Abstract
The objective of this study was to evaluate the effect of repeated arthrocentesis and a single joint lavage on cytologic variables of synovial fluid. The left tarsi of 5 healthy Holstein calves were selected for the study. Samples of synovial fluid were collected daily for 4 d, then every 4 d until day 24. On day 2, joint lavage was performed with lactated Ringer’s solution in all the calves. Cytologic examinations, performed by the same clinical pathologist, included the determination of total protein concentration, total leukocyte count, and differential counts (of neutrophils, lymphocytes, and monocytes). The presence of lameness or swelling and other results of physical examination were recorded regularly during the study. No clinical signs of joint disease were observed during the study. Bacterial cultures of specimens collected on day 2 were negative for all the calves. All cytologic values but 1 peaked on day 2 and progressively returned to normal. In comparison with the results for day 1, the synovial fluid total leukocyte, neutrophil, and monocyte counts were significantly increased on days 2 and 3, and the total leukocyte and monocyte counts were also significantly increased on day 4. The monocyte and lymphocyte percentages were significantly decreased until day 4, whereas the neutrophil percentages were significantly increased until day 8. The total protein concentrations were significantly increased until day 3. There were no significant differences between values for specimens taken 4 d apart. This study demonstrated that, although arthrocentesis induces a moderate inflammatory response, the joints seem to rapidly adapt. A 4-d interval between arthrocenteses is suitable when studying cellular components of the synovial fluid. However, when arthrocentesis is repeated daily, a minimal interval of 8 d should be respected.
Résumé
L’objectif de cette étude était d’évaluer l’effet de ponctions articulaires répétées et d’un lavage articulaire sur des paramètres cytologiques du liquide synovial. Les tarses gauches de 5 veaux Holstein en santé ont été utilisés dans l’étude. Les liquides synoviaux ont été prélevés quotidiennement pendant 4 jours, puis tous les 4 jours jusqu’au jour 24. Au jour 2, un lavage articulaire avec une solution de lactate de Ringer a été réalisé chez tous les veaux. Les examens cytologiques ont tous été faits par le même pathologiste clinique. Ils consistaient en la détermination de la concentration des protéines totales, un comptage des leucocytes totaux, et l’établissement du différentiel cellulaire (neutrophiles, lymphocytes, et monocytes). La présence de boiterie ou d’enflure et tout autre signe clinique étaient notés régulièrement durant l’étude. Aucun signe clinique de maladie articulaire n’a été noté durant la période de l’étude. Les résultats de culture bactériologique réalisée au jour 2 étaient négatifs pour tous les veaux. Tous les paramètres, sauf 1, culminaient au jour 2 pour progressivement retourner à des valeurs normales. Les comptages des leucocytes totaux, des neutrophiles, et des monocytes des liquides synoviaux étaient significativement augmentés aux jours 2 et 3 et les comptages des leucocytes totaux et des monocytes étaient significativement augmentés au jour 4 en comparaison avec le jour 1. Les pourcentages des monocytes et des lymphocytes étaient significativement diminués jusqu’au jour 4, alors que les pourcentages de neutrophiles étaient significativement augmentés jusqu’au jour 8. Les concentrations de protéines totales étaient significativement augmentées jusqu’au jour 3. Il n’y a eu aucune différence significative entre les valeurs d’échantillons pris à 4 jours d’intervalle. Cette étude a montré que même si une ponction articulaire induit une réponse inflammatoire modérée, les articulations semblent s’adapter rapidement. Un intervalle de 4 jours entre les ponctions articulaires semble adéquat lors d’études des composants cellulaires du liquide synovial. Par contre, quand les ponctions articulaires sont effectuées quotidiennement, un délai de 8 jours devrait être respecté pour un retour à des valeurs normales.
