Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1989 Sep;48(9):737–742. doi: 10.1136/ard.48.9.737

Detection of crystals in synovial fluids by light microscopy: sensitivity and reliability.

C Gordon 1, A Swan 1, P Dieppe 1
PMCID: PMC1003866  PMID: 2478085

Abstract

Polarised light microscopy of synovial fluid is an established diagnostic technique widely regarded as reliable for the detection of crystals. The threshold concentration of crystals which can be detected has been investigated and the sensitivity and specificity of six observers compared. Various concentrations of laboratory manufactured crystals of monosodium urate monohydrate (MSUM), calcium pyrophosphate dihydrate (CPPD), and basic calcium phosphates (BCP) were added to the synovial fluid. The threshold for reliable identification of MSUM and CPPD was in the range of 10-100 micrograms/ml. False positives were frequent. The mean sensitivity of the six observers for MSUM was 69% and for CPPD was 82%. The mean specificity for MSUM was 97% and for CPPD was 78%. There was much discrepancy in the results of the slides stained with alizarin red S. Thus the value of alizarin red S as a screening test for BCP is questioned. In view of the variable sensitivity and specificity of different observers for MSUM and CPPD and the concentration threshold for reliable crystal identification, greater caution in the interpretation of synovial fluid analysis is advised, and recommendations for increased quality control are supported.

Full text

PDF
737

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bardin T., Bucki B., Lansaman J., Bravo E. O., Ryckewaert A., Dryll A. Coloration par le rouge alizarine des liquides articulaires. Confrontation des résultats avec ceux de la microscopie électronique et avec les données cliniques. Rev Rhum Mal Osteoartic. 1987 Feb;54(2):149–154. [PubMed] [Google Scholar]
  2. Dieppe P. A., Crocker P. R., Corke C. F., Doyle D. V., Huskisson E. C., Willoughby D. A. Synovial fluid crystals. Q J Med. 1979 Oct;48(192):533–553. [PubMed] [Google Scholar]
  3. Dieppe P. A., Crocker P., Huskisson E. C., Willoughby D. A. Apatite deposition disease. A new arthropathy. Lancet. 1976 Feb 7;1(7954):266–269. doi: 10.1016/s0140-6736(76)91400-8. [DOI] [PubMed] [Google Scholar]
  4. Doherty M., Dieppe P., Watt I. Low incidence of calcium pyrophosphate dihydrate crystal deposition in rheumatoid arthritis, with modification of radiographic features in coexistent disease. Arthritis Rheum. 1984 Sep;27(9):1002–1009. doi: 10.1002/art.1780270906. [DOI] [PubMed] [Google Scholar]
  5. Eisenberg J. M., Schumacher H. R., Davidson P. K., Kaufmann L. Usefulness of synovial fluid analysis in the evaluation of joint effusions. Use of threshold analysis and likelihood ratios to assess a diagnostic test. Arch Intern Med. 1984 Apr;144(4):715–719. [PubMed] [Google Scholar]
  6. Fawthrop F., Hornby J., Swan A., Hutton C., Doherty M., Dieppe P. A comparison of normal and pathological synovial fluid. Br J Rheumatol. 1985 Feb;24(1):61–69. doi: 10.1093/rheumatology/24.1.61. [DOI] [PubMed] [Google Scholar]
  7. Gibilisco P. A., Schumacher H. R., Jr, Hollander J. L., Soper K. A. Synovial fluid crystals in osteoarthritis. Arthritis Rheum. 1985 May;28(5):511–515. doi: 10.1002/art.1780280507. [DOI] [PubMed] [Google Scholar]
  8. Halverson P. B., McCarty D. J. Identification of hydroxyapatite crystals in synovial fluid. Arthritis Rheum. 1979 Apr;22(4):389–395. doi: 10.1002/art.1780220412. [DOI] [PubMed] [Google Scholar]
  9. Hasselbacher P. Variation in synovial fluid analysis by hospital laboratories. Arthritis Rheum. 1987 Jun;30(6):637–642. doi: 10.1002/art.1780300606. [DOI] [PubMed] [Google Scholar]
  10. MCCARTY D. J., HOLLANDER J. L. Identification of urate crystals in gouty synovial fluid. Ann Intern Med. 1961 Mar;54:452–460. doi: 10.7326/0003-4819-54-3-452. [DOI] [PubMed] [Google Scholar]
  12. Paul H., Reginato A. J., Schumacher H. R. Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid. Arthritis Rheum. 1983 Feb;26(2):191–200. doi: 10.1002/art.1780260211. [DOI] [PubMed] [Google Scholar]
  13. Schumacher H. R., Jr, Sieck M. S., Rothfuss S., Clayburne G. M., Baumgarten D. F., Mochan B. S., Kant J. A. Reproducibility of synovial fluid analyses. A study among four laboratories. Arthritis Rheum. 1986 Jun;29(6):770–774. doi: 10.1002/art.1780290610. [DOI] [PubMed] [Google Scholar]
  14. Schumacher H. R., Smolyo A. P., Tse R. L., Maurer K. Arthritis associated with apatite crystals. Ann Intern Med. 1977 Oct;87(4):411–416. doi: 10.7326/0003-4819-87-4-411. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES