoz; Rodolfo Del Carmen Arape Toyo; Maria Soledad Gálvez Elkin; Walter Javier Spindler; Clarisa Sandobal; Josefina Marin; Manuella Lima Gomes Ochtrop; Ricardo Pavao Ayala; Erika Roxana Catay; Guillermo Enrique Py; Gabriel Hector Aguilar; Yvonne Yona Rengel Colina; Carla Antonela Airoldi; Claudia Selene Mora-Trujillo; Maria Paula Kohan; Lorena Evelin Urioste Eguez; Concepción Castillo-Gallego; Jose Francisco Diaz-Coto; Patricio Tate; Carla Magali Saucedo; Oscar Vega-Hinojosa; Cristian Jonatan Troitiño; Maria Florencia Marengo; Priscila Maria Marcaida; Irene Monjo Henry; Roberto Muñoz-Louis; Carla Solano; Felix Reinaldo Fernandez Castillo; Cesar Enrique Graf; Mara Guinsburg; Maria Julia Santa Cruz; David Alejandro Navarta Ortiz; Magaly Alva Linares; Marcos Gabriel Rosemffet Journal: Rheumatol Int Date: 2018-12-11 Impact factor: 2.631