(Traduit par les auteurs)
Introduction
Lameness in cattle causes important economic losses because of decreased milk yield, treatment costs, and culling of affected animals (1–3). Joint diseases, reported to be the 2nd most important cause of lameness in cattle (4), can be divided into noninflammatory and inflammatory diseases. The noninflammatory diseases include mainly osteochondrosis, degenerative joint disease, joint trauma, and hemarthrosis. The inflammatory diseases include noninfectious and infectious arthritis. Noninfectious arthritis includes idiopathic arthritis, immune-mediated arthritis, and synovitis caused by periarticular infections. In cattle, septic arthritis is the most common cause of joint disease (4). In Sweden, the incidence rate of septic arthritis was reported to be 0.002 cases per calf-months at risk (5).
Treatment of septic arthritis in cattle consists of early administration of antibiotics combined with joint lavage and administration of anti-inflammatory drugs (6–8). Repetition of joint lavage every 24 or 48 h, until amelioration of cytologic abnormalities (9,10), is recommended.
Cytologic analysis of synovial fluid is reported to be 1 of the most important ancillary tests for differentiating between infectious and noninfectious joint diseases (11). This analysis is also useful for evaluating the response to treatment. Normal parameters have been reported (8,12,13), as have cut-off points of the total nucleated cell count, neutrophil cell count and percentages, and total protein concentration for differentiating between inflammatory and infectious joint diseases in cattle (11).
In horses, endogenous factors such as joint of origin and age, as well as exogenous factors such as exercise and repeated arthrocentesis, have been reported to influence some biomarkers and cellular components of synovial fluid (14–16). Studies have demonstrated that arthrocentesis is not innocuous, and its effects must be taken into account in any evaluation involving repetitive sampling (17–19). Its effects on the cytologic analysis of synovial fluid are not completely understood in equine medicine: some authors have reported an increase in the count of mononuclear cells (17), whereas others have reported an increase in the count of polymorphonuclear cells (18). Since most of the studies did not evaluate the long-term effects of repeated arthrocentesis (17,19), the duration of these modifications is not known. Joint lavage has also been reported to induce an increase in leukocyte counts in synovial fluid (20–22). The real impact of arthrocentesis or joint lavage is not known in cattle.
Since repeated sampling of synovial fluid by arthrocentesis is sometimes necessary for diagnosis of joint diseases (by bacterial culture and cytologic analysis), monitoring of treatment, and study of joint diseases during in vivo protocols, it is important to know the effects on the cytologic analysis of synovial fluid.
The objective of this study was to evaluate the impact of repeated arthrocentesis and joint lavage on the total leukocyte and differential counts and the total protein concentration in synovial fluid.
Materials and methods
The experimental protocol was approved by the Université de Montréal Institutional Animal Care Committee.
Calf selection
Three male and 2 female Holstein calves, aged between 20 and 36 d (mean, 21.6 d; median, 23 d), originating from 2 dairy herds, were selected. No manipulations were performed on these animals during the 15 d before the study. On day 1 of the study, a complete physical examination was performed on each animal, and blood samples from the jugular vein were submitted for complete blood counts and chemistry profiles. The calves were determined to be healthy on the basis of the results of the physical examination as well as the hematologic and biochemical analysis. At the end of the study, the calves were kept on a farm near the Centre Hospitalier Universitaire Vétérinaire for observation.
Synovial fluid sampling
On day 1, day 2 before joint lavage, and days 3, 4, 8, 12, 16, 20, and 24, synovial fluid was obtained with the following procedure. The calves were sedated with 0.05 mg/kg of xylazine (Rompun; Bayer Santé Animale, Toronto, Ontario), administered intravenously, and then placed in right lateral recumbency. The left tarsocrural joint was prepared for aseptic surgery with the use of standard procedures (23). An 18-gauge, 3.8-cm needle was placed in the dorsomedial pouch of the joint, and 5 mL of synovial fluid was obtained with a 5-mL syringe. This sampling protocol was selected to represent the procedures recommended for the treatment and the monitoring of septic arthritis in calves (24).
