Abstract
This study is in two parts. In the first synovial fluid from 1892 patients with 14 different arthropathies was examined microscopically. Crystals of different types were identified and the disease distribution of these and various cell types, including several not previously reported in synovial fluid, have been described. These features have been used to derive a series of microscopic diagnostic criteria for each arthropathy. The criteria have been used in the second part of the study to examine synovial fluids from 200 patients without knowledge of any clinical diagnosis. Cytological and clinical diagnoses were compared at the end of the study. Matching diagnoses were made in 71 (35.5%) and a short list of differential diagnoses (based on cytological criteria), which included the clinical diagnosis, was made in a further 43 (21.5%). Of the rest, 63 (31.5%) were correctly described as inflammatory or non-inflammatory and in five (2.5%) no diagnosis could be made. Only in seven cases (3.5%) was an inaccurate (false positive) cytological diagnosis made. The results indicate that synovial fluid microscopy is a potentially more important diagnostic screening test in rheumatological and orthopaedic practice than it would at first appear from published reports.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
- Eghtedari A. A., Bacon P. A., Collins A. Immunoblasts in synovial fluid and blood in the rheumatic diseases. Ann Rheum Dis. 1980 Aug;39(4):318–322. doi: 10.1136/ard.39.4.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
- HOLLANDER J. L., MCCARTY D. J., Jr, ASTORGA G., CASTRO-MURILLO E. STUDIES ON THE PATHOGENESIS OF RHEUMATOID JOINT INFLAMMATION. I. THE "R.A. CELL" AND A WORKING HYPOTHESIS. Ann Intern Med. 1965 Feb;62:271–280. doi: 10.7326/0003-4819-62-2-271. [DOI] [PubMed] [Google Scholar]
- Hunder G. G., Pierre R. V. In vivo LE cell formation in synovial fluid. Arthritis Rheum. 1970 Jul-Aug;13(4):448–454. doi: 10.1002/art.1780130415. [DOI] [PubMed] [Google Scholar]
- Naib Z. M. Cytology of synovial fluids. Acta Cytol. 1973 Jul-Aug;17(4):299–309. [PubMed] [Google Scholar]
- Revell P. A. Examination of synovial fluid. Curr Top Pathol. 1982;71:2–24. [PubMed] [Google Scholar]
- Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
- Traycoff R. B., Pascual E., Schumacher H. R., Jr Mononuclear cells in human synovial fluid. Identification of lymphoblasts in rheumatoid arthritis. Arthritis Rheum. 1976 Jul-Aug;19(4):743–748. doi: 10.1002/1529-0131(197607/08)19:4<743::aid-art1780190414>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
- Wolf A. W., Benson D. R., Shoji H., Riggins R. S., Shapiro R. F., Castles J. J., Wild J. Current concepts in synovial fluid analysis. Clin Orthop Relat Res. 1978 Jul-Aug;(134):261–265. [PubMed] [Google Scholar]