Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1999 Sep;58(9):559–562. doi: 10.1136/ard.58.9.559

The value of synovial fluid analysis in the assessment of knee joint destruction in arthritis in a three year follow up study

S Aman 1, J Risteli 1, R Luukkainen 1, L Risteli 1, M Kauppi 1, P Nieminen 1, M Hakala 1
PMCID: PMC1752947  PMID: 10460189

Abstract

OBJECTIVES—To assess the predictive significance of synovial fluid (SF) analysis for progressive radiological knee joint destruction in arthritis.
METHODS—Altogether 55 patients with arthritis and knee joint effusion were included in the study. The diagnosis was rheumatoid arthritis (RA) for 44 of them, chronic seronegative spondylarthropathy for seven and juvenile rheumatoid arthritis for four. The mean age of the patients was 51.8 (SD 14.9, range 19-82) years, and the mean duration of disease 10.9 (SD 9.2, range 0.5-37) years. In addition to the routine laboratory tests, different markers of collagen synthesis and breakdown in serum and SF were assessed. The radiological grade of the knee joint was assessed by Larsen's method at the baseline and after a three year follow up.
RESULTS—During the follow up, Larsen's grade deteriorated in 22 (40%) patients. These patients had a significantly higher median level of cross linked carboxyterminal telopeptide of type I collagen (ICTP) in SF at entry than those who had a stable index (p = 0.035). Serum ICTP did not have any predictive value for a specific joint. The median levels of total SF leucocytes (p = 0.012) and the subgroup of polymorphonuclear leucocytes (p = 0.018) were higher in the patients with a stable Larsen's index. However, the relation of SF leucocyte level to radiological progression could not be confirmed in the RA group.
CONCLUSION—It is concluded that SF analysis may help in the identification of patients with inflammatory arthritis who are at risk for progressive destruction in a particular joint. A high total SF leucocyte level is not necessarily associated with a poor prognosis. Instead, a high SF ICTP level seems to reflect accelerated bone degradation.



Full Text

The Full Text of this article is available as a PDF (59.5 KB).

Selected References

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

  1. Aman S., Hakala M., Risteli L., Risteli J. Increased type I collagen degradation is associated with a need for total joint replacement surgery in rheumatoid arthritis. Ann Rheum Dis. 1996 Feb;55(2):147–147. doi: 10.1136/ard.55.2.147-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. 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]
  3. Fisher L. W., McBride O. W., Termine J. D., Young M. F. Human bone sialoprotein. Deduced protein sequence and chromosomal localization. J Biol Chem. 1990 Feb 5;265(4):2347–2351. [PubMed] [Google Scholar]
  4. Hakala M., Aman S., Luukkainen R., Risteli L., Kauppi M., Nieminen P., Risteli J. Application of markers of collagen metabolism in serum and synovial fluid for assessment of disease process in patients with rheumatoid arthritis. Ann Rheum Dis. 1995 Nov;54(11):886–890. doi: 10.1136/ard.54.11.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Larsen A., Dale K., Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977 Jul;18(4):481–491. doi: 10.1177/028418517701800415. [DOI] [PubMed] [Google Scholar]
  6. Melkko J., Kauppila S., Niemi S., Risteli L., Haukipuro K., Jukkola A., Risteli J. Immunoassay for intact amino-terminal propeptide of human type I procollagen. Clin Chem. 1996 Jun;42(6 Pt 1):947–954. [PubMed] [Google Scholar]
  7. Månsson B., Geborek P., Saxne T. Cartilage and bone macromolecules in knee joint synovial fluid in rheumatoid arthritis: relation to development of knee or hip joint destruction. Ann Rheum Dis. 1997 Feb;56(2):91–96. doi: 10.1136/ard.56.2.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Peel N., Eastell R., Russell G. Markers of bone and collagen breakdown in early inflammatory arthritis. Baillieres Clin Rheumatol. 1992 Jun;6(2):351–372. doi: 10.1016/s0950-3579(05)80179-7. [DOI] [PubMed] [Google Scholar]
  9. Poole A. R. Immunochemical markers of joint inflammation, skeletal damage and repair: where are we now? Ann Rheum Dis. 1994 Jan;53(1):3–5. doi: 10.1136/ard.53.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Risteli J., Elomaa I., Niemi S., Novamo A., Risteli L. Radioimmunoassay for the pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen: a new serum marker of bone collagen degradation. Clin Chem. 1993 Apr;39(4):635–640. [PubMed] [Google Scholar]
  11. Risteli J., Niemi S., Trivedi P., Mäentausta O., Mowat A. P., Risteli L. Rapid equilibrium radioimmunoassay for the amino-terminal propeptide of human type III procollagen. Clin Chem. 1988 Apr;34(4):715–718. [PubMed] [Google Scholar]
  12. Robins S. P., Stewart P., Astbury C., Bird H. A. Measurement of the cross linking compound, pyridinoline, in urine as an index of collagen degradation in joint disease. Ann Rheum Dis. 1986 Dec;45(12):969–973. doi: 10.1136/ard.45.12.969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Saxne T., Wollheim F. A., Pettersson H., Heinegård D. Proteoglycan concentration in synovial fluid: predictor of future cartilage destruction in rheumatoid arthritis? Br Med J (Clin Res Ed) 1987 Dec 5;295(6611):1447–1448. doi: 10.1136/bmj.295.6611.1447. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Saxne T., Zunino L., Heinegård D. Increased release of bone sialoprotein into synovial fluid reflects tissue destruction in rheumatoid arthritis. Arthritis Rheum. 1995 Jan;38(1):82–90. doi: 10.1002/art.1780380113. [DOI] [PubMed] [Google Scholar]
  15. Seibel M. J., Duncan A., Robins S. P. Urinary hydroxy-pyridinium crosslinks provide indices of cartilage and bone involvement in arthritic diseases. J Rheumatol. 1989 Jul;16(7):964–970. [PubMed] [Google Scholar]
  16. St Clair E. W., Moak S. A., Wilkinson W. E., Sanders L., Lang T., Greenwald R. A. A cross sectional analysis of 5 different markers of collagen degradation in rheumatoid arthritis. J Rheumatol. 1998 Aug;25(8):1472–1479. [PubMed] [Google Scholar]
  17. Taylor A. K., Lueken S. A., Libanati C., Baylink D. J. Biochemical markers of bone turnover for the clinical assessment of bone metabolism. Rheum Dis Clin North Am. 1994 Aug;20(3):589–607. [PubMed] [Google Scholar]
  18. Wollheim F. A. New insight into joint damage from analysis of released biochemical markers. Br J Rheumatol. 1994 Jan;33(1):1–2. doi: 10.1093/rheumatology/33.1.1. [DOI] [PubMed] [Google Scholar]

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

RESOURCES