Joint lavage
On day 2, through-and-through lavage of the left tarsocrural joint was performed on all calves with 1 L of lactated Ringer’s solution USP (Baxter Corporation, Toronto, Ontario). A hand-pumped pressure bag was used to keep a steady flow of fluid into the joint with an average pressure of 400 mm Hg. After preparation of the joint for aseptic surgery (23), an 18-gauge, 3.8-cm needle was placed in the dorsomedial pouch of the joint, and distension was achieved with the lactated Ringer’s solution until all pouches were visible. A 2nd 18-gauge needle was then placed in the plantar lateral pouch and a 3rd 18-gauge needle in the plantar medial pouch. At the end of lavage, the needle in the dorsomedial pouch was removed, fluid was expelled manually from the joint, and the needles in the plantar lateral and medial pouches were then removed. The tarsus was not bandaged.
Clinical assessment
Each calf was evaluated by the same investigator for joint heat, swelling, pain, and lameness 3 times per day for the first 6 d, then once daily until day 24. A grading scale previously described (24) was used to evaluate the calves’ pain. Appetite was also monitored. Heart rate, respiratory rate, and rectal temperature were obtained 4 times a day for the first 6 d and then twice daily until day 24.
Synovial fluid analysis
We placed 1 mL of each synovial fluid sample into a 3-mL evacuated glass container containing ethylene diamine tetraacetic acid (EDTA) (Vacutainer; Becton Dickinson, Franklin Lakes, New Jersey, USA). All specimens were subjectively analyzed for gross physical features and analyzed for total protein concentration by refractometer (Reichter Goldberg Ultra-precision Handheld Refractometer; Reichert Analytical Instruments, Depew, New York, USA). Leukocyte counts were determined manually in all the samples with the use of a hemacytometer and the Unopette (Becton Dickinson) dilution technique according to the manufacturer’s recommendations. Leukocyte differential counts were determined by the same clinical pathologist after cytocentrifugation of the samples at 250 × g for 5 min and application of a modified Wright-Giemsa stain. Cell populations were determined with the use of criteria previously described (25). Neutrophils were assessed for degenerative changes. All these procedures were performed within 1 h of sampling.
Bacteriologic culture
On day 1, the sterile status of all joints was assessed by culture. Immediately after the collection of synovial fluid, 2 mL was inoculated into a blood culture bottle (Oxoid Signal Blood Culture System; Oxoid Limited, Basingstoke, England), which was incubated at 35°C. Culture was performed according to the manufacturer’s recommendations.
Statistical analysis
Mean values were calculated for total and differential counts and percentages of leukocytes and for total protein concentration for each day. The repeated-measures linear model was used to evaluate the influence of the day on the mean values. For statistical analysis, percentages were transformed by the square root of arcsine. Values obtained on and after day 2 were compared with those obtained on day 1 by means of Dunnett’s post-hoc tests. Values for 2 consecutive samples were also compared by means of Dunnett’s post-hoc tests. Slopes between days 2 and 3 and between days 3 and 4 were calculated for total and differential leukocyte counts and for total protein concentration for each calf to evaluate the effect of joint lavage. Comparisons were performed using Wilcoxon’s signed-rank test. Differences were considered statistically significant when the P-value was less than 0.05.
Results
Clinical signs and bacteriologic results
On day 1, all calves were in good health. No calves demonstrated clinical or cytologic signs of joint disease during the study. No bacterial growth was observed in the bacterial cultures of synovial fluid submitted on day 1, nor were microorganisms observed in the synovial-fluid smears.
Clinical signs of respiratory disease (abnormal results of pulmonary auscultation, nasal discharge, and fever) developed in 1 calf on day 15. That day, a 10-d antibiotic regimen was instituted that was based on the results of culture of tracheobronchial lavage fluid. Clinical signs persisted for 5 d and then resolved by the end of the follow-up period. Cytologic analysis of synovial fluid obtained from this calf on day 16 showed no abnormalities.
Synovial-fluid findings
The repeated-measures linear model indicated a significant effect of sampling day on the total protein concentration, the total leukocyte, neutrophil, and monocyte absolute counts, and the neutrophil and monocyte percentages in the synovial fluid (P < 0.0001). On days 1, 12, and 16, the total protein concentration and the total leukocyte and differential counts agreed with previously reported normal values (8,12).
Physical features
Some samples obtained during the study demonstrated slight to moderate blood contamination. On day 1, the synovial fluid was clear to turbid and translucent to pale yellow. On days 2 and 3, all samples were turbid to severely turbid and pale yellow to white. During the rest of the study, the sample appearance varied from clear to turbid and the color from translucent to yellow.
Total protein concentration (Table I)
Table I.
Total protein concentration in the synovial fluid of the left tarsocrural joint of 5 calves on each day of the experiment, day 2 being the day of joint lavage
| Day | Concentration: mean (and range), g/La |
|---|---|
| 1 | 12 (11–13) |
| 2 | 20b (13–24) |
| 3 | 17bc (13–21) |
| 4 | 14c (13–15) |
| 8 | 12 (11–15) |
| 12 | 11 (9–13) |
| 16 | 11 (9–15) |
| 20 | 9b (7–11) |
| 24 | 9b (7–11) |
Normally less than 18 g/L (8).
Significantly different from the mean on day 1.
Significantly different from the mean on the previous sampling day.
The mean concentration was significantly increased on day 2 (P < 0.001) and decreased significantly between days 2 and 3 (P = 0.0066) and between days 3 and 4 (P = 0.004), all values reaching the normal range by day 4. The mean concentration was significantly higher on day 3 compared with day 1 (P < 0.001) and remained elevated, but not significantly so (P = 0.06), on day 4. On days 20 and 24, the mean concentrations were within the normal range but significantly lower than those on day 1 (P = 0.01 and 0.004, respectively). There were no significant differences between 2 consecutive samples taken 4 d apart. The slopes between days 2 and 3 and between days 3 and 4 were not significantly different.
Total leukocyte count (Table II)
Table II.
Cell counts in the synovial fluid of the left tarsocrural joint of the 5 calves
| Count: mean (and range), × 109/La |
||||
|---|---|---|---|---|
| Day | Total leukocytes | Neutrophils | Monocytes | Lymphocytes |
| 1 | 0.45 (0.22–0.83) | 0.05 (0–0.15) | 0.31 (0.18–0.60) | 0.27 (0.03–0.91) |
| 2 | 14.36b (3.74–25.74) | 7.92b (1.38–16.99) | 5.99b (2.32–10.16) | 0.38 (0.13–0.92) |
| 3 | 7.84bc (4.12–15.68) | 4.24bc (1.77–8.00) | 3.14bc (1.66–6.27) | 0.41 (0.12–1.12) |
| 4 | 4.72b (2.97–6.27) | 2.13 (1.69–2.50) | 2.24b (1.01–3.32) | 0.33 (0.10–0.78) |
| 8 | 0.84 (0.22–1.60) | 0.14 (0.03–0.26) | 0.55 (0.18–1.12) | 0.19 (0.03–0.55) |
| 12 | 0.82 (0.28–1.49) | 0.17 (0–0.45) | 0.60 (0.24–1.10) | 0.23 (0–0.99) |
| 16 | 0.93 (0.33–2.09) | 0.08 (0.01–0.25) | 0.75 (0.26–1.73) | 0.23 (0.05–0.72) |
| 20 | 0.98 (1.43–0.60) | 0.03 (0–0.11) | 0.86 (0.46–1.32) | 0.19 (0.02–0.63) |
| 24 | 0.91 (1.43–0.28) | 0.01 (0–0.01) | 0.72 (0.23–1.23) | 0.26 (0.04–0.77) |
Normally less than 2.5 × 109/L (8).
Significantly different from the mean on day 1.
Significantly different from the mean on the previous sampling day.
The mean count was significantly increased (P < 0.0001) on day 2 and decreased progressively to normal by day 8. However, compared with those on day 1, the means on days 3 and 4 remained significantly increased (P = 0.006 and 0.03, respectively). The mean decreased significantly between days 2 and 3 (P = 0.0019). There were no significant differences between days 3 and 4 or between 2 consecutive samples taken 4 d apart. The slopes between days 2 and 3 and between days 3 and 4 were not significantly different.
Neutrophil count and proportion (Tables II and III)
Table III.
Cell proportions in the synovial fluid of the left tarsocrural joint of the 5 calves
| Proportion: mean (and range), %a |
|||
|---|---|---|---|
| Day | Neutrophils | Monocytes | Lymphocytes |
| 1 | 8 (0–18) | 74 (39–92) | 18 (7–44) |
| 2 | 52b (37–66) | 45b (32–62) | 2b (1–5) |
| 3 | 55b (43–70) | 41b (28–54) | 4b (2–7) |
| 4 | 47b (32–58) | 45b (33–59) | 4b (2–7) |
| 8 | 18b (9–30) | 68c (52–83) | 10 (4–29) |
| 12 | 13 (0–34) | 79 (58–92) | 7b (0–12) |
| 16 | 7 (2–12) | 78 (59–91) | 14 (4–36) |
| 20 | 4 (0–15) | 86 (77–92) | 9 (77–92) |
| 24 | 2 (1–5) | 81 (58–91) | 12 (58–91) |
Normally less than 10% (8).
Significantly different from the mean on day 1.
Significantly different from the mean on the previous sampling day.
The mean count and proportion were significantly increased from day 2 (P < 0.001) and, starting on days 3 and 4, respectively, decreased progressively, reaching normal levels on days 4 and 16, respectively. Neutrophils were the most predominant cell population until day 4 except in 2 calves on day 2, 1 calf on day 3, and 2 calves on day 4. The mean count remained significantly higher on day 3 than on day 1 (P = 0.021), and the mean proportion remained significantly higher on days 3, 4, and 8 than on day 1 (P < 0.0001, P < 0.0001, and P = 0.025, respectively). The mean count decreased significantly between days 2 and 3 (P = 0.006). There were no significant differences between 2 consecutive samples taken 4 d apart. The slopes between days 2 and 3 and between days 3 and 4 were not significantly different for either parameter. Morphologic evaluation of neutrophils revealed no degenerative changes during the study.
Monocyte count and proportion (Tables II and III)
The mean count was significantly increased on day 2 (P < 0.001) and decreased progressively until day 8. The mean proportion was significantly decreased on day 2 (P < 0.0014) and increased progressively until day 12. The mean count and proportion were significantly different on days 3 and 4 compared with day 1 (P = 0.001 and 0.019, respectively, for the count; P = 0.0003 and 0.0013, respectively, for the proportion). The mean count decreased significantly between days 2 and 3 (P = 0.001). There were no significant differences between 2 consecutive samples taken 4 d apart except between days 4 and 8, when the monocyte proportion increased significantly (P = 0.039). The slopes between days 2 and 3 and between days 3 and 4 were not significantly different for either parameter.
Lymphocyte count and proportion (Tables II and III)
The mean count remained constant during the study. The mean proportion was significantly decreased on day 2 (P < 0.0013) and increased progressively until day 8. The mean proportion was significantly lower on days 2, 3, 4, and 12 than on day 1. There were no significant differences between 2 consecutive samples taken 4 d apart. The slopes between days 2 and 3 and between days 3 and 4 were not significantly different for either parameter.
Discussion
On the basis of our results, we can postulate that arthrocentesis has a significant effect on the total protein concentration and the cellular counts of the synovial fluid. In horses, arthrocentesis has already been reported to significantly affect cellular components of the synovial fluid (15,17–19). In this study, the results of synovial-fluid cytologic analysis were significantly different for different parameters 1 d after the 1st arthrocentesis. Nevertheless, all the modifications observed peaked 1 d after the 1st arthrocentesis and then progressively returned to normal. This could have been due to the joint lavage performed on day 2. However, an equine study demonstrated that cytologic modifications secondary to repeated arthrocentesis peaked 24 h after the 1st arthrocentesis and then began to return to normal 24 h later (19). Since samplings were stopped at that time, this tendency could not be confirmed. The investigators suspected that the joint adapted to repetitive centesis, tolerance progressively developing. Such a phenomenon could also be suspected in our study.
Different complications have been associated with arthrocentesis, particularly repeated arthrocentesis. They include joint infection by direct inoculation of microorganisms into the joint when aseptic procedures are not respected, hemarthrosis, and joint trauma. No calf demonstrated clinical signs of joint disease during our study. The sampling procedure was very well tolerated, and no complications were observed.
In horses, contradictory results with respect to cellular differential counts secondary to arthrocentesis have been reported. In 1 study (17), horses were euthanized 1 to 10 d (1 horse per day) after the initial arthrocentesis to evaluate the effect of a single arthrocentesis alone on the leukocyte total and differential counts: the leukocyte counts increased, but with a predominance of mononuclear cells instead of neutrophils. In 2 other studies (18,19), absolute counts of neutrophils and large mononuclear cells increased significantly 24 h after the 1st arthrocentesis; large mononuclear cells predominated in 1 study, and neutrophils predominated in the other study. In the present study, neutrophils predominated in both count and percentage; however, large mononuclear cells were predominant on day 2 in 2 calves.
On days 2 and 3 of our study, the total protein concentrations were significantly increased, but only moderately so (to 24 g/L or less) when compared with the cut-off points reported for the diagnosis of infectious arthritis (≥40 g/L) (8,11,24). The total protein concentration increases with inflammation of the synovial membrane (25,26). This measure has been reported to be more accurate than the total leukocyte count in synovial fluid for the diagnosis of acute synovitis (21). False-positive increases in the total protein concentration secondary to excessive EDTA can be suspected in EDTA tubes that are not adequately filled (25). In the present study, false results were unlikely since all the EDTA tubes were uniformly filled with an adequate volume of synovial fluid.
Inflammatory arthritis is characterized by an increase in total leukocyte counts, with a predominance of neutrophils, associated with an increase in total protein concentration (11,25). In cattle, cytologic reference values have been established for the differentiation of infectious and noninfectious arthritis (11). On the basis of those values, the cytologic modifications in the synovial fluid observed on day 2 of the present study were compatible with noninfectious inflammatory arthritis.
Repeated arthrocentesis is necessary for diagnosis and monitoring of the response to treatment. Total leukocyte, neutrophil, and differential counts, as well as the total protein concentration, are particularly useful in differentiating between infectious and noninfectious diseases. The cytologic modifications in the synovial fluid observed in this study were minor when compared with those reported in an experimental model of septic arthritis (24). For example, the mean total leukocyte and neutrophil counts in that study 1 d after experimental infection of the tarsus were much higher (114 × 109 cells/L and 109 × 109 cells/L, respectively) than the means on day 2 of the present study (14 × 109 cells/L and 8 × 109 cells/L, respectively). Three days after the beginning of treatment, the mean total leukocyte and neutrophil counts in that study had decreased (to 101 × 109 cells/L and 93 × 109 cells/L, respectively) but were still significantly increased compared with those on day 4 of the present study (4 × 109 cells/L and 2 × 109 cells/L, respectively). It is unlikely that a single arthrocentesis, or repeated daily arthrocentesis, could modify cytologic findings in the synovial fluid sufficiently to misdiagnose septic arthritis. Arthrocentesis and repeated arthrocentesis have no clinical impact on the diagnosis and monitoring of joint infection.
No differences were noted between samples taken 4 d apart (between days 12 and 24) in this study. These results agree with those previously reported in equine medicine (18). When studying variations in the cytologic findings and total protein concentration in the synovial fluid, a minimum of 4 d between samples should be respected to avoid the effect of the previous arthrocentesis. However, from the results between days 4 and 12 in this study, we conclude that at least 8 d should pass after daily repeated arthrocentesis to be sure that the cellular differential count is not affected by the previous arthrocentesis.
Most studies have demonstrated that lactated Ringer’s solution can safely be used for joint irrigation (27–29), even if others have demonstrated some deleterious effects on cartilage metabolism (30). Joint lavage with a buffered lactated Ringer’s solution (31) or a balanced electrolyte solution (21) has been reported to induce moderate synovitis characterized by increased leukocyte counts and total protein concentrations. This inflammatory response was greater than that seen with arthrocentesis alone (31). These modifications persisted until 9 d after the joint lavage (21,31). Since in the present study all values except neutrophil percentages were decreased on day 3 compared with day 2, joint lavage with 1 L of lactated Ringer’s solution did not seem to induce further inflammation. One explanation for these differences could be that in the equine studies arthrocentesis was not performed the day before the joint lavage, and the effect of joint lavage was evaluated on normal joints with no signs of cytologic modifications (21,31). In the present study, the joint lavages were performed on joints with moderate inflammation. Consequently, the effects of joint lavage could have been similar to those expected in cases of joint disease; that is, lessening of clinical signs and cytologic modifications in the synovial fluid through removal of potentially deleterious enzymes and their cellular sources and, thus, reduction or inhibition of the inflammatory response reported with joint lavage.
Joint lavage is a treatment option for numerous joint diseases (32). It is an important step in the treatment of septic arthritis (9,22). Some evidence suggests that it could help stop the inflammatory cascade and normalize joint metabolism (32). Since in the present study there were no significant differences in slopes between days 2 and 3 or between days 3 and 4, it is unlikely that the progressive return to normal observed starting on day 2 was due to the effect of joint lavage. Moreover, the mean neutrophil percentages increased between days 2 and 3. Joint lavage with 1 L of lactated Ringer’s solution has probably minimal if any impact on a joint with moderate inflammation.
The primary goal of this study was to evaluate the impact of repeated arthrocentesis and joint lavage under clinical conditions. Consequently, the effect on calf joints of joint lavage alone with lactated Ringer’s solution was not independently evaluated. Further studies are needed to clearly evaluate the confounding effect of arthrocentesis and joint lavage, as well as the tolerance to repeated joint lavage, on the cytologic findings in the synovial fluid.
Various physiological factors can affect cellular counts and the total protein concentration in the synovial fluid of normal or inflamed joints. In cattle, analysis of the synovial fluid of normal tarsocrural joints demonstrated that cows have greater leukocyte counts than steers, probably because they have smaller synovial-fluid volumes (12). In equines, a significant difference in total protein concentration was noted between various joints (15,31). Differences between joints in matrix metalloproteinase activity secondary to repeated arthrocentesis were also reported in horses (16). The impact of a moderate localized inflammation could be different in large joints compared with smaller ones. Activated cells and their products are probably more diluted in large joints than in smaller ones. Since only 1 joint and 1 age group were studied, the influence of these parameters could not be evaluated. Consequently, the present results should be extrapolated to other joints and age groups with caution.
The results of this study tend to demonstrate that arthrocentesis induces a moderate inflammatory response in the joint and that joint tolerance to repeated arthrocentesis and joint lavage develops rapidly. The cytologic modifications observed secondary to repeated arthrocentesis and joint lavage cannot be mistaken for those of an infectious arthritis. Cellular modifications in the synovial fluid are not affected by the previous arthrocentesis when a 4-d interval between samples is respected. Owing to the small number of animals in this study, these results should be confirmed in a larger population.
Footnotes
Dr. Latouche’s current address is Veterinary Diagnostic Imaging & Cytopathology, 16900 SE 82nd Drive, Clackamas, Oregon 97023, USA.
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